doi:10.1111/iej.
12071
The influence of simulated clinical use on the
flexibility of rotary ProTaper Universal, K3 and
EndoSequence nickel–titanium instruments
A. C. D. Viana1, E. S. J. Pereira1, M. G. A. Bahia1 & V. T. L. Buono2
1
Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG; and
2
Department of Metallurgical and Materials Engineering, Engineering School, Universidade Federal de Minas Gerais, Belo
Horizonte, MG, Brazil
Abstract
Viana ACD, Pereira ESJ, Bahia MGA, Buono VTL.
The influence of simulated clinical use on the flexibility of
rotary ProTaper Universal, K3 and EndoSequence nickel–
titanium instruments. International Endodontic Journal, 46,
855–862, 2013.
Aim To investigate the influence of cyclic flexural
and torsional loading on the flexibility of ProTaper
Universal, K3 and EndoSequence nickel–titanium
instruments, in view of the hypothesis that these
types of loading would decrease the flexibility of the
selected NiTi rotary files.
Methodology The instruments evaluated were S2
and F1 ProTaper Universal, sizes 20 and 25, .06
taper K3, and sizes 20 and 25, .06 taper EndoSe-
quence. Flexibility was determined by 45° bending
tests according to ISO 3630-1 specification. Values of
the bending moment (MB) obtained with new instru-
ments were considered as the control group (CG).
Bending tests were then conducted in instruments
previously fatigued to one-fourth and three-fourths of
their average fatigue life (fatigue groups, FG¼ and
FG¾), as well as after cyclic torsional loading
(torsional group, TG). Fatigue tests were carried out
Introduction
The use of superelastic nickel–titanium (NiTi) alloys
in the manufacture of engine-driven endodontic
Correspondence: Vicente T. L. Buono, Department of Metal-
lurgical and Materials Engineering, Universidade Federal de
Minas Gerais, Av. Antonio Carlos 6627 – Bloco 2 – room
2640 31270-901, Belo Horizonte, MG, Brazil (e-mail:
vbuono@demet.ufmg.br).
© 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd
in a bench device that allowed the files to rotate freely
inside an artificial canal with an angle of curvature of
45° and a radius of 5 mm. Cyclic torsional loading
tests were performed that entailed rotating the instru-
ment from zero angular deflection to 180° and then
returning to zero applied torque in 20 cycles. Data
were analysed using one-way analysis of variance at
a significance level of 5%.
Results Simulated clinical use by means of flexural
fatigue tests did not affect the flexibility of the instru-
ments, except for a significant increase in flexibility
observed in a few instruments (P < 0.05). In addition,
comparative statistical analyses between the values of
MB measured in new instruments and after cyclic
torsional loading showed no significant differences
between them (P > 0.05).
Conclusions The flexibility of rotary ProTaper Uni-
versal, K3 and EndoSequence NiTi instruments, mea-
sured in bending tests, was not adversely affected by
simulated clinical use in curved root canals.
Keywords: NiTi endodontic instruments, flexibility,
flexural fatigue, torsional cyclic loading.
Received 4 December 2011; accepted 22 January 2013
instruments has simplified the preparation of root
canal systems, facilitating the maintenance of the
original canal shape (Sch€ afer et al. 2004). The prop-
erties of NiTi alloys, one of which is superelasticity,
are related to a reversible solid-to-solid phase transfor-
mation – the martensitic transformation – which can
be thermally or stress-induced (Otsuka & Wayman
1998). Traditionally, manufacturers have improved
the flexibility of the instruments by changing the size
and design of features such as cross-sectional
International Endodontic Journal, 46, 855–862, 2013 855
 How simulated use affects flexibility of NiTi instruments Viana et al.
geometry, pitch number and length, amongst other
characteristics (Miserendino 1991, Sch€ afer & Tepel
2001, Sch€ afer et al. 2003). However, it is well known
that the flexibility of engine-driven endodontic instru-
ments also depends on the chemical composition and
thermomechanical history of the alloy (Turpin et al.
2000, Sch€ afer & Tepel 2001, Sch€ afer et al. 2003,
Zhou et al. 2012, El Batouty & Elmallah 2011).
In recent years, an increasing number of rotary
NiTi endodontic systems have been marketed. These
systems differ from one another in the design of the
cutting edges, helicoidal angles, body taper and
instrument tip configuration. Amongst these, the Pro-
Taper Universal (PTU) system (Dentsply Maillefer, Bal-
laigues, Switzerland) features a convex triangular
cross-section and has a progressive taper increase
along the shaft. K3 instruments (SybronEndo, Orange,
CA, USA) are designed with an asymmetrical cross-
section and wide radial lands, which are intended to
increase the instrument’s resistance to torsional stres-
ses (Mounce 2004). EndoSequence (ES) instruments
(Brasseler, Savannah, GA, USA) have a triangular
cross-sectional design and alternating points of con-
tact with the canal walls and are electrochemically
treated to remove surface irregularities formed during
traditional grinding manufacturing processes. In addi-
tion to their different design characteristics, there are
small differences in their phase constitution and
transformation temperatures despite the fact that the
chemical compositions are similar for these other
instruments (Viana et al. 2010).
Regardless of the NiTi system chosen, rotating an
endodontic instrument during shaping of curved
canals will subject it to cyclic flexural and torsional
loads simultaneously, eventually leading to fracture
(Pruett et al. 1997, Sattapan et al. 2000, Melo et al.
2002, Bahia & Buono 2005). Cyclic loading is associ-
ated with structural and functional fatigue, and the
literature has established that in many cases, the
functional properties of NiTi superelastic alloys are
affected by this type of loading (Eggeler et al. 2004).
Recent studies have pointed out that changes in
the manufacturing process can improve the fatigue
life of endodontic instruments (Johnson et al. 2008,
Gao et al. 2010, Gambarini et al. 2011, Plotino et al.
2012). Nevertheless, detailed knowledge of how
rotary endodontic instruments behave under fatigue
remains fundamentally important to ensure their safe
clinical use. Various studies have shown that not only
fatigue resistance but also torsional resistance reduces
after clinical or simulated clinical use (Gambarini
856 International Endodontic Journal, 46, 855–862, 2013
2001, Fife et al. 2004, Bahia & Buono 2005, Vieira
et al. 2008, Kim et al. 2012). This suggests that flexi-
bility, which is one of the most important properties
of NiTi endodontic instruments, might also be altered
following repeated use. In fact, Kuhn & Jordan (2002)
reported that the stiffness of NiTi ProFile (Dentsply
Maillefer) instruments increased after each use in
curved canals. However, whether accompanying the
original trajectory of a curved canal becomes more
difficult with used instruments still remains to be veri-
fied.
The aim of this study was to assess how instru-
ments with different design characteristics respond, in
terms of their flexibility, to cyclic flexural and tor-
sional loading, which simulate their clinical use to
shape curved root canals.
Materials and methods
The instruments evaluated were S2 and F1 ProTaper
Universal (Dentsply Maillefer, Ballaigues, Switzerland)
instruments; regularly tapered size 20, .06 taper and
size 25, .06 taper K3 (SybronEndo, Orange, CA, USA)
instruments; and regularly tapered size 20, .06 taper
and size 25, .06 taper EndoSequence (Brasseler,
Savannah, GA, USA) instruments.
Bending tests
Flexibility was determined using a testing apparatus
built according to the specification of ISO 3630-1
(International Organization for Standardization
1992): the instruments were secured at a distance of
3 mm from the tip and then bent by 45° about their
long axis (Fig 1), whilst the bending moment (MB)
was automatically recorded by a load cell. A higher
MB value indicates a less flexible instrument. Bending
tests were performed with new instruments (control
group, CG) and with instruments previously fatigued
to one-fourth and three-fourths of their average fati-
gue life (fatigue groups, FG¼ and FG¾). Instruments
were also tested after cyclic torsional loading (tor-
sional group, TG), as described below.
Flexural fatigue tests
Fatigue tests were carried out in a bench device that
allowed files to rotate freely inside artificial canals
made of AISI H13 tool steel, with an angle of curva-
ture of 45° and a radius of 5 mm (Bahia & Buono
2005, Viana et al. 2006, Melo et al. 2008). The
© 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd
 Viana et al. How simulated use affects flexibility of NiTi instruments

(a) instrument’s tip was clamped in another chuck with

brass jaws to prevent sliding. The machine was pro-
grammed to repeatedly rotate from zero angular
deflection to 180° and then return to zero applied
torque. Each rotation was defined as one cycle, and
the rotation speed was set clockwise to 2 rpm. Ten
new instruments of each type and size, totalling sixty
instruments, were each subjected to twenty cycles of
torsional loading as described. Subsequently, these
instruments were bent at 45° as part of the test,
under the same conditions as those employed previ-
ously for the other sets of instruments.
(b) The number of cycles employed in the cyclic
torsional straining tests was selected based on the
assumption that 20 torsional strain cycles should be
approximately equivalent to the instrument’s use in
six root canals, which represents about half of the
recommended number of uses for rotary instruments,
as explained in Bahia et al. (2008).

Figure 1 Apparatus used during flexibility tests; initial
position (a) and instrument at 45° bending (b).
Statistical analysis
Data obtained in the bending, fatigue and torsion
tests were subjected to a one-way analysis of variance
(ANOVA). Significance was determined at the 95% con-
fidence level.

Results
number of cycles until fracture (NCF) was obtained
by multiplying the rotation speed used in the fatigue
Flexural fatigue tests
test (300 rpm) by the test time registered with a digi-
tal chronometer. Sixty new NiTi endodontic instru- The mean NCF values (and standard deviations)
ments, S2 and F1 ProTaper Universal, and sizes 20 determined in the flexural fatigue tests of new instru-
and 25, .06 taper K3 and EndoSequence (10 of each ments are listed in Table 1. The table also lists the
size and taper), were tested until rupture in the flex- values of the maximum tensile strain amplitude, eT,
ural fatigue test device described, to establish their
fatigue life by means of the average NCF. Following Table 1 Diameter at 3 mm from the tip, maximum tensile
that, 10 other PTU, K3 and ES instruments of each strain amplitude and average number of cycles to failure
size and taper, totalling 60 instruments for each (NCF) (standard deviation) determined in new ProTaper Uni-
experimental group, were fatigued to one-fourth and versal, K3 and EndoSequence instruments. NCF values
three-fourths of their average fatigue life and then marked with the same letter were not statistically different
subjected to bending tests, as described above, to eval- (p > 0.05) from each other
uate the effect of cyclic flexural loading on flexibility. Diameter at
3 mm from Maximum tensile
Instruments the tip (mm) strain amplitude (%) NCF
Torsional fatigue tests
PTU S2 0.35 3.6 654 (77)a
Cyclic torsional loading tests were performed using a PTU F1 0.42 4.4 378 (49)b
machine described by Bahia et al. (2006). Before test- K3 20/.06 0.38 4.0 500 (69)c
ing, each instrument handle was removed, the end of K3 25/.06 0.42 4.4 413 (61)b
ES 20/.06 0.38 4.0 419 (64)d
the shaft was clamped into a chuck connected to a
ES 25/.06 0.44 4.6 363 (77)b
reversible geared motor, and 3 mm of the

© 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd International Endodontic Journal, 46, 855–862, 2013 857
 How simulated use affects flexibility of NiTi instruments Viana et al.

to which each instrument was subjected under the (a)

flexural fatigue testing conditions; this amplitude is
given by the expression
eT ¼ D=ð2R  DÞ ð1Þ

where D is the diameter 3 mm from the instrument

tip and R is the outer radius of curvature of the
canal. The mean values of D used to calculate these
tensile strain amplitudes were measured in a previous
study (Viana et al. 2010) and are also presented in
Table 1. The value of R = 5 mm was set by the
geometry of the artificial canal.

Bending after flexural fatigue tests

The mean values of MB determined in the bending
(b)
tests of CG and those obtained after flexural fatigue
cycling to one-fourth and three-fourths of the total
fatigue life of the instruments are presented in Fig 2.
As an expected general trend, the flexibility of the
instruments decreased as their diameters increased.
The effect of simulated clinical use in terms of flexural
fatigue can be assessed by comparing the mean val-
ues of MB from CG, FG¼ and FG¾ for each type of
instrument. Figure 2 shows that the flexibility of the
fatigue-tested instruments showed the trend of
remaining unchanged; out of the total of 12 compari-
sons made between the control group and experimen-
tal flexural fatigue groups, statistically significant
changes were observed in only 3. Comparative statis-
tical analyses showed a significant increase
(c)
(P = 0.006) in the flexibility of EndoSequence instru-
ments of size 25, .06 taper after flexural fatigue
cycling to one-fourth of their fatigue life. Similarly,
statistically significant increases in flexibility were
observed for K3 size 20, .06 taper (P = 0.025) and
EndoSequence size 25, .06 taper (P = 0.003) instru-
ments in FG¾ in comparison with similar instruments
in the control group. However, comparison of similar
instruments in the two experimental groups FG¼ and
FG¾ revealed that there were no differences in their
flexibilities.

Bending after torsional fatigue tests

The mean values of MB measured in new instruments
and after cyclic torsional loading are shown in Fig 3.
As before, the flexibility of these instruments showed
a trend of remaining unchanged under cyclic tor-
sional loading. Comparative statistical analyses
between the values of MB for the same type of
Figure 2 Mean values (standard deviations shown as error
bars) of bending moment (MB) of new and previously
fatigue-cycled ProTaper Universal (a), K3 (b) and EndoSe-
quence instruments (c). Bar values marked with the same
letter were not statistically different (P > 0.05) from each
other.

858 International Endodontic Journal, 46, 855–862, 2013 © 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd
 Viana et al. How simulated use affects flexibility of NiTi instruments
(a)
(b)
(c)
Figure 3 Mean values (standard deviations shown as error
bars) of bending moment (MB) of new and previously
torsion-cycled ProTaper Universal (a), K3 (b) and EndoSe-
quence instruments (c). Bar values marked with the same
letter were not statistically different (P > 0.05) from each
other.
© 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd
instruments in CG and TG showed no significant
differences between them.
Discussion
Endodontic instruments made of NiTi shape memory
alloy have had a revolutionary impact on root canal
treatment. The unique material properties of NiTi
make it particularly suited for endodontic rotary
instruments (Gutmann & Gao 2012). Because of their
great flexibility, NiTi instruments have been developed
to overcome the limitations of stainless steel manual
files. The S2 and F1 ProTaper Universal instruments,
together with size 20 and size 25 instruments with .06
taper each of both K3 and EndoSequence, were chosen
because they are used during the final steps of prepara-
tion of curved root canals and are responsible for the
shaping of the middle and apical thirds of the canal,
operating in the region of high curvature, where
instrument flexibility is of fundamental importance.
The results presented in Table 1 show, as expected,
that the rotating bending fatigue resistance of instru-
ments varies inversely with the maximum tensile
strain amplitude to which the instruments are sub-
jected in the root canal, which, in turn, is a direct
function of instrument diameter (Bahia & Buono
2005). Statistically significant differences in fatigue
resistance were observed between size 20, .06 taper
K3 and EndoSequence instruments, which have the
same tip size and maximum tensile strain amplitude,
indicating that instrument design is also an important
factor determining the stress and strain magnitudes
in rotating bending (Grande et al. 2006, Tripi et al.
2006, Yao et al. 2006, Ray et al. 2007). In fact, the
importance of instrument design can surpass that of
surface finishing, because the electrochemically pol-
ished EndoSequence instruments had the lowest fati-
gue resistance amongst the same-size instruments.
One possible explanation for this result is the charac-
teristic sharp cutting edges of ES that may concen-
trate stress, masking the beneficial effects of
electropolishing reported by other authors (Tripi et al.
2006, Anderson et al. 2007, Condorelli et al. 2010).
The work of Shen et al. (2011) on prototype NiTi
instruments from a novel controlled-memory alloy
offers further corroboration of this hypothesis, as
triangular cross-section instruments had significantly
smaller fatigue resistance when compared with their
square counterpart.
The literature has established that in many cases,
the functional properties of NiTi superelastic alloys are
International Endodontic Journal, 46, 855–862, 2013 859
 How simulated use affects flexibility of NiTi instruments Viana et al.
affected by cyclic loading (Eggeler et al. 2004). The
relevant question is thus whether cyclic loading dur-
ing shaping of curved root canals affects the flexibility
of NiTi instruments. The expectation that repeated use
could negatively affect the flexibility of these instru-
ments (Kuhn & Jordan 2002) as it does with torsional
resistance (Yared et al. 2003, Bahia et al. 2006, Veira
et al. 2009, Kim et al. 2012) and flexural fatigue
(Haickel et al. 1999, Gambarini 2001, Fife et al.
2004, Bahia & Buono 2005) was not confirmed in
this study, in which clinical use was simulated by
rotational bending and cyclic torsional straining. The
results presented in Figs 2 and 3 reveal that the bend-
ing resistance measured after cyclic deformation was
not substantially affected after experimental testing. In
the few cases in which statistically significant changes
were observed, there was an increase in flexibility.
After being subjected to cyclic loading, NiTi alloys
usually undergo some residual deformation, which is
generally attributed to the generation of dislocations
and the presence of nontransformed martensite vari-
ants near grain boundaries after unloading (Tobushi
et al. 1996). In fact, Kuhn & Jordan (2002) associated
the increase in rigidity they observed in instruments
used in canals with abrupt curvatures to this genera-
tion of lattice defects, which would restrict the easy
movement of martensite variants. Conversely, it is
possible that the internal stresses associated with
these defects contribute to the nucleation of stress-
induced martensite during subsequent loading, thus
decreasing the required transformation stress and
improving flexibility. Nevertheless, it is important to
observe that the amount of pre-deformation in the
work by Kuhn & Jordan (2002), which was produced
by using the instruments in 18 canals, can be quite
different from the values of the maximum tensile
strain amplitude employed in the present study
(Table 1). Thus, the differences observed can be the
result of the different pre-deformations applied to the
instruments: for instance, larger values of maximum
tensile strain amplitude can lead to the generation of
higher dislocation densities, which in fact may hinder
the motion on martensite variant interfaces.
It has been observed that when NiTi wires are
cyclically strained, the changes in their stress–strain
behaviour characterized by the development of a
residual deformation take place mainly in the initial
straining cycles (Bahia et al. 2005). This possibly
means that the generation of lattice defects is a tran-
sient process, which tends to stabilize as the number
of cycles increases; the saturation in the amount and
860 International Endodontic Journal, 46, 855–862, 2013
distribution of internal defects after the initial load–
unload cycles is thus responsible for the observed
stabilization effect. This effect would explain why
there were no differences between the experimental
groups FG¼ and FG¾, that is, flexural fatigue condi-
tions that would correspond to little and widely used
instruments, respectively.
The influence of previously applied torsional load-
ing on flexural fatigue resistance has been recently
evaluated, and it was observed that even with tor-
sional loads below the elastic limit of the material,
this type of loading significantly decreased the flexural
fatigue resistance (Barbosa et al. 2007, Bahia et al.
2008). Conversely, cyclic torsional loading did not
seem to affect the torsional resistance (Bahia et al.
2008). The results shown in Fig 3 are a good indica-
tion that this type of cyclic loading also does not
induce any undesirable effects on the instrument’s
flexibility.
Laboratory studies are not able to reproduce
precisely the behaviour of NiTi instruments. During
clinical use, instruments are simultaneously subjected
to torsional, flexural and shear stresses; however, dur-
ing laboratory tests, it is not possible to effectively
conjoin these, and they can be evaluated properly
only separately. Moreover, the files in vivo are oper-
ated in constant motion in and out of the canal. The
conditions employed here to simulate instrument use
are strong in the sense that the absence of the peck-
ing motion in the flexural fatigue tests concentrates
cyclic flexural straining to a fixed region on the
instrument’s length. The stationary test conditions
applied do not reproduce the clinical situation, but
because the test conditions are more extreme than
those in clinical practice and they were identical for
the different instruments evaluated here, the results
can be considered valid and to reflect the behaviour
of the instruments. Recently introduced single-use
endodontic files, which are claimed to be able to com-
pletely prepare and clean root canals with only one
instrument (Berutti et al. 2012, B€ urklein et al. 2012),
alleviate the concerns about changes in instrument
behaviour after subsequent uses. However, decoding
the various aspects of the mechanical behaviour of
NiTi instruments is essential to prevent fracture and
other mishaps for reciprocating instruments as well.
Conclusions
The flexibility of rotary ProTaper Universal, K3 and
EndoSequence NiTi instruments, measured in bending
© 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd
 Viana et al. How simulated use affects flexibility of NiTi instruments
tests, was not adversely affected by simulated use in
artificial curved root canals. In the few cases in which
statistically significant changes could be observed,
there was an increase in flexibility after straining.
Irrespective of their different design characteristics,
the three instrument systems behave similarly in
terms of flexibility in their response to simulated use.
Acknowledgements
The authors deny any conflicts of interests related to
this study. This work was partially supported by the
Fundacßa~o de Amparo a  Pesquisa do Estado de Minas
Gerais (FAPEMIG), Belo Horizonte, MG, Brazil; Conselho
Nacional de Desenvolvimento Cientıfico e Tecnol ogico
(CNPq), Brasılia, DF, Brazil; and Pr
o-Reitoria de Pesqu-
isa da Universidade Federal de Minas Gerais, Belo
Horizonte, MG, Brazil.
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