You are on page 1of 4

Endodontic Topics 2005, 10, 151–154 Copyright r Blackwell Munksgaard

All rights reserved ENDODONTIC TOPICS 2005


1601-1538

Root canal instrumentation with


ProFilet instruments
ADAM LLOYD

The history behind the introduction of rotary nickel–titanium instruments of increasing taper is outlined along
with a logical sequence of crown-down canal that can be applied to a variety of cases. Clinically applicable canal
instrumentation is explained for small, medium and large canals with actual examples prepared with the same
technique.

Background (Dentsply Tulsa Dental) were introduced in 1993 with


a .04 taper, while instruments with .06 taper were
The introduction of engine-driven instruments in
added later. In due course, a more traditional ISO
tapers greater than the standard 2% taper in 1992
series of ProFile instruments with conventional sizes
by Dr Wm. Ben Johnson substantially changed the
was manufactured and marketed by Dentsply Maillefer
way root canal preparation was accomplished. These
(Ballaigues, Switzerland) along with a series of Orifice
instruments made it possible to create an appropriately
Shapers. The latter instruments are similar to ProFile
flared canal shape without the need for time-consum-
but, in general, have large tip diameters, shorter
ing serial stepback shaping procedures. Furthermore,
cutting blades and greater tapers. More recently,
the use of the ProFile (Dentsply Tulsa Dental, Tulsa,
ProFile instruments with a .02 taper were introduced
OK, USA) instrument sequence allowed greater
to provide a comprehensive range of tapers that are
predictability in canal shape allowing earlier and deeper
capable of dealing with most canals shapes.
penetration of irrigating solutions and increased flow
The use of Series 29 instruments initially presented
dynamics when using thermoplasticized obturation
some difficulties, with the non-standard tip size, the
materials, such as ThermaFil (Dentsply Tulsa Dental).
change in the file numbering system and the use of
metallic colours designating size. These factors pro-
duced a system that had a steep learning curve and as
Instrument usage and design such Series 29 ProFiles were mostly the purview of
The design of the original ProFile instruments was a specialists. The introduction of ISO tip diameters
considerable departure from the ISO hand file speci- simplified their adoption to a wider range of general
fication because the tip size corresponded to a uniform dentists and specialists. The flutes of ProFile instru-
increase of 29% between instruments and accordingly ments have radial lands that cut radicular dentine with a
the nomenclature of each instrument in the series neutral rake angle, planing the walls smooth and
ranged from 2 to 10. The rationale behind this minimizing canal transportation. A tip with no sharp
paradigm shift provided the operator with more transitional line angles further enables the instrument to
instruments of smaller tip size to be used in the delicate remain centred around canal curvature virtually elim-
apical anatomy, while fewer larger instruments were inating ledge formation. The flutes are cut deep into the
necessary coronally, where flexibility is of less concern. core from tip to shank allowing greater flexibility at
The series also decreased the number of instruments larger cross-sectional diameters, while allowing larger
used in canal preparation. These Series 29 ProFiles amounts of debris to be removed. The cross-section of

151
Lloyd

the instrument is referred to as a U-blade design, and popularized by ProFile rotary instruments. Gates–
hence has passive cutting ability (Fig. 1). Glidden drills were supplemented or replaced with
ProFile Orifice Shapers. Orifice Shapers share the same
U-blade design permitting straight-line access to the
coronal and middle thirds without encroaching on the
Preparation sequence so-called danger zone, which may occur with Gates–
The crown-down preparation technique recommended Glidden drills. The use of viscous chelating agents and
today for most rotary nickel–titanium systems was Orifice Shapers can effectively extirpate the vital pulp
from the canal.
After coronal flaring with Orifice Shapers and initial
scouting of the canal shaping with the ProFile
instruments can commence. Several instrumention
sequences have been described for ProFile, including
the variable taper sequence, the variable tip sequence
and a sequence that alternates between .06 and .04
tapers. The technique described here consists of using
decreasing tip sizes and and then decreasing taper in
accordance with current recommendations by the
manufacturer (see concept box in Table 1).
The concept of bringing a predefined taper to the
Fig. 1. SEM of ProFile instrument showing radial lands canal terminus is thus realized through use of ProFile
and safe-ended tip (courtesy of Dr Ove A. Peters). .06 followed by .04 taper instruments. ProFile instru-

Table 1. Concept box: canal preparation using ProFile rotary files

 Colours represent ISO instrument sizes


 Lubrication with viscous chelator during canal scouting and coronal flaring
 Sodium hypochlorite irrigant used throughout cleaning and shaping procedure
 Use 17% EDTA during apical preparation and as rinse before canals are dried

152
ProFile canal instrumentation

with sodium hypochlorite throughout the remainder of


the treatment. The estimated working length (EWL) is
recorded from a well-angulated periapical radiograph
and transferred to the rubber stops of each instrument
or measured at the respective markings on the
instruments’ shaft.

Small canals
A size 25 .06 instrument is used between 150
and 300 RPM while allowing the instrument to
progress passively into the canal. A light pecking
motion is recommended, withdrawing and advancing
Fig. 2. Maxillary first molar shaped with ProFile Series the instrument until it will not proceed further and
29.06 files to canal terminus. Additional flaring in palatal never more than approximately 3 mm short of the
canal performed with Gates–Glidden drills.
EWL. The flutes are cleaned and inspected for
unwinding. The canal is irrigated and the glide path
confirmed by recapitulating with a small hand instru-
ment, followed by a size 20 .06 rotary instrument that
is advanced with the same technique to working length.
A size 20 .04 ProFile shapes the apical third and is
followed by a size 25 .04 instrument. Hand files are
used to gauge the cross-sectional diameter at the canal
terminus (master apical file, MAF) and confirm the
presence of acceptable taper. Final flaring is completed
with a .06 ProFile with a tip diameter one size smaller
than the hand file that bound at the working length
(MAF, see concept box in Table 1). Again, the use of a
.06 rotary instrument ensures taper in the apical third
and blends the various stages of preparation in an
Fig. 3. Canal shaping of mandibular second molar with attempt to create a uniform taper from orifice to apex.
combination .04 and .06 ProFile Series 29 instruments. A circumferential movement may be used to flare the
Acute apical curve on distal canal demonstrates ability of coronal canal third canal further for additional taper.
rotary file to negotiate such anatomical variants.
Examples of the kinds of taper and shape of canals
shaped with ProFile rotary instruments are shown in
ments with a .06 taper are used to refine and ensure a
Figs 2 and 3.
more consistent flare once the apical preparation is
complete. By using .06 and then .04 tapers, friction
between root canal walls and the rotating instrument is
Other sequences
reduced and taper-lock is avoided. This phenomenon is
believed to occur when the taper of the file closely One sequence for preparation of medium and large
matches that of the canal, producing greater amounts canals is shown in the concept box in Table 1. As stated
of torque on the instrument and increasing the risk of earlier, alternative sequences are possible and have been
instrument breakage. advocated, including the use of a single taper through-
Larger tip diameters are chosen initially to prepare out, varying only the tip diameter, and using the same
the middle and coronal third of the canal, effectively tip diameter but alternating the taper. In particular the
decreasing binding of smaller instruments used later in use of the five instruments with .06 tapers, ranging
the sequence. It should be noted that initial canal entry from 0.4 to 0.15 mm tip diameter, is a rapid way
is aided by the use of a lubricant, with copious irrigation to shape larger and rather straight canals. In sum-

153
Lloyd

mary, ProFile instruments with the possibility of Further reading


variation in sequences allows for variations in apical
anatomy, with the tip size chosen according to the size 1. Blum JY, Machtou P, Micallef JP. Location of contact areas
at the terminus. on rotary Profile instruments in relationship to the forces
developed during mechanical preparation on extracted
teeth. Int Endod J 1999: 32: 108–114.
2. Kavanagh D, Lumley PJ. An in vitro evaluation of canal
preparation using Profile .04 and .06 taper instruments.
The Gold standard Endod Dent Traumatol 1998: 14: 16–20.
3. Schrader C, Ackermann M, Barbakow F. Step-by-step
The ProFile series has been the most widely researched description of a rotary root canal preparation technique.
nickel–titanium rotary instrument in endodontics over Int Endod J 1999: 32: 312–320.
4. Schrader C, Peters OA. Analysis of torque and force
the last 10 years establishing it as the gold standard
during step-back with differently tapered rotary endo-
against which others are measured. dontic instruments in vitro. J Endod 2005: 31: 120–
Introduction of these rotary instruments has enabled 123.
practitioners to provide a more predictable level of care 5. Yared GM, Bou Dagher FE, Machtou P. Influence of
to patients in a more timely and reproducible manner rotational speed, torque and operator’s proficiency on
ProFile failures. Int Endod J 2001: 34: 47–53.
and has caused a paradigm shift in the way endodontic 6. Zmener O, Banegas G. Comparison of three instrumenta-
treatment is accomplished and has raised the standard tion techniques in the preparation of simulated curved
of care. root canals. Int Endod J 1996: 29: 315–319.

154

Related Interests