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Basic Endodontic Instruments (Classification-Iso Standardization of Endo.

Instruments, Intracanal Instruments ( K-File ,K-Reamer, H-File ) .

Research · June 2020

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Tanta university ‫جامعة طنطا‬
Faculty of dentistry ‫كلية طب األسنان‬

Student Research Project

*Course Name : Technology Of Endodontics.

*Research Topic: Basic Endodontic Instruments

(Classification-Iso Standardization of Endo.
Instruments, Intracanal Instruments ( K-File
,K-Reamer, H-File ) .

*Students Name:

1-Ayah Mohamed Elkablawy.

aya_d30896828@dent.tanta.edu.eg

2-Ayah Mabrouk .

3-Ayah Magdy El Magdely.

4- Ayah Mohamed Elgendy.

5- Ayah Mostafa Elabed

Page 1 of 14
 Tanta university ‫جامعة طنطا‬
Faculty of dentistry ‫كلية طب األسنان‬

Introduction:

Root channel preparation is often observed the most significant and resistant step during
root channel treatment. It needs using mechanical and analytical signify to eliminate
intracanal tissue and pathogens, and enable appropriate obturation of the radicular path. The
mechanical objectives are: 1- Continuously tapering infundibulum from the apex to the access
cavity. 2- Cross-sectional diameter should be narrower at every instant apically. 3- The origin
channel preparation should inundate with the regulate of the inventive channel. 4-The apical
opening should be in its original position. 5- The apical opening should be kept as small as
practical. This mechanical part are made by instruments that have different classifications,
types & uses. Our Objectives in this research are to clarify classification of endodontic
instruments, clarify ISO standardization of basic instruments and clarify intra canal basic
instruments (k-file , H-file & k-reamer) .(1)
Historical Development:
"In his 1733 book, “Le chirurgien dentiste,” Pierre Fauchard described instruments for
root canal preparation. The basic treatment technique at that time was cauterization of the
pulp with heated instruments. At the end of the 18th century, only primitive hand instruments
and excavators, some iron cauter instruments and very few thin and flexible instruments for
endodontic treatment were available. In the 19th century, enlargement of root canals was
performed with broaches. In 1885, the Gates Glidden drill was introduced, and in 1904, the
K-file was developed by the Kerr Company" (1).
Classifications of root canal enlarging instruments are several according to method of use,
function, sequence of usage , material of construction, energy supply or power source,…..
From these classifications the following ones :
1-ISO classification (according to method of use whether hand or engine driven).
2-grossman classification (according to function).
3- according to sequence of usage during performing root canal procedure.
" Although standardization of instruments had been proposed in 30 Endodontic Topics
2005, All rights reserved Copyright r Blackwell Munksgaard ENDODONTIC TOPICS 2005
1601-1538 1929 by Trebitsch and again by Ingle in 1958, ISO specifications for endodontic
instruments were not published before 1974 " (2) . there is specific standardization for basic
endodontic instruments (Manually-operated instruments): such as K-file , K-reamear and H-
file from ( size ,length ,color coding, taper & tip angle).

Page 2 of 14
 Tanta university ‫جامعة طنطا‬
Faculty of dentistry ‫كلية طب األسنان‬

Content:
The aim of this study is to examine the status of standardization of endodontic
instruments. Measurements of instrument dimensions such as stainless steel H- and K-files
(sizes 08-40) , to determine the degree of deviation from ISO specification .

Classifications of Endodontic Instruments:

1-ISO classification (according to method of use):

Group I: manually operated instruments. E.g. K- and H-file.

Group II: low-speed instruments with latch-type attachment. E.g. gates glidden drills and
peeso reamers.

Group III: engine-driven rotary Ni-Ti files. E.g. Ni-Ti ProTaper rotary files. (continuous
rotation)

Group IV: engine-driven instruments that adjust themselves to shape of root canal. Self-
Adjusting file (SAF).

Group V: engine driven reciprocating instruments. E.g. Wave-one and reciprocating rotary
Ni-Ti files.

Group VI: ultrasonic instruments.

2-grossman classification (according to function).

1-Exploring instruments: such as endodontic explorer & smooth broach.

2- Extirpating instruments : for removal of pulp tissue such as barbed broach & k-file.

3- Shaping instruments : for cleaning & shaping of root canal such as files & reamers.

4-Obturating instruments : such as spreader , plugger to fill root canal with filling material.

3- Classification of endodontic armamentarium according to sequence of

use:

Page 3 of 14
 Tanta university ‫جامعة طنطا‬
Faculty of dentistry ‫كلية طب األسنان‬

1-Diagnostic instruments., 2-Isolating instruments., 3-Access cavity instruments

4-Extirpating instruments, 5-Devices for tooth length determination, 6- Root canal enlarging
instruments., 7-Obturation materials, instruments, and devices.

4-According to material of construction:

1-Carbon steel: it is a solid solution of carbon in iron with higher carbon content , they
have high mechanical properties but with low flexibility and corrosion resistance due to
carbon precipitation at the grain boundaries which inhibit dislocation movement .

2- Stainless steel: it is also an interstitial primary solid solution of carbon in iron.

Stainless stands for corrosion resistance thanks to their high content of chromium which
form a skinny cohesive protective layer of chromium oxide on surface of steel, but Stainless
steel is more flexible than carbon steel, so Stainless steel is widely used for both hand files
and endodontic burs (Fig.1).

Fig 1, stainless steel files

3- Nickel-titanium:

" Endodontic therapy from 1990 to the present has utilized super elastic nickel-titanium
(NiTi) instrumentation. This material has enhanced the armamentarium, and NiTi is now
the material of choice for engine-driven endodontic instruments" (3).

4- Diamonds: used with sonics and ultrasonics, very effective in managing canal
obstructions, separated instruments, post, and heavily mineralized root
canal system moreover as retro cavity preparation in microsurgical endodontics.(Fig.2)

Fig 2, diamonds with ultrasonic

Page 4 of 14
 Tanta university ‫جامعة طنطا‬
Faculty of dentistry ‫كلية طب األسنان‬

5- According to manufacturing process:

1-Counter-clockwise twisting:

it's the oldest method of producing file and reamer. A wire that's ground into triangular or
square cross section is rotated during a counterclockwise direction to form a file or reamer.
Counterclockwise twisting may be a matter of plastic deformation which debate why
instrument are more prone to separation if rotated during a counterclockwise direction at
half number of cycles. E.g. K-reamer, K-file. (3)

2- Machine grinding: grinding helical flutes into circular or tapered rods to make a file
with one or more cutting surfaces. this method of producing creates more flexible
files thanks to absence of plastic deformation from twisting. E.g. all Ni-Ti files except
twisted files and K3XF files, H-files, Flex-R-file.(3)

6-According to energy supply or power source:

1- Hand-driven or manually-operated: basic or hybrid instrument. (Fig,3)

Fig 3, hand driven instruments.

2- Engine-driven: rotary or vibratory instruments.(Fig,4)

Fig 4, engine driven instruments.

ISO STANDERIZATION OF BASIC ENDODONTIC INSTRUMENTS :

For many years hand instrumentation was considered the simplest thanks to prepare
the intricacies of root canal systems. Hand instruments require artful and diligent hand

Page 5 of 14
 Tanta university ‫جامعة طنطا‬
Faculty of dentistry ‫كلية طب األسنان‬

movements to form the specified canal shapes . instruments are manufactured to a size and
type advised by the International Standards Organisation (ISO). The specifications
recommended are complex and differ consistent with the kind of instrument. (3)

" For most standardized instruments the number refers to its diameter at the tip in one-
hundredths of a millimetre; a number 10, for example, means that it has a tip diameter of
0.10 mm. Colour coding originally denoted the size, but now represents a sequence of sizes.
All these instruments have a standard 2% taper over their working length".(4)

Conventional standardized instruments are product of steel, which can wear quickly in
dentine, and tiny size files could also be thought to be disposable..

In 1975, Ingle stablished a logical nomenclature for standerization of instruments, so all

manufacturer could conform length, width, and taper to specific standards. This
nomenclature is applied for all ISO standardized files, reamers, gutta percha points, paper
points, and spreaders. (1)

Landmarks of standardized instruments are:

1-Length of instrument:

-The position where the cutting edges begin on the instrument is called Do. The flutes
extend along the shaft for at least 16mm to stop at position D16.

-The rest of shaft has no flutes. The whole length of instrument from tip to handle is
either 25mm, 21mm, or 31mm. The length of blade with flutes is 16mm regardless of total
instrument length. (Fig,5)

Fig 5, length of ISO standardized instruments.

Page 6 of 14
 Tanta university ‫جامعة طنطا‬
Faculty of dentistry ‫كلية طب األسنان‬

-Iso standardization files are available in three lengths :

standered (25 mm):we make all cases by it.
Long (31 mm) : specially for long tooth as maxillary canine .
Short (21 mm): limited mouth opening & in maxillary second molars .
But all have a 16 long section of cutting flutes starting at D0 and ending at D16 .

2-Numbering of instrument:

The standardized instruments are manufactured from number 6 to 140. The number of
instrument expresses the instrument diameter at tip (Do) in hundredth of millimeter. E.g.
instrument number 20 has a diameter at tip or Do= 20/100= 0.2mm.(Fig,6)

3-size of instruments :

In small sizes instruments from number 10 up to 60, there's an incremental increase

at handle 0.05mm or 50 microns. In large sizes instruments from number 60 up to
140, there's an incremental increase at handle 0.1mm or 100 microns. For sizes from 6 up to
10, the incremental increase at Do is 0.02mm or 20 microns. a complete of 21 instruments
with the subsequent sequence (Fig 6).
6,8,10,15,20,25,30,35,40,45,50,55,60,70,80,90,100,110,120,130,140.

Special sizes : (6,8,10) these are used for initial preparation inside narrow canals or
calcified canals. Sizes from (15-80) for cleaning &shaping .Sizes from (90-140) used in
special conditions such as in child has immature tooth with large canal (2)

Fig 6, different sizes of hand instruments.

Page 7 of 14
 Tanta university ‫جامعة طنطا‬
Faculty of dentistry ‫كلية طب األسنان‬

4-color coding of different instruments :

instrument handles are color coded for easer recognition.

White (15), yellow (20), red (25), blue (30), green (35), and black (40). This color coding is
repeated up to instrument number 140 such instrument number 45 and 90 are white. File 6
is pink, 8 is grey, and 10 is purple. File number 6 not preferred to be used because it’s very
weak. Files from white to black are used in sequence for cleaning and shaping the root canal
system. File number 25 is red for warning for curved canals because the flexibility of this
file decrease due to increasing of size so can’t use this file in curved canal as it’snot able to
be bent. Colour coding originally gives the size, but now represents a sequence of sizes.
(Fig,7), (Fig 8). (4)

Fig 7, color coding of ISO instruments.

5-Standerdization of taper of instrument: (increase in diameter/mm along

its working length)

The taper of standardized instrument is that the same no matter its tip diameter or size
of instrument. Iso taper is ready at 0.02 mm increase/mm i, e, the instrument at D16 is 0.32
mm thicker than Do. this is often calculated by multiplying length of working a part
of instrument 16mm by 0.02= 0.32mm. (4)

Page 8 of 14
 Tanta university ‫جامعة طنطا‬
Faculty of dentistry ‫كلية طب األسنان‬

Fig 8, table showing color coding and taper of instruments.

6- standardization of tip angle:

Iso standardization of all instruments is sharp cutting tip. The angle between the
instrument tip and the long axis of the instrument shaft is standardized to be
75o ±15o. It has some advantages such as providing cutting efficiency without an excessively
sharp transition angle and facilitate penetration of root canal, on the other hand, has some
disadvantages such as ledge formation in curved canals. (Fig,9)

Fig 9 showing tip angle of iso standardized instruments.

7-Tolerance (quality control):

Any instrument remains accepted if it's within ±0.02 mm of the quality at Do. therefore,
number 30 is ideally 0.3 mm at tip or Do but is also as small as 0.28 or as wide as 0.32mm.
The filling material (gutta-percha cone) should be 0.009 mm (9microns) but the
corresponding instrument size.

BASIC INTRACANAL INSTRUMENTS: (K-FILE, H-FILE, K

REAMER)

Page 9 of 14
 Tanta university ‫جامعة طنطا‬
Faculty of dentistry ‫كلية طب األسنان‬

Development of hand instruments:

" For many years the standard cutting instruments have been the reamer, K-type file
and Hedstroem file. These root canal preparation instruments have been manufactured to a
size and type advised by the International Standards Organisation (ISO). The specifications
recommended are complex and differ according to the type of instrument".(4)

The first manual and mechanical rotary files were formed from straight piano wire
which had flats ground on its sides and twisted to result in the shape of files that still used
today , files were firstly produced by kerr company in the very early 1900's hence the name
,k-type file and k-type remear. (5)

K-Reamers:
Kerr manufacturing company was the first to produce files in the early 1900, hence the
name K-reamer and K-file. K- files and K-reamers were manufactured by counterclockwise
twisting square or triangular metal blanks along their long axis, producing partly horizontal
cutting blades. Three or four equilateral, flat surfaces were ground at increasing depths
on the perimeters of a bit of wire, producing a tapered pyramidal shape. The wire then was
stabilized on one end, and also the distal end was rotated to make the spiral instrument. the
quantity of sides and also the number of spirals determine whether the instrument is
best fitted to filing or reaming. Loose twisting produce less plastic deformation or work
hardening with increased flexibility and triangular cross-section is not excessively wide so,
it is flexible instrument. (6)

Tip design is sharp for better initial scouting of root canals but unfortunately, sharp tip
increase tendency for ledge creation, zipping, and apical transportation.Number
of flutesis less than K-file. Clearance space is wider than K-file with superior
debris removal quality. Helical angle is angle formed between cutting edge and
long-axis of file. 10- 30o (Fig,10).

The Motion rotation which is either watch winding or reaming motion due to
decreased helical angle and mainly used in preparing apical round portion of root
canal and scouting extremely narrow canals.We start rotation Fig, Fig 10,Helical angle

in clockwise direction to avoid further deformation. (7)

Page 10 of 14
 Tanta university ‫جامعة طنطا‬
Faculty of dentistry ‫كلية طب األسنان‬

K-type file:

These files were originally made from a square or triangular blank, machine
twisted counterclockwise to form a tight spiral. The angle of the blades or flutes is
consequently near a right-angle to the shank, so either a reaming or a filing action could even
be used. The K-type file has been subject to continuous development (4).

"K-Type Manually operated instruments are generically called files. Defined by

function, files are instruments that enlarge canals with apico-coronal insertion and
withdrawal motions. Historically, root canal instruments were manufactured from carbon
steel. Subsequently, the use of stainless steel greatly improved the quality of instruments.
More recently, K-type files manufactured from NiTi were introduced (NiTiFlex, Dentsply
Maillefer, Ballaigues, Switzerland). Files were first mass produced by the Kerr
Manufacturing Co. of Romulus, Michigan, in the early 1900s, hence the name “K-type” file
(or K-file) and K-type reamer (K-reamer)"(6).

Number of flutes is higher than K-reamer. Clearance space is smaller than K-reamer with
increase tendency for clogging. Helical angle of this file is 25-40o. universal file can be used
in filing motion for preparing middle third or reaming motion in preparing apical third due
to intermediate helical angle. K-files are produced to give a smooth tactile sense inside the
canal during instrumentation. K-type instruments are useful for penetrating and enlarging
root canals.specially, a reaming motion. (6)

H-file:
"H-Type Instruments H-type instruments, also known as Hedström files. are milled
from round, stainless steel blanks. These files are very efficient for translational strokes,437
because of a positive rake angle and a blade with a cutting rather than a scraping angle.
Rotational working movements are strongly discouraged because of the possibility of
fracture. Hedström file rotation causes less transportation than a filing motion (translational
or “in and out” motion). (Transportation is defined here as the excessive loss of dentin from
the outer wall of a curved canal in the apical segment".(4)

Page 11 of 14
 Tanta university ‫جامعة طنطا‬
Faculty of dentistry ‫كلية طب األسنان‬

The Technique of manufacturing is machine grinding which results in more flexibility due
to less work hardening than counterclockwise rotation The Cross-section of the instrument is
round with one pointed projection, coma-shape or tear-drop. Helical angle is 60-70o, whereas
the motion of the instrument is linear motion only due to high helical angle as rotation of the
file inside root canal result in blade locking into dentine as screw locks in wood with
subsequent file separation. It is preferred because this file has superior cutting efficiency. It
can be used for preparing straight canals or straight part of curved canals.

Fig 11, comparison of helical angles for the 3 types.

"files up to size 25 can be efficiently used to relocate canal orifices and, with adequate
filing strokes, to remove overhangs. Similarly, wide oval canals can be instrumented with
Hedström files as well as with rotary instruments. On the other hand, overzealous filing can
lead to considerable thinning of the radicular wall and strip perforations. As with stainless
steel K-files, Hedström files have been described as disposable instruments.490 Bending
Hedström files results in points of greater stress concentration than in K-type instruments.
These prestressed areas may lead to the propagation of cracks and ultimately fatigue
failure."(4)

Fatigue fractures might occur without visible signs of deformation. Hedström files are
produced by grinding one continuous flute into a tapered blank. Computer-assisted machining
technology has allowed the event of H-type instruments with complex forms. This process,
called multiaxis grinding, allows adjustment of the rake angle, angle, multiple flutes, and
tapers and is additionally wont to fabricate the bulk of NiTi instruments. Because the H-file
generally has sharper edges than the K-file, it's a bent to string into the canal during rotation,
particularly if the instrument’s blades are nearly parallel. Awareness of threading-in forces is

Page 12 of 14
 Tanta university ‫جامعة طنطا‬
Faculty of dentistry ‫كلية طب األسنان‬

vital to avoid instrument failurefatigue fractures may occur without visible signs of
deformation. Hedström files are produced by grinding one continuous flute into a tapered
blank. Computer-assisted machining technology has allowed the event of H-type instruments
with complex forms. This process, called multiaxis grinding, allows adjustment of the rake
angle, angle, multiple flutes, and tapers and is additionally wont to fabricate the bulk of NiTi
instruments. Because the H-file has sharper edges than the K-file, it's a bent to string into the
canal during rotation, particularly if the instrument’s blades are nearly parallel. Awareness of
threading-in forces is vital to avoid instrument failure. (6)

Conclusion:

Under the conditions of this study, Root canal preparation must serve the goals of
supporting debridement while exerting the smallest amount of structural damage. Toward
those goals, several trends for innovation are noted some changes in instrument design, but
there is standardization of these instruments that give standardization for any new instrument
that will serve the proper cleaning and shaping ,these standardization make us have the ability
to compare between instruments to choose the best one for the procedure , There is some
classifications that categorize instruments to facilitate the election of instrument according to
some properties that mentioned before. These results may explain the clinical difficulty found
in negotiating in narrow and curved canals and may stablish the need for a more
comprehensive approach on the evaluation methods used in root canal. In the end, to obtain
proper cleaning, you must choose the safe and efficient protocol of the instruments.

Page 13 of 14
 Tanta university ‫جامعة طنطا‬
Faculty of dentistry ‫كلية طب األسنان‬

References:

1-PATEL, Biraj. Preparation of the Coronal and Radicular Spaces, Ingles Endodontics 7
.Journal of Endodontics, 2019, 45.11: 1406. pp 557-559.

2-HÜLSMANN, Michael; PETERS, Ove A.; DUMMER, Paul MH. Mechanical preparation
of root canals: shaping goals, techniques and means. Endodontic topics, 2005, pp 30.

3- MCSPADDEN, John T. Mastering endodontic instrumentation. Chattanooga, TN: Cloudland

Institute, 2007, pp 9.

4-CARROTTE, P. Endodontics: Part 5 Basic instruments and materials for root canal
treatment. British dental journal, 2004, 197.8: 455-464.

5-HOLLIDAY, R. Cohen's pathways of the pulp. 2011.

6. HARGREAVES, Kenneth M. Cohen's Pathways of the Pulp. 10th. St. Louis, Mo, USA: Mosby,
2016.

7. PETERS, Ove Andreas; DE AZEVEDO BAHIA, Maria Guiomar; PEREIRA, Erika Sales
Joviano. Contemporary root canal preparation: innovations in biomechanics. Dental Clinics,
2017, pp 37-58.

8. GARG, Nisha; GARG, Amit. Textbook of endodontics. Boydell & Brewer Ltd, 2010.

9- ZINELIS, S., et al. Clinical relevance of standardization of endodontic files dimensions

according to the ISO 3630-1 specification. Journal of endodontics, 2002, pp 367-370.

10-SCHÄFER, E. Root canal instruments for manual use: a review. Dental Traumatology, 1997,
pp 51-64.

Page 14 of 14

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