doi:10.1111/iej.

13182

REVIEW
A critical appraisal of studies on cyclic fatigue
resistance of engine-driven endodontic
instruments

€ lsmann1
M. Hu , D. Donnermeyer2 & E. Scha
€fer3
1
Department of Preventive Dentistry, Periodontology and Cariology, University Medicine G€
ottingen (UMG), G€
ottingen;
2
Department of Periodontology and Operative; and 3Central Interdisciplinary Ambulance, Westphalian Wilhelms-University,
M€
unster, Germany

Abstract
€fer E. A critical
€ lsmann M, Donnermeyer D, Scha
Hu
appraisal of studies on cyclic fatigue resistance of engine-
driven endodontic instruments. International
Journal, 52, 1427–1445, 2019.
The endodontic literature contains a plethora of stud-
ies on static and dynamic cyclic fatigue resistance
tests performed on a large array of rotary or recipro-
cating nickel–titanium endodontic instruments. It was
the aim of this review to summarize the currently
available evidence to point out the different outcomes
from static versus dynamic tests and to assess
whether cyclic fatigue tests provide useful data and
information for clinical practice. An electronic litera-
ture research in the database PubMed was performed
using appropriate search terms, and the titles and
abstract were screened for relevance. Language was
restricted to English. The review reveals marked differ-
ences between the results obtained in static and
dynamic tests, and also, the results for the same
instruments assessed either under static or dynamic
experimental conditions are widely inconsistent.
Between the lowest and the highest value for one and
Endodontic
the same pathfinding instrument was a factor of
about 123 when cyclic fatigue was assessed either
under static or dynamic experimental conditions.
Moreover, standard deviations of up to 30% have
been reported. Environmental temperature has a
500% impact on the lifetime of instruments. In con-
clusion, fatigue resistance tests conducted under room
temperature should be regarded as having little mean-
ing and the scientific and clinical benefits of fatigue
resistance tests are very limited. These data should be
provided by the manufacturer of the instruments.
Keywords: cyclic fracture, dynamic fatigue tests,
environmental temperature, nickel–titanium instru-
ments, static fatigue tests.
Received 14 January 2019; accepted 30 June 2019

interest of these instruments include bending proper-

Introduction
In recent years, numerous engine-driven nickel–tita-
nium (NiTi) systems have been introduced to the
market (Haapasalo & Shen 2013). Topics of major
Correspondence: Michael H€ ulsmann, Department of Preven-
tive Dentistry, Periodontology and Cariology, University Med-
icine G€ottingen (UMG), G€ ottingen, Robert-Koch-Str. 40,
37075 G€ ottingen, Germany (e-mail: michael.huels-
mann@med.uni-goettingen.de).
ties and flexibility, cutting efficacy and safety of use/
fracture resistance (H€ ulsmann et al. 2005). As the
main reasons for instrument fractures are torsional
overload or cyclic fatigue – or even a combination of
both – many studies describe the torsional or cyclic
fatigue behaviour of instruments (Wei et al. 2007,
Shen et al. 2009a,b,c Shen & Cheung 2013); in fact,
one of the first on cyclic fatigue behaviour of Light-
Speed instruments dates from as far back as 1997
(Pruett et al. 1997). The basic requirements for test-
ing endodontic instruments are defined in the revised

© 2019 International Endodontic Journal. Published by John Wiley & Sons Ltd International Endodontic Journal, 52, 1427–1445, 2019 1427
 Instrument fatigue studies H€
ulsmann et al.
ADA Specification No. 28 (Council on Dental Materi-
als & Devices 2013) and the ISO Specification 3630-
1:2008 (International Organization for Standardiza-
tion 2012).
It should be kept in mind that all tests defined in both
specifications are static in nature, although Dederich &
Zakariasen (1986) demonstrated that an axial move-
ment can significantly increase the resistance to cyclic
fatigue of endodontic instruments. Pruett et al. (1997)
criticized static tests, preferred at that time, with only
bending of the file until fracture as not being appropri-
ate to test the dynamic properties of engine-driven NiTi
instruments. They subsequently developed a model
consisting of a hollow tube in which the instrument
could rotate freely; however, no vertical motion of the
file was performed (Pruett et al. 1997). Dederich &
Zakariasen (1986) were amongst the first to develop a
dynamic testing device allowing vertical movement of
the file. Ray et al. (2007) also used dynamic study
designs with a standardized axial movement. The axial
movement in dynamic test designs prolonged the stress
interval until cyclic fatigue occurred (Dederich &
Zakariasen 1986).
Dynamic movement of the file better simulates the
stress that is generated on a file in a clinical situation
as the maximum point of flexure varies along the file
throughout the testing procedure. Extended lifespan
of NiTi instruments in dynamic test designs therefore
should be regarded as providing more clinically rele-
vant information than static tests. Regardless of this
fact, static tests can provide better information on the
impact of various design features of instruments or
pre-treatment (heat or surface treatment) of the alloys
on cyclic fatigue (Saber & Fawzy 2011), which might
be more interesting for the development and optimiza-
tion of new root canal instruments. Nonetheless,
dynamic tests also have several disadvantages.
Depending on the tube used to bend the instrument
in the dynamic test, torsional fatigue also stresses the
metallurgy of the instrument in addition to cyclic fati-
gue (Dederich & Zakariasen 1986). Indeed, torsional
and cyclic fatigue instrument fractures cannot be
clearly distinguished in dynamic test designs. Further-
more, a standardization of the axial movement of the
file without any lateral movement inducing torsional
loads is complicated. A lateral movement of a rotating
file could also lead to a second bending point at the
beginning of the tube distorting the outcome of
dynamic tests.
In summary, dynamic fatigue studies have
remained a small minority amongst the many
1428 International Endodontic Journal, 52, 1427–1445, 2019
publications on cyclic fatigue resistance of NiTi instru-
ments. Although it has been proposed in an editorial
in this journal (H€ ulsmann 2013) that this basic infor-
mation on physical/mechanical properties of root
canal instruments should be provided by the manu-
facturers, fatigue studies are still performed in consid-
erable numbers by researchers from universities.
Temperature has been reported as another impor-
tant confounding factor in cyclic fatigue studies. It
has been shown in several studies (Capar et al. 2014,
Shen et al. 2016, Dosanjh et al. 2017, Grande et al.
2017, Alfawaz et al. 2018, Yilmaz et al. 2018) that
environmental temperature significantly influences
the cyclic fatigue behaviour of NiTi instruments. The
metallurgy of NiTi alloys exhibits an eminently differ-
ent behaviour at room or at body temperature
(Zupanc et al. 2018).
Plotino et al. (2010) additionally described a highly
significant impact of the trajectory of the files inside
the tubes on the outcome of studies.
The aim of this review was to summarize the cur-
rently available knowledge regarding the following
questions:
• Are there different outcomes from static versus
dynamic tests?
• Do cyclic fatigue tests provide reliable and repro-
ducible data and useful information for clinical
practice (e.g. selection of a certain file system, fre-
quency and mode of use)?
Literature search strategy
A preliminary literature research on reviews concern-
ing cyclic fatigue resistance was performed in October
2018 in the database PubMed using the search terms
“cyclic[All Fields] AND ("fatigue"[MeSH Terms] OR
"fatigue"[All Fields]) AND ("nitinol"[Supplementary
Concept] OR "nitinol"[All Fields] OR "nickel tita-
nium"[All Fields]).”The search resulted in 12 reviews,
of which 10 were considered relevant according to
their titles and abstracts. These 10 reviews were
ordered in full text and analysed for their content.
Only 1 review dealt with methodological issues (Plo-
tino et al. 2009), and others focussed on NiTi material
science or comparisons of different instrument kine-
matics, surface and thermomechanical treatments of
NiTi instruments.
An electronic literature research in the database
PubMed was performed in November 2018 using
the search terms “cyclic[All Fields] AND ("fa-
tigue"[MeSH Terms] OR "fatigue"[All Fields]) AND
© 2019 International Endodontic Journal. Published by John Wiley & Sons Ltd

("nitinol"[Supplementary Concept] OR "nitinol"[All
Fields] OR "nickel titanium"[All Fields])”; “cyclic[All
Fields] AND ("fatigue"[MeSH Terms] OR "fatigue"[All
Fields]) AND niti[All Fields]”; “cyclic[All Fields] AND
("fatigue"[MeSH Terms] OR "fatigue"[All Fields])
AND static[All Fields] AND ("research design"[MeSH
Terms] OR ("research"[All Fields] AND "design"[All
Fields]) OR "research design"[All Fields] OR "test"[All
Fields])” and “cyclic[All Fields] AND ("fatigue"[MeSH
Terms] OR "fatigue"[All Fields]) AND dynamic[All
Fields] AND ("research design"[MeSH Terms] OR ("re-
search"[All Fields] AND "design"[All Fields]) OR "re-
search design"[All Fields] OR "test"[All Fields]).”
Language was restricted to English. Reviews were
excluded from the search. In the attempt to include
further relevant publications, a hand search of arti-
cles published in Endodontic Topics and ENDO-
Endodontic Practice Today was performed.
The search resulted in 450 hits. The titles and
abstracts were screened for relevance, and the
remaining 270 articles were obtained in full text. The
full-text articles were evaluated for being suitable to
answer the questions in this review, and finally, 74
articles were included.
Number of studies on cyclic fatigue
From January 2014 to September 2018, a total of 68
studies on cyclic fatigue have been published in the
Journal of Endodontics and the International Endodontic
Journal. The number of such papers increased remark-
ably during the last 3 years compared to previous
years, probably related to the increasing number of
engine-driven NiTi instruments available on the mar-
ket. Only 8 of the 68 studies (12%) used a dynamic
study design, the vast majority (n = 60, 88%) pre-
ferred the static test.
Clinical relevance of instrument
fractures
Instrument fracture is not a completely uncommon
incidence during root canal preparation. The preva-
lence of NiTi instrument fracture has been described
as to 0.4%–5% of root canal treatments (McGuigan
et al. 2013) or 5% of instruments used (Parashos
et al. 2004, Zinelis 2018a). The proposed reasons for
such fractures amongst others include operator expe-
rience (Mandel et al. 1999, Yared et al. 2002), rota-
tional speed (Zelada et al. 2002, Martın et al. 2003),
number of uses (Parashos et al. 2004), number of
© 2019 International Endodontic Journal. Published by John Wiley & Sons Ltd
H€
ulsmann et al. Instrument fatigue studies
rotations (Ferreira et al. 2017), pre-flaring (Roland
et al. 2002), glide path (Pati~ no et al. 2005), angle
and radius of a curvature (Li et al. 2002, Zelada et al.
2002), and sterilization of the instruments (Hilfer
et al., 2011). In some studies, up to 93% of instru-
ment fractures have been classified as result of flexu-
ral fatigue (Cheung et al. 2005, Peng et al. 2005). As
a retained instrument will compromise further root
canal preparation, disinfection and root canal filling,
the success rate of root canal treatment may decrease
at least for teeth associated with apical periodontitis
(Parashos & Messer 2006, McGuigan et al. 2013).
Thus, it seems reasonable that any preventive strat-
egy has to take into account the mechanical and
physical properties of the instruments used for root
canal preparation and therefore should be based on
the sound and reliable results of studies performed
under conditions reflecting the clinical setting.
Although Topcuoglu et al. (2018b) argued that the
clinical relevance of cyclic fatigue tests is difficult to
assess as laboratory studies differ from the clinical sit-
uation in which many different factors – including
torsional stress – contribute to instrument fracture, it
is often argued that such laboratory studies are bene-
ficial to evaluate a single parameter (cyclic fatigue)
under standardized conditions.
Modes of fracture
In general, under clinical conditions two modes of
fracture can be distinguished. Torsional fracture occurs
when the tip of an instrument is firmly engaged in a
root canal, whilst the endodontic motor continues to
rotate or reciprocate, thus exceeding the shear
strength of the instrument.
Instrument fracture due to cyclic (flexural) fatigue
occurs after development of microcracks on the sur-
face of the instrument as a consequence of repeated
loading, particularly in a curved root canal with
opposite maxima of compression or tension at one
point of the instrument in the height of a curve. Usu-
ally, resistance to cyclic fatigue is measured as the
number of rotations/cycles until fracture (NRF/NCF)
or as time to fracture. Such studies mainly are per-
formed in metal tubes with defined curvatures (angle,
length and radius of curvature), filled with a lubri-
cant, thus preventing torsional load, although differ-
ent study designs also have been developed such as
rotation against a plane, three-point bending tests or
block-and-rod assemblies (Plotino et al. 2009, Shen &
Cheung 2013). In some studies, a 3-pin model has
International Endodontic Journal, 52, 1427–1445, 2019 1429
 Instrument fatigue studies H€
ulsmann et al.
been used instead of the tube model (Cheung & Dar-
vell 2007a,b, Tokita et al. 2017). A survey on study
designs is presented in Table 1.
These tests can be static (as the majority of studies)
or more or less dynamic in nature. A great variability
between results is obvious between static and
dynamic test designs. In static cyclic fatigue tests, the
instrument is inserted into the simulated root canal to
a certain depth and rotated without further move-
ment until file fracture occurs. The static model gen-
erates the highest flexural stress at the centre of the
curve. In dynamic cyclic fatigue tests, the file is
moved inside the simulated root canal with a certain
amplitude to simulate the clinical situation. Due to
the movement of the file, the localization of the metal
structure transformation varies along the file during
the test resulting in higher cyclic fatigue resistance.
Pedulla et al. (2017) argued that interruption of con-
tinuous rotation increased the fatigue resistance of
nickel–titanium instruments. The same of course is
true when flexural stress at one point of the instru-
ment working in the centre of the curvature is
relieved by vertical movement of the file.
No study design has been detected in which a
defined lateral pressure of the instrument against the
root canal can be exerted, for example, as used in cir-
cumferential filing techniques or outward brushing
motions of a file. In one study, ProTaper Universal
instruments were used with and without lateral pres-
sure, although this was not standardized (Vieira et al.
2011). There was a nonsignificant decrease in tor-
sional fatigue resistance for finishing files F1 and F2
and a slight nonsignificant increase for S1 and S2
shaping instruments when lateral pressure was added.
It was assumed by the authors that lateral pressure
results in increased tensile strength, thus altering the
fatigue behaviour, but further research seems neces-
sary to elucidate the clinical relevance of the presence
and intensity of lateral pressure on cyclic fatigue
resistance.
In a critical review of cyclic fatigue testing meth-
ods, Plotino et al. (2009) hypothesized that although
many studies at that time (and still today) used a
roughly comparable design, no attention had been
paid to the diameter of the tubes or to the fit of the
instrument inside the tubes. Nevertheless, when look-
ing at the details of the published studies a large vari-
ance in details of study protocols becomes evident,
making comparisons of results very difficult and prob-
lematic and to some degree even impossible (Plotino
et al. 2009).
1430 International Endodontic Journal, 52, 1427–1445, 2019
The main question to be discussed is: Can it be
assumed that an instrument moves inside a human
root canal just as it does in static fatigue tests? In
clinical reality, an instrument encounters some degree
of friction at various lengths and points of its blades
whilst at the same time performing a predetermined
rotation or reciprocation. Interestingly, in the study of
Karatas et al. (2016), using a static test design,
instruments working in rotary motion (OneShape;
Micro-Mega, Besancßon, France) had a greater cyclic
fatigue resistance than instruments working in recip-
rocating motion (WaveOne primary; Dentsply Sirona
Endodontics, Ballaigues, Switzerland). In this study,
the off-centred cross-sectional design reducing the
degree of friction of OneShape files was thought to be
mainly responsible for the superior performance of
this instrument rather than the movement
kinematics.
Degree, location and time of this torsional friction
amongst others, namely the geometry and design of
the instrument (i.e. number of blades, taper, size),
depend on the vertical movement of the file as
induced by the operator. As most stress for the instru-
ment occurs at the height of a curvature with maxi-
mum compression at the inner side of the curve and
maximum flexure at the outer side of the curve, per-
forming vertical motions with the endodontic hand-
piece automatically results in varying points of
maximum stress. This means that all results from sta-
tic fatigue tests are only valid for an instrument of
defined size used in a root canal with identical length,
curvature (length, angle and radius) and diameter
without any vertical movement and without any fric-
tion, a situation rather unlikely to occur under clini-
cal conditions. In other words, as soon as an
additional vertical motion or lateral pressure is added,
the situation is no longer comparable to a static test
situation.
Zinelis (2018b) argued that probably overloading
with resulting torsional fracture should be regarded
a more severe problem and that research on the
number of uses of instruments is ‘of questionable
value’.
Variables in study designs
Table 1 presents an overview of study designs used in
investigations on cyclic fatigue of engine-driven NiTi
instruments. Karatas et al. (2016) argued that the
use of standardized artificial canals for such tests
reduces the influence of several clinical variables such
© 2019 International Endodontic Journal. Published by John Wiley & Sons Ltd
 Table 1 (Incomplete) survey on the differences in design of static and dynamic cyclic fatigue studies

Size and
Material of Diameter Length of Angle taper Radius of Length Motion of Temperature of
Authors Year Method tube of tube tube of tube of tube curvature of curve instrument environment Lubricant

Shen et al. 2018 Static Ceramic 60° 30/.06 5 mm 0–60 °C Dist

tubes water
Keskin 2018a Dynamic 1.5 mm 60° 5 mm 3 mm Synthetic
et al. axial oil
motion
Pedulla 2018a Static 1.5 mm 60° 5 mm, centre Synthetic
et al. of curve oil
5 mm from
tip of canal
AlShwaimi 2018 Static 17 mm 60° 5 mm Oil
Topcuoglu 2018a Dynamic S-shaped 0.8–1 mm 18 mm 60°/70° Coronal 2 mm Oil
et al. curve: 60°, axial
radius 5 mm, motion
centre 8 mm
from
instrument
tip
apical

© 2019 International Endodontic Journal. Published by John Wiley & Sons Ltd
curve: 70°,
radius 2 mm,
centre 2 mm
from
instrument tip
Yilmaz 2018 Static According to 16 mm 60° 5 mm, centre 35 °C Water
et al. instrument of curve 5 mm
size from tip
of canal
H€

Adig€uzel & 2017 Static 19 mm 90° 5 mm Synthetic

Capar 60° 3 mm oil
ElNaghy & 2017b Static 6 mm 19 mm 60° 5 mm, centre 20 °C 5%
Elsaka of curve NaOCl
5 mm 37 °C Saline
from tip
Tokita 2017 Static 38° 5 mm Silicone
et al. oil

International Endodontic Journal, 52, 1427–1445, 2019

ulsmann et al. Instrument fatigue studies

1431
 1432
Table 1 Continued

Size and
Material of Diameter Length of Angle taper Radius of Length Motion of Temperature of
Authors Year Method tube of tube tube of tube of tube curvature of curve instrument environment Lubricant

Topcuoglu 2017 Dynamic S-shaped 1.4 mm 18 mm 60°/70° Coronal Continuous Oil

et al. curve: 60°, up and
radius 5 mm, down
centre 8 mm pecking
Instrument fatigue studies H€

from motion
instrument
tipapical
curve: 70°,
radius 2 mm,
ulsmann et al.

centre 2 mm
from

International Endodontic Journal, 52, 1427–1445, 2019

instrument
tip
Cai et al. 2017 Static 45° 3 mm Room Synthetic
temp oil
Pedulla 2017 Static 60° Various 5 mm, 5 mm Synthetic
et al. centre of oil
curve 5 mm
from tip
Elnaghy & 2017a Static Max diameter 16 mm 60° 5 mm, Synthetic
Elsaka of each centre of oil
instrument curve 5 mm
(+/ 0.2 mm) from tip
Plotino 2017 Static According to 60° According 5 mm 20 °C Synthetic
et al. instrument to or 35 °C oil
size instrument
taper
Ozy€
€ urek 2017 Dynamic 1.5 mm 60° 5 mm Axial Synthetic
et al. amplitude oil
3 mm/s
Karatas 2016 Static 1.5 mm 19 mm 60° 3 mm Synthetic
et al. oil
Pirani 2016 Static 16 gauge 10 mm 18 mm 70° 5 mm, Glycerine
et al. needle centre 5 mm
from the tip
Uygun 2016 Static 1.5 mm 60° 3 mm Synthetic
et al. curve starting oil
5 mm or
8 mm
from tip

© 2019 International Endodontic Journal. Published by John Wiley & Sons Ltd
 Table 1 Continued

Size and
Material of Diameter Length of Angle taper Radius of Length Motion of Temperature of
Authors Year Method tube of tube tube of tube of tube curvature of curve instrument environment Lubricant

Topcuoglu 2016a Static greater 45° or 60° 5 mm 5 mm Synthetic

et al. than file oil
diameter
Elnaghy & 2016 Static 60° 5 mm, 5 mm Synthetic
Elsaka centre 5 mm oil
from tip
Pedulla 2016 Static According to 60° 3 mm
et al. instrument
size
De 2016 Static 19 mm 60° 3 mm, Water
Vasconcelos centre
et al. 4.5 mm
from tip
Topcuoglu 2016b Static First 5 mm, Oil
et al. curve 50° centre 8 mm
from tip
Second 2 mm,
curve 70° centre 2 mm

© 2019 International Endodontic Journal. Published by John Wiley & Sons Ltd
from tip
Lopes et al. 2016 Static 1.4 mm 19 mm 86° 6 mm Glycerine
Shen et al. 2016 Static 60° 30/.06 5 mm Synthetic
first 30/.06 5 mm oil
curve 60°
second 30/.06 2 mm
curve 30°
first 30/.06 5 mm
curve 60°
H€

second 30/.06 2 mm
curve 60°
Oz€
€ urek 2016 Static 1.5 mm 60° 5 mm Synthetic
oil
Uslu et al. 2016 Static 1.5 mm 60° 5 mm Synthetic
oil
Kaval et al. 2016 Static 1.5 mm 19 mm 60° 3 mm 23 °C Synthetic
oil
Leal Silva 2016 Static 60° 5 mm, Glycerine
et al. centre 5 mm
from tip
Elnaghy & 2015 Static 90° 5 mm, Synthetic
Elsaka centre 5 mm oil

International Endodontic Journal, 52, 1427–1445, 2019

ulsmann et al. Instrument fatigue studies

from tip

1433
 1434
Table 1 Continued

Size and
Material of Diameter Length of Angle taper Radius of Length Motion of Temperature of
Authors Year Method tube of tube tube of tube of tube curvature of curve instrument environment Lubricant

Higuera 2015 Static 60° 5 mm Synthetic

et al. oil
Duke 2015 Static Single 60° 5 mm Synthetic
et al. curve oil
Double 60°/30° First
Instrument fatigue studies H€

curve curve 60°

5 mm
Second
curve 30°
ulsmann et al.

2 mm
Double First
curve curve 60°

International Endodontic Journal, 52, 1427–1445, 2019

5 mm
Second
curve 60°
2 mm
Vadhana 2014 Static Rotation 60° Start of Glycerine
et al. Reciprocation curve 5 mm
from tip
Capar et al. 2014 Static 1.5 mm 19 mm 45° and 60° 3 mm Synthetic
oil
Nguyen et al. 2014 Static 90° 5 mm Synthetic
oil
Pedulla et al. 2014a Static 2 mm 16 mm 60° 5 mm, Synthetic
centre 5 mm oil
from tip
Plotino et al. 2014 Static 60° 5 mm, 5 mm Synthetic
centre 5 mm oil
from tip
Kiefner et al. 2014 Dynamic 1.4 mm 60° 5 mm, not defined Glycerine
centre 5 mm
from tip
De Deus et al. 2014 Dynamic 1.4 mm 19 mm 6 mm, 9 mm 9 mm 3 mm Glycerine
Static
Moreira 2014 Static 45° 5 mm Room
Braga et al. temperature
Tsujimoto 2014 Static 25 mm 60° 3 mm Oil
et al.
Shen et al. 2014 Static 16 mm 42° 9 mm Water
Elnaghy 2014 Static 45° 5 mm, 5 mm
centre 5 mm

© 2019 International Endodontic Journal. Published by John Wiley & Sons Ltd
from tip
 Table 1 Continued

Size and
Material of Diameter Length of Angle taper Radius of Length Motion of Temperature of
Authors Year Method tube of tube tube of tube of tube curvature of curve instrument environment Lubricant

Pedulla et al. 2014b Static 60° 5 mm, 6 mm

centre 6 mm
from tip
Lopes et al. 2013b Static 1.4 mm 19 mm 90° 6 mm 9 mm Glycerine
Dynamic 3 mm
axial
amplitude
Gabarini et al. 2008 Static According to 60° 5 mm,
instrument centre 5 mm
size from the tip
Ray et al. 2007 Dynamic Modified Max 28° 1.5 mm
test axial
design amplitude

© 2019 International Endodontic Journal. Published by John Wiley & Sons Ltd
Plotino et al. 2006 Static According to 60° 5 mm, 6 mm Synthetic oil
instrument centre
size 6 mm
from tip
Li et al. 2002 Static Sloped 37°,40.5°, Oil
metal block 45°, 48°
Dynamic 45°, 48° 1, 2 or
3 mm
axial
amplitude
H€

Pruett et al. 1997 Static 0.83 mm 30°,45°, 2 mm

60° and
5 mm

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ulsmann et al. Instrument fatigue studies

1435
 Instrument fatigue studies H€
ulsmann et al.
as length, degree and location of the curve, and diam-
eter of the root canal.
Obviously, there is a great variability regarding
• length of tube
• material of tube
• diameter and taper of tube
• length of curvature
• radius of curvature
• angle of curvature
• temperature
• angle of instrument insertion
• position of curvature
• rotational speed
• liquid used for lubrication
• preloading of instruments.
Table 1 clearly reveals that in most studies, the rel-
evant parameters of the experimental set-up are either
not given (e.g. tube length, length of curvature) or
not sufficiently standardized (e.g. material of tube,
rotational speed, angle of curvature, lubrication).
Whilst the vast majority of studies performed the cyc-
lic fatigue test in metal tubes, some used simulated
canals in a ceramic material (Huang et al. 2017,
Shen et al. 2018). According to the authors, the
material was chosen to secure a close fit of the instru-
ment without binding.
Whilst a constant diameter of the tube of 1.4–
2 mm was described in the majority of the studies,
the tube was designed to reproduce the instrument
size in several other investigations (Plotino et al.
2006, 2017, Gambarini et al. 2008, Pedulla et al.
2016, Elnaghy & Elsaka 2017a,b, Yilmaz et al.
2018). This variability may have an impact on the
obtained results as tube sizes imitating the instrument
size are prone to include torsional fatigue into the
cyclic fatigue model, whilst loose tube designs may
focus on the cyclic fatigue evaluation, but suffer from
missing a constant trajectory of the loosely inserted
instruments (Plotino et al. 2010).
Other insufficiently standardized parameters that
probably exert a relevant impact on the results are
the radius and the position of curvature. Most com-
monly, a radius of 5 mm has been described. In case,
a description was given, the centre of the curvature
was most commonly positioned 5 mm from the
instrument tip. The static model as used by Pedulla
et al. (2017) and others (Plotino et al. 2009, Pedulla
et al. 2013, 2018a,b,c) generates the highest flexural
stress at the centre of the curve. Reducing the radius
results in a reduced lifespan of NiTi instruments (Elba-
touty et al. 2016). Lopes et al. (2011, 2013a)
1436 International Endodontic Journal, 52, 1427–1445, 2019
investigated the influence of the position of the curva-
ture along the simulated root canal on the resistance
against cyclic fatigue and found that a curvature in
the middle of the canal reduced the number of frac-
tures compared to a curvature in the apical portion.
Certainly, the most relevant shortcoming of numer-
ous studies is the fact that the impact of the environ-
mental temperature was not taken into consideration
as in the majority of fatigue studies information
regarding the temperature used during the experi-
ments is not provided. It has been shown in several
studies (Capar et al. 2014, Shen et al. 2016, Dosanjh
et al. 2017, Grande et al. 2017, Alfawaz et al. 2018,
Yilmaz et al. 2018) that the environmental tempera-
ture significantly influences the cyclic fatigue beha-
viour of NiTi instruments. Grande et al. (2017) tested
several instruments at +20 °C and 20 °C, and the
environmental temperature exerted a 300% to up to
500% impact on the lifetime of instruments. Even
markedly smaller differences in temperature exerted a
measurable influence on cyclic fatigue. De Vascon-
celos et al. (2016) compared the fatigue resistance of
four different NiTi instruments at 20 °C and 37 °C
(ProTaper Universal F2 [Dentsply Sirona Endodon-
tics]; HyFlex CM [Coltene Whaledent, Altst€ atten,
Switzerland]; TRUShape (Dentsply Sirona); and Vortex
Blue [Dentsply Sirona]). Increasing the temperature
resulted in a decrease of the NCFs in the range from
32.7% to even 85.3%. Similar results were reported
by Alfawaz et al. (2018). Increase in surrounding
temperature from laboratory to body temperature
resulting in lower NCF was also reported for ProTaper
Universal (Plotino et al. 2017); Reciproc Blue (VDW)
(Plotino et al. 2018); Vortex Blue (Dosanjhet al. 2017,
Arias et al. 2019); Edge File (Edge Endo, Albuquerque,
NM, USA) (Dosanjhet al. 2017); Edge Sequel Sapphire
(Edge Endo) (Arias et al. 2019); TRUShape (Dentsply
Sirona) (Arias et al. 2018); EndoSequence (Brasseler
USA, Savannah, GA, USA) (Dosanjh et al. 2017, Shen
et al. 2018); ProFile (Shen et al. 2018); and K3
(Sybron Endo, Orange, CA, USA)(Shen et al. 2018).
On the contrary, no such effects could be proven for
HyFlex EDM (Coltene/Whaledent) (Arias et al. 2018)
and ProTaper Gold (Plotino et al. 2017).
Finally, there is also some evidence that the angle
of instrument insertion is yet another relevant param-
eter in as far as changing the angle of instrument
insertion from 0° to 30° reduced the time to fracture
from 231 s (Reciproc; VDW, Munich, Germany) to
86.4 s, and for Reciproc Blue (VDW) from 288 s to
34.5 s (Pedull a et al. 2018b). Interestingly, with the
© 2019 International Endodontic Journal. Published by John Wiley & Sons Ltd
 H€
ulsmann et al. Instrument fatigue studies

more severe insertion angle of 30° the thermally pre-
treated instrument Reciproc Blue fractured earlier
than the M-wire instrument, whereas with angles
below 30°, the opposite had been measured (Pedull a order to facilitate comparisons, only instruments
et al. 2018b). The time to fracture from other studies
on Reciproc Blue has been reported as 872 s (Keskin
et al. 2017), 325 s (De-Deus et al. 2017) or even
2875 NCF (G€ € urek 2017). This phe-
undogar & Ozy€
nomenon is explained by the authors who speculated
that pre-heated Reciproc Blue instruments are more
flexible than Reciproc, but can absorb less stress (Ped-
ulla et al. 2018c).
Thus, in conclusion it can be stated that there is a
need for much better standardization of cyclic fatigue
resistance studies of engine-driven endodontic instru-
ments (Plotino et al. 2009). Therefore, it is required
that the impact of the environmental temperature
must be taken into account. The relevance of studies
assessing cyclic fatigue resistance at room tempera-
ture seems to be limited.
Results for the same instrument in
different studies
A more detailed analysis of the results of fatigue
resistance studies for certain instruments reveals
that the results are rather inconsistent. Tables 2
and 3 provide an exemplary overview of the pub-
lished data for several different instruments. In
with a nominal tip size of 25 were included and
NCF was transferred to time until fracture. Further-
more, only studies using single-curved tubes were
considered as studies using double-curved tubes (S-
shaped) create a further parameter making mean-
ingful comparisons nearly impossible.
For studies using a static approach, maximal differ-
ences between the values published for a particular
instrument between 17.8% (WaveOne Gold) and
200.9% (WaveOne) can be found. For studies using a
dynamic set-up, the maximal differences range
between 234.8% (WaveOne) and 798.5% (Reciproc).
It is obvious that both static and dynamic cyclic fati-
gue testing lack sufficient reproducibility. Unfortu-
nately, explanations for these differences are missing
in most of the studies. However, it can be speculated
that dynamic testing seems to be even more prone to
inherent procedural errors compared to static set-ups.
Presumably, variabilities in the amplitude of the axial
motion of the instruments and the angle of instru-
ment insertion displayed a relevant impact on the
obtained results. Li et al. (2002) showed that

Table 2 Exemplary comparison of data published for different instruments with a tip size #25 in static tests. Studies using S-
shaped tubes are not included. All values are given in seconds

Reciproc WaveOne ProTaper

Mtwo Blue WaveOne Gold ProTaper Gold
Authors Year 25/.06 Reciproc 25/.08 25/.08 Primary Primary Universal F2 F2

Pedulla et al. 2018a 108

Elnaghy & Elsaka 2017b 250.2 258
Elnaghy & Elsaka 2017a 120.6 196.5
De-Deus et al. 2017 240 325
Pedulla et al. 2017 112.0
Gu € u
€ ndogar & Ozy € rek 2017 575 303.9
Elnaghy & Elsaka 2016 93.6 269.4
Pedulla et al. 2016 105 69.8
€ u
Ozy € rek 2016 264.6 197.7 279
Leal Silva et al. 2016 217 99.7
Kaval et al. 2016 105 274.5
Higuera et al. 2015 265 210
Nguyen et al. 2014 81.6
Pedulla et al. 2014b 97.9 (350 rpm)
156.5 (250 rpm)
200.8 (150 rpm)
Lopes et al. 2013b 38 214
Tripi et al. 2006 21.8
Plotino et al. 2006 99.9
Maximum difference 821 % 152.4% 76.9% 200.9% 17.8% 47.8% 39.7%

© 2019 International Endodontic Journal. Published by John Wiley & Sons Ltd International Endodontic Journal, 52, 1427–1445, 2019 1437
 Instrument fatigue studies H€
ulsmann et al.

Table 3 Exemplary comparison of data published for different instruments with a tip size #25 in dynamic tests. Studies using
S-shaped tubes are not included. All values are given in seconds

Authors Year Mtwo25/.06 Reciproc25/.08 Reciproc Blue25/.08 WaveOnePrimary WaveOne GoldPrimary

Keskin et al. 2018a 230a 164 #

303a
Keskin et al. 2017 343 872 549
Kiefner et al. 2014 729 2066.5
Lopes et al. 2013b 99 286
Maximum difference 636.4% 798.5% — 234.8% —
a
Interrupted motion.

increasing the axial pecking motion of the instrument
from 1 to 3 mm resulted in an increase in the time
until fracture of about 15%.
Moreover, different electronic motors were used in
these studies and it has been reported that actual
kinematics values (angles of rotation in reciprocating
motion) of some motors differ from manufacturers’
declared values (Fidler 2014) and that intrinsic set-
tings for do not result in consistent kinematics
(B€urklein et al. 2019). Thus, another possible expla-
nation for the marked differences might be (unno-
ticed) deviations from the rotational speed
recommended by the manufacturer. A 100% increase
in speed has been demonstrated to result in a 30%
reduction in terms of NCF (Lopes et al. 2009).
Furthermore, to a certain extent the use of different
lubricants during testing may be responsible for the
inconsistent results (Elnaghy & Elsaka 2017b, Uslu
et al. 2018). When assessing Reciproc instruments in
air fracture occurred after 1251 cycles, in sodium
hypochlorite it occurred after only 882 cycles (Elna-
ghy & Elsaka 2017b). This difference is nearly 250%.
Table 4 shows similar inconsistent results obtained
when testing the cyclic fatigue resistance of
pathfinding instruments. The maximal differences
between the lowest and the highest published values
were even substantially higher compared with single-
file reciprocating or full-sequence rotary instruments
and ranged between 339.3% (R-Pilot) and
12 196.7% (Pathfile).
Static versus dynamic tests
To better simulate the clinical situation in some stud-
ies using a dynamic design, an additional vertical
motion has been added (Tables 3 and 4). In the
dynamic test models, a standardized procedure is
missing, as well as in static designs. The added verti-
cal motion differs in those studies from 2 mm, per-
formed by the operator (Topcuoglu et al.
2018a,2018b), 3 mm (Rodrigues et al. 2011, Keskin
et al. 2018a), or 1, 2 or 3 mm (Li et al. 2002,
€ urek et al. 2017, Soares et al. 2017), or even
Ozy€
8 mm (Dederich & Zakariasen 1986), whereas no
data are presented in other studies (Topcuoglu et al.
2017, Topcuoglu & Topcuoglu 2017).
One of the first studies using a dynamic test design
(Dederich & Zakariasen 1986) performed a

Table 4 Exemplary comparison of data published for different pathfinding instruments with a tip size #16 in both static and
dynamic tests. Studies using S-shaped tubes are not included. All values are given in seconds

Authors Year Method ProGlider 16/.02 Pathfile 16/.02 R-Pilot16/.02

Yilmaz et al. 2018 Static 193 912

Keskin et al. 2018b Dynamic 1254 712.4
Topcuoglu et al. 2018b Dynamic 437.2 (45°)
271 (60°)
Serefoglu et al. 2018 Static 53.2 207.6
€ u
Ozy € rek et al. 2018 Static 214.6
Uslu et al. 2016 Static 5816.4
€ urek et al.
Ozy€ 2017 Dynamic 4806 8853.6
Elnaghy & Elsaka 2015 Static 98 72
Capar et al. 2015 Static 131.2 (3 mm radius) 102.4 (3 mm radius)
211.2 (5 mm radius) 146.6 (5 mm radius)
Maximum difference 10 833.1% 1 2196.7 339.3

1438 International Endodontic Journal, 52, 1427–1445, 2019 © 2019 International Endodontic Journal. Published by John Wiley & Sons Ltd
 H€
ulsmann et al. Instrument fatigue studies

Table 5 Studies providing results of dynamic and static fatigue tests

Static test Dynamic test

Difference
Static vs.
Authors Year Instrument Study design Results (s) Study design Results (s) dynamic (%)

Lopes et al. 2010 ProTaper 1.4 mm diameter 68.1 1.4 mm diameter 125.1 83.7
Universal S2 90° curvature 90° curvature
radius 6 mm radius 6 mm
length of arc 9 mm length of arc 9 mm
Lopes et al. 2013b Mtwo 25/.06 1.4 mm diameter 38.9 1.4 mm diameter 99 154.5
90° curvature 90° curvature
radius 6 mm radius 6 mm
length of arch 9 mm length of arch
9 mm
Gambarra- 2013 Mtwo 25/.06 1.4 mm diameter 43 1.4 mm diameter 109.5 154.7
Soares et al. 90° curvature 90° curvature
radius 6 mm radius 6 mm
length of arch 9 mm length of arch
9 mm
Lopes et al. 2013b Reciproc R25 1.4 mm diameter 214.5 1.4 mm diameter 286.3 33.5
90° curvature 90° curvature
length of arch 9 mm length of arch
radius 6 mm 9 mm
radius 6 mm
De Deus et al. 2014 Reciproc R40 1.4 mm diameter 170 1.4 mm diameter 240 41.2
length of arch 9 mm length of arch
radius 6 mm 9 mm
radius 6 mm

comparison between static and dynamic cyclic fatigue
testing using an axial amplitude of 8 mm with up to
230%–530% increased time until fracture in the
dynamic test. Unfortunately, only a few nickel–tita-
nium rotary instruments have been investigated in
static as well as in dynamic fatigue tests (Li et al.
2002, Lopes et al. 2010, 2013b, Rodrigues et al.
2011, Gambarra-Soares et al. 2013, De-Deus et al.
2014) (Table 5).
Li et al. (2002) compared the static and dynamic cyc-
lic fatigue resistance of ProFile size 25, .04 taper instru-
ments with different vertical amplitudes of 1–3 mm.
The time until fracture in the dynamic tests was
approximately 20%–40% higher than in the static test
(Li et al. 2002). The finding that in general the time
until fracture was higher in dynamic tests than in sta-
tic test has been corroborated by several subsequent
investigations (Rodrigues et al. 2011, Gambarra-Soares
et al. 2013, De Deus et al. 2014) (Table 5).
Race instruments and Twisted Files, both size 25,
.06 taper, were compared in static and dynamic tests
(Rodrigues et al. 2011). The time until fracture in the
dynamic tests was about 80% (Race) to 91% (Twisted
Files) higher than in the static test. For Mtwo files size
25, .06 taper, the time till fracture was as much as
154% higher in a dynamic test, whilst interestingly,
the mean lengths of the fractured file segments were
nearly equal (Gambarra-Soares et al. 2013). De-Deus
et al. (2014) tested the resistance to cycling fatigue of
Reciproc size 40, .08 taper and WaveOne large (size
40, .08 taper) both in a static and in a dynamic set-
ting. In the dynamic setting, the time until fracture
increased 41% for Reciproc R40 and 22% for
WaveOne, respectively.
Nevertheless, it has been criticized that in a
dynamic test model, it is difficult to keep the instru-
ments in a precise trajectory (Li et al. 2002, Pedulla
et al. 2018a). If an instrument is not well retained in
a precise trajectory at the simulated canal entrance,
different bending properties and geometric features of
the instruments may result in a different trajectory
inside the curvature (Plotino et al. 2010). A direct
comparison between instruments may be difficult in
the situation when instruments of the same dimen-
sions follow different trajectories in the test apparatus
during dynamic tests (Plotino et al. 2018).
In summary, it can be concluded that in general
the dynamic cyclic fatigue resistance of a certain
instrument is markedly greater than its static fatigue
resistance; for some instruments, the difference was

© 2019 International Endodontic Journal. Published by John Wiley & Sons Ltd International Endodontic Journal, 52, 1427–1445, 2019 1439
 Instrument fatigue studies H€
ulsmann et al.
up to about 150% (Table 5). This increased lifespan
of NiTi instruments in dynamic cyclic fatigue tests is
mainly explained by the distribution of the bending
load along the instrument, thereby avoiding a local-
ized load on a single point of the file (Gambarra-
Soares et al. 2013). The phase transformation of NiTi
alloys distributed along the instrument in the
dynamic test prevents microcrack formation at a cer-
tain point of the instrument, which results in an
expanded lifespan of NiTi instruments in dynamic
tests (Zupanc et al. 2018).
Standard deviations
Gambarini et al. (2008) compared the cyclic fatigue
resistance of several instruments amongst these
Twisted Files (Sybron Endo), GT series X (Dentsply,
Tulsa, OK, USA) and K3 (Sybron Endo). The standard
variations ranged between 16.1% and 25.4%. Stan-
dard deviations of even nearly 30% were reported in
another study (Barbosa et al. 2007).
The substantially varying standard deviations give
a hint to the lack of standardization and the challeng-
ing interpretation of cyclic fatigue tests. In the situa-
tion when the lack of standardization of the study
protocol can be excluded, a substantial variation in
the fabrication quality of NiTi instruments has to be
considered as a possible reason for the high standard
deviations and should be a topic of further research.
Discussion
The aim of this focussed review was to provide evi-
dence-based answers to two main questions:
1. Are there different outcomes from static versus
dynamic tests?
2. Do cyclic fatigue tests provide useful data and
information for clinical practice?
The review of the currently available literature not
only reveals marked differences between the results
obtained in static and dynamic tests (Tables 4 and 5),
but also the results for the same instruments assessed
under either static (Table 2) or dynamic experimental
conditions (Table 3) are widely inconsistent. Between
the lowest and the highest value for one and the
same pathfinding instrument was a factor of about
123 (Table 4). Moreover, standard deviations of up to
30% have been reported (Barbosa et al. 2007, Gam-
barini et al. 2008).
These results suggest that both static and dynamic
tests are currently poorly standardized. Numerous
1440 International Endodontic Journal, 52, 1427–1445, 2019
parameters have been shown to exert a marked
impact on the results (Plotino et al. 2009), with the
environmental temperature clearly representing the
most relevant parameter (Capar et al. 2014, De Vas-
concelos et al. 2016, Shen et al. 2016, Dosanjhet al.
2017, Grande et al. 2017, Alfawaz et al. 2018, Yil-
maz et al. 2018). Environmental temperature has a
500% impact on the lifetime of an instrument
(Grande et al. 2017). It can therefore be deduced that
studies conducted under room temperature or under
temperatures that do not correspond to the clinical
situation do no longer appear acceptable from a scien-
tific point of view. Furthermore, the available data
strongly suggest that there is an urgent need to agree
on either static or dynamic experimental set-ups. Evi-
dence suggests that dynamic tests might have some
advantages compared to static approaches, although
maximal differences between highest and lowest pub-
lished values for one instrument were considerably
higher in dynamic than in static tests (Table 5). Thus,
it might be speculated that dynamic tests are more
prone to procedural errors and are more technique-
sensitive than static tests as it is difficult to keep the
instruments in a precise trajectory (Li et al. 2002, Plo-
tino et al. 2010, Pedulla et al. 2018a).
Once a consensus has been reached on the
favoured method, the next step should be to clearly
define all relevant experimental parameters in order
to limit the diversity of experimental designs and, as a
result, distortion of the results. A clearly defined test
design, preferably similar to an ISO specification, is a
prerequisite for a reliable assessment of the corre-
sponding studies (Plotino et al. 2009).
The second question of this review, namely whether
cyclic fatigue tests provide useful data and information
for clinical practice, must also be clearly rejected. As
long as data on one and the same instrument differ by
more than 10 000% in different studies, the credibility
of such data is extremely limited. In the present form,
the results published so far are of very limited impor-
tance to the reader. A recent mini-review of clinical
studies concluded that the incidence of fractured
instruments has dropped and seems to be a minor prob-
lem in current endodontics (Coelho et al. 2018). There-
fore, it is more than questionable whether data on
cyclic fatigue resistance will even play any role in the
selection of a suitable instrument for the clinician. This
assumption currently seems highly questionable, as
there is at present no convincing evidence that cyclic
fatigue resistance values are of any clinical relevance,
and due to the great variance of study designs and
© 2019 International Endodontic Journal. Published by John Wiley & Sons Ltd

results, they will not be helpful for clinicians to under-
stand the behaviour of different files and to assist them
in the selection of an appropriate system.
Against this background and the explosive growth of
studies on fatigue resistance in the scientific literature,
there seems to be no need for further experimental
studies at present, at least as long as no clinically rele-
vant study design has been proposed, that can assure
reproducible and clinically useful data. On the con-
trary, it seems that the manufacturers of the instru-
ments should be held accountable. Provided that the
manufacturers are convinced of the relevance of these
data, it should be their task to provide appropriate data
in the instruction leaflet of the respective instruments.
Scientifically and clinically, this topic is of very limited
relevance (H€ ulsmann 2013).
Finally, Arens et al. (2003) recommended a single-
use approach of endodontic instruments for the best
achievable security with regard to surface defects and
fracture of engine-driven NiTi instruments. Moreover,
it has been shown that used endodontic instruments
cannot be reliably decontaminated by methods cur-
rently employed in dental practice (Letters et al.
2005). Thus, taken into account the problems, costs
and amount of work strongly linked with proper
reprocessing of endodontic instruments in accordance
with national and international guidelines for clean-
ing, disinfecting and sterilizing endodontic instru-
ments, the concept of single-use instruments gains
even more importance (Sonntag et al. 2016). Already
in 2007, the UK Health Department instructed all
dentists in the country that all endodontic instru-
ments must be treated as single use as a precaution
to reduce any risk of variant Creutzfeldt–Jakob disease
(vCJD) transmission (Walker et al. 2009).
If the current trend towards single-use instruments
continues to strengthen (and some manufacturers
already offer instruments that can no longer be steril-
ized), studies on cyclic fatigue resistance will continue
to lose importance. The average times until fracture
or NCFs published in the available studies (Tables 2–
5) will unlikely be exceeded in a single-use concept.
Consequently, the increasing importance of a single-
use approach also clearly indicates that in the future
there will be no need to conduct further studies on
cyclic fatigue resistance of such instruments.
Conclusions
• Cyclic fatigue tests have a wide range of differing
designs making the results hardly comparable.
© 2019 International Endodontic Journal. Published by John Wiley & Sons Ltd
H€
ulsmann et al. Instrument fatigue studies
• In most of the studies on cyclic fatigue, static as
well as dynamic, are missing sufficiently detailed
descriptions of all design parameters that possibly
could influence outcome.
• The results of static fatigue tests differ widely, in some
cases are contradictory, and to a large extent are not
reproducible. The same is true for dynamic tests.
• Dynamic fatigue tests better simulate the clinical
situation than static tests and result in signifi-
cantly increased fatigue resistance.
• Amongst many other factors, temperature differ-
ences seem to influence the outcome of fatigue tests
significantly. Fatigue resistance tests conducted
under room temperature should be regarded as hav-
ing little meaning and thus as outdated.
• The scientific and clinical benefits of fatigue resis-
tance tests seem to be limited. These data should
be provided by the manufacturer of the instru-
ments. Further scientific research on this topic is
currently not required.
• In times of single-use instruments to prevent
cross-contamination, cyclic fatigue does not play a
major role in clinical situations as the number of
rotations during clinical use of the instruments is
much lower than the limits measured in cyclic
fatigue tests.
Conflict of interest
The authors have stated explicitly that there are no
conflicts of interest in connection with this article.
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