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JOURNAL OF ENDODONTICS
Copyright 9 1991 by The American Association of Endodontists

Printed in U.S.A.

VOL. 17, NO. 4, APRIL 1991

Effect of CoronaI-Radicular Flaring on Apical

Transportation
Robed B. Swindle, DMD, Elmer J. Neaverth, DDS, Eugene A. Pantera, Jr., DDS, MS, and Robert D. Ringle

The purpose of this study was to evaluate the effect

early and late radicular flaring has on apical canal
transportation when using balanced force instrumentation. Sixty-six extracted human teeth with curvatures ranging from 20 to 65 degrees were equally
divided into two groups. Canals were cleaned and
shaped using balanced force and one of two flaring
techniques. A pre- and postoperative double exposure radiographic technique was used to evaluate
apical canal transportation. While early radicular
flaring made instrumentation much easier, no significant differences were found when comparing apical
transportation between the two experimental
groups.

length. Since this technique depends on dispersion of energies,

it was suggested that the more dentin in contact with a given
file, the greater would be the tendency to keep that file
centered in the canal. The purpose of this investigation was
to determine the effects of early and late radicular flaring on
apical canal transportation utilizing rotational forces with a
non-end cutting file.
MATERIALS AND METHODS
Sixty-six freshly extracted maxillary and mandibular human molar teeth were selected for this study. The preoperative
radiographs, positioning device, degree of curvature, and
tooth preparation followed the protocol described by Sepic et
al. (8). This study also used the double exposure radiographic
technique introduced by Sepic et al. (8), whereby each tooth
serves as its own preoperative control. The positioning index
originally described was modified for the present study by
using a Type I, very high viscosity vinyl polysiloxane impression material (Reprosil; L. D. Caulk, Milford, DE) instead of
acrylic resin to stabilize the tooth and X-ray film packet.
The teeth were paired according to their degree of curvature
and divided into two groups of 33 each (Table 1). These were
designated the early and the late coronal-radicular flaring
groups.
Access preparations were made under water spray with a
#4 carbide bur in a high-speed handpiece. A #10 K-Flex file
(Kerr, Romulus, MI) was used as a pathfinder to negotiate
the canal. The working length (WL) was established by subtracting 0.5 mm from the file length with the tip of the
instrument just at the anatomical apex. If the file did not
penetrate the anatomical apex, the WL was selected as being
the maximum penetration of the file in the canal provided
that it reached to within 1 mm of the radiographic apex.
Apical patency and WL were maintained by recapitulation
with a #15 K-Flex file.
Both a clinical and a proximal radiograph of the WL were
taken for each tooth as has been described (8) and served as
preoperative instrument controls for each root. The vinyl
polysiloxane index and attached X-ray film remained in the
positioning device and the X-ray was not processed at this
time.
All canals were initially negotiated with K-Flex file #10
and 15 utilizing the stem-winding motion as described by
Southard et al. (11) All subsequent apical preparation was
with Flex-R files (Union Broach, New York, NY) using BF

Cleaning and shaping of the root canal while maintaining the

original spatial relationship to the root surface is an important
aspect of endodontic treatment. The treatment of narrow,
curved canals, especially in posterior teeth, can be frustrating,
often presenting instrumentation problems that can result in
procedural errors such as instrument failure, ledge formation,
or root perforation. To avoid these procedural errors, several
techniques are used, including the precurving of files ( 1); the
passive, sequential use of instruments with copious irrigation
(1); the step-back technique (2); the anticurvature filing
method (3); the step-down technique (4); the crown-down
pressureless preparation (5); the double-flared technique (6),
and balanced force (7).
The balanced force (BF) technique reduces the tendency
toward zipping, maintains the file in the center of the canal,
and reduces the incidence of canal blockage from loose debris
in fine, curved canals (7). Sepic et al. (8) found significantly
less apical transportation in curved molar root canals when
using BF and Flex-R files as compared to a step-back technique with K-type files.
Radicular flaring (or radicular access) has been reported to
have an effect on the apical preparation. Morgan and Montgomery (9) reported better evaluations when comparing the
effect of preflaring to other techniques. Leeb (10) found that
early orifice enlargement made instrumentation easier because of the elimination of interfering dentin.
When describing BF, Roane et al. (7) advocate radicular
flaring after use of a #30 or #35 instrument to the working

147

148

Swindle et al.

Journal of Endodontics
TABLE 1. Canal curvature summary statistics

Samples

No. of
Observations

Mean
(deg)

SD
(deg)

Median
(deg)

Maximum
(deg)

Minimum
(deg)

Early
Late

33
33

34.1
34.5

10.2
10.6

35
35

65
65

20
21

as described by Roane et al. (7) Canals were irrigated with 1

ml of 2.6% sodium hypochlorite between each file size. A
new set of instruments was used for each canal and one
operator (R. B. S.) performed all instrumentation procedures.

Early Group
After use of the #20 file, the canals were flared coronal to
the curvature using Gates Glidden drills #2 to 4. Following
the coronal-radicular flaring, all subsequent cleaning, shaping,
and apical preparation was accomplished with Flex-R file #20
through 40 to the WL, utilizing BF (7).

Late Group
Cleaning and shaping was completed to a #40 file at WL
using BF only. To maximize the extremes, coronal-radicular
flaring was not used with this group.
After apical preparation, the largest instrument used to
reach the working length was left in the canal. This was a #40
file for both groups. Using the positioning device, a second
radiographic exposure on the previously exposed but unprocessed X-ray film was made from both the clinical and
proximal views. The radiograph thus obtained demonstrated
a double exposure with both pre- and postinstrumentation
files clearly visible on each image. The film was processed
using IFP chemicals (M&D International, Carpinteria, CA).
Positive controls were made by exposing a film with a file in
the canal, removing the tooth from its index, replacing it in
the index without moving the file, and exposing it again. This
verifies the accuracy of the technique. Negative controls were
created by moving pilot teeth slightly, thereby creating a
double tooth outline (8).
The double-exposed radiograph was inserted into a 2 2
slide mount and placed on a light board. The image of the
radiograph was transmitted to a ZW-248-82 microcomputer
(Zenith Data Systems, St. Joseph, MI) via a video camera
(Microcomp MTI System; Southern Micro Instruments, Atlanta, GA) which was mounted on the light board. A stylus
was used to mark on a digitizing pad (Microcomp MTI
System; Southern Micro Instruments) the preoperative image
of the # 15 K-Flex file tip as well as the tip of the #40 Flex-R
file used for the postoperative image. When touched to the
digitizing pad, the stylus marked a point which was visualized
on the computer monitor and corresponded to the position
of the stylus on the digitizing pad. The distance between the
points of the pre- and postoperative indicators was calculated
and recorded by the system software. Five measurements of
each view for each sample were compiled for data analysis.
Two-sample (paired t testing) analysis for differences in means
was performed using Statgraphics (Ver 2.1, STSC. Inc., Rockville, MD).

TABLE 2. Two-sample analysis of canal alteration: early versus

late radicular access

View

Null
Hypothesis

cr

Computed
t

Significance

Reject
HO?

Clinical
Proximal

Early = late
Early = late

0.01
0.01

-1.451
-0.531

0.152
0.597

No
No

RESULTS
Analysis of data (Table 2) indicates that there is no significant difference at a = 0.01 when comparing apical canal
transportation after early or late radicular flaring. No significant differences were seen after evaluation of both the clinical
and proximal radiographic views. The early group produced
a mean canal alteration of 0.072 m m and 0.052 m m (Table
3) as measured on the clinical and proximal radiographic
views, respectively. In those canals with late radicular flaring,
the mean canal alteration was 0.043 and 0.061 m m as measured from the clinical and proximal radiographic views, respectively. Representative radiographs of both groups are
shown in Figs. 1 and 2.
No significant difference in canal alteration at a = 0.01
was found for curvatures greater than 35 degrees or less than
35 degrees when comparing early and late, or clinical and
proximal radiographic views.
DISCUSSION
Our results demonstrate no significant differences between
early or late development of radicular access when apical
canal alteration is measured. The small amount of apical
transportation in both groups supports the earlier study by
Sepic et al. (8) which demonstrated less apical transportation
using BF when compared with a step-back technique (2).
Additionally, Sepic et al. (8) reported mean apical canal
alterations of 0.050 m m and 0.049 mm when measured in
the clinical and proximal views. These findings compare
favorably with the corresponding early and late measurements
of both experimental groups in the present study. This relationship further illustrates that the minimal apical canal transportation that was found in the Sepic study was not serendipitous since these separate studies with different clinicians,
using corresponding methodology, resulted in similar data.
The clinicians' observations during the present study suggest that early radicular access made rotational instrumentation much easier. There was less binding in the coronal third
of the canal which allowed the files to rotate with less resistance and reduced the chance of instrument failure. This
observation was interesting because in early descriptions of
BF, it was felt that contact between the file and the dentin
wall over the length of the canal would provide an advantage
by dissipating excess forces in the dentin wall (7). Intuitively,
this seems reasonable. However, as observed in this study,

Vol. 17, No. 4, April 1991

Coronal Radicular Flaring

149

TABLE 3. Observed canal alteration summary statistics

View
Clinical
Early
Late
Proximal
Early
Late

No. of
Observations

Mean
(mm)

SD
(mm)

Median
(mm)

Maximum
(mm)

Minimum
(mm)

33
33

0.072
0.043

0.104
0.049

0.029
0.035

0.374
0.184

0
0

33
33

0.052
0.061

0.077
0.072

0
0.041

0.224
0.329

0
0

the file. Our experimental and clinical observations suggest

that early radicular access reduces the chance of this type of
file failure by reducing the surface area of the file that can
become "locked" in dentin.

This research was supported in part by a Student Research Support Grant

from the Research and Education Foundation of the American Association of
Endodontists.
The opinions, assertions, materials, and methodologies herein are private
ones of the authors and are not to be construed as official or reflecting the
views of the American Association of Endodontists or the Research and
Education Foundation.

F~G 1. Late flaring in 51-degree root curvature with measured instrument deflection of 0,099 mm in clinical view and no measurable
deflection in proximal view.

Dr. Swindle is a former endodontic postgraduate student, School of Dentistry, Medical College of Georgia, Augusta, GA and is currently in private
practice limited to endodontics, Jacksonville, FL. Dr. Neaverth is professor,
Department of Endodontics, School of Dentistry, Medical College of Georgia.
Dr. Pantera is associate professor, Department of Endodontics, School of
Dentistry, Medical College of Georgia. Mr. Ringle is a research scientist,
Department of Restorative Dentistry, Division of Dental Physical Sciences,
School of Dentistry, Medical College of Georgia.

References

FIG 2. Early flaring in 45-degree root curvature with no measurable

deflection in either view.

there was considerable resistance to rotation in the late coronal access group, especially in canals with >35-degree curvature. This is consistent with the concept that file breakage
occurs when the file locks and there is a torsional failure of

1. Schilder H. Cleaning and shaping the root canal. Dent Clin North Am
1974;18:269-96.
2. Mullaney TP. Instrumentation of finely curved canals. Dent Clin North
Am 1979;23:575-92.
3. Abou-Rass M, Frank AL, Glick DH. The anticurvature filing method to
prepare the curved root canal. J Am Dent Assoc 1980;101:792-4.
4. Goerig AC, Michelich RJ, Schultz HH. Instrumentation of root canals in
molars using the step-down technique. J Endodon 1982;8:550-4.
5. Marshall FJ, Pappin J. A crown-down pressureless preparation root
canal enlargement technique. Technique manual. Portland, OR: University of
Oregon Health Sciences University, 1988.
6. Fava, RG. The double-flared technique: an alternative for biomechanical
preparation. J Endodon 1983;9:76-80.
7. Roane JB, Sabala CL, Duncanson MG. The "balanced force" concept
for instrumentation of curved canals. J Endodon 1985;11:203-11.
8. Sepic AO, Pantera EA, Neaverth EJ, Anderson RW. A comparison of
Flex-R files and K-type files for enlargement of severely curved molar root
canals. J Endodon 1989;15:240-5.
9. Morgan LF, Montgomery S. An evaluation of the crown-down pressureless technique. J Endodon 1984;10:491-8.
10. Leeb J. Canal orifice enlargement as related to biomechanical preparation. J Endodon 1983;9:463-70.
11. Southard DW, Oswald RJ, Natkin E. Instrumentation of curved molar
root canals with the Roane technique. J Endodon 1987;13:479-89.