Clinical Oral Investigations (2021) 25:3691–3698

https://doi.org/10.1007/s00784-020-03694-7

ORIGINAL ARTICLE

Does the type of endodontic access influence in the cyclic fatigue

resistance of reciprocating instruments?
Emmanuel João Nogueira Leal Silva 1 & Rafael Santos Attademo 1 & Marcia Cristina Dutra da Silva 1 &
Karem Paula Pinto 2 & Henrique dos Santos Antunes 1 & Victor Talarico Leal Vieira 1

Received: 1 July 2020 / Accepted: 10 November 2020 / Published online: 21 November 2020
# Springer-Verlag GmbH Germany, part of Springer Nature 2020

Abstract
Introduction The aim of the present study was to compare the cyclic fatigue resistance of Reciproc R25 (R25) and Reciproc Blue
R25 (R25B) instruments, after simulated clinical use in traditional (TradAC) and ultraconservative (UltraAC) endodontic access
cavities.
Methods Forty mandibular molars were randomly assigned into the following groups, according to the type of access and instru-
ment to be used: TradAC and R25, TradAC and R25B, UltraAC and R25, and UltraAC and R25B. Teeth were accessed accord-
ingly, and the root canals were prepared using “RECIPROC ALL” kinematics. The cyclic fatigue resistance of the forty used
instruments was obtained measuring the time to fracture in an artificial stainless-steel canal. Ten brand new R25 and R25B were
used as control groups. The fracture surfaces and the side cutting edges of the instruments were examined with a scanning electron
microscope. Data were statistically analyzed using one-way ANOVA and post hoc Tukey tests with a significance level of P < 0.05.
Results R25B instruments showed significantly higher cyclic fatigue resistance than R25, regardless of the access cavity type (P
< 0.05). No differences were observed in the cyclic fatigue resistance between instruments without simulated clinical use and
used in TradAC (P > 0.05). R25 and R25B used in UltraAC showed significantly lower cyclic fatigue resistance compared with
the instruments used in TradAC and without simulated clinical use (P < 0.05).
Conclusions R25B files showed improved cyclic fatigue resistance than R25. The use of R25B and R25 files in mandibular
molars with UltraACs decreased their cyclic fatigue resistance, compared with TradAC.
Clinical relevance The use of Reciproc and Reciproc Blue files in mandibular molars with ultra-conservative endodontic
access cavities reduced their cyclic fatigue resistance. Clinicians should be aware about the reduced cyclic fatigue resistance
of these files when used in mandibular molars with UltraAC, due to the synergistic effect of access angulation and severe
curvature induced in the endodontic files.

Keywords Cyclic fatigue resistance . NiTi files . Minimally invasive access . Reciprocating instruments . Reciproc files

Introduction instruments still occurs [2]. The separation of the instrument

The use of nickel-titanium (NiTi) alloys in the manufacturing of
endodontic instruments enhanced their mechanical properties
[1]. However, even with this advance, fracture of endodontic
* Emmanuel João Nogueira Leal Silva
nogueiraemmanuel@hotmail.com
1
Endodontics Department, Grande Rio University (UNIGRANRIO),
Rua Herotides de Oliveira, 61/902, Icaraí, Niterói, Rio de
Janeiro 24220-000, Brazil
2
Endodontics Department, Rio de Janeiro State University (UERJ),
Rio de Janeiro, Brazil
can be a result of two mechanisms: torsional failure and cyclic
fatigue. Torsional fracture occurs when the tip of the instrument
gets stuck into the dentin and the instrument continues to move
[1, 3]. On the other hand, cyclic fatigue happens when the
tension-compression force exceeds the elastic limit of the in-
strument in curved root canals [4]. The main variables that can
affect the cyclic fatigue resistance of an endodontic instrument
are related to the tooth, such as the root canal curvature [5, 6]
and inclined insertion of the instrument into the canal [7, 8], and
related to the manufacturing process of the instrument, such as
the different treatments of the NiTi alloys [9].
Reciproc (VDW, Munich, Germany) and Reciproc Blue
(VDW) are single-file systems used in a reciprocation motion.
This motion results from a counterclockwise motion, when
3692
the file edges cut the dentin, and a clockwise motion, when the
file edges disengage from the dentin and so the stress on the
file is relieved [10]. As a result, this movement enhances the
torsional and cyclic fatigue resistance of the instruments com-
pared with continuous rotation [11, 12]. The Reciproc and
Reciproc Blue instruments have the same design and differ
only in the received thermomechanical treatment: M-Wire
alloy for Reciproc, while the alloy of Reciproc Blue is gener-
ated by an innovative thermal treatment [9]. This process con-
sists of a complex heating-cooling proprietary treatment that
results in a visible blue titanium oxide surface layer [9]. This
treatment provides to this instrument superior mechanical
properties, such as higher flexibility, memory shape, and cy-
clic fatigue resistance [9, 13].
Lately, minimally invasive access cavities emerged within
the concept that the preservation of the pulp chamber roof and
pericervical dentin could better preserve the fracture resistance
of the teeth when compared to traditional endodontic
access cavities (TradAC) [14]. One modality of these access
preparations that have been recently used is the ultraconserva-
tive endodontic access cavity (UltraAC) [15]. Popularly
known as “ninja” access cavity, due to the difficulty inherent
to its execution, this access consists on a point cavity per-
formed without further extension, maintaining the maximum
chamber roof as possible [14, 15]. However, reduced access
cavities may increase the access inclination of the file into the
root canals [8] and also induce a supplementary curvature in
addition to anatomic ones [7]. Recent studies showed that the
more inclined the insertion of the file into the canal, the lower
the cyclic fatigue resistance of the endodontic instruments [16,
17]. These excessive angles could be a result of coronal inter-
ferences presented in contracted access configurations, lead-
ing to a more challenging instrumentation and higher stress on
the endodontic instruments [8].
To date, there are no studies evaluating the influence of
UltraACs on the cyclic fatigue resistance of endodontic instru-
ments. Therefore, the aim of this study was to compare the
cyclic fatigue resistance of Reciproc and Reciproc Blue used
in TradAC and UltraAC. The null hypotheses tested were as
follows: (1) there are no differences in the cyclic fatigue resis-
tance between Reciproc and Reciproc Blue; (2) there are no
differences in the cyclic fatigue resistance of the files when
used in TradAC or UltraAC.
Material and methods
The sample size was calculated based on a pilot study, con-
sidering an effect size of 0.80 added to a power β = 95 and α =
5%, which resulted in a sample of nine instruments per group;
thus, ten instruments were included in each group. Thirty
Reciproc R25 (25/0.08v) (R25) and thirty Reciproc Blue
R25 (25/0.08v) (R25B) were used. All instruments were
Clin Oral Invest (2021) 25:3691–3698
inspected under an optical microscope (DF Vasconcellos;
Valença, Rio de Janeiro, Brazil) at × 16, looking for defects
or deformities before the experiment. None were discarded.
Simulated clinical use
After approval by the local ethics committee (protocol
n.2.695.692), a total of forty mandibular molars extracted for
reasons not related to this study, with intact crowns (without
cavities and/or restorations), and fully formed roots, out of a
total of ninety-eight teeth, were selected for this study. The
teeth had one mesiobuccal, one mesiolingual, and one distal
root canal, and anatomy of type 2MnM M2-1 D1 based on
classification proposed by Ahmed et al. [18], and presenting
similar length and degree of canal curvature, up to 20°
Schneider classification [19]. Subsequently, the specimens
were scanned by a micro-CT device (SkyScan 1174, Bruker,
Kontich, Belgium) with the following parameters: 800 mA
and 50 Kv, isotropic resolution of 19 μm, 180° rotation, rota-
tion step of 0.5, frame averaging of 2, camera exposure time of
5200 ms, and 0.5-mm-thick aluminum filter. The images were
reconstructed with the software NRecon v1.6.1.0 (Bruker
micro-CT) using 30% beam hardening correction and ring
artifact correction of 3 resulting in the acquisition of 800 to
900 axial cross sections per sample. After the reconstruction
of the images, the teeth were matched to create groups of four
samples (n = 10), based on similar surface area, volume and
3D configuration, obtained by the software CTAn (v. 1.6.6.0,
Bruker Micro-CT) and CTvol (Bruker Micro-CT), respective-
ly. The selected specimens were washed with saline solution
and all remaining attached tissue was removed.
Then, each tooth was randomly assigned into the following
groups according to the endodontic access cavity to be per-
formed (TradAC or UltraAC) and type of instruments to be
used (R25 or R25B):
TradACR25
TradACR25B
UltraACR25
UltraACR25B
A single operator, a certified specialist in endodontics with
more than 10 years of experience, performed the endodontic
access cavities, root canal detection, and root canal preparation.
Prior to the procedures, each tooth was mounted on a manne-
quin in a lower jaw to simulate clinical conditions (Manequim
Odontológico; Marília, São Paulo, Brazil), and all procedures
were performed under operating microscope magnification (×
16) (DF Vasconcellos; Valença, Rio de Janeiro, Brazil).
TradAC group
The endodontic access cavities were performed using high-
speed diamond burs (1014 HL; KG Sorensen, São Paulo,
Brazil) and Endo Z burs (Dentsply Maillefer, Ballaigues,
Clin Oral Invest (2021) 25:3691–3698
Switzerland) mounted on a high-speed handpiece with water
cooling following conventional guidelines already described
in literature [20, 21]. The roof of the pulp chamber was re-
moved, and a straight-line access up to the coronal third of the
root canal was established.
UltraAC group
The endodontic access cavities were performed using
high-speed diamond burs (1012 HL; KG Sorensen).
The teeth were accessed at the central fossa and extend-
ed only as necessary to detect canal orifices, preserving
as much as possible of the pericervical dentine and pulp
chamber roof [14, 15].
Root canal procedures
In all groups, root canal orifices were detected with an
endodontic explorer and a size 8 or 10 K-file (Dentsply
Maillefer, Ballaigues, Switzerland). The teeth were re-
moved from the mannequin to determine the working
length (WL), which was established 1.0 mm short of
the apical foramen. Apical patency was achieved by
inserting a size 10 K-file (Dentsply Maillefer) into the
root canal until the tip was visible at the apical fora-
men, at which point a size 15 K-file (Dentsply
Maillefer) was used creating a glide path.
The preparation with the instruments R25 or R25B was
performed with “RECIPROC ALL” movement on a VDW
Silver motor (VDW, Munich, Germany) in accordance with
manufacturer’s instructions. Briefly, the instrument was
moved in the apical direction using three “in-and-out” pecking
motions, with slight apical pressure and amplitude of 3 mm.
After each cycle, the instrument was removed from the canal,
cleaned with sterile gauze, and reintroduced. Root canal irri-
gation was performed after each instrument use with 2 ml of
5.25% NaOCl using a 30G NaviTip needle (Ultradent, South
Jordan, UT, USA) attached to a 5-ml hypodermic syringe
inserted up to 3 mm from the WL. A total of 8 ml of NaOCl
was used in each root canal. The total time of instrumentation
and contact of NaOCl within the root canals was clocked and
remained consistent among all groups.
Cyclic fatigue test
Ten brand new R25 and R25B were used as control
groups. In addition, ten instruments used in each of
the above described groups (TradAC and UltraAC) were
tested regarding the cyclic fatigue. Instruments run until
fracture occurred using a custom-made device which
allowed a reproducible test of an instrument working
loose inside a curved canal until fracture occurs. The
test settings included an artificial canal with 86 degrees
3693
of curvature with 6-mm radius, and presenting a maxi-
mum stress point located at 7.5 mm from the tip [22],
in which the tested instrument mounted on a 6:1
handpiece (VDW/Sirona Dental Systems, Bensheim,
Germany) and powered by a torque-controlled motor
(VDW Silver; VDW), using “RECIPROC ALL” move-
ment, in accordance with manufacturer’s instructions.
All tests were conducted in saline solution at 37 °C
[23]. All instruments were tested continuously until
fracture occurs. The time to fracture was recorded in
seconds with a digital chronometer and stopped when
the file fracture was detected visually and/or audibly.
Scanning electron microscopy and optical microscopy
A scanning electron microscope (SEM; JSM 5800; JEOL,
Tokyo, Japan) was used to evaluate the topographic features
of the fracture surfaces and side cutting edges of the instru-
ments after cyclic tests using a × 200, × 1500, and × 2000
magnifications. Moreover, the instruments were inspected un-
der optical microscope at × 16 magnification to observe the
presence or absence of plastic deformation in the helical shaft
of fractured instruments.
Statistical analysis
Data analysis revealed a bell-shaped distribution (Shapiro-
Wilk test; P > 0.05), and statistical analysis was performed
amongst groups using one-way ANOVA and post hoc Tukey
tests with an alpha-type error set at 5% (Biostat; Instituto
Mamirauá, Tefé, Brazil).
Results
R25B showed significantly higher resistance to cyclic
fatigue than the R25, regardless of the simulated clinical
use or the access cavity type (P < 0.05). No differences
were observed in the cyclic fatigue resistance between
instruments without simulated clinical use and instru-
ments used in teeth with TradAC (P > 0.05). R25 and
R25B instruments used in UltraAC showed significantly
lower cyclic fatigue resistance compared with used in
TradAC and with the instruments without simulated
clinical use (P < 0.05). The mean time to fracture and
standard deviation of each group are presented in
Table 1.
The scanning electron microscopic analysis of the fractured
surfaces of the tested instruments after the cyclic fatigue test
indicated that all instruments showed fractographic character-
istics of ductile fracture (Fig. 1). Wide-ranging forms of dim-
ples were identified overall (Fig. 2), and no plastic
3694 Clin Oral Invest (2021) 25:3691–3698

Table 1 Mean and standard deviation of time to fracture (in seconds) of Discussion
the experimental and control groups

Reciproc Reciproc Blue In the present study, the cyclic fatigue resistance of R25 and
R25B instruments used in TradAC and UltraAC was evaluated.
No use 211 ± 10a1 295 ± 11a2 The methodology used to evaluate cyclic fatigue was already
TradAC 188 ± 19a1 270 ± 30a2 validated and used in several previous published articles [9, 13,
UltraAC 133 ± 23b1 218 ± 24b2 24, 25]. The use of standardized stainless-steel artificial canals
minimize the variables of the cyclic fatigue test and increase its
Different superscript lowercase letters indicate statistically significant dif-
ference in cyclic fatigue resistance among the groups regarding the access reproducibility, since the complex and diversified anatomy of
cavity type in which they were used. Different superscript numbers indi- natural teeth makes standardization of the experimental condi-
cate statistically significant difference in cyclic fatigue resistance between tions impossible [26]. In addition, similar to previous studies
the R25 and R25B files (P < 0.05)
[16, 24], the fatigue resistance of the instruments was evaluated
by time and not by the number of cycles to failure. Time is
deformations in the helical shaft of the fractured instruments much more reliable for the operator, especially while using
were observed (Figs. 3 and 4). reciprocating instruments [27]. It is worth mentioning that there

Fig. 1 Representative scanning electron microscopic images of the TradAC, c R25 used in UltraAC, d R25B no use, e R25B used in
fractured surfaces of the tested instruments after cyclic fatigue test. The TradAC, and f R25B used in UltraAC
images show magnifications of × 200. a R25 no use, b R25 used in
Clin Oral Invest (2021) 25:3691–3698 3695

Fig. 2 Representative scanning electron microscopic images of the TradAC, c R25 used in UltraAC, d R25B no use, e R25B used in
fractured surfaces of the tested instruments after cyclic fatigue test. The TradAC, and f R25B used in UltraAC
images show magnifications of × 2000. a R25 no use, b R25 used in

Fig. 3 Representative scanning electron microscopic images of the side used in UltraAC, d R25B no use, e R25B used in TradAC, and f R25B
cutting edges after performing the cyclic fatigue test. The images show used in UltraAC
magnifications of × 1500. a R25 no use, b R25 used in TradAC, c R25
3696
Fig. 4 Representative operative microscopic images of the helical shaft after performing the cyclic fatigue test. The images show magnifications of × 16.
a R25 no use, b R25 used in TradAC, c R25 used in UltraAC, d R25B no use, e R25B used in TradAC, and f R25B used in UltraAC
are no specifications or international standards for the evalua-
tion of cyclic fatigue resistance in NiTi endodontic instruments.
The comparison between R25 and R25B instruments elim-
inated the influence of the file design on the cyclic fatigue
resistance, since the instruments only differ in the NiTi alloy
thermomechanical treatment, presenting the same taper, di-
mensions, and cross section, which allow a direct comparison
between the two endodontic files [9]. In the present study, the
brand new instruments, used as control groups, presented
values of time to fracture similar to those of previous studies
[9, 16]. Moreover, for all tested groups (control, TradAC, and
UltraAC), R25B files had significantly higher cyclic fatigue
resistance than R25 (P < 0.05). Therefore, the first null hy-
pothesis was rejected. This finding corroborates with previous
studies that showed that the blue thermomechanical treatment
increased the cyclic fatigue resistance of Reciproc files [9, 28],
even while tested in S-shaped [28, 29] or severely curved
canals [23]. Moreover, in the present study, both instruments
presented significantly lower cyclic fatigue resistance when
used in UltraAC compared to TradAC (P < 0.05). Thus, the
second null hypothesis tested was also rejected. Minimally
invasive accesses increase the angle and curvature of file in-
sertion into the root canals, inducing an additional curvature,
similar to an S-shaped (double curvature) canal, which in-
creases the stress generated on the endodontic file. Some stud-
ies reported a significant decrease of fatigue resistance when
rotary NiTi files were tested in double curvatures versus single
curvatures [5, 6], and the same was recently observed in heat-
treated NiTi reciprocating systems [30].
In conservative endodontic access cavities, the angle of file
access in mesial canals of mandibular molars is between 20
and 30 degrees [8]. So, it is expected that this angle is even
Clin Oral Invest (2021) 25:3691–3698
more pronounced in UltraACs. Pedullà et al. [16] evaluated
the influence of different angles of file access—0, 10, 20, and
30 degrees—on the cyclic fatigue resistance of R25 and R25B
files. The cyclic fatigue resistance of both files decreased with
the increase in the angle of file access, which is corroborated
by the results of the present study. Another recent study com-
paring the influence of different angles of file access and cur-
vature radius on the cyclic fatigue resistance of Ni-Ti rotary
files also observed that a higher angle of file access and in-
creased curvature decreased the cyclic fatigue resistance of the
files [17]. However, it is worth noting that there were impor-
tant methodological differences between these experiments
and the present study. Pedullà et al. [16, 17] used a mobile
platform containing the artificial canals to reproduce different
inclinations of instrument insertion, while in the present study
it was previously simulated the clinical use of the instruments
in different access cavities and then the cyclic fatigue resis-
tance test was performed.
Even though Reciproc files were designed for single use,
some studies highlighted the possibility to reuse these files
[31, 32]. A prospective clinical study showed a low fracture
incidence of R25 files when used up to three times and con-
cluded that the reuse is a viable option [32]. Moreover, the
same study showed that the R25 instrument can fracture even
during its first use [32]. This emphasizes the importance that
the reduced time to fracture of Reciproc used in UltraAC may
have in the clinical setting. However, it is worth noting that the
present study only evaluated the cyclic fatigue resistance of
R25 and R25B files used in ultraconservative endodontic
access cavities, and future studies should be performed with
other endodontic instruments and also access other mecha-
nisms related to instrument fracture, such as torsional failure.
Clin Oral Invest (2021) 25:3691–3698
Future studies should be performed using the same methodo-
logical design but with other new and consecrated endodontic
instruments in continuous rotation and/or reciprocating
kinematics.
Conclusion
In conclusion, R25B showed increased resistance to cyclic
fatigue than R25, regardless of the type of access cavity where
they were used, and both files presented significantly de-
creased cyclic fatigue resistance when used in mandibular
molars with UltraAC in comparison with TradAC.
Authors’ contribution Emmanuel João Nogueira Leal Silva contributed
to idea, to hypothesis, and to final approval of the version to be published.
Rafael Santos Attademo and Marcia Cristina Dutra da Silva contributed
to the experimental design. Karem Paula Pinto, Henrique dos Santos
Antunes, and Victor Talarico Leal Vieira contributed to the experimental
design, to analysis, and interpretation of data. All authors read and ap-
proved the final manuscript.
Funding This study was partially founded by Conselho Nacional de
Desenvolvimento Científico e Tecnológico (CNPq) and Fundação de
Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ).
Compliance with ethical standards
Conflict of interest The authors declare that they have no conflict of
interest.
Ethical approval All procedures performed in studies were in accor-
dance with the ethical standards of the institutional and/or national re-
search committee and based on welfare of animals.
Informed consent For this type of study, formal consent is not required.
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