H-Type Instruments

H-type instruments have a design that facilitates cutting

during pulling stroke. Example of H-type instrument is
Hedstrom file.
• Manufacture: Hedstrom files are manufactured by
cutting spiral flutes from a round stainless steel wire.
Hedstrom configuration resembles cones or a wooden
screw (Christmas-tree pattern). Its flutes appear as
successive triangles set one on another.
Figure 11.27 shows single helix teardrop configuration
of Hedstrom file.
Figure 11.28 shows photograph of Hedstrom file
No. 30.
• Design:
– H-type instruments have a more positive rake angle
that increases its cutting efficiency.
– The blade of these instruments has a cutting rather
than scraping angle.
• Motion of use:
– H-files cut the canal wall when they are rotated
clockwise within the canal and pulled.
– They are relatively ineffective when pushed or
rotated counterclockwise.
– Rotational working movements like that of reamers
should be avoided with H-files because of the
possibility of fracture.
• Cutting efficiency: H-type instruments have higher
cutting efficiency than K-type instruments.
• Instrument fracture:
– H-type instruments are fragile and tend to fracture
easily.
– When a Hedstrom file is bent, there are points
of greater stress concentration that can cause
propagation of cracks and fatigue failure.
– Improper use of Hedstrom file can cause the
instrument to get screwed or locked in the dentin
within the canal, which may be impossible to be
retrieved. So, the Hedstrom files should not be used
in torquing action.
• Caution: Considerable thinning of radicular wall even
strip perforations can occur with overzealous use of
Hedstrom files.
• Uses:
– Can bring about enlargement or negotiation of small
constricted canals and blocked canals.
– Can be used to remove gutta-percha fillings from the
root canal
– Adequate filing strokes can be given with Hedstrom
files to remove the overhangs from the canal.
• Design modification: “S” file, Unifile and Safety Hedstrom
file.
– “S” file has double-helix configuration, rather than
the single helix teardrop cross-section of Hedstrom
file as seen in Figure 11.29. It is stiffer than the
Hedstrom file and has good cutting efficiency.
– Unfiles:
- A modification of Hedstrom file.
- Manufactured from round stainless steel wire by
grinding superficial grooves in order to produce
flutes with a double-helix design.
- Less fragile and hence less subject to fracture as
compared to Hedstrom files
- But they are less efficient.
– Safety Hedstrom file has noncutting side to prevent
ledge formation in curved canals. The noncutting
side is directed to the side of the canal where cutting
is not required.
Table 11.3 gives the distinguishing features between
K-files and H-files.
C+ Files
• These are special files made for difficult and calcified
canals as they have better buckling resistance than
K-files.
• Made of stainless steel and have square cross-section.
Fig. 11.27 Tear-drop cross-section of Hedstrom file
Fig. 11.28 Hedstrom file No. 30 Fig. 11.29 Double-helix configuration of “S” file
Endodontic Armamentarium: Instruments, Materials and Devices 177
• Available in sizes of No. 8, 10 and 15 and of lengths 18,
21 and 25 mm.
Figure 11.30 shows the photograph of C+ file.
ENGINE-DRIVEN INSTRUMENTS
• Engine-driven instruments are used with contra-angle
handpiece. Different types of handpieces have been
designed for use.
• Engine-driven handpieces have been developed for
opening of root canals and less preferred for preparation
of root canals.
• Before using the engine-driven instruments, hand
instruments should be used to gain access to apical
foramen.
Engine-driven Handpieces
• Reciprocating or quarter turn handpiece:
– Giromatic handpiece is a commonly used flat plane
reciprocating handpiece
– It is mounted with latch type instruments that
undergo quarter-turn motion at the rate of 3000
times/minute
– Broaches, K-type and H-type instruments can be
mounted.
– It activates a stainless steel barbed broach or reamer
in root canal through a 90 degrees reciprocating arc.
– Disadvantages of this handpiece: Packs dentinal
debris in the canal, takes longer time and creates
ledges and may over-enlarge the apical foramen.
It is found to be less effective as compared to hand
instrumentation for preparing root canals.
• The Racer contra-angle handpiece makes use of a
standard file and oscillates the file in the root canal.
Due to contra-angle design, the instrument length can
be adjusted till the working length. But there are more
chances of clogging of canal and pushing of debris into
the periapical area.
• M4 safety handpiece:
– It has 30 degrees reciprocating motion.
– It has a unique chuck that locks regular hand files in
place by their handles.
– The safety Hedstrom instrument (Kerr company) can
be used with this handpiece.
• The vertical stroke handpiece:
– Introduced by Levy
– It is either electrically-driven or air-driven
– It delivers a vertical stroke ranging from 0.3 to 1 mm.
– The more freely the instrument moves in the canal,
longer would be the vertical stroke.
– This handpiece also has a quarter-turn reciprocating
motion along with the vertical strokes.
• Electric handpieces: Many newer electrical handpieces
have been developed to be used with or without motors.
In these handpieces, speed and torque can be set. These
have been explained later in this chapter along with the
nickel-titanium instruments.
Engine-driven Rotary Instruments
Most widely used engine-driven rotary instruments
include the Gates Glidden drills and the Peeso reamers. A
modification of Gates Glidden drill, called Flexogates has
been developed, made of nickel-titanium.
• Gates Glidden drills: Discussed earlier in this chapter
• Flexogates:
– Flexogates is the modification of Gates Glidden drill.
– It is made up of nickel-titanium.
– It is more flexible and can be used for curved canals.
– It is rotated in the handpiece through 360 degrees.
– It has a safety design with noncutting tip and its
weakest part at the neck (about 16 mm from tip), so
it can be easily retrieved if fractured.
• Peeso reamers:
– Instrument design: Peeso reamers have long, sharp
flutes on a thick shaft and with a safe tip.
Fig. 11.30 Photograph of C+ file
(Courtesy of Dentsply)
TABLE 11.3 Distinguishing features between K-files and H-files
K-type instruments (K-files) H-type instruments (H-files)
• Have square cross-section
• Lesser cutting efficiency
when compared to H-files
• Rake angle is less positive and
blade has scraping angle
• Less sharp edges
• Less fragile compared to
H-file
• Motion of use: Rasping
motion or reaming motion
• Have round cross-section
• More cutting efficiency when
compared to K-files
• Rake angle is more positive and
blade has cutting angle
• More sharp edges
• More fragile and tends to fracture
easily
• Motion of use: Slight clockwise
rotation (about quarter turn) and
retraction
178 Short Textbook of Endodontics
– Available as 28 mm and 32 mm long instruments.
– Peeso reamers are usually available in a set of 6
instruments Peeso 1 to 6, identified by the number
of rings on the shank.
– Peeso reamers are available in tip diameters ranging
from 0.7 to 1.7 mm.
The tip diameter of Peeso 1 is 0.7 mm, peeso 2 is
0.9 mm, Peeso 3 is 1.1 mm, Peeso 4 is 1.3 mm, Peeso
5 is 1.5 mm and that of Peeso 6 is 1.7 mm.
Figure 11.31 shows photograph of peeso drills 1 to 6.
– Cutting action: Peeso reamers have lateral cutting
action.
– Use: Mainly used for postspace preparation in the
coronal portion of the root canal.
– Caution: Peeso reamers should be used in a slow
speed and in correct angulation to prevent lateral
perforations or excessive removal of radicular
dentin.
ULTRASONIC AND SONIC INSTRUMENTS
Ultrasonic Devices for Endodontic Use
• Principle: Sound is used as energy source at 20–25 KHz
for the three-dimensional activation of an Endodontic
file (K-file) resulting in three-dimensional activation of
the file in the surrounding medium.
• Mechanism: Two physical actions occur during
ultrasonic oscillation namely: cavitation, acoustic
streaming.
– Bubbles are formed by the free ultrasonic vibration
of Endodontic file within the fluid of the canal during
negative pressure oscillation and these unstable
bubbles implode with a great force during positive
pressure phase of oscillation. This process is called
cavitation. Earlier it was thought that the main
debriding action of the ultrasonics was by cavitation.
Now it is believed that debridement is caused due
to the other physical phenomenon called ‘Acoustic
streaming’.
– Circular fluid movement called Eddy flow occurs
around the Endodontic instruments due to acoustic
streaming, which is the main mechanism involved in
bringing about the cleaning effect of the irrigant in
the pulp space. It depends on the free displacement
amplitude of the file.
• Use: Effective for irrigating the root canal systems for
root canal cleaning. When ultrasonic oscillation is used
in conjunction with sodium hypochlorite irrigation, it
brings about effective root canal disinfection.
• Requirements: Free vibration of file within the canal is
required for optimum cleansing action with ultrasonic
oscillation.
So, it is recommended that:
For optimum cleansing action with ultrasonic
oscillations:
– Canals should be enlarged and prepared, i.e. biomechanical
preparation of the canals should be
completed.
– Use a smaller size Endodontic file, such as of size No.
15, that has minimal contact to the walls of the root
canal.
– Files should be loose in the canal.
– Ultrasonic oscillation with an Endodontic file
combined with sodium hypochlorite irrigation
brings about effective cleaning and disinfection of
root canals.
• Types: Ultrasonic devices of 2 types can be used:
1. Piezoelectrical.
2. Magnetostrictive.
Piezoelectrical unit generates less heat, does not
require cooling system and transfers more energy
to the file as compared to the magnetostrictive unit
and hence are more preferred devices.
Figures 11.32A and B show photograph of
ultrasonic device and ultrasonic tips respectively for
Endodontic use.
Sonic Devices for Endodontic Use
Sonics (6 KHz, 8K Hz and 10 KHz) can be used for root canal
preparation and disinfection.
Example is MM1500 Sonic handpiece that can be used
for cleaning, shaping and disinfecting the canal system.
Fig. 11.31 Photograph showing Peeso drills-1 to 6
(Courtesy of Mr Amar, Dr Mukul Dabholkar’s clinic)
Endodontic Armamentarium: Instruments, Materials and Devices 179
This has been explained in detail in Chapter 14 Cleaning
and Shaping of the Root Canal System Including Working
Length Determination and Chapter 15 Disinfection of the
Root Canal System.
• Mechanism: Sonically powered files oscillate up and
down in a longitudinal oscillation motion to bring about
preparation of root canals.
• Uses:
– Remove pulp remnants and necrotic debris from
root canals.
– Rasp and remove dentin during preparation of root
canals.
• Requirements: Sonic instruments should be loose and
free to oscillate within the root canal. So, canals should
be enlarged to the working length and apical part of root
canal prepared using conventional files after which the
sonic files are used.
• Sonic length: The Sonic instruments, with 1.5–2 mm safe
tips, begin their rasping action 1.5–2 mm from the apical
stop. This is called ‘Sonic length’.
• Examples:
– Rispi sonic files
– Shaper sonic files
– Trio Sonic files
of which shaper sonic files are found to be more
effective for widening the canals than Rispi Sonic
files. But Rispi Sonic files are less aggressive than
shaper Sonic files.
A mind-map to remember all points of Sonics
and Ultrasonics in Endodontics is given in Figure
11.33.
Uses of Ultrasonics and Sonics in Endodontics
(Endosonics)
• Removes isthmus tissue between canal
• Helps in location of orifices
• Smoothens the axial walls and floor of the pulp chamber
during access cavity preparation finishing
• Removes pulp stones smoothly and safely from pulp
chamber without scoring
• Opens calcified canals
• Brings about effective irrigation when used along with
sodium hypochlorite and results in cleaner root canals
• It can be used for obturation of root canal (Ultrasonicplasticized
gutta-percha obturation technique)
• Used during retreatment to remove gutta-percha, to
remove cement around posts that aids in post removal
• It can be used to help retrieve separated files
• It can be used for MTA placement in the canals.
NICKEL-TITANIUM HAND AND ROTARY
INSTRUMENTS
• Nitinol alloys contain 55% nickel and 45% titanium
by weight. (Ni—Nickel, Ti—Titanium, NOL—Naval
Ordnance Laboratory).
• Property of Super elasticity: It is the property of nickeltitanium
alloy that allows it to return to its original
shape following significant deformation. This property
of nickel-titanium makes Endodontic files more flexible,
better able to conform to curvatures of canal, resist
fracture and wear less than stainless steel instruments.
Figs 11.32A and B Ultrasonic device and ultrasonic tips for Endodontic use. (A) Ultrasonic unit for Endo purpose; (B) Ultrasonic tips
(Courtesy of Sybron Endo)
AB
180 Short Textbook of Endodontics
Fig. 11.33 A mind-map to remember sonics and ultrasonics in Endodontics
Fig. 11.34 Mind-map of properties of nickel-titanium instruments
Figure 11.34 lists the other properties of nickeltitanium
instruments.
Root canal preparation with Ni-Ti rotary files is very
effective, rapid and safe procedure. But it demands that the
clinician understands the:
• Root canal anatomy
• Principles of use of the selected rotary system.
The length, width and the curvature of the root canal
needs to be evaluated to decide the strategy for preparation
of the root canal.
Components of a rotary file:
• Flute of file: It is the groove in the working surface of file
used to collect soft tissue and dentin chips removed from
canal wall.
Endodontic Armamentarium: Instruments, Materials and Devices 181
• Land: The surface formed in between flutes that projects
axially from the central axis.
• Cutting/Leading edge: The surface where the flute and
land intersect that has the greatest diameter and follows
the groove as it rotates is called the cutting edge or blade
of file.
• Helix angle: It is the angle formed by the cutting edge
with the long axis of the file as shown in Figure 11.35. It
augers debris collected in the flute from the root canal.
• Rake angle: It is the angle formed by the cutting edge
with the radius of the file when the file is sectioned
perpendicular to its long axis. If this angle is obtuse, it
is called positive or cutting and if it is acute, it is said to
be negative or scraping.
• Pitch of file: It is the distance between a point on the
cutting edge and the corresponding point on the
adjacent cutting edge as shown in Figure 11.35.
When the instrument is designed in such a way
that there is balance between the helical angle and
pitch of file, there is better cutting action and debris is
effectively removed from the canal. Also the instrument
is prevented from inadvertently screwing in the canal.
Nickel-titanium instruments are superior to stainless
steel instruments for Endodontic use.
The comparative properties of stainless steel and nickeltitanium
instruments are given in Table 11.4.
Comparative Properties of Stainless Steel
and Nickel-titanium Instruments
See Table 11.4.
Phases of Nickel-titanium Alloys
Phase Transformation
• On heating, Martensite → R-phase → Austenite
This is called forward transformation.
• On cooling, Austenite → R-phase → Martensite
This is called reverse transformation.
• During Endodontic use:
– External stresses cause transformation of Austenitic
crystalline phase to martensitic crystalline phase.
Martensitic crystalline phase can accommodate
stresses without resulting in proportional strain.
– When the stress is released, reverse transformation
to austenitic crystalline phase occurs and the
instrument recovers its original shape in the process.
Manufacture
Nowadays, nickel-titanium instruments are precision
ground into different designs (K-style, Hedstrom, U files,
etc) and made in different sizes and tapers for hand use
(manual) or mechanical rotation (Rotary). In addition,
Ni-Ti spreaders and pluggers are also available.
Precautions to be Taken While Using
Nickel-titanium Instruments
See Table 11.5.
Recommended Motions of use for Ni-Ti
Rotary Instruments
• Research studies have shown that Ni-Ti instruments
should be used with rotational or reaming motion and