Basic ResearchTechnology

Comparison of Canal Transportation and Changes in Canal Curvature of Two Nickel-Titanium Rotary Instruments
Kariem M. El Batouty, DDS, MSc, PhD,* and Waleed E. Elmallah, DDS, MSc, PhD
Abstract
Introduction: The aim of this study was to compare the canal transportation and changes in canal curvature after canal preparation with 2 nickel-titanium (NiTi) rotary instruments, Twisted (TF) and K3 le systems. Methods: Forty mandibular molar canals with angles of curvature between 25 and 35 degrees were randomly divided into 2 groups. Canals in K3 group were instrumented by using K3 rotary system. Canals in TF group were instrumented by using TF rotary system. All canals were instrumented with crown-down methodology to working length at a speed of 350 rpm and a torquecontrol level of 3 by using an 8:1 reduction handpiece. The nal apical preparation was set to #30 in both groups. By using a radiographic platform, reproducible preinstrumentation and postinstrumentation radiographs were taken. The difference between the preinstrumentation and postinstrumentation angles was calculated and statistically analyzed by using unpaired t test. Results: TF recorded statistically signicant lower percentage of change in canal curvature (2.99%) than K3 group (P < .05). Conclusions: TF system produced signicantly less transportation and preserved the original canal to a greater degree than did the K3 system. (J Endod 2011;37:12901292)

Key Words
Apical transportation, K3 le, twisted le

leaning and shaping the root canal system have been recognized as the main phase in root canal treatment (1). A primary goal of cleaning and shaping is to maintain the original path and outline of the root canal. However, this is difcult in curved canals, where there is a great tendency for all instrumentation techniques to change canal curvature and divert the prepared canal away from its original axis (2). Changing the canal curvature results in an increased incidence of ledge, zip, elbow formation, canal transportation, and stripping (2, 3). The advent of nickel-titanium (NiTi) rotary instrumentation has revolutionized root canal treatment by reducing time required to nish the preparation, and other procedural errors associated with root canal instrumentation (48). The K3 system (Sybron Endo, Orange, CA) was introduced in 2002. These les were designed with a wide radial land to make the instrument more resistant to torsional stresses. It also features radial land relief, which aids in preventing the le from overengagement in dentin; thus, less instrument separation or distortion should occur. This le features a variable core diameter designed to increase exibility, and it has a safe-ended tip to decrease the incidence of ledging, perforations, and zipping (9). More recently, the Twisted File (TF) has been developed by SybronEndo (Orange, CA). These les are manufactured with twisting to have a triangular cross section with constant tapers of 0.04, 0.06, 0.08, 0.10, and 0.12. In addition, they are available in 5 sizes (2550). The manufacturer claims that the R-phase heat treatment, twisting of metal, and special surface conditioning signicantly increase the instrument resistance to cyclic fatigue and exibility, maintaining the original canal curvature and minimizing canal transportation even in severely curved root canals. It was reported to have a higher fracture resistance than ground les (10, 11). The aim of the present study was to compare the changes in canal curvature after canal preparation by using K3 and TF rotary systems. The null hypothesis tested stated that there is no difference among these 2 NiTi rotary instruments with respect to change in canal curvature.

From the *Department of Endodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt; and Department of Endodontics, Riyadh Care Hospital, Riyadh, Saudi Arabia. Address requests for reprints to Dr Kariem Mostafa El Batouty, Department of Endodontics, University of Ain Shams, 7 Tayser Tour Alanba Pola Square, Nasr City, Cairo 111232, Egypt. E-mail address: kbatouty@hotmail.com 0099-2399/$ - see front matter Copyright 2011 American Association of Endodontists. doi:10.1016/j.joen.2011.05.024

Materials and Methods

Human mandibular rst molars extracted for periodontal and prosthetic reasons were used for this study. Tissue fragments and calcied debris were removed from teeth by scaling, and the teeth were stored in 10% formalin solution. After access cavity preparation, the distal root of all samples was separated by using stainless steel disk (Finzier Schrock & Kimmel GmbH, Germany) under coolant (12). The working length (WL) was measured by inserting K-le (#10) until it was visible from apex and then subtracting 1 mm from tooth length. The apical foramen of all samples was sealed with wax to prevent blockage of the canal with acrylic resin. A four-sided plastic mold (length, 10 mm; width, 10 mm; height, 25 mm) was constructed. Acrylic resin (Orthoplast; Vertex-dental bv J.V, Rotterdam, Netherlands) was mixed according to manufacturers instructions and poured into the mold. Each sample was inserted in the unset acrylic resin so that its long axis was parallel to long axis of the mold, and the acrylic resin was allowed to set. Preoperative radiographs from the buccolingual view were taken with a K-le (#15) inserted to WL by using radiovisiograph (Eastman Kodak, Health Group Division, Atlanta, GA). Images were taken by using standardized paralleling technique with the Rinn XCP alignment system (Rinn Corporation, Elgin, IL) as described by Sydney et al (13). The preoperative angle of curvature was measured by Image J Software (Image J software 1.36b; National Institutes of Health, Bethesda, MD) according to

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TABLE 1. Angle of Curvature (mean values standard deviations [SD]) for Both Groups Mean SD Preinstrumentation
22.8 6.7 22.75 5.4

NiTi rotary system

Postinstrumentation
22.1 5.5 19.1 5.38 t value P value

Mean different change (%)

0.68 (2.99%) 3.6 (18.9%) 14.7 <.0001*

t test (preinstrumentation vs postinstrumentation) t value

4.01 34.18

P value
.0013* <.0001*

TF group K3 group t test comparing percentage change (K3 vs TF)

*Signicant (P < .05).

the method of Schneider (14). On the basis of the preoperative measuring of angle of curvature, 40 canals with curvatures ranging from 2535 degrees were chosen for this study. The teeth (n = 40) were randomly divided into 2 groups (K3 group and TF group) according to the instrument used. The homogeneity of the 2 groups with respect to angle of curvature was assessed by using an unpaired t test. In the K3 group (n = 20), canals were instrumented by using the K3 system procedure pack. In the TF group (n = 20), canals were instrumented by using the TF system. All canals were instrumented with crown-down methodology to WL at a speed of 350 rpm and a torque-control level of 3 by using an 8:1 reduction handpiece powered by torque control motor (X-Smart; Dentsply Tulsa Dental, Tulsa, OK). The nal apical preparation was set to #30 in both groups. In the K3 group, all canals were prepared according to the guidelines for instrumentation with the procedure pack (9): (1) starting the preparation by taking the 0.10 taper #25 K3 le to resistance; (2) taking the 0.08 taper #25 K3 le to resistance, followed by 0.04 taper #25 and 0.04 taper #20; (3) reaching the full WL by using 0.04 taper #15; and (4) after reaching the full WL, a 0.06 taper #15 K3 le was used, followed by 0.06 taper #20, 0.06 Taper #25, and ending the preparation by 0.06 taper #30. In the TF group, canals were enlarged according to the sequence recommended by the manufacturer: (1) the shaping procedure commenced with taper 0.08 #25; the coronal one-third or twothirds of the root canal was shaped if passive penetration was possible; (2) the TF 0.06 #25 was inserted and used until 2 mm short of WL; and (3) shaping was continued with TF 0.04 #25 to WL, followed by 0.06 #25 and then by 0.06 #30 (15). Each le was coated with 1214 mg of RC-Prep (Stone Pharmaceuticals, Philadelphia, PA) as a lubricant before introduction into the canal. Copious irrigation with water was performed after the use of each le by using a disposable syringe and 27gauge irrigation needle (16). No instrument fractures occurred during the present study. After instrumentation, the master apical rotary les (K3 and TF) were inserted into the canals to full WL. By using the same radiographic platform, each tooth was radiographed from the buccal view exactly in the same position as in preinstrumentation radiographs, and the postoperative angle of curvature was measured. The difference between the preinstrumentation and postinstrumentation angles was calculated and tabulated. Data were subjected to statistical analysis by using unpaired t test with INSTAT software (Graphpad Software Inc, La Jolla, CA).

percentage of change in canal curvature (2.99%) than the K3 group (P < .05) (Fig. 1).

Discussion
The NiTi les used in this study were designed by Sybron Endo to improve various aspects of the properties required for root canal preparation instruments, including less canal transportation, less instrument separation, and fewer procedural steps. However, no articles in the literature compared their effects on canal curvature during the shaping procedure. Hou et al (17) investigated the effect of the manufacturing of NiTi instruments by twisting and heat treatment on phase transformation temperatures and exibility of both TF and K3. They found that the phase transformation temperatures of TF were signicantly higher than those of K3. The bending load values were signicantly lower for TF than those for K3 in both the elastic and superelastic ranges. They concluded that the new method of manufacturing NiTi instruments by twisting coupled with heat treatment might contribute to increased phase transformation temperatures and superior exibility. The results of this study indicated that the null hypothesis should be rejected. The TF demonstrated the least changes in canal curvature, indicating a greater tendency to preserve the curvature of curved canals than the K3. The better shaping results in the current study can be explained by the fact that TF (manufactured by twisting) is more exible than other NiTi instruments manufactured by grinding. Another reason is the different designs of these 2 instruments. The K3 has a U-shaped le design with 3 radial land areas, and it differs from TF in having a positive 45-degree rake angle. Because dentin is a dense and resilient material, instruments with a positive rake angle actually work like a shaver on the

Results
The results of the current study are summarized in Table 1. The TF group recorded statistically signicant lower postoperative angle of curvature mean value (22.1 5.5) than preoperative (22.8 6.7) (P < .05). The K3 group recorded statistically signicant lower postoperative angle of curvature mean value (19.1 5.38) than preoperative (22.75 5.4) (P < .05). Concerning the percentage of change in canal curvature, TF group recorded statistically signicant lower
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Figure 1. Percentage of change in canal curvature for both groups.

Comparison of Canal Transportation and Changes in Canal Curvature

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dentin surface. In contrast, instruments that have a negative rake angle are less efcient and require more energy to cut dentin (1820). The results of the current study are in accordance with the previous report of Gergi et al (15). They stated that TF instruments transported the least root canal preparations, with a signicant difference when compared with PathFile-ProTaper group. They justied their results in accordance to the manufacturing of TF with twisting a NiTi wire, resulting in more exibility than NiTi ground instruments. The relationship between taper size and exibility was studied by Schafer and Vlassis (21). They concluded that 0.08 tapered TF les could be used for apical preparation without creating severe aberrations when using less tapered les before the 0.08 tapered ones. Concerning K3, previous studies have reported on its effect on canal curvature compared with other NiTi systems than TF. A study by Al-Sudani and Al-Shahrani (22) compared the K3 system with the ProFile system, which produced signicantly less transportation, followed by the K3 system. Similar results have been reported by other investigators (23, 24). On the other hand, Gharehgozloo and McDonald (25) indicated that K3 showed the least deviation among the other systems. This is in addition to the results reported by Yoshimine and Akamine (26), who stated that in the K3 group, the prepared canals displayed a smooth shift to the original canals at the end-point of preparation.
6. Gambill M, Alder M, del Rio E. Comparison of nickel-titanium and stainless steel hand-le instrumentation using computed tomography. J Endod 1996; 22:36975. 7. Ferraz C, Gomes V, Gomes P, Zaia A, Teixeira B, Souza-Filho J. Apical extrusion of debris and irrigants using two hand and three engine-driven instrumentation techniques. Int Endod J 2001;34:3548. 8. Park H. A comparison of greater taper les, Proles, and stainless steel les to shape curved root canals. Oral Surg Oral Med Oral Pathol Oral Radiol 2001;9:7158. 9. Gambarini G. The K3 rotary nickel titanium instrument system. Endodontic Topics 2005;10:17982. 10. Gambarini G, Grande M, Plotino G. Fatigue resistance of engine-driven rotary nickel-titanium instruments produced by new manufacturing methods. J Endod 2008;34:10035. 11. Larsen M, Watanabe I, Glickman N, He J. Cyclic fatigue analysis of a new generation of nickel titanium rotary instruments. J Endod 2009;35:4013. 12. Karago C, Handan E, Akkoca E, Sedat K, Tankut G. Effect of rotational speed on root canal preparation with Hero 642 rotary Ni-Ti Instruments. J Endod 2003;29: 4479. 13. Sydney G, Batista A, DeMelo L. The radiographic platform: a new method to evaluate root canal preparation in vitro. J Endod 1991;17:5702. 14. Schneider W. A comparison of canal preparations in straight and curved root canals. Oral Surg Oral Med Oral Pathol 1971;32:2715. 15. Gergi R, Rjeily A, Sader J, Naaman A. Comparison of canal transportation and centering ability of Twisted Files, Pathle-ProTaper system, and stainless steel hand K-les by using computed tomography. J Endod 2010;36:9047. 16. Homan J, Ghasem J. A comparison of three Ni-Ti Rotary instruments in apical transportation. J Endod 2007;33:2846. 17. Hou X, Yahata Y, Hayashi Y, Ebihara A, Hanawa T, Suda H. Phase transformation behaviour and bending property of twisted nickel-titanium endodontic instruments. Int Endod J 2011;3:2538. 18. Himel T, McSpadden J, Goodis E. Instrument, materials and devices. In: Cohen S, Hargreves K, Keiser K, eds. Pathways of the pulp. 9th ed. St Louis: Mosby; 2006: 23389. 19. Wildey L, Senia S, Montgomery S. Another look at root canal instrumentation. Oral Surg Oral Med Oral Pathol 1992;74:499507. 20. Jeon S, Spangberg W, Yoon C, Kazemi B, Kum Y. Smear layer production by 3 rotary reamers with different cutting blade designs in straight root canals: a scanning electron microscopic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 96:6017. 21. Schafer E, Vlassis M. Comparative investigation of two rotary nickel-titanium instruments: ProTaper versus Racepart 1: shaping ability in simulated curved canals. Int Endod J 2004;37:22938. 22. Al-Sudani D, Al-Shahrani S. A comparison of the canal centering ability of ProFile, K3, and RaCe nickel titanium rotary systems. J Endod 2006;32:1198201. 23. Kavanagh D, Lumley J. An in vitro evaluation of canal preparation using Prole 04and 06 taper instruments. Endod Dent Traumatol 1998;14:1620. 24. Rhodes S, Ford R, Lynch A, Liepins J, Curtis V. A comparison of two nickel titanium instrumentation techniques in teeth using micro computed tomography. Int Endod J 2000;33:27985. 25. Gharehgozloo B, McDonald N. A comparison of the canal centering ability of K3 and ProFile nickel titanium rotary les. J Endod 2003;29:310. 26. Yoshimine Y, Akamine A. The shaping effects of three nickel-titanium rotary instruments in simulated s-shaped canals. J Endod 2005;31:3735.

Conclusions
Within the limitations of this in vitro study, it can be concluded that the TF system produced signicantly less transportation and preserved the original canal to a greater degree than did the K3 system.

Acknowledgments
The authors deny any conicts of interest related to this study.

References
1. Schilder H. Cleaning and shaping the root canal. Dent Clin North Am 1974;18: 26996. 2. Abou-Rass M, Frank L, Glick H. The anti-curvature ling method to prepare the curved root canal. J Am Dent Assoc 1980;101:7924. 3. Weine FS, Kelly RF, Lio PJ. The effect of preparation procedures on original canal shape and on apical foramen shape. J Endod 1975;1:25562. 4. Short A, Morgan A, Baumgartner C. A comparison of canal centering ability of four instrumentation techniques. J Endod 1997;23:5037. 5. Bryant T, Thompson A, Al-Omari O, Dummer H. Shaping ability of prole rotary nickel-titanium instruments with ISO sized tips in simulated root canals. Int Endod J 1998;31:27581.

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