Basic Research—Technology

Glide Path Management with Single- and

Multiple-instrument Rotary Systems in Curved Canals:
A Micro–Computed Tomographic Study
Alison Lu
ıs Kirchhoff, DDS, MSc,* Rene Chu, DDS, MSc,† Isabel Mello, DDS, MSc, PhD,‡
Andres Dario Plazas Garzon, DDS,§ Marcelo dos Santos, DDS, MSc, PhD,k
and Rodrigo Sanches Cunha, DDS, MSc, PhD†

Abstract
Introduction: Securing a reproducible glide path before
instrumentation is recommended to maintain the orig-
inal geometry of the root canal system and to prevent
file separation. Mechanical glide path management sys-
tems have been introduced to expedite this step. The
aim of this study was to compare apical transportation,
canal volume increase, and working time during glide
path management with ProGlider (PG; Dentsply Tulsa
Dental Specialties, Tulsa, OK) and PathFiles (PF, Dents-
ply Tulsa Dental Specialties). Methods: Forty curved
mesial canals of mandibular molars were randomly allo-
cated into 2 experimental groups (n = 20) according to
the glide path management system: PG or PF. A glide
path was achieved according to the manufacturers’ pro-
tocol. Micro–computed tomographic analysis was per-
formed to assess apical transportation at 1, 3, and
5 mm and volume increase. The time required to achieve
the glide path was measured. Results: The overall api-
cal transportation mean values ( standard error) were
13.33  3.37 mm for PG and 19.21  4.4 mm for PF
(P > .05). The mean ( standard error) volume increase
values were 0.49  0.06 mm3 for PG and
0.48  0.06 mm3 for PF (P > .05). A statistically signif-
icant difference in the working time was found between
the groups (P < .0001) where the mean ( standard er-
ror) values for time were 7.38  1.73 seconds for PG
and 20.61  5.54 seconds for PF. Conclusions: Similar
apical transportation and volume increase occurred dur-
ing glide path management with PG single-file and PF
multi-file systems; however, PG achieved glide path
faster than PF. (J Endod 2015;-:1–4)
Key Words
Apical transportation, glide path, micro–computed
tomography, ProGlider, PathFile
E ndodontic glide path management has been described as the patency from the
canal orifice to the apical foramen, and it is considered an important step for
the safety of the cleaning and shaping procedure (1). The glide path can be
achieved with both hand and rotary instruments (2); however, the performance
of this procedure using hand files may be difficult and time-consuming, particularly
in teeth with constricted and/or severely curved canals (3). Hence, recent investiga-
tions have focused on nickel-titanium (NiTi) rotary instruments to achieve a safe and
predictable glide path (2–5).
Clinical procedures and an ideal shaping protocol are still being developed as new
instruments continue to be introduced to the market. New versions are rapidly
becoming available, and the clinician may find it difficult to choose which file system
and/or technique is more suitable for each individual case (6). The PathFile system
(PF; Dentsply Tulsa Dental Specialties, Tulsa, OK) consists of 3 instruments with a fixed
.02 taper and a square cross section used for the purpose of achieving a glide path. The
tip size varies depending on the file number; PF #1 has an ISO .13-mm tip size, the PF #2
has an ISO .16-mm tip size, and the PF #3 has an ISO .19-mm tip size. PF instruments are
manufactured out of conventional NiTi alloy (4), and their use is associated with
improved centering ability and a reduction of canal aberrations (7, 8).
More recently, a new single-file rotary instrument was introduced to the
market also for the purpose of producing a glide path. The ProGlider (PG, Dentsply
Tulsa Dental) is manufactured using a heat-treated M-Wire NiTi alloy to enhance flex-
ibility and cyclic fatigue resistance (4), and its design and mechanical features enable
the glide path to be created by a single instrument. PG has a square cross section, tip size
of .16 mm, a progressive taper (from .02 to .08), and 18 mm of cutting surface. The
progressively tapered design allows the PG to provide a preliminary preflaring of the
middle and coronal portions of the canal while creating a glide path (5).
Micro–computed tomographic (micro-CT) scanners accurately reproduce inter-
nal and external tooth morphology without tooth destruction and have the ability to
accurately determine surface and volume changes after instrumentation (9–13).
They also allow the superimposition of 3-dimensional renderings of the preoperative
and postoperative canal system with high resolution (14).
To our knowledge, no study has yet compared differences in glide path manage-
ment using PG and PF with regard to apical transportation, canal volume increase, and
working time.

From the *Endodontic Fellowship Program and †Department of Restorative Dentistry, Discipline of Endodontics, University of Manitoba, Winnipeg, Manitoba,
Canada; ‡Department of Dental Clinical Sciences, Division of Endodontics, Dalhousie University, Halifax, Nova Scotia, Canada; §Discipline of Endodontics, University
of Toronto, Toronto, Ontario, Canada; and kDiscipline of Endodontics, University of S~ao Paulo, S~ao Paulo, S~ao Paulo, Brazil.
Address requests for reprints to Dr Rodrigo Sanches Cunha, Department of Restorative Dentistry, Faculty of Health Sciences, College of Dentistry, D227 A–780
Bannatyne Avenue, Winnipeg, MB R3E 0W2 Canada. E-mail address: rodrigo.cunha@umanitoba.ca
0099-2399/$ - see front matter
Copyright ª 2015 American Association of Endodontists.
http://dx.doi.org/10.1016/j.joen.2015.07.014

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Basic Research—Technology
Materials and Methods
The research design was approved by the University of Manitoba
Research Ethics Board (H2014:311).

Sample Selection
Twenty fully developed human mandibular molars with 2 separate
curved mesial roots ending in 2 separate foramens and with an average
curvature of 34 as determined by Schneider’s method (15) were
selected for this study. The sample size was determined based on pre-
vious studies of this nature (2, 3, 13, 16–18). All experimental
procedures were performed by 1 endodontist. The crowns were
flattened with steel disks, and a standardized length of 16 mm was
achieved for each tooth.

Micro-CT Analysis
Pre- and postinstrumentation micro-CT scans were performed to
allow for a nondestructive, quantitative assessment of both volume in-
crease and apical transportation. Individual custom jigs were fabricated
to ensure that each specimen was placed exactly in the same position for
pre- and postinstrumentation imaging. The SkyScan 1176 micro-CT sys-
tem (Bruker microCT; Bruker, Aartselaar, Belgium) was used to scan
all teeth, and all scanning and reconstruction parameters were kept
constant for pre- and postinstrumentation scans (scanning: source
voltage: 80 kV, current: 313 mm, 18-mm resolution, copper and
aluminum filter, 83-second exposure time, 0.7 rotation step, and
360 acquisition; reconstruction: ring artifact reduction factor of 10
and beam hardening correction of 30%). CTAn v1.10.1.0 software
(Bruker-microCT, Kontich, Belgium) was used for the 3-dimensional
volumetric visualization analysis and measurement of the volume in-
crease. Comparison of the equivocal 2-dimensional slices obtained
before and after instrumentation allowed for direct visualization of
the location, amount, and direction of apical transportation (Fig. 1).
The 3 sections of interest were 1, 3, and 5 mm from the foramen. Figure 1. Cross sections of the superimposed root canals before (green) and
The sections were determined by identifying the slice in which the fora- after (red) glide path management.
men was first visible (0-mm mark) and then adding 56 slices to achieve
the first mm followed by 112 slices to achieve 3 mm and another 112 gation was executed with 2 mL 5% sodium hypochlorite delivered with a
slices to achieve 5 mm. The same slices were compared pre- and post- 27-G needle attached to a syringe (Endo Eze; Ultradent Products Inc,
instrumentation. South Jordan, UT) after each file insertion. Patency was maintained
with a #08 K-file set 1 mm past the WL and used after every irrigation
Experimental Procedures cycle. Canals were irrigated with 3 mL 17% EDTA after glide path pro-
Access to the canal was obtained in the conventional manner. The cedures were completed in each group. After glide path management,
canals were negotiated with a #08 hand file (Dentsply Tulsa Dental) in micro-CT scans were taken as previously described.
the presence of 5% sodium hypochlorite, and the working length (WL)
was determined under 10 magnification (Carl Zeiss, Oberkochen,
Working Time
Germany) by advancing the same file until it was visible at the apex
The working time for glide path management was measured and
and then subtracting 0.5 mm from this length. The initial glide path
recorded in seconds with a digital chronometer set only when the files
was created with #08 and #10 hand files (Dentsply Tulsa Dental).
were rotating inside the canal.
The canals were then randomly divided into 2 groups using a computer
algorithm (http://www.random.org) according to the system for glide
path management in which 1 canal of each tooth was allocated to PG Assessment of Apical Transportation
and the other to PF. The PG single-file glide path was achieved with Two calibrated examiners, blinded as to which file system had
the PG rotary file (016, .02 at tip level, with progressive taper). The instrumented which canal, measured the cross-sectional images using
PF system glide path was achieved with PF rotary instruments #1 (13/ DataViewer software (Bruker-microCT). The final values were obtained
.02), #2 (16/.02), and #3 (19/.02). Equal numbers of mesiobuccal by taking the mean of the examiners’ measurements. The method modi-
and mesiolingual canals were allocated to both sample groups during fied by Gergi et al (19) was used whereby the shortest distance from the
randomization. The files were used following the manufacturer’s periphery of the canal to the periphery of the root was measured. Pre-
instructions. and postinstrumentation measurements were compared to assess the
Only new instruments were used for the following procedures. In magnitude and direction of apical transportation using the following
both groups, all the instruments had to reach the WL. Files were pow- formula: (X1  X2)  (Y1  Y2), where X1 represents the shortest
ered by an electric engine (ProMark, Dentsply Tulsa Dental) operated at distance from the mesial edge of the uninstrumented canal to the mesial
300 rpm with a 16:1 reduction handpiece and 5-Ncm torque. Canal irri- edge of the root, Y1 is the shortest distance from the distal edge of the

2 Kirchhoff et al. JOE — Volume -, Number -, - 2015

 Basic Research—Technology
uninstrumented canal to the distal edge of the root, X2 is the shortest TABLE 2. Absolute Mean Values and Standard Error (SE) of Volume Changes
distance from the mesial edge of the instrumented canal to the mesial (in mm3) after Glide Path Management with ProGlider and PathFiles
edge of the root, and Y2 is the shortest distance from the distal edge Before After Difference
of the instrumented canal to the distal edge of the root (10). A positive
value represented mesial movement, whereas a negative value Group Mean SE Mean SE Mean SE
represented distal movement or movement toward the furcation. ProGlider 1.93a 0.21 2.42b 0.25 0.49A 0.06
PathFiles 1.87a 0.22 2.35b 0.25 0.48A 0.06
Statistical Analysis Different lowercase letters in the same row and different uppercase letters in the same column denote
SAS software (version 9.3; Institute Inc, Cary, NC) was used for statistical difference (P < .05).
statistical analysis. Significance was set at P < .05. Between-group effects
were tested using the Wilcoxon test (apical transportation) and gener-
alized linear mixed model (volume and working time) to control for
glide path created mechanically might be faster and associated with a
same specimen correlation. Comparisons before and after glide path
lower prevalence and severity of postoperative pain (7, 14).
management within the group were analyzed using paired t tests (apical
Several studies have stated that the use of NiTi rotary files is the
transportation and volume).
most efficient method to achieve a glide path while preventing iatrogenic
endodontic mishaps (7, 8, 14). The present study compared 2
Results mechanical glide path systems: the PG single-file system and the PF
Apical Transportation multiple-file system.
No significant difference was found in apical transportation The samples were carefully selected for this study. Only mesial
between the PG and PF in all levels assessed (P > .05). Comparisons roots of lower molars with an average curvature of 34 that had 2 sepa-
made among the levels showed a statistical difference only between rate canals ending in 2 separate foramina were used. These features in
the 3- and 5-mm levels in both groups (P < .05, Table 1). the same tooth provide an excellent model of side-by-side comparison
for the 2 glide path management systems (23, 24). Curved canals were
Volume selected for this study because they pose a challenge for glide path
A significant increase in volume occurred after mechanical glide management (6).
path management in both groups (P < .05). No significant difference Micro-CT scanning is a nondestructive technique capable of
in volume was found between PG and PF (P > .05, Table 2). qualitative and quantitative assessment of the root canal system in 3
dimensions (12). Data obtained with micro-CT scans enable the iden-
Working Time Analysis tification of morphologic changes associated with different biomechan-
A significant difference in the length of time needed for glide path ical preparations including canal transportation, dentin removal, and
management was found between PG and PF (P < .0001, Table 3), with final canal preparation (6, 13, 14). A major advantage of micro-CT
PG requiring less time than PF. scanning is the ability to obtain highly accurate evaluation of root canal
shape by the superimposition and measurement of preoperative and
postoperative 3-dimensional renderings (26).
Discussion Some degree of apical transportation occurs during glide path
Identifying factors that might impact canal transportation such as preparation with either manual or mechanical techniques, and several
root canal anatomy, file design, alloys used for instrument studies showed no difference in apical transportation between the 2
manufacturing, and instrumentation technique have been widely approaches (2, 16, 27–29). PF has proved to be capable of
discussed (13, 20–24). Transportation of the canal increases the maintaining the original canal anatomy, decreasing instrument
risk of blockage, perforation, ledge creation, and unnecessary separation during canal shaping, causing fewer canal aberrations,
removal of tooth structure, resulting in decreased prognosis of the and causing less postoperative pain when compared with hand files
endodontic treatment (17). (2, 7, 8, 14, 17, 30). Although the PF system has been well studied,
The creation of a glide path is essential to allow proper action of there is no research evaluating the apical transportation caused by
NiTi instruments either used in a rotary or reciprocating motion (17). A the PG system. In this study, root canal transportation caused by PG
mechanical or manual glide path is key to reducing the effect of and PF was evaluated at 1, 3, and 5 mm short of the apical foramen
torsional stresses along the canal, the screwing effect of rotary instru- because this is the area where transportation may potentially occur
ments, and the risk of instrument failure (1, 25). Furthermore, a (18, 31, 32). Transportation occurred at all levels, and it was more
pronounced at 1 and 3 mm. The apical area is where instruments
TABLE 1. Absolute Mean Values and Standard Error (SE) of Canal are likely to cause canal transportation. The 2 systems caused a
Transportation (in mm) at 1, 3, and 5 mm from the Apex after Glide Path similar degree of apical transportation at each level.
Management with ProGlider and PathFiles Although it was expected that PG would create a higher increase in
volume than PF because of its progressive taper, there were no differ-
Group
ences between the 2 groups. PF #3 has a D1 of .21 mm and PG has a
ProGlider PathFiles
Level Mean SE Mean SE
aA aA
1 mm 18.68 3.97 26.68 5.9 TABLE 3. Absolute Mean Values and Standard Error (SE) of Time Needed (in
3 mm 16.88aA 4.4 21.31aA 3.9 seconds) for Glide Path Management with ProGlider and PathFiles
5 mm 4.42aB 1.75 9.65aB 3.4
Total 13.33a 3.37 19.21a 4.4 Group Mean ± SE Lowest Highest P value
Different lowercase letters in the same row and different uppercase letters in the same column
ProGlider 7.38  1.73 6.41 8.34 .0001
PathFiles 20.61  5.54 19.65 21.58
(Wilcoxon test) denote statistical difference (P < .05).

JOE — Volume -, Number -, - 2015 Glide Path Management in Curved Canals 3

Basic Research—Technology
D1 of .18 mm so, although lacking a progressive taper, the PF system
probably managed to cause a greater increase in volume in the more
apical area than PG because of its tip size. Additionally, the average
length of the root canals in this study was 11 mm. PG has a .44 taper
at 10 mm, and #3 PF has a .39 taper. Perhaps the variation in taper
of .05 between the 2 systems was not enough to cause a difference.
To summarize, the combination of D1 size and taper in each system
may explain the results obtained.
PG achieved a glide path faster than PF. This may be explained by
the fact that the PG is composed by only 1 instrument in comparison
with the PF in which 3 instruments are needed to complete glide path
management. Rotary instrumentation has been shown to be faster
when glide path management was performed with PG in comparison
with PF #1 and #2 (5).
In conclusion, according to this ex vivo study, apical transporta-
tion and volume increase occurred during glide path management with
both PG single-file and PF multifile systems with no difference between
them; however, PG achieved a glide path faster than PF.
Acknowledgments
The authors would like to thank Dentsply Tulsa Dental Spe-
cialties for provision of files, Dr. Michael Jackson for his support
with the micro-CT analysis, and Drs. Martha Brilliant and Wayne
Maillet for reviewing the paper.
The authors deny any conflicts of interest related to this study.
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