Basic Research—Technology
A Comparison of the Dentin Cutting Efficiency
of 4 Pointed Ultrasonic Tips
Matthew P. Godfrey, DDS, James C. Kulild, DDS, MS, and Mary P. Walker, DDS, PhD
Abstract
Introduction: Pointed ultrasonic tips can be used for
several applications including troughing around
intracanal obstructions. With the variety of pointed
ultrasonic tips available, the purpose of this in vitro
investigation was to compare the dentin cutting
efficiency of 4 commonly used pointed ultrasonic tips.
Methods: The ultrasonic tips (n = 5 tips/group)
included in the study were the following: CPR-3D
(Obtura Spartan, Algonquin, IL), BL 6A (B&L Biotech,
Bala Cynwyd, PA), PUENDO2 (Dentsply Tulsa Dental
Specialties, Tulsa, OK), and WH1 (eie2, San Diego,
CA). The tips were attached to a testing apparatus
that produced linear movement and a 15-g axial force
during instrumentation of a human dentin specimen.
For all tips, instrumentation was completed at the
same power setting, which fell within the power setting
range recommended by each manufacturer. Dentin
specimens were weighed at baseline and after 6
minutes of instrumentation to measure dentin loss to
the nearest 0.01 mg. A qualitative analysis of the shape
and surface topography of new and used ultrasonic tips
was performed via scanning electron microscopy.
Results: A 1-factor analysis of variance and Tukey
post hoc analysis of dentin removal revealed a statisti-
cally significant difference between the 4 ultrasonic
tips (P < .05). The CPR-3D removed more dentin than
the other 3 tips, whereas the BL 6A removed more
dentin than the WH1. Scanning electron microscopic
analysis revealed the CPR-3D as having the least change
to tip shape and topography as compared with the other
tips. Conclusions: Within the limits of this study,
CPR-3D showed the greatest dentin removal, which
may be linked to the stability of the CPR-3D tip shape
and topography. (J Endod 2013;39:897–900)
Key Words
Ultrasonic efficiency, ultrasonic instrumentation, ultra-
sonic tips
From the University of Missouri-Kansas City, School of
Dentistry, Kansas City, Missouri.
Address requests for reprints to Dr Matthew P. Godfrey,
650 East 25th Street, Kansas City, MO 64108. E-mail address:
godfmatt@yahoo.com
0099-2399/$ - see front matter
Copyright ª 2013 American Association of Endodontists.
http://dx.doi.org/10.1016/j.joen.2013.04.016
JOE — Volume 39, Number 7, July 2013
C urrently, ultrasonic instruments are used in many different phases of endodontic
treatment such as access refinement, locating calcified root canal systems, removal
of attached pulp stones, removal of intracanal obstructions, increasing the action of
irrigating solutions, placement of mineral trioxide aggregate, and surgical endodontics
(1). Ultrasound is sound energy above the range of human hearing, which is
20 kHz (2). Ultrasound energy used for endodontic instrumentation is based on the
piezoelectric principle in which a crystal is used that changes dimensions when an
electric charge is applied (1). This crystal deformation is converted to mechanical
oscillation without producing heat (2). This lack of heat production represents one
of several advantages of piezoelectric ultrasonics in endodontics (2).
The removal of intracanal obstructions is 1 phase of endodontic treatment vastly
improved by ultrasonics. Pointed ultrasonic tips can be used for this purpose to trough
around obstructions to maximize the benefits of subsequently applied vibratory or
extraction forces (3). In order to conserve tooth structure, a small pointed tip is
able to not only remove any cement but also a thin shelf of dentin around the perimeter
of the obstruction (3). Previously, trephine drills were used for this purpose, which led
to complications including the destruction of root structure and the perforation of
root trunks (3). With ultrasonics, troughing around root canal obstructions can be
performed in a predictable and controlled manner (3).
Various investigations have evaluated the cutting efficiency of ultrasonic tips. Some
studies tested the cutting efficiency of one ultrasonic tip over time (4), whereas others
examined the efficiency of various rounded ultrasonic tips over time (5, 6). In
a comparison of the cutting efficiency of 4 ultrasonic tips, Dentkos and Berzins (6)
included 1 pointed tip. Lin et al (7) compared the cutting efficiency of various pointed
ultrasonic tips, but dental stone was used as the cutting medium. With the variety of
pointed ultrasonic tips available on the market, it would be valuable to evaluate the
cutting efficiency of various tips to allow the clinician to choose a tip most appropriate
for a particular purpose. The purpose of this in vitro investigation was to compare the
efficiency of 4 commonly used pointed ultrasonic tips to remove dentin.
Materials and Methods
Previously extracted third molars were collected from the Oral Surgery Clinic at
the University of Missouri-Kansas City School of Dentistry, Kansas City, MO, according
to an institutional review board–approved protocol. In this protocol, no patient
identifiers were associated with the teeth, and all patients signed waivers to permit
the use of their teeth for research purposes. Teeth were mounted in dental stone,
and dentin blocks were prepared by grinding the occlusal surfaces flat with a model
trimmer (Ray Foster Dental Equipment, Huntington Beach, CA). Desiccation of the
specimens was accomplished by storing the dentin blocks in the same environment
in which all tests were conducted. Specimens were weighed daily to the nearest
0.01 mg on a Mettler-Toledo AG 245 Lab Balance (Mettler-Toledo Inc, Columbus,
OH). Complete desiccation was confirmed by a lack of change in weight for
3 consecutive days as in a previous study (4).
Dentin specimens were mounted to the slow-speed alternating current motor of
the testing apparatus (Obtura Spartan, Algonquin, IL), which provided a 6-mm linear
movement at an approximate rate of 1.5 mm/s. A Satelec ultrasonic handpiece (Acteon
Group, Mount Laurel, NJ) was mounted on an adjustable inclinable slide, which
provided a constant and continuous axial force on the dentin specimen (8). An axial
Dentin Cutting Efficiency of 4 Ultrasonic Tips 897
Basic Research—Technology
force of 15 g, which was established by a previous study (4), was re-
checked and recalibrated between each group by using a digital mini
scale (model 1479V; Tanita Corporation, Arlington Heights, IL) that
was fastened to the testing apparatus via an attachment (Fig. 1).
Pointed ultrasonic tips of similar size and shape were chosen to
be included in this investigation. The 4 types of pointed ultrasonic tips
included in the investigation were the CPR-3D (Obtura Spartan,
Algonquin, IL), the BL 6A (B&L Biotech, Bala Cynwyd, PA), the
PUENDO2 (Dentsply Tulsa Dental Specialties, Tulsa, OK), and the
WH1 (eie2, San Diego, CA). For all ultrasonic tips, the Satelec P5
Newtron XS US unit (Acteon Group) was used at a power setting of
30%, which fell within the power setting range recommended by
each manufacturer. The ultrasonic tips were firmly attached to the
handpiece, with each tip being placed at a 90 angle to the dentin
specimen. Adjustments to the dentin specimen allowed the ultrasonic
tips to remain in dentin during instrumentation and not extend into the
peripheral enamel (8).
Instrumentation was completed for a total of 6 minutes for each
tip. After each 20-second interval, a 1-second blast of compressed air
was blown onto the specimen to remove debris. The dentin specimen
was weighed before and after instrumentation to the nearest 0.01 mg
on a Mettler-Toledo AG 245 Lab Balance (Mettler-Toledo Inc) (8).
This same process was performed for 5 ultrasonic tips from each of
the 4 respective tip groups. A 1-factor analysis of variance and the Tukey
post hoc analysis (a = 0.05) were used to determine whether there
were statistically significant differences in dentin removal between the
4 ultrasonic tip groups.
To potentially explain possible differences in dentin removal
efficiency that might be related to changes in the cutting surface,
a qualitative analysis of the effects of usage on tip shape and surface
topography was performed using scanning electron microscopy
(FEG ESEM XL 30; FEI, Hillsboro, OR). Images were captured at
25, 100, and 300 magnification of both a new and used
ultrasonic tip from each respective group, and all images were
reviewed by 3 evaluators.
Figure 1. A testing apparatus showing the ultrasonic tip in contact with the flat
dentin surface and the apparatus inclined to provide a constant 15-g axial
force. The reciprocating jig holds the dentin specimen.
898 Godfrey et al.
TABLE 1. Dentin Removal (mg) after 6 Minutes of Instrumentation
Tip (n = 5) Mean dentin removal (SD)*
CPR-3D 5.13 (1.61)a
BL 6A 3.29 (1.05)b
PUENDO2 2.06 (0.38)b,c
WH1 1.40 (0.47)c
Superscript letters indicate tip subsets.
*There was a significant difference (P # .05) in dentin removal between tips.
Results
The mean and standard deviation dentin removal values are
presented in Table 1. There was a significant difference in dentin
removal as a function of tip type (P < .05). The CPR-3D removed
more dentin than the other 3 types, whereas the BL 6A removed
more dentin than the WH1. Representative scanning electron
microscopic (SEM) images at 100 of a new and used tip of each
type are presented in Figure 2. The CPR-3D showed little change after
6 minutes of use (Fig. 2B), whereas the others showed substantial
changes to the tip shape and topography. For example, with the BL
6A, there was pitting after use (Fig. 2D), whereas the PUENDO2 showed
what appears to be the removal of its zirconium nitride coating (Fig. 2F).
With the WH1, there was a shearing of the tip, which resulted in a less
pointed instrument (Fig. 2H).
Discussion
Ultrasonic tip cutting efficiency is an important factor to consider
during endodontic treatment. The results of this in vitro investigation
indicated that the CPR-3D removed significantly more dentin across
time than the BL 6A, the PUENDO2, and the WH1. These 4 ultrasonic
tips were chosen because they all had pointed tips of similar size.
Five tips of each respective type were used in this investigation, and
none of them fractured.
Considerable effort was made to remove confounding variables in the
present investigation. The same power setting was used for all the tips,
which fell within each respective manufacturer’s guidelines. Besides using
human dentin, a clinically relevant substrate and the same axial force (15 g)
as established from a previous study (4) were included in the protocol.
Although the tips were of a similar size, the tip coatings varied.
The CPR-3D has a diamond coating; the PUENDO2 has a zirconium
nitride coating, whereas the WH1 and BL 6A have no surface coating.
The results of the current study are consistent with another investiga-
tion that reported superior cutting efficiency of diamond-coated tips
(7). In that investigation, diamond-coated tips required significantly
less time than stainless steel tips or zirconium nitride tips to penetrate
a 3-mm block of dental stone (7). In the current study, the pointed
diamond-coated tip displayed superior cutting efficiency of dentin.
Besides the tip surface coating effect on dentin removal efficiency,
another factor to consider is tip size. In an effort to choose pointed
tips from various manufacturers, the exact size of the tips used in
the study varied between brands. The WH1, which happened to be
the smallest, removed significantly less dentin than the CPR-3D and
the BL 6A, which were larger. The CPR-3D, the largest ultrasonic tip
used, removed significantly more dentin than the other 3 tips. In
addition to the diamond coating, the larger size of the CPR-3D may
have contributed to its superior efficiency at removing dentin.
However, a previous investigation of various-sized diamond-coated
tips reported that the largest tip produced the least efficiency at 2
different power settings (6). They reported that the surface area or
size of diamonds might not be the most important factor for cutting
efficiency (6). Furthermore, they reported that the sharpest tip
produced the second most dentin removal (6). This is contrary to
JOE — Volume 39, Number 7, July 2013

Figure 2. SEM images of ultrasonic tips: (A) a new CPR-3D, (B) a used CPR-3D, (C) a new BL 6A, (D) used BL 6A, (E) a new PUENDO2, (F) a used PUENDO2, (G)
a new WH1, and (H) a used WH1.
the current investigation in which the sharpest and smallest tip (WH1)
was among the least efficient tips studied.
In order to examine any change in ultrasonic tip shape and
topography, a SEM qualitative analysis was performed on randomly
chosen used (Fig. 2B, D, F, and H) and unused tips (Fig. 2A, C, E, and
G) of each respective type. A previous investigation that included SEM
imaging of new and used diamond-coated tips reported that wear was
observed as diamond loss from the cutting surface (6). In this investiga-
tion, all 4 ultrasonic tips showed signs of wear in either surface topog-
raphy or overall tip shape. However, the CPR-3D showed the least
amount of surface and tip change, whereas with the other 3 tips, there
was notably more change. For example, there was only a minimal loss
of diamond crystals and some rounding of remaining crystal edges
(Fig. 2B) with the CPR-3D. In contrast, the PUENDO2 exhibited a consid-
erable loss of the zirconium nitride coating at the tip (Fig. 2F), whereas
the BL 6A showed surface pitting (Fig. 2D) and there was a shearing of the
JOE — Volume 39, Number 7, July 2013
Basic Research—Technology
WH1 tip (Fig. 2H). Overall, it appeared that the CPR-3D underwent the
least amount of change to tip shape and topography, and this could be
a possible explanation as to why the CPR-3D removed more dentin across
time. This knowledge may aid in the manufacturing process because the
ultrasonic tips with the greatest stability of shape and topography may be
the most effective cutting ultrasonic tips.
Conclusion
Within the limits of this investigation, the CPR-3D showed the
greatest dentin removal, which may be linked to the stability of the
CPR-3D tip shape and topography.
Acknowledgments
The authors acknowledge the donation of ultrasonic tips by
the respective companies mentioned as well as the use of testing
Dentin Cutting Efficiency of 4 Ultrasonic Tips 899
Basic Research—Technology
equipment from Obtura Spartan and the donation of a Satelec P5 4. Lawlor K, Yelton C, Kulild J, et al. Dentin removal efficacy over time of the Buc-1
Newtron XS US unit from Acteon Group. ultrasonic tip. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:
e107–9.
The authors deny any conflicts of interest related to this study. 5. Yelton C, Lawlor K, Kulild JC, et al. Comparison of the efficiency of four different ultra-
sonic tips to remove dentin over time. J Endod 2010;36:529–31.
References 6. Dentkos TR, Berzins DW. Evaluation of cutting efficiency of orthograde ultrasonic tips
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literature. J Endod 2007;33:81–95. 7. Lin YH, Mickel AK, Jones JJ, et al. Evaluation of cutting efficiency of ultra-
2. Stock CJ. Current status of the use of ultrasound in endodontics. Int Dent J 1991;41: sonic tips used in orthograde endodontic treatment. J Endod 2006;32:
175–82. 359–61.
3. Iqbal MK. Nonsurgical ultrasonic endodontic instruments. Dent Clin North Am 2004; 8. Cloutier DL, Kulild JC, Walker MP. A novel methodology to evaluate the use of an ultra-
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