InstrumentsofCriticalPath PartI

MichaelJ.Scianamblo,DDS

April10,2013

Abstract InstrumentsofCriticalPathareanewsetofendodonticinstrumentsusedto cleanandenlargetherootcanalspace.Variousprototypesthathavebeen providedbyMaiffeler(DentsplyInternational)arereferredtonominallyasX FilesorSwaggeringFiles.Theinstrumentsfeaturesymmetricalcrosssections thatareoffset,placingthecenterofmassoftheinstrumentataspecified distanceawayfromtheaxisofrotation.Theoffsetcenterofmassallowsthe instrumentstogenerateprecession,andformmechanicalwaveswithinthe canal.PartIdiscussesthecriticalpathoftherootcanalspace,whichis definedasapaththatisequidistantcircumferentiallyfromthecenterofthe canalforminganidealendodonticcavitypreparation.Atheoreticalorcritical setofinstrumentsisdescribed,wherebythediameterofthefilesincrease equallyandisafunctionoftheareaofacircler^2,therebyexpanding exponentially. Introduction TheobjectiveofarootcanalpreparationorECP(endodonticcavity preparation)istocreateaspacethatcanbepredictablycleanedor disinfectedandfilledtopreventfurtherinfection.Theseobjectiveswere outlinedbytheearliestinvestigatorsHunter(1911),Hess(1916),Rosenow (1917)andStewart(1955).Thefirstendodonticinstrumentswereintroduced byMaynardin1838,whofashionedthemfromnotchedpianowire.They werecalledrattailorRTypefilesandarestillinuseasthebarbedbroaches (Figure1A).TheKerrManufacturingCompanydevelopedKTypeinstruments (Kerr,1919).ExamplesofKTypeinstrumentsarereamersandfiles(Fig1B andC).Theyareavailableincarbonsteel,stainlesssteel,andmorerecently, analloyofnickeltitanium.Traditionalfilesandreamersweremanufactured in21,25and30mmlengthswithaworkingorcuttingsurfacethatwas extendingfromthetip(D0)toshank(D16)withastandardized0.02mmper
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m mmtaper r(seefigu ure2).Htypefiles sareman nufacture edbygrindingflute esinto t taperedroundme etalblankstoformaseriesofinterse ectingcones.Duringuse, c cuttingoc ccursinth hepulldirectiononly. o Heds stromfile es(Fig.1D D)areext tremely e efficientcutting c instrument tsduepri imarytot thefactt thattheyhavepos sitive c cuttingan ngles.

Figu ure1

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Figu ure2

S Schilder(1974)wa asthefirs stclinician ntoprovideadeta aileddisc cussionof fthe r rootcana alprepara ationrefe erringtothe t proce edureasc cleaninga andshapi ingand o outlinedspecific s designobj jectives,which w inc cludedthe econtinu uouslytap pering s shape.Th histaperin ngspacewasacqu uiredbyh handinstr rumentat tionalternating r reamersand a filescreating c an a envel lopeofm motion.W Weineetal(1975)used c clearacry ylicblocks stoevalu uatetheeffectiven e nessofva ariousinst trumenta ation t technique es.Theirconclusio c onsweresomewha atdisconcerting,d demonstr rated neitherareaming t thattheutilization u nofstand dardinstrumentsin g,filing,o ora r reamingand a filingproducedprepara ationstha atwereir rregularinshapea andnot c continuou uslytapering.Thenarrowestpart,th hesocall led"elbow w",waslocated a atapoint tcoronaltotherootapex.These T cha aracterist ticswerefelttore esult f fromtheelasticmemoryof finstrumentsandapredile ectiontos straightenas t theyaremigrated m aroundcurves. c To oalleviate ethispro oblem,Weinesugg gested r removing gtheflute esfromth heoutersurface s o ofaprecu urvedfile e,andthe euseof instrumen ntsininte ermediateISO(Int ternationalStanda ardsOrga anization) )sizes b bycutting gasmallsegmentfromthe etipoftheinstrum ment.Cof ffaeandB Brilliant ( (1976)corroborate edthewo orkofSch hilderdem monstratingthatatapering g ovalofde p preparationwasmore m effic caciousintheremo ebrisfrom mthecon nfines o oftheroo otcanalsystemthanparalle elprepar rations.Theyalsod demonstrated t thattheuse u offile esserially,andinastepbac ckmodali ity,wasm moreeffe ective inproduc cingtheta aperingshape.To ominimizethepro oblemsde escribedb by W Weine,AbouRassetal(198 80)engag gedinad discussion nofantic curvature efiling.
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Thismethodadvocatedtheremovalofconspicuousamountsoftooth structurefromtheouterwallsofthecurveofarootcanalsystem.This providedasaferapproachtotherootapex,inadditiontoprotectingthe furcationofmultirootedteeth.MarshallandPappin(1980)advocatedan innovativeapproachtorootcanalpreparationdescribedasacrowndown technique.Thismethodaddressesthecanalbyexpandingthepreparation coronallybeforeanattemptismadetoreachtheapex.Precurvatureof instrumentswasfoundtobeunnecessary,however,theapicalzip,as describedbyWeine,couldstillbedetected. Roaneetal(1985),describedatechniqueforrootcanalpreparation calledbalancedforce.Thetechniquewasavariationofreaming, whichincluded"backturning"thefileinacounterclockwisedirection, andpurportedlymaintainedthecontourofthecanalwithout transportingtheapicalforamen.Theoretically,therestoringforceor elasticmemoryofthefile,asdescribedbyWeine,wasbeovercome whenitispitagainstdentinalresistance. However,Blum,Machtouandothers(1997)foundthatthesetechniques, wereapredisposingfactorsassociatedwithunpredictablebreakage. TheadventofNickelTitaniumrotaryinstrumentationhaschangedthe landscapeofendodonticcavitypreparationmeasurably.Theearliest investigatorsincludingGlossonetal(1995)andEspositoetal(1995), suggestedthatNickelTitaniumrotaryinstrumentsweresuperiortohand instrumentationinmaintainingtheoriginalanatomyrequiringfewer instruments.However,Schafer(1999)foundthatNickelTitaniuminstruments withtraditionalcrosssectionsandsizesleftallcurvedcanalspoorlycleaned andshaped,wherebytoothstructurewasremovedalmostexclusivelyfrom theouterwallofthecurve.Kumetal(2000),Calbersonetal(2002),and SchaferandFlorek(2003)statedthatthegreatestfailingofcurrentNiTi designsisthecontinuedpredispositiontotorsionalandcyclicfatigueand breakage.Currentresearchdoesnotcompletelyendorsehand instrumentationorrotaryinstrumentationexclusively.Endodonticcavity
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p preparations,how wever,willbedone eusingbo othhandinstrume entsandr rotary instrumen ntsdueto othefaci ilityandsafety s oft theseinst truments s,whenu usedin c combinat tion.Inad ddition,ro otaryinst trumenta ationfacilitatesthe ecoronal r removalof o debris,whichisdesirable e. T TheEndo odonticFi ileSequence T Thechalle engesofcurrent c Nickel N Tita aniumins strumentdesigns,asdescribed sassociat a above,maybecom mpounde edbytheproblems tedwiththeinstru ument s sequence eitself.Sp pecifically y,instrum mentstha atincreas seinsizet toorapid dlycan b besubjec ctedtorapidincrea asesinth heworklo oad,whic chpredisp posesthe e instrumen nttoinef fficiency,prematurefatigue eandbre eakage. T Theresist tancethataninstr rumentencounter rsincreas sesexpon nentiallya asthe s sizeordia ameterof ftheinstrumentin ncreases. .Asthecanalisen nlarged,c changes o occurinthecircum mferenceorperim meterofth heECSan ndtheare eathatisbeing e enlarged.Thesech hangesca anbecalc culatedus singthef formulasforthe c circumfer renceofacircleC=2r,the eareaoracircleA=r2,andthelateral s surfacear reaofatruncatedcone,als soknown nasafrus stum,Sf=s(r1+r2). T TofurtherevaluatetheenlargementoftheE ECS(endo odonticca avityspac ce)or r rootcana alspace,we w needto t examin neatheo oreticalto oothmod delandideal r rootcana alprepara ation(Figu ures3Aand a 3B).

FIG.3AF FIG.3B
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Aprepare edECS(endodonti iccavityspace) s iss showninFigure3B B.Althou ugh d disagreem mentsma ayexistre egardingthe t config gurationofanidealendodontic c cavitypre eparation,describe edhereas a theECP P,orroot tcanalpreparation n,itis g generallyagreedthatthepreparatio p onshould dbesmallintheapicalfora amen ( (from0.200.30mm m)andlargeinthe eorifice( (from1.01.2mm m).Ifwe c calculatethechangeinsurf faceareasoftheE ECP,betw weentheorificean ndthe f foramenas a thespaceisenl largedcir rcumferen ntially(an ndequally),wecan b betterest timatethechange esinresistancetha ataninstrumentu undergoes. R Referringtofigure e4B,ifthe eprepare edcanalb betweentheorific ceandthe e f foramenwere w assu umedtobe12mm msinleng gth(theav veragele engthofthat s space)an ndthatlen ngthwassectionedtransve erselyinto otwelveequal s segments s,eachse egmentco ouldbevi iewedseparately.Thesese egmentsa are c calledfrustumswiththedia ameterco ontinually yincreasingfromtheforam men t totheorifice.Thes sefrustum msareno ominallyr referredt toasD0 D12.

FIG.4A 4
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FIG.4

FIG.4C

Referringbacktofigure3A,assumingthatthediameteroftheECSaverages 0.20mm(initially)alongitsentirelength,thesurfaceareaofeachofa transversecrosssectionofanypartoftheoriginalcanalwouldequalr2orA =times(0.10)2,whichequals0.0314mm2.Referringtofigure4Aand4B,if thediameteroftheforamen(Dzero)wouldremainat0.20mmandthe diameterattheorifice(D12)wouldincreasenominally1.0mms,thediameter attheorificewouldequal1.2mmandthemiddlediameter(D6)wouldequal to0.70mm.Theoutlineofthisidealcavitypreparationin(figure3B)istermed thecriticalpathoftheendodonticcavitypreparation.Incalculatingthe increasesinsurfaceareasofthevariouscrosssectionsasthecanalis enlargedandusingtheformulafortheareaofacircleA=r2,theareaatthe orificeatD12wouldincreasesfrom0.0314mm2to1.1131mm2.Thisisan increaseinsizeofapproximately36times.Ifthesamecalculationweremade atD6,thediameteroftheECSwouldincreasefrom0.0314mm2to0.7854 mm2andincreaseinsizeof25times.Thus,eachoftheseareasisseento increaseexponentiallynotlinearlyorgeometrically.Almostallmanufactures ofendodonticsinstrumentsusetheISOsystemtosequencefiles,whichis linear(seetable1).Thus,arrivingatanidealECPefficientlyandsafelywitha smallnumberofinstrumentsisproblematicuselessanexponentialsystemfor sizesisadopted.

ThecrosssectionaldiametersoftraditionalinstrumentsspecifiedbytheISO System.Instrumentsortipsizes2070withaninvariabletaper0.02mmper mmareshown. Expressedin100sofmms 20/0 25/0 30/0 35/0 40/0 45/0 50/0 55/0 60/0 2 2 2 2 2 2 2 2 2 D1 20 25 30 35 40 45 50 55 60 D2 22 27 32 37 42 47 52 57 62 D3 24 29 34 39 44 49 54 59 64 D4 26 31 36 41 46 51 56 61 66 D5 28 33 38 43 48 53 58 63 68 D6 30 35 40 45 50 55 60 65 70 0% 17% 14% 13% 11% 10% 9% 8% 7% * D7 32 37 42 47 52 57 62 67 72 D8 34 39 44 49 54 59 64 69 74 D9 36 41 46 51 56 61 66 71 76 D1 38 43 48 53 58 63 68 73 78 0 D1 40 45 50 55 60 65 70 75 80 1 D1 42 47 52 57 62 67 72 77 82 2 *Representsthepercentageincreaseinarealdiameterfromtheprevious crosssectional.TheaverageofthesechangesfromatD6is10%. Table1 FurtherevaluatingtheconventionalISOsystem,weagainrefertofigure2 andthediameteratD1.Theinstrumentsarespecifiedtoincreasein0.05mm incrementsfromasD1beginningwiththenumber10,whichis0.10mmat D1,progressingtothenumber15,whichis0.15mm,andcontinuing0.20, 0.25,0.30,0.35,0.40,0.45,0.50,0.55,upto0.60.Then,theinstruments increaseinsizevia0.10mmincrementsto0.70,0.80,0.90,1.00etc.All instrumentsmaintainaconstanttaperof0.02mmpermm(withcalibrations
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in100thsofmms)fromD1toD16.Thus,usinganISOsequenceof instrumentstoincreasethediameteratD6from0.20mmto0.70mmwould requiretheuseofatleast9differentinstrumentsthatincreaseindiameter linearlyandsomewhatrandomly.Asseenintable1,thechangeindiameter fromasize30filetoasize70fileatD6rangesfrom17%to8%.Thus,the changeindiameteroverthis9instrumentsequenceisexactly9%oralinear changeofexactly1%perinstrument.Whileitmaybereasonablysafeitis notconsideredefficient,andisinconsistentwiththerapidchangein diameterthatoccursduringECP. OtherinvestigatorshaverecognizedthedeficienciesoftheISOsystem. Schilder(1991)attemptedtomitigatetheproblembyimposingaconstant 29.17%increasesizeofthediameteroftheinstrumentatD1,while maintainingaconstanttaperof0.02mm/mm.Thisinstrumentsetwascalled Series29,wherebytheISO#10(0.10mmatD1)wasdesignatedastheNo.1 andtheISO#60(0.60mmatD1)theNo.8.Asdescribedinthepatent, literaturethissystemcouldalsobeappliedtoasetof6instrumentswitha constant43.1%increaseatD1orasetof7instrumentswithaconstant 34.8%increaseatD1.AlthoughSchilderdidnotdelineatethismathematical formulatodeterminehowasetcontainingNnumberofinstrumentswould haveanequalpercentincrease,youwouldneedN1stepstogetfrom instrumentno.1(0.10mmatD1)tothenumber8(0.60mmatD1).You wouldthenneedtofindtheincreaseratio,A,whereA=6^(1/N1).Foraseries of8instrumentsA=6^(1/(81)or6^(1/7).Tofindpercent,wemultiplytheratio by100%,andthentofindincrease,wesubtract100%.Anumericalsequence wherebyeachterm(ornumber)ismultipliedbythesamefactortoobtain thefollowingtermisacalledgeometricsequence.Thus,thissetof instrumentswasmoreefficient,butwasgeometricalnotexponential,which ismorelogical. Withtheintroductionofnickeltitaniumalloysinendodonticdrill manufacture,itbecameclearthatlargeamountsoftoothstructurecouldbe removedrapidlyinandaroundthegreatercurvatureofthecanal.This inspiredtheintroductionofabroadrangeofnewinstrumentswithcommon
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tipsizes,butwithtapersthatweresignificantlygreaterthanthe0.02taper oftheISOconventionalinstruments(McSpadden1998andJohnson,2000). Theseincludedinstrumentswith0.04,0.6,0.8,1.0and1.2mmpermm tapers.Someofthefirstnickeltitaniuminstrumentstobecomepopular wereProfileandtheProfileGTmanufacturedbyTulsaDentalProducts.The distributionofthediametersofthe0.06taperedinstrumentsislistedin table2below.Althoughfewerinstrumentsarerequiredtocarryoutthe sameworkastheinstrumentsdesignatedbytheISOsystem,itcanbeseen thattheseinstrumentsstillincreaseinsizelinearly.Withthesedeficiencies inmind,anewinstrumentsequencederivedbysubdividingtheECP,and particularlythemostvulnerableareaofthecanal,intoequalpartswas undertaken.Thissetofinstrumentsistermedthecriticalsetwhich dictatesequalsubdivisionofthe"criticalpath"(seeFigure5Aand5B). Thearraysofdiametersusingtipsizes15,20,25,30,35,and40and0.06 tapersoftypicalNiTiinstrumentsareshownbelow. Expressedin100sofmms 15/06 20/06 25/06 30/06 35/06 40/06 D1 15 20 25 30 35 40 D2 21 26 31 36 41 46 D3 27 32 37 42 47 52 D4 33 38 43 48 53 58 D5 39 44 49 54 59 64 D6 45 50 55 60 65 70 7%* 11% 10% 9% 8% 7% D7 51 56 61 66 71 76 D8 57 62 67 74 77 82 D9 63 68 73 80 83 88 D10 69 74 79 86 89 94 *Representsthepercentageincreaseinarealdiameterfromtheprevious crosssectional.TheaverageofthesechangesfromatD6is7.5%. Table2
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 InstrumentsofCriticalPathProgressiveandEqualDiameters Method Again,referringtoFigure4A,4Band4C,thecriticalpathoftheendodontic cavitypreparationhasbeendefinedasthatspacewhichliesbetweenthe orificeareaandtheforamenofthetooth,wherebythediameterofthe canalhasbeenenlargedfromoftheforamentotheorificeand approximates0.20mmsto1.2mmsrespectivelyandhasacontinuously taperingshape.Experiencedcliniciansareaware,thattheinstrumentsused inthisenlargementprocedure,particularlynickeltitaniumrotary instruments,aremostvulnerableatthefulcrumorgreatestcurvatureofthe criticalpath.Indeed,instrumentfailureisrareincanalsthatarereasonably straight.Althoughthepointofgreatestcurvatureissomewhatvariable,itis clearthatthepoint,alsoknownastheelbowofthecurve,ismostoften equidistantbetweenD0andD12orthemidpointofthepreparation.Ifthe averagelengthofthecriticalpathis12mm,thefulcrumwouldmostoften befoundatD6orthatsegmentlocatedapproximately6mmfromthe foramen.Thus,ifsixseparateinstrumentsareemployedtoaccomplishthe workofenlargingacurvedcanal,anidealsequenceofinstrumentscouldbe constructedbycalculatingthechangesthatoccurinthediameteroftheECS atD6ortheelbowofthecurve.Morespecifically,ifthecanalistobe enlargedsequentiallyfrom0.20to0.70mmatD6and0.20to1.2mmat D12,aninstrumentsetwherethediameterofeachinstrumentsincreasesin areaequallycanbedevisedusingtheformulaoftheareaofacircleA=r2. Thespecificcalculationsforthesevaluescanbefoundintable3andare derivedinthefollowingmanner.WithreferencetoD6ofFigure4Cand referringtoFigures5Aand5B,anoutercircleandaninnercircleforman annulus.Ifthetotalareaoftheinnercircleissubtractedfromthetotalarea iftheoutercircle,thetotalareatobepreparedorenlargedcanbedefined. Thus,thetotalareaoftheannulusatD6canbesubdividedintosixseparate areaseachwithitsowndiameter.Thesediametersmaybenominally referredtoasd0,d1,d2,d3,d4,d5,andd6withcorrespondingradiir0,r1, r2,r3,r4,r5,andr6.
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FIG.5A FIG G.5B Aoutercircle =(.3 35)2(.1 1)2 eAinnercircle c

Aofannu ulusatD6=(.1225 5)(.01) Aofannu ulusatD6=(.1125 5) Iftheann nuluswerethendividedequ uallyinto o6segme entstofas shionanideal o ormodelsetofins struments,alsocalledthe criticalse et,theneach instrumen ntwouldincreaseindiame eterbyon nesixthth hetotala areaofth he a annulusat a D6or Aofannu ulusatD6=(.112 25)=0.01875 66

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 Thus,aformulatodeterminethevariousradiithatemergeatD6asthearea ofannuliatD6aredividedequally,whereasnisthenumberoftheannulito beprepared,is rn2=rn12+0.01875 =rn2=rn12+0.01875 =rn2=rn12+0.01875 Thus,theradiusthatoccursatr1afterinstrumentNo.1isallowedto preparethecanaltoitsmaximumdiameteris r12=ro2+0.01875 r12=(0.1)2+0.01875 r12=0.010+0.01875 r12=0.0388 r1=0.1696 Ifthediameteristwicetheradius,thentheinnerdiameterofD6isd1,whichis d1=0.339mm. Continuingtousetheformula=rn2=rn12+0.01875,valuesforr2,r3,r4,r5, andr6canbedeterminedandintermvaluesford2,d3,d4,d5,andd6atD6 wherebythecriticalsetofinstrumentcanbederived. Thecrosssectionaldiameters,d1,d2,d3,d4,d5,andd6,thatoccuratD0,D6, andD12inthecriticalpathofanendodonticcavitypreparation.These diameterscanbeutilizedtodevelopanidealorpreferredsetof instruments,alsocalledthecriticalset,andis,forthemoment,theoretical.
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Result ThetotalareaofannulusatD6canbesubdividedintosixseparateareas eachwithitsowndiameter.Thesediametersmaybenominallyreferredto asd1,d2,d3,d4,d5,andd6 d0 d1 d2 d3 d4 d5 d6 D0 .20 .20 .20 .20 .20 .20 .20 D6 .20 .339 .436 .515 .583 .644 .700 70%* 28% 15% 13% 10% 8% D12 .20 .522 .712 .86 .986 1.098 1.2 *Representsthepercentageincreaseincrosssectionalareafromthe previousdiameterorinstrument. Table3 Asmentionedabove,constructingthecriticalinstrumentsetwillnecessarily requiretipsizesandtapersthatcannotbegarneredfromconventional endodonticinstrumentsclassifiedbytheISOsystem,whichvarylinearly.A distributionsofinstrumentdiametersthatwouldcorrespondtothecritical pathconceptusingnoveltipsizesandtapersisofferedbelow(seetable4). Interestingly,theaverageincreaseindiameteris29%,however,this increaseisachievedviaanexponentialprogressionnotageometric progressionasdescribedbySchilder(1991).

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Examplesofarraysofdiametersofinstrumentswhichconformtothe criticalpathcouldbeexpressedasfollows: Expressedin100sofmms 20/00 15/05 20/06 24/07 27/08 29/09 30/10 D1 20 15 20 24 27 29 30 D2 20 20 26 31 35 38 40 D3 20 25 32 38 43 47 50 D4 20 30 38 45 51 56 60 D5 20 35 44 52 59 65 70 D6 20 40 50 59 67 74 80 100% 25% 18% 13% 10% 8% 20 .339 .436 .515 .583 .644 .700 Critical 70%* 28% 15% 13% 10% 08% 0% Set D7 20 45 56 66 75 81 90 D8 20 50 62 73 83 90 100 D9 20 55 68 80 91 99 110 D10 20 60 74 87 99 108 120 D11 20 65 80 94 107 117 130 D12 20 70 86 101 115 126 140 Table4 Discussion Providingasetofinstrumentsthatcorrespondstothecriticalpathconcept, buthastipsizesandtapersthatarerecognizabletomostclinicianis challenging.Thetipsizesandtapersprovidedbyanovelsetofinstruments termedProTaperNext,manufacturedbyMailleferdentalproducts accomplishesthisobjective(seetable5).

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Anarrayoffiveinstrumentsinaccordancewiththe"criticalpath"concept withcommontipssizesandtapers Expressedin100sofmms 20/00 17/04 25/06 30/07 40/06 50/06 D1 20 17 25 30 40 50 D2 20 21 31 37 46 56 D3 20 25 37 44 52 62 D4 20 29 43 51 58 68 D5 20 33 49 58 64 68 D6 20 37 55 65 70 75 85% 32% 15% 7% 6% .339 .436 .515 .583 .644 CriticalSet 70%* 28% 15% 13% 10% Table5 ItcanbefurthermodifiedbyapplyingvariabletapersasdefinedbyMaillefer (1998).Whenthevolumetricexpansionoftherootcanalspaceiscalibrated bymeasuringthediameteroftheXfilesandplottedfromD0(apex)toD10 (foramen),substantialuniformityindentinremovalispossible(figure6).The X1istheonlyinstrumentthatdeviatesslightlyfromthisuniformity,but maystillbeconsideredsafe,becauseitwouldhavethenarrowestcross sectionatD6,andthereforebethemostflexibleinstrumentintheset.

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F Figure6 W Whenthe esameca alibrationsandcalculations saremad deforthepredecessor t theProTa aperNext t,namely,ProTape erUnivers sal,inwh hichtheIS SOsystem mof f fileseque encingwa asutilized d,adisparityinvol lumetricremovalisnoted ( (figure7).

F Figure7
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 Furthertestingwasundertakentodemonstratethatthisimprovementinfile designassistsinendodonticcavitypreparationinminimizationof transportation,whichispartofthenextdiscussion,InstrumentsofCritical PathDynamicsofPrecessionMechanicalAnalysis. Conclusions The"criticalpath"oftheendodonticcavityspaceisdefined.Thecross sectionalareaofthatspaceisseentoexpandexponentiallyandisafunction oftheareaofacircle.Asetofmathematicalstepsisoutlinedthatwould establisha"criticalset"ofinstrumentsthatcouldbeusedtoenlargethe canal,dividingtheworkequallybetweeneachinstrument.Thisconceptand similarmeasurementswereusetocreateanovelsetoffilescalledProTaper Next.Calculationsofthevolumetricremovalofdentinascomparedtoits predecessorProTaperUniversalweremadedemonstratingamoreeven distributionofremoval.

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RoaneISandSabalaCL,andDuncansonMGJr:Thebalancedforceconceptfor instrumentationofcurvedcanals.IEndod11:203,1985 Rosenow,EC:Therelationshipofdentalinfectiontosystemicdisease.DCosmos59:485 491,1917 Schfer,E:Relationshipbetweendesignfeaturesofendodonticinstrumentsandtheir properties.Part2.Instrumentationofcurvedcanals.JEndod25:5659,1999 Schfer,E.andFlorek,H,EfficiencyofrotaryNickeltitaniumK3instrumentscompared withstainlesssteelhandKFlexofile.Part1.Shapingabilityinsimulatedcurvedcanals. IntEndoJ36:199207,2003 SchilderH:Cleaningandshapingtherootcanal.DentClinNorthAm18:269,1974 Schilder,H:Setofendodonticinstruments.U.S.Patent.No.5,017,138,May,1991 Stewart,CC:Theimportanceofchemomechanicalpreparationoftherootcanal.Oral Surg8:993997,1955 Walia,H,Brantley,WA,andGerstein,H:Aninitialinvestigationofthebendingand torsionalpropertiesofnitinolrootcanalfiles.JEndod,14:346351,1988 WeineFS,KellyRF,andLioPI:Theeffectofpreparationproceduresonoriginalcanal shapeandonapicalformationshape.JEndod1:255,1975 Publication pending. All rights are reserved by Critical Path Technology. The contents of this article may not be reproduced, downloaded, disseminated, published, or transferred in any form or by any means, except with the prior written permission.

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