Review Article
Current Assessment of Reciprocation in Endodontic
Preparation: A Comprehensive Review—Part II:
Properties and Effectiveness
Gianluca Plotino, DDS, PhD,* Hany Mohamed Aly Ahmed, BDS, HDD (Endo), PhD,†
Nicola Maria Grande, DDS, PhD,‡ Stephen Cohen, MA, DDS, FICD,§
and Fr
ed
eric Bukiet, DDS, MSc, PhDk¶
Abstract
Introduction: Many reciprocating file systems (RFs)
have recently been introduced. This article reviews the
properties, effectiveness, and clinical outcomes of the
RFs. Methods: A PubMed electronic search was con-
ducted by using appropriate key words to identify inves-
tigations on RFs. After retrieving the full-text relevant
articles, the cross citations were also identified. Results:
This review summarizes the mechanical properties,
shaping ability, preservation of the root canal anatomy,
shaping time, cleaning effectiveness, microcrack forma-
tion, bacterial reduction, extrusion of debris, and
removal of root canal filling materials of RFs. Conclu-
sions: The favorable results of RFs indicate their
potential application as viable alternatives to rotary
file systems, yet no filing system is able to entirely
prepare the dentin of canals, totally eliminate sessile
and planktonic microorganisms, or remove the filling
material completely from the root canal system. (J Endod
2015;-:1–12)
Key Words
Nickel-titanium instruments, reciprocation, review, root
canal preparation
From the *Sapienza University of Rome, Rome, Italy;
†
School of Dental Sciences, Universiti Sains Malaysia, Kubang
Kerian, Kelantan, Malaysia; ‡Catholic University of Sacred
Heart, Rome, Italy; §Arthur A Dugoni School of Dentistry, Uni-
versity of the Pacific, San Francisco, California; kUFR Odontolo-
gie de Marseille, Aix Marseille Universit
e, Assistance Publique
des H^opitaux de Marseille, France; and ¶Laboratoire Biologie
Sant
e et Nanosciences, Montpellier, France.
Address requests for reprints to Dr Gianluca Plotino, Via
Calabria 25, 00187 Rome, Italy. E-mail address: endo@
gianlucaplotino.com
0099-2399/$ - see front matter
Copyright ª 2015 American Association of Endodontists.
http://dx.doi.org/10.1016/j.joen.2015.08.018
JOE — Volume -, Number -, - 2015
P reparation of the root canal system (RCS) is one of the most critical steps in root
canal treatment, including the removal of pulp tissues, microorganisms, infected
dentin, and root canal filling materials (RCFMs) in retreatments (1). Thorough prep-
aration of the RCS would enhance the efficiency of irrigants and medicaments, and
would optimize root canal geometrics for subsequent filling procedures (1, 2).
In the last 2 decades, numerous advances in endodontic instrumentation have
been developed to achieve proper enlargement of the main root canals (RCs) without
procedural errors (2). Recently, the use of reciprocating motion (RM) is gaining in
popularity, as reported in part 1, and reciprocating files (RFs) have been the subject
of numerous investigations. Hence, part 2 of this review was undertaken to introduce
a comprehensive and current overview of the published literature on this topic.
Literature Search Methodology
A search was performed in the PubMed database to identify the available inves-
tigations on RFs spanning the period from 1990 to March 2015. The following key
words were used in the search: ‘‘Reciprocating’’ OR ‘‘Reciprocation’’ AND ‘‘Files.’’
The research was limited to dental publications written in English. An additional
hand search was extensively performed in the Journal of Endodontics; Interna-
tional Endodontic Journal; Oral Surgery, Oral Medicine, Oral Pathology, Oral
Radiology, and Endodontology; Australian Endodontic Journal; British Dental
Journal; and Journal of American Dental Association, with subject matter expertise
by the citation of selected studies and available review articles.
After the removal of duplicate articles, title review, and abstract selection, full-text
articles were used to verify that the topic was pertinent. Selected articles were
reviewed by the authors and divided according to the following topics: mechanical
properties, shaping ability and preservation of the root canal anatomy, shaping time,
cleaning effectiveness, microcracks, bacterial reduction, debris extrusion, and removal
of filling materials.
Mechanical Properties of RFs
The incidences of instrument separation and deformations of RFs were reported to
be considerably low (3, 4), even less than those reported for rotary instruments (4).
Investigators (3) reported that only 3 WaveOne files (WOFs) (Dentsply Maillefer, Bal-
laigues, Switzerland) separated during use (0.13% of the number of canals shaped),
and others (4) found that 6 Reciproc instruments (VDW, Munich, Germany) deformed
during clinical use (0.15% of the RCs treated) and 8 Reciproc instruments were frac-
tured during treatments (0.21% of the RCs treated).
Furthermore, it was found that the fracture risk of files when used under contin-
uous rotation (CR) was significantly higher compared with RM (5, 6), and clinician
experience appeared to have no effect on the deformation rate (7) and the life span
of the WOFs (8) with or without the creation of a mechanical glide path (9). This initial
enlargement of the canals significantly increased the average life span and the survival
rate of WOFs (10), and the reusability of WOFs and Reciproc was reported to be 5 canals
with minimal surface deformations (11).
Reciprocation in Endodontic Preparation 1
Review Article
Cyclic Fatigue and Bending Resistance
RFs were developed to reduce their incidence of breakage
(Table 1). RFs are claimed to travel a shorter circumferential distance
than a rotary instrument, which subjects the file to lower stress values
(36). Consequently, an instrument should have a greater resistance to
fatigue when used in RM as opposed to CR. Only 1 study has reported
that RM offers stronger cyclic fatigue resistance (CFR) compared with
conventional rotary movement (21). The first study published on this
topic (12) showed that movement kinematics is among the main factors
determining the resistance of rotary nickel-titanium (NiTi) files to cyclic
fracture; RM promoted an extended cyclic fatigue life of the F2 ProTaper
instrument (Dentsply Maillefer) in comparison with CR. These results
were later confirmed by other studies (13–15, 20, 22), which
concluded that RM extends the life span of NiTi endodontic files.
Among the RFs present in the market, a difference in CFR between
Reciproc and WaveOne is evident. Reciproc files are associated with a
significantly higher CFR than WOFs (16, 17, 22, 23, 27, 28). The
probability of the mean life for Reciproc is 62% higher than
WaveOne at 5 mm from the tip and 100% higher at 13 mm (16). Inves-
tigators (18, 29) also reported that the CFR of Reciproc was greater than
other NiTi single-file systems tested including OneShape (Micromega,
Besançon, France) and WaveOne. Others (35) found that the CFR of Re-
ciproc R25 was significantly higher than WaveOne. In any case, the RFs
marketed nowadays showed longer cyclic fatigue life than rotary full-
sequence systems (RFSSs) (17, 19, 24, 25, 30, 31). In 1 study, the
authors also correlated a longer fatigue life for files with higher
flexibility (25).
Altering the amplitude of reciprocation has a significant influence
on the cyclic fatigue life of NiTi files. In fact, increasing the angle of
reciprocation and consequently increasing the angle of progression
for each reciprocation cycle can reduce the resistance to cyclic fatigue
(26, 32). Fatigue life also decreases with increasing reciprocating
amplitude in stationary reciprocation (oscillation with angle
clockwise = angle counterclockwise); fatigue life increases by 50%
to 355% over that in CR (34). Furthermore, progressive RM yields a
longer fatigue life than stationary RM, with a fatigue life enhancement
up to 990% above that under CR (34). In progressive RM, the most crit-
ically strained locations move forward to new locations during the pe-
riodic angular increment instead of remaining stationary. This
effectively distributes fatigue damage to different points on the circum-
ference, thus reducing the detrimental effect of localized damage. From
these observations, the progressive increment should preferably be
small and should not completely divide 360 to be effective.
Results obtained by the cyclic fatigue tests may be correlated to the
flexibility of the files, which is an important property for shaping narrow
and curved RCs. WaveOne presented significantly higher bending resis-
tance than Reciproc, which means significantly less flexibility, as ex-
pected by the different cross-sectional design of the 2 files (33, 37).
WaveOne showed higher flexibility than the OneShape in another
study (38).
Immersion in sodium hypochlorite (NaOCl) did not reduce the
CFR of RFs (23, 27), whereas EDTA immersion reduced the CFR in 1
study (27) but not in another (18).
Torsional Resistance
Investigators (39) examined the torsional resistance of Reciproc
and WaveOne operated at the maximum rotating angle in their
proprietary motors. The authors found that the rotation angle at the
beginning point of torsional deformation was greater than the
operating angle of the dedicated motors for these files (170 ), and
thus, it was concluded that the 2 brands of RFs are safe when operated
2 Plotino et al.
at the rotational angle in their proprietary motor. In terms of maximum
torsional load, both Reciproc and WaveOne showed significantly higher
torsional resistance than ProTaper (17), and WaveOne had a
higher torsional resistance than Reciproc (17) and OneShape (38).
Researchers (40) performed a torsional analysis of WaveOne
based on finite element analysis and in vitro torsional tests. The
same simulation was performed on virtual files with identical geometry
and load condition based on the M-Wire or conventional NiTi alloy. At
fracture, the files did not take complete advantage of the enhanced frac-
tural resistance of the M-Wire material, which determines only limited
improvements of the torsional performance.
Cutting Efficiency
The capability of a file to efficiently remove dentin depends on the
number of flutes, cross-sectional area design, sterilization, chip
removal capacity, helical and rake angle, tip design, metallurgical prop-
erties, and surface treatment of the files (41). There are only a few
studies investigating the cutting efficiency of the new RFs. Studies
showed that there is no significant difference in the cutting ability of Re-
ciproc and Twisted File (TF) Adaptive (SybronEndo, Orange, CA) used
in their proprietary RM or CR, thus showing that this movement does not
reduce the cutting ability of these files (42, 43). Cutting ability was also
not reduced by prolonged clinical use (43). Reciproc and TF Adaptive
showed a significantly higher cutting efficiency than WaveOne (41, 44).
In particular, when used with their proper RM, Reciproc presented a
significantly higher cutting efficiency than WaveOne.
Surface Analysis
One study showed that there is no significant difference in the sur-
face alteration for WaveOne and Reciproc after 1, 2, or 3 RCSs were
shaped (45). Both files showed limited alteration, such as tip deforma-
tion and wear. No initiation of microdefects or tip abrasions were found
until they were reused up to 5 canals (11). However, some files that
were reused in up to 10 canals showed slight wear of the file tip (apical
blunting) and microdefects on the surface. Shaping in extracted molars
was possible for up to 6 RCs with TF and up to 9 RCs with Reciproc
before the appearance of superficial defects (46). Scanning electron
microscopic (SEM) analysis revealed that 60% of ProTaper files used
in reciprocation showed the initiation of microcracks on the surface,
whereas surface microcracks were detected in only 1 WOF (47).
Shaping Ability and Preservation of Anatomy
of the RC Space
Reciprocating Files
Studies on previous stainless steel (SS) RFs did not claim that this
technology is suitable for the preparation of curved RCs (48, 49)
(Table 2). Current developments in RFs have shown a paradigm shift
in root canal preparation (RCP) techniques. Adequate shaping ability
of contemporary RFs while preserving the original RC shape mainly is
a result of the interplay of 3 main factors: the reciprocation kinematics,
the file cross section, and the M-wire alloy.
One study showed an excellent centering ability of the WaveOne
regardless of the clinician’s level of experience (63). Investigators
(67) reported similar observations with R25, and they found that this
file was able to reach the full working length (WL) of RCs impenetrable
to a #10 K-file. Another study found that both WaveOne and R25 were
able to prepare the apical portion of J-shaped simulated RCs adequately,
but a greater number of pecking times after reaching the WL may result
in an apical size that is larger than the actual file size (78).
The necessity to obtain a glide path before RF usage is controver-
sial. Despite favorable observations reported with Reciproc without the
JOE — Volume -, Number -, - 2015
 Review Article
TABLE 1. Summary of Studies: Cyclic Fatigue Resistance
Authors Year Instruments Conclusions
De-Deus et al (12) 2010 ProTaper F2 Reciprocating movement promoted an
extended cyclic fatigue life in
comparison with conventional rotation.
Vadhaha et al (13) 2010 RaCe, Mtwo Instruments showed a significantly higher
cyclic fatigue resistance in reciprocating
motion compared with continuous
rotation.
Gavini et al (14) 2012 Reciproc R25 Reciprocating movement promoted an
extended cyclic fatigue life in
comparison with conventional rotation.
Gambarini et al (15) 2012 Twisted Files The reciprocating movement was
associated with an extended cyclic
fatigue life.
Arias et al (16) 2012 Reciproc R25, WaveOne Primary Reciproc files were more resistant to cyclic
fatigue than WaveOne files.
Kim et al (17) 2012 Reciproc R25, WaveOne Primary, Reciproc had a higher life span than
ProTaper F2 WaveOne and both reciprocating files
higher than ProTaper.
Dagna et al (18) 2012 Reciproc R25, WaveOne Primary, Cyclic fatigue resistance of Reciproc R25
OneShape was greater than other NiTi file systems
tested.
Castello-Escriva et al (19) 2012 WaveOne primary, Twisted Files 25/.08, Reciprocating movement with WaveOne
ProTaper F2 instruments showed a longer cyclic
fatigue life than conventional rotary
movement.

rez-Higueras et al (20)
Pe 2013 K3, K3XF, Twisted Files Reciprocation extended the life span of
the endodontic files tested.
Lee et al (21) 2013 ProTaper F2 and ProFile#25/.06 The results found using reciprocation were
comparable with those found using
continuous rotation.
 et al (22)
Pedulla 2013 Reciproc R25, WaveOne Primary, Mtwo, The reciprocal motion showed a
Twisted Files significantly higher cyclic fatigue
resistance in all brands.
 et al (23)
Pedulla 2013 Reciproc R25, WaveOne Primary Reciproc R25 instruments were associated
with a significantly higher cyclic fatigue
resistance than WaveOne Primary.
Lopes et al (24) 2013 Reciproc, Mtwo Instruments operated in a reciprocating
movement presented prolonged
fatigue life than instruments used in
rotation.
Lopes et al (25) 2013 WaveOne, ProTaper Instruments operated in a reciprocating
movement presented prolonged
fatigue life than instruments used in
rotation.
Saber et al (26) 2013 WaveOne The time to fracture recorded increased as
the reciprocation angles decreased.
 et al (27)
Pedulla 2014 Reciproc R25, WaveOne Primary, Reciproc R25 was associated with a
ProTaper F2 significantly higher cyclic fatigue
resistance than WaveOne Primary and
ProTaper F2.
Plotino et al (28) 2014 Reciproc R25, WaveOne Primary Reciproc R25 instruments were associated
with a significantly higher cyclic fatigue
resistance than WaveOne Primary.
Dagna et al (29) 2014 Reciproc R25, WaveOne Primary, Cyclic fatigue resistance of Reciproc R25
OneShape, ProTaper F2 was greater than other NiTi file systems
tested.
Pirani et al (30) 2014 WaveOne primary, ProTaper F2 The time taken for the WaveOne to break
was considerably longer than that of
ProTaper F2.
Kiefner et al (31) 2014 Reciproc, Mtwo Reciprocating movement increased the
cyclic fatigue resistance of NiTi
instruments.
Gambarini et al (32) 2014 K3XF Angles of reciprocating movements had a
significant influence on the cyclic
fatigue life of the tested nickel-titanium
instruments.
De-Deus et al (33) 2014 Reciproc R40, WaveOne Large Reciproc revealed a significantly longer
cyclic fatigue life in both static and
dynamic tests and more flexibility.
(Continued )

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Review Article
TABLE 1. (Continued )
Authors Year Instruments
Shin et al (34) 2014 ProTaper F2
Higuera et al (35) in press Reciproc R25, WaveOne Primary, TF
Adaptive M-L1
technically demanding glide path procedure (67), 2 studies showed
that the prior use of a small-size K-file followed by a more flexible
and less tapered NiTi rotary file maintained the original canal anatomy
better, minimized procedural errors, and required fewer pecking mo-
tions to reach the WL; this was observed with WaveOne (54, 61).
Another study has confirmed this finding when WaveOne was
compared with Reciproc (69). It appears that the larger core diameter
and greater number of spiraling flutes of WaveOne increases the stiff-
ness of the tip, which results in alterations of the original RC shape
and length (69).
Reciprocation of Rotary File Systems
Studies have examined the potential application of RM of rotary
systems (Table 2). Investigators (56) studied the application of this
movement on the FlexMaster system (VDW); the RM shaped a prepara-
tion in a more uniform manner centered on the original canal anatomy
compared with that of CR.
Literature continues to support the favorable shaping outcomes of
single and multiple ProTaper (47, 58, 60, 64) files as well as Mtwo
(VDW) (77) automated via RM. One study (68) compared ProFile
and RaCe (FKG, La-Chaux-de-Fonds, Switzerland) automated via both
CR (full set) and RM (only 25/0.06 taper); results revealed that RFs
maintained a similar centering ratio to that achieved by the rotary tech-
nique. However, SEM analysis showed gross morphological deforma-
tions in files automated via reciprocation, probably because of fatigue
caused by a periodic change in direction.
One study compared the shaping ability of ProTaper (full
sequence) with/without reciprocation and WaveOne in S-shaped simu-
lated canals (76). Results showed the best performance with ProTaper
in reciprocation. This technique offered the advantage of reaching the
WL with a more gradual and centered enlargement, progressing from
small to large tapers without forcing the file apically.
Reciprocation Versus Rotary and Other Systems
Previous SS RFs did not show promising shaping ability that could
support its potential use as a substitute to rotary NiTi systems (50–53,
55, 57, 59). After the introduction of NiTi RFs into the market,
numerous studies have compared those systems with different types
of NiTi rotary files. Investigators (62) found that WaveOne enhanced
the canal centering ability with less modification of the RC curvature
compared with ProTaper. Similar results have been reported in another
study (65). In general, reciprocating single files (RSFs) had similar
shaping ability and can preserve the original anatomy compared with
other NiTi RFSSs (66, 71, 79–84) as well as the Self-Adjusting File
(SAF) system (ReDent Nova Ltd, Ra’anana, Israel) operated with an
up/down vibration (71, 72) (Table 2). However, 1 study showed that
TF resulted in significantly lower RC transportation than WaveOne
(70). The authors referred this finding to the gradual increase in taper
in TF compared with WaveOne. Differences among studies might be
attributed to different canal curvatures used and methods for evaluation
(70, 79).
4 Plotino et al.
Conclusions
The amplitude of reciprocation has also
influenced the fatigue life of NiTi rotary
endodontic instruments.
Cyclic fatigue resistance of Reciproc R25
and TF Adaptive M-L1 was significantly
higher than WaveOne Primary.
Several studies compared the shaping ability of RFs with that of
OneShape in moderate and severe canal curvatures (66, 74, 85, 87,
88). Investigators (74) found that WaveOne maintained the original
RC anatomy better, with less modification of the canal curvature,
compared with OneShape. Similar observations have been reported
in other investigations (85, 87). However, another study (88)
showed that OneShape maintained the anatomy of S-shaped canals
better than both WaveOne and Reciproc. Other investigators (73)
compared the shaping ability of Reciproc and BioRaCe for long
oval canals, and the results showed that neither system was able
to completely contact all the dentin walls of RCs. BioRaCe left fewer
untouched dentin walls in the more coronal thirds, whereas R40 left
fewer in the apical third.
Three studies compared the shaping ability of WaveOne and
Reciproc with that of TF Adaptive (75, 84, 86). Two of them
found that TF Adaptive produced the least transportation and
better centering ratio compared with WaveOne and Reciproc. The
adaptive motion combined with the flexibility of the TF can be
the reason for the shaping results obtained with the TF Adaptive.
Another study (84) found that both Reciproc and TF Adaptive re-
tained the original RC curvature of severely curved and S-shaped
canals and caused no canal perforation or apical transportation.
This might be attributed to the prior use of a sequence of PathFiles
(Dentsply Maillefer) for obtaining a glide path in addition to the
application of resin-made prototype molds that showed lesser draw-
backs than the commercial resin blocks. Study findings may vary
because of the different hardness between simulated resin canals
and human root dentin (69).
Shaping Time
Reducing the shaping time (ST) allows clinicians to spend more
time refreshing NaOCl using activation techniques to enhance its
cleaning and disinfection (89). Some experiments assessed the total
time to shape the RC, clean the flutes, change the files, and irrigate
(59, 63, 66, 87, 88, 90–92). Other studies only considered the time
needed to mechanically shape the RCs, excluding the other steps (11,
26, 56, 58, 64, 68, 77, 93). As a result, it is quite difficult to make
fair comparisons of these different investigations. Several studies have
reported that using RSFs reduced the ST compared with RFSSs (58,
68, 90–93). However, another study did not reveal any significant
differences between the ST using RSF F2 and RFSS ProTaper (up
to F2) and TF (64).
Several publications found that the ST using Reciproc was signif-
icantly faster than WaveOne (87, 88, 90, 91) but slower than OneShape
(87). Only 1 study reported that WaveOne was significantly faster than
Reciproc (11).
The inexperience of students, who never used the WaveOne
before the experiment, led to a significantly extended ST (63). Like-
wise, experienced clinicians took more time to enlarge S-shaped ca-
nal simulators than L-shaped canals because of complex RC anatomy.
JOE — Volume -, Number -, - 2015
 Review Article
TABLE 2. Summary of Studies: Shaping Ability and Preserving the Anatomy of the Root Canal Shape
Author(s) Year System(s) Conclusion(s)
Lloyd et al (48) 1997 Safety H files Safety H files created hourglass
(Simulated root canals) preparations and have the potential to
[20 and 40 , 8 and 12 mm from orifice] create strip perforations in teeth.

et al (49)
Paque 2005 AET AET shaped root canals with substantial
(Human extracted teeth) canal transportation and removed high
[Slight to moderate curvatures] volumes of dentin even though apical
preparation was size 30. AET cannot be
recommended for the preparation of
teeth with curved root canals.
Grande et al (50) 2007 AET/ProTaper AET removed tooth structure at coronal
(Human extracted teeth) and middle thirds more than ProTaper.
[Oval-shaped canals] However, no differences were observed
at the apical third.
€ ttermann et al (51)
Ru 2007 AET/FlexMaster Both systems were not able to completely
(Human extracted teeth) prepare oval root canals.
[Oval-shaped canals]

pez et al (52)
Lo 2008 Triple Flex hand SS (balanced force and Reciprocating handpiece with size #35 and
reciprocation)/K3 #40 instruments caused significant
(Human

extracted teeth) apical transportation. When apical
[<40 curved canals] transportation is considered, the use of
size #30, 35, and 40 NiTi rotary files are
effective for apical preparation.
Taha et al (53) 2010 AET/H files/EndoWave None of the techniques resulted in
(Human extracted teeth) completely prepared and cleaned
[Oval-shaped canals] canals. No significant difference was
found among the 3 techniques with
regard to untouched surface.
Berutti et al (54) 2011 WaveOne Primary A significant decrease in the WL has been
(Human extracted teeth) observed. (The canal curvature
[10 –25 and >25 curved canals] significantly influenced the WL
variation.)
Eid and Amin (55) 2011 Manual H-files/ProTaper/SafeSiders None of the 3 instrumentation techniques
[Long oval canals] completely prepared the oval root
canal. Manual and rotary NiTi
instrumentation may perform better
than SafeSiders.
Franco et al (56) 2011 FlexMaster (Rotary vs Reciprocation) The shaping of simulated canals is more
(Endo training blocks) centered by using a reciprocating
[70 curved canals] motion when compared with
continuous rotation, but the
reciprocating motion could be more
time-consuming.
Nordmeyer et al (57) 2011 FlexMaster/AET AET cannot be recommended for the
(Human extracted teeth) preparation of curved root canals
[20 –40 curved canals] because of unacceptable straightening.

et al (58)
Paque 2011 Rotary ProTaper/ProTaper F2 Shaping outcomes with the single-file F2
(reciprocation) ProTaper and conventional ProTaper
(Human extracted teeth) were similar. However, the single-file F2
[20 –40 curved canals] ProTaper was markedly faster in
reaching the WL.
Rhodes et al (59) 2011 Vortex 0.06/SafeSiders Vortex .06 maintained the original root
(Human extracted teeth) canal curvatures well, whereas
[20 –50 curved canals] Safesiders showed significant
straightening and irregular preparation
shapes when used in sizes larger than
ISO 20.
You et al (60) 2011 ProTaper (continuous rotation and The application of reciprocating motion
reciprocation) during instrumentation did not result in
(Human extracted teeth) an increased apical transportation when
[20 –45 curved canals] compared with continuous rotation
motion.
Berutti et al (61) 2012 WaveOne Primary (With/without PathFile) A previous glide path before reciprocation
(Endo training blocks) appears to be appropriate for safely
shaping the canal.
Berutti et al (62) 2012 WaveOne Primary/ProTaper up to F2 WaveOne Primary better maintained the
(Endo training blocks) original canal anatomy, with less
modification of the canal curvature
compared with the ProTaper.
(Continued )

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Review Article
TABLE 2. (Continued )
Author(s) Year System(s) Conclusion(s)
Goldberg et al (63) 2012 WaveOne WaveOne had excellent centering ability
(Endo training blocks) with a low risk of fracture/blockage and
[30 curved L-shaped canals] a short shaping time regardless of the
operator’s experience.
Stern et al (64) 2012 TF/ProTaper—reciprocation and rotation All systems were capable of producing
up to F2 centered preparations with no
(Human extracted teeth) substantial procedural errors.
[20 –45 curved canals]
You and Cho (65) 2012 Reciproc/WaveOne/ProTaper/Profile/K-file Reciproc and WaveOne maintained the
(Endo training blocks) original canal curvature better than
[40 curved canals] ProTaper and Profile, which tend to
transport toward the outer canal wall of
the curve in the apical part of the canal.
€ rklein et al (66)
Bu 2013 Reciproc/F360/OneShape/Mtwo All instruments respected the original
(Human extracted teeth) canal curvature. The use of Reciproc and
[25 –35 curved canals] OneShape required less time compared
with Mtwo and F360.
De-Deus et al (67) 2013 Reciproc R25 Reciproc is able to reach the FWL of
(Human extracted teeth) straight- and moderate-curved canals
[0 –5 and 10 –20 curved canals] without a glide path in a large
proportion of cases.
Jin et al (68) 2013 Profile/RaCe Although the reciprocating technique
[Rotary (full set) vs Reciprocation (25/ seems to be an effective alternative to
0.06)] the rotation technique, the risk of
(Endo training blocks) torsional distortion and fracture should
[J-shaped canals] be considered before clinical
application.
Kim et al (47) 2013 WaveOne Primary/ProTaper F2 Both systems can be safely used under each
(Reciprocation) reciprocating motion without apical
(Human extracted teeth) transportation. However, the
[20 –45 curved canals] metallurgic property resists cyclic
fatigue was more favorable with
WaveOne. (Crack propagation was
more frequent in ProTaper F2.)
Lim et al (69) 2013 WaveOne Primary/Reciproc (with and Both instrumentation systems show an
without glide path) adequate centering ability. However,
(Endo training blocks) WaveOne should be used following
[45 curved canals] establishment of a glide path larger
than #15.
Marzouk and Ghoneim (70) 2013 Twisted File/WaveOne Primary Application of WaveOne increased canal
(Human extracted teeth) transportation when compared with TF,
[25 –35 curved canals] but both systems can be safely used to
the full WL.
Siqueira et al (71) 2013 Twisted File/SAF/Reciproc The 3 instrumentation systems have similar
(Human extracted teeth) shaping performance in the preparation
[Straight or slightly curved] of mesial canals of mandibular molars.
Versiani et al (72) 2013 SAF/WaveOne/Reciproc/ProTaper All systems performed similarly in terms of
(Human extracted teeth) the amount of touched dentin walls.
[Straight single rooted] Neither technique was capable of
completely preparing the oval-shaped
root canals.
Busquim et al (73) 2014 Reciproc 40/BioRaCe Neither system was able to completely
(Human extracted teeth) prepare the outline of canals. BioRaCe
[Long oval canals] left fewer untouched dentin walls in the
more coronal thirds, whereas Reciproc
left fewer in the apical third.
Dhingra et al (74) 2014 WaveOne Primary/OneShape WaveOne NiTi Primary better maintained
(Endo training blocks) the original canal anatomy, with less
[J-shaped canals] modification of the canal curvature
compared with OneShape.
Gergi et al (75) 2014 WaveOne/Reciproc/TF Adaptive The TF Adaptive system was found to have
(Human extracted teeth) less canal transportation and better
[Severe curvatures] centering ability when compared with
the reciprocating groups.
Giuliani et al (76) 2014 WaveOne/Full sequence ProTaper Full-sequence ProTaper files used in a
universal (with/without reciprocation) reciprocating motion exhibited better
(Resin blocks) shaping effects than full-sequence
[S-shaped canals] ProTaper used in a conventional motion
and WaveOne.
(Continued )

6 Plotino et al. JOE — Volume -, Number -, - 2015


TABLE 2. (Continued )
Author(s) Year System(s)
Hwang et al (77) 2014 Mtwo (with and without reciprocation)/
Reciproc
(Human
extracted teeth)
[25-35 curved canals]
Jeon et al (78) 2014 WaveOne/Reciproc 25
(Endo training blocks)
[J-shaped canals]
Junaid et al (79) 2014 WaveOne/TF
(Human

extracted teeth)
[20 curved canals]
Junior et al (80) 2014 MTwo/Reciproc (0.25 and 0.40-mm)
(Human extracted teeth)
[25 –35 curved canals]
Marceliano-Alves et al (81) 2014 Reciproc/WaveOne/TF/HyFlex CM
(Human extracted teeth)
[10 –20 curved canals]
Moghadam et al (82) 2014 Reciproc/TF
(Human extracted teeth)
[15 –30 curved canals]
Nabavizadeh et al (83) 2014 Reciproc/BioRace
(Human extracted teeth)
[25 –35 curved canals]
Ordinola-Zapata et al (84) 2014 Reciproc/TF adaptive
(Simulated resin models)
[S-shaped and 62 curved canals]
Tambe et al (85) 2014 ProTaper/OneShape/WaveOne
(Human extracted teeth)
[<10 curved canals]
Gergi et al (86) 2015 WaveOne/Reciproc/TF Adaptive
(Human extracted teeth)
[Severe curvatures]
Saber et al (87) 2015 WaveOne/Reciproc/OneShape
(Human extracted teeth)
[25 –35 curved canals]
Saleh et al (88) 2015 WaveOne/Reciproc/OneShape/F360
(Endo training blocks)
[S-shaped canals]
AET, Anatomic Endodontic Technology; NiTi, nickel-titanium; WL, working length.
One study reported that there was a linear inverse relationship
between decreasing the reciprocating range (clockwise/counterclock-
wise angles) of the WaveOne and the time needed to reach the WL (26).
Because numerous publications have compared RFs versus rotary
files, it is difficult to distinguish the respective influence of different pa-
rameters, including kinematics, file design, and the number of instru-
ments on the ST. One study did not detect significant
JOE — Volume -, Number -, - 2015
Review Article
Conclusion(s)
Mtwo in a reciprocating motion exhibited
similar shaping ability to Reciproc.
Mtwo in a continuous rotation caused
more transportation than when used in
a reciprocating motion.
Although the 2 reciprocating systems did
not show differences in apical
preparation size, a greater number of
pecking times at the WL may result in an
apical size that is larger than the actual
file size.
No difference exists between WaveOne
and TF when considering apical
transportation in curved canals.
Both systems performed similarly. The
increase of the root canal preparation
with the 0.40-mm instrument
significantly increased the root canal
volume at the apical third without
significantly reducing the dentin
thickness in the danger zone.
TF and HyFlex CM were able to maintain
the original canal anatomy with less
canal transportation than Reciproc and
WaveOne; however, these differences
are unlikely to be of clinical significance.
TF and Reciproc systems do not differ
significantly in terms of canal centering
ability and transportation.
Both systems caused slight alteration of
the original root canal shape. Reciproc
resulted in more apical transportation
than BioRace. However, the difference is
unlikely to be of clinical significance.
Both systems were able to maintain the
original shape at the apical third of
severely curved mesial canals of molar
replicas.
The canal preparation with WaveOne files
showed lesser transportation and better
centering ability than OneShape and
ProTaper.
None of the NiTi systems was able to
instrument completely the entire root
canal. The TF Adaptive maintained the
original canal anatomy with less canal
transportation and better centering
ability.
Reciproc and WaveOne respected the
original canal curvature better than
OneShape files. The use of OneShape
instruments required less time to
prepare the curved canals compared
with Reciproc and WaveOne.
Both reciprocating files showed a marked
tendency to straighten the S-shaped
canals, whereas F360 and OneShape
files maintained the original canal
curvatures well. Single files that are less
tapered should be preferred.
differences between Reciproc and Mtwo used in RM and CR in ST, sug-
gesting that kinematics did not influence the latter (77).
The time needed to remove the RCFMs and to reach the WL has
been studied. Investigators found that reciprocation usage may not
reduce the time for RCFM removal compared with conventional retreat-
ment sequences (94–97). However, others have reported a reduction
of the time needed for RCFM removal with RFs (98–100). The time
Reciprocation in Endodontic Preparation 7
Review Article
needed for removing RCFMs was also compared between WaveOne and
Reciproc with no significant difference (101). Overall, the conflicting
conclusions should not lead one to consider the time for RCFM removal,
separately, as a critical factor for choosing files. It should be correlated
with the cleaning effectiveness and debris extrusion during retreatment
procedures.
Cleaning Effectiveness
The amount of smear layer (SL) and debris has been assessed at
different levels of the RCSs using SEM analyses associated with a
numeric evaluation scale (91, 102, 103). Histologic evaluation of the
residual pulp tissue was also used to determine the debridement
quality after RCP (104). Recent studies used micro–computed tomo-
graphic (microCT) imaging to determine the 3-dimensional distribu-
tion of remaining inorganic debris in the RCS irregularities such as
isthmus and fins (105, 106).
Prior studies have shown that thorough cleanliness is often not at-
tained, especially in the apical third (107–109). The shaped canal may
still contain bacteria and debris after mechanical shaping (110);
copious irrigation with NaOCl is essential to reduce the bacterial
colonies. One study found no significant difference regarding the
pulp tissue remnants in the last 3 mm after using an RSF F2 ProTaper
or an RFSS ProTaper in round canals (104). However, the percentage
of pulp remnants was significantly higher for the RSF group in oval-
shaped RCs. Investigators (111) concluded that there was no significant
difference in cleaning ability among the SAF, WaveOne, and K3 except in
the isthmus where the shaping was the worst after WaveOne usage.
A study using microCT analysis reported that WaveOne usage led to
more debris accumulation than ProTaper, especially in the isthmuses
and fins of mandibular molars (105). Another experiment compared
the volume of debris generated after different apical enlargement with
RFs (WaveOne and Reciproc) or rotary files (BioRaCe), and it showed
that all canals contained packed debris with no significant difference
between the systems (106). Another study evaluated the amount of
debris and SL remaining after RCP with RSFs (Reciproc or WaveOne)
or RFSSs (Mtwo or ProTaper) (91). In that study, Mtwo and Reciproc
led to better debris removal in the apical third than WaveOne and Pro-
taper. These results suggested that the file design was more decisive than
the number of instruments used and their kinematics. Findings
concerning the remaining SL revealed that there was no significant
difference between different systems. Another publication confirmed
these findings and showed that Mtwo, WaveOne, and Reciproc were
quite similar in terms of SL removal (103).
Microcracks
Dentin microcracks (DMs) and fractures can lead to endodontic
failures. Several factors can induce DMs (112, 113) including RCP. In
terms of methodology, DM incidence is generally assessed at different
levels of the RC under magnification (114–127). Some studies used
infrared thermography (128), finite element analysis (129), or
microCT to determine the risk of DMs after RCP (130, 131). The rate
of DM is highly variable depending on the methodologies that were
used. The generic term dentinal defects was generally used to
include different types of DMs (132) that extend from the RC toward
the outer surface (partial or complete if it reaches the outer
surface of the root) and that extend from the outer root surface into
the dentin without reaching the RC (craze lines [CLs]).
Results of numerous studies did not distinguish CLs from DMs ex-
tending from the canal lumen, and results were generally pooled in 1
group (dentinal defects; ie, cracks) (113–119, 122, 123, 126, 127,
130). Indeed, considering a possible relationship between CL
8 Plotino et al.
incidence and RCP, their presence observed in 1 root section should
communicate with the canal in another section (133), depending on
the root section inclination and the path of the DMs.
To more closely simulate in vivo conditions, a pilot study was per-
formed with cadaver mandibles, and no relationship between RCP and
DM incidence was reported (118). Likewise, some studies did not show
a significant increase of DMs after RCP with different systems (119),
including RSFs (130) compared with unshaped control groups. How-
ever, other publications clearly highlighted DM incidence after RCP us-
ing CR or RM (117, 120–122, 124, 126, 127, 129, 131, 134) or after
retreatment procedures (125). Some have suggested that the file design
may influence the dentin fracture susceptibility (129), but others did
not (115, 134). Another study advocated that the alloy of the file may
also affect DM incidence more than the kinematics used for RCP
(117). Several recent investigations have also compared the incidence
of DMs after RCP with either RM or CR. Studies showed that WaveOne
could be associated with less DMs than ProTaper Universal (114, 120,
123). Similarly, Reciproc caused fewer DMs than ProTaper and
OneShape (116, 124). Other studies did not yield significant
differences regarding the frequency of DMs after RCP using
reciprocating or rotating systems (121, 126, 127).
Overall, DMs can occur independently regardless of the type of
files used and its kinematics (RFSSs or RFs). To date, considering the
findings of previous studies, RFs generally led to fewer or equivalent
DMs compared with RFSSs.
Bacterial Reduction
Disinfection of the RCS is of utmost importance in endodontic ther-
apy (71, 135–139). Investigators (137) compared the bacterial reduc-
tion in oval-shaped RCs using Reciproc R40 and BioRaCe under the
same irrigation protocol, and they found that both systems were com-
parable, yielding significant bacterial reduction. Others (135) reported
significant count reductions of Enterococcus faecalis when WaveOne
and Reciproc were used; similar observations have also been reported
(136).
Investigators (71) examined the ability of Reciproc R25, SAF, and
TF systems to reduce bacterial counts isolated from the mesial roots of
mandibular molars. Results confirmed the ability of all systems to pro-
mote significant bacterial reduction despite the detection of positive cul-
tures, probably because of the complex RCS of the mesial roots.
Researchers (138) reported similar findings when Reciproc was
compared with other RFSSs; all systems were able to effectively eliminate
virtually all the bacteria and their endotoxins.
Based on these results, we can conclude that the mechanical
action of endodontic files on dentin together with adequate exposure
to NaOCl irrigation is more effective for disinfection than the number
of files used. A clinical study showed that both RFs and RFSSs showed
similar effectiveness in reducing endotoxins and cultivable bacteria,
but they were not able to completely disinfect all RCSs analyzed
(139). Similar observations have been reported in removing endo-
toxins and cultivable bacteria in endodontic retreatment (140).
Extrusion of Debris
During RCP, dentin chips, pulp tissue, microorganisms, endo-
toxins, and/or irrigants may be extruded into the periradicular tissues,
which may potentially cause postoperative complications (90, 141).
Researchers (141) reported favorable input of the F2 ProTaper under
RM in terms of debris extrusion. One study compared debris extrusion
associated with ProTaper and Mtwo with that of Reciproc and WaveOne,
and it was found that more debris extrusion was associated with the
latter 2 systems (90), which is consistent with 2 studies (92, 142).
JOE — Volume -, Number -, - 2015

However, other studies have reported lesser debris extrusion us-
ing RM compared with other systems (143–146). Investigators (143)
compared 4 NiTi systems and found that the SAF system showed the least
debris extrusion followed by ProTaper Next and WaveOne, which were
significantly better than ProTaper Universal. However, WaveOne showed
less debris extrusion than ProTaper Next and TF when used at a smaller
size (ie, 25/0.08) (145). Similar results have been reported (146).
Others (144) found that both WaveOne and Reciproc were able to mini-
mize the extrusion of bacteria compared with BioRaCe. No significant
differences between RFs and continuous rotary files (CRFs) were
reported (98, 147). These contradicting findings might be explained
by differences in the design of the investigations (98, 146).
Despite the differences reported among different RFs (148, 149),
it seems that the apical debris extrusion of RFs is not affected by the
irrigation system used or the size of apical preparation (149, 150).
Two studies compared the extrusion of debris during retreatment
procedures using CRFs and RFs (97, 151), and results showed they are
associated with lesser debris extrusion compared with CRFs (97, 151).
Removal of Root Canal Fillings
The proper removal of RCFMs from inadequately prepared and
filled RCs requires a substantial effort and can be challenging and
time-consuming (99, 101). Many studies evaluated the application of
RFs to remove gutta-percha from the RCS (94–96, 99–101, 125,
152–158). With the exception of 4 studies (99, 152, 154, 156),
there is a general agreement:
1. The application of RFs is as effective as CRFs (95, 96, 100, 153, 157,
158), yet no one system is able to effectively remove RCFM
completely from the RCS.
2. The extrusion of RCFMs can occur in both systems (100).
One study showed that ProTaper used with adaptive motion
enhanced the removal of RCFMs from the RCS compared with CR
(94). This might be attributed to the synergistic effect of both CR and
RM.
The literature indicates that procedural errors might occur during
the retreatment procedure. Investigators (96) compared the ProTaper
retreatment files with that of Reciproc and reported 3 lateral perfora-
tions in the coronal third of RCs with the rotary system, which was
not observed in the latter. However, 1 file out of 20 from each system
was fractured.
Concluding Remarks
Based on the discussion we just described, we conclude the
following:
1. Reciprocation extends the life span of the NiTi files.
2. The amplitude of reciprocation has a significant influence on the
cyclic fatigue life of the files.
3. Reciprocation does not reduce the cutting efficiency of the files.
4. RFs have adequate shaping ability and can preserve the original RC
shape, yet no system is able to entirely prepare the RCS.
5. The cleaning effectiveness of RFs appears comparable with RFSSs.
Further experiments should be conducted to understand the
respective influence of the kinematics, the file design, and the num-
ber of instruments.
6. RSFs usage reduces the ST compared with RFSSs.
7. DMs can occur independently, regardless of the type of file and its
kinematics, but considering the results of studies, reciprocating
files seem to cause fewer or an equivalent rate of DMs compared
with rotary full-sequence systems.
JOE — Volume -, Number -, - 2015
Review Article
8. RFs combined with adequate irrigation procedures can promote
significant bacterial reduction but are not able to completely disin-
fect the RCS.
9. The ability of RFs to extrude less debris than CRFs is controversial.
10. RFs are effective in removing the RCFMs in less time compared with
CRFs, yet no system is able to remove the filling material completely
from the RCS.
Acknowledgments
The authors deny any conflicts of interest related to this study.
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