[2008]

ENDODONTIC INSTRUMENTS DR.SHAWFEKAR (KOD) IIUM

User TOSHIBA [Pick the date]

Manual preparation instruments

1. REAMER 2. K-FILE 3. FLEXOREAMER 4. FLEXOFILE 5. HEDSTROEM FILE 6. NiTi

A.REAMER
Reamer: Design & Structure
A reamer is manufactured from a triangular or square steel wire that is twisted to give the typical shape of a reamer. The angle between the long-axis and the cutting blade is small, which is why preparation by reamer is effective only in rotating motion. The tip of the instrument is cutting which makes a reamer suitable for the preparation of straight canals only without the risk of ledging.

Reamer: Sizes & Codes

Reamers come in sizes 06 - 140, all with a taper of 0.02. Reamer design is identified by the triangle symbol on the handle.

R08-10

R15-R40 R45-R80

R90-140

Reamer: Recommended use

A reamer is the most effective hand instrument in straight canals. It is used by continuous rotation (upper picture) when the resistance is small or moderate and by balanced force (lower picture) when the resistance is greater. In curved canals ledging easily occurs with even small reamer sizes if instruments are not pre-curved. Reamers are excellent instruments in straight canals but poorly adaptable to curved canals.

Reamer: Safety tips

Reamers can be rotated only using moderate pressure. Use of force, particularly with smaller sized instruments, may result in distortion of the helical structure and ultimately in fracture. Each instrument should be checked for symmetry by rotating it against an even background before introducing it into the canal.

B. K-FILE
K-file: Design & Structure
K-files are manufactured from square or sometimes triangular steel wire that is twisted to give the typical shape of a K-file. The angle between the long-axis and the cutting blade is greater than in a reamer, and therefore preparation by a K-file is effective both in rotary and filing motion. The tip of the instrument is cutting which makes the K-file best suited for the preparation of straight canals. Small K-files (ISO 06 - 15) can be also used in curved canals without the risk of ledging. Small K-files are particularly good for the initial preparation of very narrow canals.

K-file: Sizes & Codes

K-files are produced in sizes 06 - 140, all with a taper of 0.02. K-file design is identified by the square symbol on the handle.

K06-10

K15-40 K45-80

K90-140

K-file: Recommended use

The K-file is suited for the preparation of straight canals. It prepares dentin effectively both in filing motion (up and down) and when rotated. In slightly curved canals the recommended techniques are continuous rotation (lower picture) when the resistance is small and balanced force (upper picture) against greater resistance. Compared to reamers, the use of continuous rotation is limited because of the screwing effect typical of K-files.

K-file: Safety tips

K-files can be rotated only using moderate pressure. Use of force, particularly with smaller sized instruments may result in distortion of the helical structure and ultimately in fracture. Balanced force technique and filing instead of continuous rotation should be used with sizes 06 - 15 to minimize fracture risk. Each instrument should be checked for symmetry by rotating it against an even background before introducing it into the canal.

C. FLEXOREAMER

Flexoreamer: Design & Structure

Flexoreamers are manufactured from a triangular steel wire that is twisted to give the typical shape of a reamer. The angle between the long-axis and the cutting blade is small, and therefore preparation by flexoreamer is effective only in rotatory motion. The tip of the instrument is non-cutting ('bat-tip', 'inactive tip') making flexoreamer well suited for the preparation of evenly curved canals without risk of ledging.

Flexoreamer: Sizes & Codes

Flexoreamers come in sizes 15 - 40, all with a taper of 0.02. Reamer design is identified by the triangle symbol on the handle. Flexoreamers are best distinguished from normal reamers by the size code at the top of the instrument: in flexoreamers the colour of the number is the same as the colour of the handle.

Flexoreamer: Recommended use

The flexoreamer is well suited both for straight canals and slightly curved canals. It prepares dentin in rotation but not if used as a file. The cutting efficiency and usability of flexoreamers are excellent. In slightly curved canals the recommended techniques are continuous rotation (upper picture) when the resistance is small and balanced force (lower picture) against greater resistance.

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Flexoreamer: Safety tips

Flexoreamers can be rotated only using moderate pressure. Use of force, particularly with smaller sized instruments, may result in distortion of the helical structure and ultimately in fracture. Every instrument should be checked for symmetry by rotating it against an even background before introducing it into the canal.

D. FLEXOFILE

FlexoFile: Design & Structure

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Flexofiles are manufactured from triangular (note!) steel wire that is twisted to give the typical profile of a K-file. The angle between the long-axis and the cutting blade is bigger than in reamers, which is why preparation by flexofile is effective both in rotating motion and in filing motion (up and down movement) The tip of the instrument is non-cutting ('bat-tip')which makes the flexofile well suited for the preparation of evenly curved canals without the risk of ledge formation

FlexoFile: Sizes & Codes

Flexofiles come in sizes 15 - 40, all with a taper of 0.02. K-file design is identified by the square symbol on the handle. Flexofiles can be best distinguished from normal K-files by the size code at the top of the instrument: in flexofiles the color of the number is the same as the color of the handle.

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FlexoFile: Recommended use

Flexofile is suited for both straight canals and slightly curved canals. The flexofile prepares dentin effectively both in filing motion (up and down) and when rotated. In slightly curved canals the recommended techniques are continuous rotation (lower picture) when the resistance is small and balanced force (upper picture) against greater resistance. Use of continuous rotation is limited as compared to reamers because of the screwing effect typical of K-files.

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FlexoFile: Safety tips

Flexofiles can be rotated (balanced force) only using moderate pressure. Use of force, particularly with smaller sized instruments, may result in distortion of the helical structure and ultimately in fracture. Every instrument should be checked for symmetry by rotating it against an even background before introducing it into the canal.

E. HEDSTR0EM FILE

Hedstroem File: Design & Structure

Hedstroem files are manufactured from round steel wire by grinding. The angle between the long-axis and the cutting blade is close to right angle, which is why preparation by Hedstroem files is effective only when using a filing motion (up and down movement).

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Hedstroem File: Sizes & Codes

Hedstroems come in sizes 08 - 140, all with a taper of 0.02. H-file design is identified by the circle symbol on the handle.

H10-H40

H45-H80

H90-H140

Hedstroem File: Recommended use

Hedstroem can be used both in straight canals and curved canals. The hedstroem prepares dentin effectively only when using a filing, up and down motion. In curved canals, files (sizes 20/25 and bigger) must be pre-curved to correspond to the shape of the curve. H-files must always fit loosely in the canal to avoid risk for fracture. This is easily obtained by selecting a smaller H-file after each rotating instrument. Small

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sizes up to #25 can be used down into full preparation length while bigger sizes are often used 1 - 3 mm short.

Hedstroem File: Safety tips

Hedstroem files show a greater risk for fracture than reamers and K-files if used in a wrong way. However, correctly used H-files rarely fracture. Hedstroem must always fit loosely in the canal and they must never be rotated. In curved canals Hedstroemfiles are pre-curved to correspond to the shape of the canal. Before introducing them into the canal, all Hedstroem files must be inspected for possible earlier damage to the instrument and discarded immediately if an asymmetry in the cutting area is found.

F. NITI 16

Niti File: Design & Structure

NiTiflex-files are manufactured from nickel-titan wire that is ground to give the typical profile of a K-file. The angle between the long-axis and the cutting blade is bigger than in reamers, and therefore preparation by NiTiflex-file is effective both in rotating motion and in filing motion (up and down movement). The tip of the instrument is non-cutting ('bat-tip') which makes the NiTiflex-file well suited for the preparation of curved canals without the risk of ledge formation.

Niti File: Sizes & Codes

NiTiflex-files come in sizes 15 - 60, all with a taper of 0.02. K-file design is identified by the square symbol on the handle. NiTiflex-files can be best distinguished from normal K-files by the code that in NiTiflex-files is printed with two colors.

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Niti File: Recommended use

NiTiflex-file is suited to be used both in straight canals as well as in curved canals. The NiTiflex-file prepares dentin both in filing motion (up and down) and when rotated. In curved canals the recommended techniques are continuous rotation when the resistance is small and balanced force against greater resistance. Use of balanced force instead of continuous rotation is easier because of the K-file design, which causes a screwing effect in continuous rotation. The use of filing motion in curved canals can cause transportation and ledging, and is not recommended.

Niti File : Safety tips

NiTiflex-files can be rotated only using moderate pressure. Use of force may result in fracture also with bigger sized instruments. NiTiflex-files are super-elastic and always return to their original shape (= elastic memory), which makes it difficult or impossible to detect weakened structure by visual observation. Fracture risk is best controlled by correct use and by using the instrument no more than ten times.

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2. Rotary preparation instruments

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A. Pro Taper
Pro Taper: Design and Structure
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ProTaper instruments are prepared from round nickel-titan wire by grinding. Crosssection of the instruments shows a triangular structure with three cutting points and no radial lands. ProTaper instruments have a non-cutting tip that guides the instrument in the canal and reduces the risk for ledge formation. The convex triangular cross-section which reduces the contact area between the file and dentine. This greater cutting efficiency has been safely incorporated through balancing the pitch and helical angles. A progressively tapered file engages a smaller zone of dentine which reduces torsional loads, file fatigue and the potential for breakage. It clinically serves to improve flexibility, cutting efficiency and typically reduces the number of recapitulations needed to achieve length, especially, in tight or more curved canals.

Pro Taper: Sizes & Codes

ProTaper instruments are manufactured in six sizes: Three shapers and three finishing files.SX file (no color ring) is 19 mm long and has varying tapers of 3.5% (D1), 19% (D9), and 2.0% (D14). The tip of the instrument is 0.19 mm in diameter. S1 (violet) has a tip diameter of 0.185 mm and a taper from 2% (D1) to 11% (D14). S2 (white) has a tip diameter of 0.20 mm and a taper from 4% (D1) to 11.5% (D14). The diameter of all three Shaper files at D14 is the same, 1.19 mm. F1 file (yellow) has a tip diameter of 0.20 mm. The taper is 7% at D1 and 5.5 % at D14. F2 (red) has a tip diameter of 0.25 mm. The taper is 8% at D1 and 5.5 % at D14. F3 (blue) has a tip diameter of 0.30 mm. The taper is 9% at D1 and 5.0 % at D14. The diameters of the F files at D14 are 1.02 mm, 1.11 mm and 1.16 mm, respectively.

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Pro Taper: Recommended use

ProTaper is used in a rotating contra-angle with a high torque and a constant speed of 250 - 350 rpm employing only light pressure. Guidelines: 1. Work instruments to light resistance and never force them. 2. Only use instruments in a well irrigated and lubricated canal. 3.The appropriate finishing file passively follows the canal to the desired length then is immediately withdrawn. 4. Use in constant rotation at a speed of 250-350 rpm. 5. Clean flutes frequently and check for signs of distortion or wear. The ProTaper technic: Explore the root canal with a stainless steel N 10K hand file using a small reciprocating back and forth motion. Work passively and progressively until it is a few millimeters short of the estimated working length. Fill the pulp chamber full with either Glyde or Sodium Hypochlorite (NaOCl) for all initial negotiation procedures. Now, start the ProTaper sequence with Shaping file N 1 which has purple ring. The S1 is carried into the canal and moved apically to just short of the depth of the hand files. In more difficult canals, one or two recapitulations may be necessary to enlarge the coronal two thirds of the canal. Irrigate and go back in with 10K hand file to break up debris and then re-irrigate.

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The SX (no colour ring) is then used with a brushstroke action to selectively remove dentine, relocate the canal away from furcal danger and achieve straight line radicular access. With improved access, the SX is passively fit a little deeper into the canal until it encounters light resistance. Bounce off this resistance and brush out of the canal in an apical to coronal direction. Continue with the SX until about two thirds of the overall length of its cutting blades are below the orifice. Dont forget to irrigate. Once the pre-enlargement procedure is finished with excellent coronal two thirds access, use a precurved 10K hand file to negotiate the rest of the canal, establish patency, and confirm working length. When working length is confirmed and a smooth GLYDE path to the terminus is verified, use Shaping file N 1 to length. Following the use of S1, irrigate and use Shaping file N 2 which has a white ring on its handle. This file will typically go to full working length on the first pass. Following its use, irrigate. When the coronal two thirds of the canal has been prepared, the apical one third can be finished. The Finishing file N 1 has a yellow ring (ISO 020) and with the canal flooded with irrigant, carefully take the F1 to working length and immediately withdraw. Gauge the size of the foramen by placing a 20 K hand file to length. If snug at working length then the canal is prepared and ready to obturate. If it is loose, use Finishing file N 2 (red ring ISO 025). Irrigate and carry the F2 to length and gauge the size of the foramen by placing a 25 K hand file to length. If snug at length then the canal is prepared and ready to obturate. If it is loose use Finishing file N 3 (blue ring ISO 030) and carefully carry it to length. Gauge the foramen with the equivalent hand file. Normally, this would be as large as you would prepare a calcified and/or curved canal. Always refer to the manufacturer's latest instructions and recommendations regarding the correct use of the instruments.

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Pro Taper: Safety tips

Only light pressure can be used with the instruments, never force them. ProTaper is an extremely effective instrument that cuts dentin smoothly. Instruments must therefore be constantly cleaned and inspected. Distorted instruments must be discarded immediately. ProTaper is not used with a pecking motion, but lightly pressed forward in the canal.

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B. Great Taper
Great Taper: Design and Structure
GT instruments are prepared from round nickel-titan wire by grinding. Cross-section of the instruments shows a U-file structure with radial lands that inhibit screwing effect in dentin. GT instruments have a bat-tip (= inactive tip) that guides the instrument in the canal and reduces the risk for ledge formation.

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Great Taper: Sizes & Codes

GT instruments are produced in three sizes, 20, 30, and 40, and each size comes in four tapers: 10, 08, 06 and 04. The size of the instrument is shown by the colour band, and the taper is indicated by the number of taper rings. In addition, three bigger instruments are included in the GT family; sizes 35, 50 and 70, all with a taper 12, for preparation of very large canals and for coronal flare in other canals.

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Great Taper: Recommended use

GT instruments are used in a rotating contra-angle with a high torque and a constant speed of (150-) 350 rpm, while employing light pressure. Each instrument is used for 5 to 10 seconds in a pecking motion: push forward - draw back - push forward etc. If the instrument does not proceed in the canal, pressure must not be increased but a smaller instrument must be tried. Preparation is based on a crown-down technique where the coronal and mid-part of the canal are prepared with four crown-down instruments before apical preparation. Preparation is finished by coronal flaring, using one or more of the three flaring instruments. Always refer to the manufacturer's latest instructions and recommendations on the correct use of the instruments.

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Great Taper: Safety tips

Only light pressure, similar to writing with a pencil, can be used with the instruments. Distorted instruments must be discarded immediately. Crown-down and apical preparation instruments can be used one to five times, flaring instruments five to ten times.

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C.ProFile
ProFile: Design and Structure
Profile instruments are prepared from round nickel-titan wire by grinding. Crosssection of the instruments shows a U-file structure with radial lands that inhibit screwing effect in dentin. Profile instruments have a bat-tip (= inactive tip) that guides the instrument in the canal and reduces the risk of ledge formation.

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ProFile: Sizes & Codes

Profile comes in three series that have different tapers. 04-series (taper 0.04) includes sizes 15-45, 60 and 90, all in lengths 21 and 25 mm. 06-series (taper 0.06) includes sizes 15-40 in lengths 21 and 25 mm. Orifice shapers are shorter instruments (19 mm) with tapers from 0.05 to 0.08 and with a different color/size match than in other instruments, as follows: white #20/05, yellow #30/06, red #40/06, blue #50/07, green #60/08, black #80/08.

ProFile: Recommended use

Profile is used in a rotating contra-angle with a high torque and a constant speed of 250-300 rpm, while employing light pressure. Each instrument is used for 5 to 10 30

seconds in a pecking motion: push forward - draw back - push forward etc. If the instrument does not proceed in the canal, pressure must not be increased but a smaller / next instrument must be tried. Preparation is based on a crown-down technique where the coronal and mid part of the canal are prepared before the apical part. Always refer to the manufacturer's latest instructions and recommendations on the correct use of the instruments.

ProFile: Safety tips

Only light pressure, similar to writing with a pencil, can be used with the instruments. Distorted instruments must be discarded immediately. Small sizes and 04 taper instruments can be used in 1 - 5 teeth, 06 taper instruments in 5 - 10 teeth.

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D.Quantec
Quantec: Design and Structure
Quantec instruments are prepared from round nickel-titan wire by grinding. Crosssection of the instruments shows a special structure of two cutting points and radial lands that inhibit screwing effect in dentin. Quantec instruments are manufactured in two types; the SC series has a cutting tip that has limited ability to penetrate into dentin, and the LX-series with a non-cutting tip.

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Quantec: Sizes & Codes

Quantec comes in a series of sixteen instruments with its own color code system and different sizes and tapers as follows: 1: #25/06 2: #15/02 3: #20/06 4: #25/02 5: #25/03 6: #25/04 7: #25/05 8: #25/06 9: #40/02 10: #45/02 A new starting set includes three nr. 25 instruments (17 mm) with tapers 12, 10 and 08, and three new finishing sizes are 50, 55 and 60 , all in taper 02. Always refer to the manufacturer's latest instructions and recommendations on the correct use of the instruments.

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Quentec: Recommended use

Quantec is used in a rotating contra-angle with a high torque and a constant speed of 250 rpm, while employing light pressure. Each instrument is used for 5 to 10 seconds in a pecking motion: push forward - draw back - push forward etc. If the instrument does not proceed in the canal, pressure must not be increased but a smaller instrument must be tried. Preparation is started in the coronal and middle parts of the canal that are flared with instruments #25/12, #25/10, #25/08 and #25/06. This is followed by a sequential use of the instruments from 4 (02/25) to 9 or 10 up to the preparation length, when possible with normal pressure. In larger canals, the preparation may be continued with sizes 50 - 60. In large canals that are easily prepared the number of instruments may be reduced as follows: 1, 4, 9, 10. However, this requires extensive experience in the use of these instruments. Always refer to the manufacturer's latest instructions and recommendations on the correct use of the instruments.

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Quantec: Safety tips

Only light pressure, similar to writing with a pencil, can be used with the instruments. Distorted instruments must be discarded immediately. Depending on the resistance in preparation, each instrument can be used in 1 - 5 teeth. Excessive force and using the instruments too many times can result in fracture.

E.RaCe
Pro Taper Design and Structure
RaCe is an acronym standing for Reamer with Alternating Cutting Edges. The crosssection of the RaCe instruments is a convex triangle, with the exeption of the two smallest instruments, #15/02 and #20/02 (taper 02), which both have a square crosssection. In the manufacturing process, special attention has been focused on achieving a smooth metal (NiTi) surface of the instruments. Each RaCe instruments has a constant taper throughout the working area, ranging from 02 taper to 10 taper, depending on the instrument. The instruments have a rounded tip (see photo folder) and three sharp cutting edges. The instruments are made of nickel titanium, however, two Pre-RaCe instruments are available also as steel instruments (Pre-RaCe #40/10 and #35/08).

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RaCe: Sizes & Codes

The RaCe instruments are produced as "Pre-RaCe" instruments with a short working area for preparation of the coronal canal and as "RaCe" instruments for the preparation of the middle and apical portions of the canal. Twenty different basic designs of RaCe instruments are available, different lengths (21 and 25 mm) give the number of instruments of ca. 30. The tapers of the Pre-RaCe and RaCe instruments vary from 06 to 10 and from 02 to 06, respectively (see tables in the photo folder). The sizes from #15 to #60 are available in the 02 taper series, while RaCe instruments in the 04 and 06 series have only three sizes (#25 - #35 and #20 - #30). RaCe is available also in four sets, designed for preparation of canals with different sizes and shapes, or to be used with different techniques (crown down, step back, e.g.)

RaCe: Recommended use

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The RaCe instruments are used with low torque at a speed of 300 - 600 rpm. Torque settings are available from the manufacturer for different motors, such as Endostepper (picture in the main window). The manufacturer recommends the use of Pre-RaCe files #40/10, #35/08, #30 and #40/06 for Crown down procedure. Except the #40/06 this files are integrated in the prefabricated sequences No. 722 and 723. Brief and quick back and forth movements are recommended to be used with the RaCe instrument.

RaCe: Safety tips

The RaCe instrument must never be forced forward in the canal, manual instruments must be used to negotiate obstacles. Instrumentation is done together with copious irrigation. RaCe system is recommended to be used with safety memory disks (SMD). Each SMD has eight petals. The SMD disk is color coded to indicate the taper of the instruments: note that the color indicates different tapers in the Pre-RaCe and RaCe instruments. The SMD gauge helps to calculate the difficulty of the case with the aid of the canals curvature on the X-ray: a three step scale with simple (S), medium (M) and difficult (D) canals make the allocation of the degree of difficulty easy and determine the number of petals to be removed after file usage in the canal.

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F.Flex Master
FlexMaster: Design and Structure
Flexmaster is a rotary NiTi instrument with a convex triangular cross section with sharp K-type cutting edges. Each Flexmaster instruments has a constant taper throughout the working area, tapers 02, 04 and 06 are available. The instruments have a self-centering and rounded tip with semiactive cutting ability because the blade runs far towards the tip. A Flexmaster IntroFile is shorter than the other Flexmaster files, and has a taper of 11.

FlexMaster: Sizes & Codes

Flexmaster instruments use the ISO color codes for different sizes. Taper 02 instruments are available in sizes #20 - #70, while the 04 and 06 taper instruments are produced in sizes #20 - #40. Different tapers are identified by the number of grooves/rings in the shaft. The Flexmaster IntroFile has a tip size #22 and a taper of 11%.

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FlexMaster: Recommended use

The manufacturer recommends the usage of FlexMaster within a speed of 150-300 rpm. A torque control motor is useful. Depending on the difficulty and wideness of canals the following sequences are recommended and offered in a Basic Kit with the IntroFile: Wide canals: blue sequence with: #30 .06, #25 .06, #20 .06 and #30 .04 Medium canals: red sequence with: #25 .06, #20 .06, #30 .04 and #25 .04

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Small canals: yellow sequence with: #20 .06, #30 .04, #25 .04 and #20 .04 Apical shaping: green sequence with: #20 .02, #25 .02, #30 .02 and #35 .02

FlexMaster: Safety tips

The number of file usages should be calculated. A control sheet makes this work easier with writing down a cross for every usage in a canal. After at least eight times shaping of canals, the file should be discarded.

G.K3
K3: Design and Structure

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The cross section of a K3 instrument reveals three cutting blades with slightly positive rake angles, followed by radial lands. Two of the radial lands have been partly reduced (Radial Land Relief) in order to improve the cutting efficiency of the file. The safe-ended non-cutting tip of the K3 instrument follows the root canal and reduces risk of transportation. K3 instruments have a "Variable Core Diameter", or variable flute depth. The proportion of the core diameter to the outside diameter is greatest at the tip, where strength is most important. The instruments also have a variable helical flute angle to reduce screwing effect.

K3: Sizes & Codes

K3 rotary instruments are available in a variety of sizes, lengths and tapers (see popup pictures for details). The picture in the main window above shows a G Pack set (Greater/Graduate Taper). The taper is shown by the color of the silicone stopper and a color ring in the metal handle, the size of the tip is indicate by the other ring color in the handle. K3 files are produced in lengths of 17 mm - 30 mm, depending on the taper and size of the tip.

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K3: Recommended use

The following instructions are a brief guide for preparing the majority of root canals. Larger canals require less preparation in the coronal and middle portions but more cleaning with sodium hypochlorite. The guidelines below follow the principles of a step-down technique. 1. Place rubber dam and cut an access cavity. Ensure there is straight-line access into at least the coronal portion of all the canals. 2. Insert a size 10 Kfile into each canal to check there is an unobstructed pathway for at least 1/2 to 3/4 of the estimated canal length. Canal length estimated from preoperative radiograph. 3. Place an Orifice Opener taper 10 into the canal(s) and penetrate for a few millimetres. Speed 250 rpm and using a slow gentle in and out movement 4. Place an EDTA lubricant into the canal opening(s). Work an 08 taper orifice opener 3-4 mms further into the canal. 5. Irrigate with sodium hypochlorite using a gauge 27 or 30 irrigation needle. 6. Measure the working length of the canal with a Kfile with the aid of an apex locator or a radiograph. Establish apical patency by passing the 10 Kfile passively through the apex by no more than 1.0mm. 7. Begin filing with K3 06 tapered instruments. Speed 200-250 rpm using light even pressure with a slow in and out movement. Use each instrument for no more than 6 seconds.

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8. Files used in sequence from the largest to the smallest. Place silicone stops on the instruments at the working length. Start with size 35, then 30, 25, 20, in a run down to size15. Repeat the step-down from size 35 until size 20 reaches the working length. 9. Irrigate after alternate instruments and at completion of filing 10. Check apical patency with size 10 Kfile. Difficult fine and long curved canals For those occasional difficult canals which are long, very fine and curved use both 04 tapers and 06 tapers. Open the coronal and middle thirds as described above, the use K3 starting with size 30 06 followed by 30 04, then 25 06 followed by 25 04, and finally 20 06 and 20 04. If this method does not reach the working length then widen the guide path with hand Kfiles from size 10 to 15 and then 20 at the full working length. Another run of 06s and 04s from 30 down to 20 will complete the preparation. K3 G-Pack (Graduating Taper) Instrumentation Guide 1. Obtain Straight-Line Access using the LA Axxess kit. 2. Locate the canal orifices and obtain coronal patency using hand files. 3. Begin Crown-down by taking the .12 Taper K3 Shaper to resistance (the .12 Taper K3 Shaper is designed to open the orifice only). 4. Take the .10 Taper K3 Shaper to resistance. 5. Establish working length. Establish this with your Elements Diagnostic Unit. A radiograph may be taken to assist in working length determination. 6. Take .08 taper K3 Shaper to resistance. 7. Take the .06 Taper #25 K3 File to resistance. Many canals will be finished after this step. 8. In more difficult, curved and narrow canals you have the option of using a .04 Taper #25 K3 File and a .02 Taper #25 K3 File until working length is achieved. Recapitulate back to .04, then .06 taper, if possible. 9. Take each instrument to resistance at 300-350 RPM in an electric torque control motor, using each instrument for no longer than 5-7 seconds. Clinical Tips Establish a glide path with hand files. Confirm patency between all rotary files with a #08 hand file. Irrigate copiously, alternating between sodium hypoclorite and SmearClear (17% EDTA containing antimicrobial and wetting agents). Use very light pressure. Never force instruments to working length. When the instrument no longer advances apically, proceed to the next smaller taper. Note: The G Pack will work in many cases, but all canals differ in size and shape so additional sizes of K3 Files may be required. K3 Procedure Pack Instrumentation Guide 1. Obtain Straight-Line Access using the LA Axxess kit. 2. Locate the canal orifices and obtain coronal patency using hand files. 3. Begin Crown-down by taking .10 Taper K3 Shaper to resistance. 4. Take .08 taper K3 Shaper to resistance. 5. Estimate apical size. 6. Begin Crown Down using a size #40 K3 File.

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7. Establish working length. Establish this with your Elements Diagnostic Unit. A radiograph may be taken to assist in working length determination. 8. Complete Crown Down preparation with a #35 K3 File, #30 K3 File, #25 K3 File, by taking each instrument to resistance at 300-350 RPM in an electric torque control motor, using each instrument for no longer than 5-7 seconds. Clinical Tips Establish a glide path with hand files. Confirm patency between all rotary files. Irrigate often, alternating between sodium hypoclorite and SmearClear (17% EDTA containing antimicrobial and wetting agents). Use very light pressure. Never force instruments. When the instrument no longer advances apically, proceed to the next file. The Procedure Pack will work in many cases, but all canals are different and additional sizes of K3 Files may be required. You will want to begin with a K3 File 3 sizes larger than your estimated apical diameter.

K3: Safety tips

All rotary files can break when used carelessly. Always inspect the files before use to detect any asymmetry in the light reflection pattern. Follow manufacturer's detailed instructions regarding speed, pressure, technics (e.g. pecking), sizes and number of uses per instrument. External motors can be helpful to maintain even torque and speed to further reduce the risk of file fracture.

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H.EndoSequence
EndoSequence: Design and Structure
EndoSequence is a rotary NiTi instrument with a triangular cross section with sharp reamer-type cutting edges. Each EndoSequence instruments has a constant taper throughout the working area, tapers 04 and 06 are available. The instruments have a self-centering and rounded tip. The instrument design includes "alternate contact points" (ACPs) along the shank of the instrument. Despite of constant taper, ACP should result in reduced contact area

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during preparation, which according to the manufacturer helps keeping the file centered in the canal and reduces the torque requirements of the file. To further reduce risk for screw effect, the EndoSequence file has both variable pitch and variable helical angles. Like the RaCe rotary file, EndoSequence file has been subjected to the process of electro polishing, which can be detected by the glossy surface of the metal. According to the manufacturer electro polishing improves the physical properties of the instrument.

EndoSequence: Sizes & Codes

EndoSequence files are manufactured in tapers 06 and 04. The smaller 04 files have a golden shank, while the 06 files have a silver color. 04 instruments are available in sizes 15 - 40; for the 06 files two additional sizes of 45 and 50 are also made. For initial canal preparation, an intermediate file with a size 27 and 04 taper is available (Expeditor file). The regular sized files are made in three lengths: 21, 25 and 31mm. Color coding shows the tip size according to the ISO color standard system.

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EndoSequence: Recommended use

EndoSequence rotary files are used with only very slight pressure for a short time in the canal. The recommended speed is 500 - 600 rpm in electric handpiece. After inspection of the canal with a #10 manual instrument (K-file), the recommended technique is crown-down preparation. Always check for the latest instructions by the manufacturer for the correct and recommended technique.

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EndoSequence: Safety tips

Any rotary file can break when used carelessly. Always inspect the files before use to detect any asymmetry in the light reflection pattern. Follow manufacturer's detailed instructions regarding speed, pressure, technics, sizes and number of uses per instrument. External motors can be helpful to maintain even torque and speed to further reduce the risk of file fracture. EndoSequence files are used with a very slight pressure, each file is only a short time in the canal.

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3. Instruments Self Assessment

Hand instruments
True False Reamers are always made of triangular steel wire

Reamers are always made of square steel wire

Reamers have a low angle between the long-axis and the cutting blade

The symbol of a reamer is a triangle

A "classical" reamer has an actively cutting tip

Reamers are manufactured in sizes #06 to #140

The optimal way of using a reamer is rotation by the clock

Reamers cannot be used with the balanced force technics

Reamers are not effective in filing motion

K-files are always made of square steel wire

The symbol of a K-file is a square

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The angle between the long-axis and the cutting blade in K-files is greater than in reamers

The optimal instrumentation technics with K-files is balanced force

Balanced force technics helps to minimize screwing effect with K-files

Screwing effect is a smaller problem in K-files than in reamers

A "classical" K-file has an actively cutting tip

Actively cutting tip help K-files to avoid transportation and ledging

Small K-files of #06 - #10 should not be using for instrumentation of narrow, calcified canals New, more flexible stainless steel K-files and reamers usually have a noncutting tip Flexofiles and Flexoreamers are both made of steel wire with a triangular cross section The most effective technics to use Hedstroem files (H-files) is balanced force technics The angle between the long-axis and the cutting blade in H-files is greater than in reamers The angle between the long-axis and the cutting blade in H-files is close to 90 degrees

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H-files remove dentine most effectively on their way down into the canal

Optimally, after reamer or K-file, same size H-file should be used

H-files can be used in curved canals

NiTi K-files are made of nickel titanium

NiTi K-files must be used in a filing motion

The optimal instrumentation technics with NiTi K-files is balanced force

NiTi K-files can be used by continuous rotation

Screwing effect is not a problem with NiTi K-files when used by continuous rotation

Rotary instruments
True False Rotary instruments are used in clockwise rotation

Most rotary files are used at 300 rpm

Some rotary files are used at 600 rpm

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All different instrument designs are used in pecking motion

Crown-down principle is seldom used with rotary instruments

Rotary files are produced in tapers ranging from 02 to 12

Radial land is supposed to prevent screw effect

RaCe has radial lands

ProTaper does not have radial lands

Profile has radial lands

It is not necessary to inspect the canals with hand instruments before using rotary Hand instrumentation should be done to sizes 15 - 20 before starting rotary

06 taper instruments are generally more flexible than 04 taper instruments

Orifice shaper/opener instruments have always 02 - 04 taper

High torsional loads increase fracture risk

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File fatigue increases fracture risk

Rotary files can be used in 1 - 5 teeth, depending on the resistance and recommendations of the manufacturer Rotary instruments can be re-used in easy canals even if they are slightly distorted

Rotary files must always be in vertical motion (going down or up)

GT files have a varying taper in each instrument

RaCe files have a varying taper in each instrument

ProTaper files have a varying taper in each instrument

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