Basic Research—Technology
Influence of Heat Treatment of Nickel-Titanium Rotary
Endodontic Instruments on Apical Preparation:
A Micro–Computed Tomographic Study
Bernardo Corr^ea de Almeida, DDS, MSc,* Fabıola Ormiga, DDS, MSc, DSc,*
ujo, DDS, MSc, DSc,* Ricardo Tadeu Lopes, DSc,†
Marcos Cesar Pimenta de Ara
a Corr^ea Barbosa Lima, DSc,† Bernardo Camargo dos Santos, DDS, MSc,†
Inay
and Heloisa Gusman, DDS, DSc*
Abstract
Introduction: The aim of this study was to make a 3-
dimensional comparison of the canal transportation
and changes in apical geometry using micro–computed
tomographic imaging after canal preparation with K3
(SybronEndo, Orange, CA) and K3XF (SybronEndo) file
systems. Methods: Twenty-eight mandibular molars
were randomly divided into 2 groups according to the
rotary system used in instrumentation: K3 or K3XF.
The specimens were scanned by micro–computed tomo-
graphic imaging before and after instrumentation. Im-
ages before and after instrumentation from each
group were compared with regard to canal volume, sur-
face area, and structure model index (SMI) (paired t test,
P < .05). After instrumentation, the canals from each
group were compared regarding the changes in volume,
surface area, SMI, and canal transportation in the last 4
apical mm (t test, P < .05). Results: Instrumentation
with the 2 rotary systems significantly changed the canal
volume, surface area, and SMI (P < .05). There were no
significant differences between instrument types con-
cerning these parameters (P > .05). There were no sig-
nificant differences between the 2 groups with regard to
canal transportation in the last 4 apical mm (P > .05).
Conclusions: Both rotary systems showed adequate ca-
nal preparations with reduced values of canal transpor-
tation. Heat treatment did not influence changes in root
canal geometry in the apical region. (J Endod 2015;-
:1–5)
Key Words
Canal transportation, heat treatment, micro–computed
tomography, nickel-titanium instrument
From the *Department of Dental Clinic and †Nuclear Instrumentation Laboratory, Federal University of Rio de Janeiro, Centro de Tecnologia, Ilha da Cidade Uni-
versitaria, Rio de Janeiro, Rio de Janeiro, Brazil.
Address requests for reprints to Dr Heloisa Gusman, Rua Prof Rodolpho Paulo Rocco 325/2 Andar, Ilha da Cidade Universitaria, Rio de Janeiro 21941-913, Brazil.
E-mail address: heloisagusman@gmail.com
0099-2399/$ - see front matter
Copyright ª 2015 American Association of Endodontists.
http://dx.doi.org/10.1016/j.joen.2015.09.001
JOE — Volume -, Number -, - 2015
C leaning and shaping the root canal system are essential to achieving clinical success
in endodontic treatment (1). Mechanical preparation should maintain the original
pathway and anatomy of the root canal (2). Mainly because of its anatomic complexity,
the apical third is the region most susceptible to accidents such as apical transportation,
ledge formation, and perforations during instrumentation (3, 4). The cross-sectional
geometry, mechanical properties, and the size of the endodontic instrument are impor-
tant factors that contribute to transportation of the root canal (5–7).
The introduction of endodontic files made of nickel-titanium (NiTi) alloy signifi-
cantly increased the quality of canal preparation and reduced the number of sessions
and the risk of errors during endodontic treatment (8, 9). NiTi instruments show
greater flexibility, which allows a safer and more precise preparation, when
compared with traditional stainless steel instruments (10).
To improve the mechanical properties of NiTi endodontic instruments, advances
in the production process have been proposed, such as heat treatment of the alloy
before or after the manufacturing process (11–13). The aim of this treatment is to
modify the phase transition temperatures of the alloy to reduce the stress level on
the superelastic plateau (8, 9, 12). As a result, the heat treatment allows the
manufacture of more flexible and resistant instruments, which generate lower stress
levels during canal preparation (14, 15).
With the advancements in the thermomechanical process developed in recent
years, different types of heat treatment have been used for manufacturing endodontic
files (14), leading to alloys such as R-phase alloy of K3XF (SybronEndo, Orange,
CA) and Twisted Files (SybronEndo); the CM Wire of HyFlex CM Instruments (Coltene
Whaledent, Cuyahoga Falls, OH) and Typhoon Infinite Flex NiTi files (Clinician’s Choice
Dental Products, New Milford, CT); and the M-Wire alloy of WaveOne (Dentsply Mail-
lefer, Ballaigues, Switzerland), Vortex (Dentsply Tulsa Dental, Tulsa, OK), Reciproc
(VDW, Munich, Germany), ProTaper Next (Dentsply Tulsa Dental), and ProFile GT Se-
ries X files (Dentsply Tulsa Dental).
Several studies have investigated the ability of different endodontic NiTi instrument
systems to maintain the original canal pathway during root canal preparation (5, 6,16–
22). However, there is no consensus on the ability to maintain a centralized preparation
when heat-treated files are compared with conventional NiTi instruments (6, 23). These
studies often compare instruments with different geometries, dimensions, kinematics,
and file sequences, which makes it difficult to evaluate the real influence of the alloy on
the centering ability during canal preparation.
Heat Treatment and NiTi Rotary Instruments 1
Basic Research—Technology
In this context, the aim of this study was to evaluate the influ-
ence of heat treatment of NiTi rotary endodontic instruments on api-
cal preparation using micro–computed tomographic (micro-CT)
imaging. The K3 (SybronEndo) and K3XF file systems were compared
for changes in apical geometry and canal transportation after instru-
mentation.
Materials and Methods
Selection and Preparation of Specimens
This study was approved by the Research Ethics Committee of the
Clementino Fraga Filho University Hospital (protocol no. 475.563).
Twenty-eight mandibular molars with complete root formation and a
root curvature angle of up to 25 extracted for clinical reasons were
used for this study. The teeth were stored in 0.1% thymol solution at
4 C until use. Access cavities were performed with round diamond
and Endo-Z burs (Dentsply Maillefer) in a water-cooled high-speed
handpiece. No file was inserted through the mesiobuccal, mesiolingual,
or distal canals to prevent changes in the original anatomy of the apical
region.
Micro-CT Evaluations
A custom-made mold of self-polymerizing resin was created for
each tooth to standardize the mounting of the specimen. The teeth
were placed in a micro-CT scanner (SkyScan 1173; Bruker micro-
CT, Kontich, Belgium) on a custom aluminum attachment. This attach-
ment ensures great similarity between the images obtained before and
after canal preparation because it allows the precise repositioning of the
specimen inside the scanner. Scanning was performed through 360
rotation with a rotation step of 0.30 using a 1.0-mm-thick aluminum
filter, energy of 70 kV, current of 114 mA, 14.8-mm pixel size, and
21.39-mm resolution.
Root Canal Instrumentation
Coronal third enlargement was performed with LA Axxess Stainless
Steel burs (SybronEndo), and size 10 K-files (Dentsply Maillefer) were
used during instrumentation to establish apical patency and to deter-
mine the canal lengths. After radiographic evaluation, the working
length was established 1 mm short of the radiographic apex. The teeth
were randomly divided into 2 groups according to the endodontic ro-
tary system used: the K3 group (n = 14) and the K3XF group (n = 14).
All canals were instrumented by the crown-down technique to the work-
ing length at a speed of 350 rpm with the use of a torque control end-
odontic motor (Easy Equipamentos Odontologicos, Belo Horizonte,
Brazil) using the sequence recommended by the manufacturer as fol-
lows: #25/.08, #25/.06, and #25/.04. All files were used passively,
and apical enlargement was performed using #25.06 and #30.04 files.
The pulp chamber was filled with 5.25% sodium hypochlorite (NaOCl)
throughout the instrumentation procedure. The canal was irrigated with
3 mL 5.25% NaOCl after each instrument. After instrumentation, all ca-
nals were irrigated with 3 mL 17% EDTA for 3 minutes (1 mL/min) and
TABLE 1. Changes in Volume and Surface Area after Preparation (mean  standard deviation)
D volume (mm3)
Group N MB ML
K3 14 0.18  0.21 0.19  0.23
K3XF 14 0.14  0.09 0.13  0.10
P value .447 .367
D, distal; MB, mesiobuccal; ML, mesiolingual.
No significant differences between instrument types (independent samples t test, P > .05).
2 Almeida et al.
3 mL 5.25% NaOCl and dried with FM size paper points (SybronEndo).
After this, the teeth were submitted to a postoperative micro-CT scan
with the parameter settings previously described.
Micro-CT Measurements
The images were reconstructed with the use of NRecon 1.6.5.8
software (Bruker micro-CT, Kontich, Belgium), and the cross-
sectional images were segmented, visualized, and quantified (CTAn
v.1.14.4, Bruker micro-CT) to evaluate the last 4 apical millimeters. In-
creases in root canal volume and changes in the surface area of the root
canal were calculated by subtracting the values found in the images ob-
tained before and after instrumentation. The cross-sectional appear-
ance was expressed as the structure model index (SMI). The SMI is
determined by an infinitesimal enlargement of the surface and is
used to evaluate surface convexity in 3-dimensional structures (24).
The structure of an object is characterized as 0 for an ideal plate to 4
for a perfect ball (24).
Canal transportation was assessed from centers of gravity that
were calculated for each slice and connected along the z-axis with
a fitted line (25). Mean apical transportation was expressed in mil-
limeters by comparing the centers of gravity before and after instru-
mentation.
Statistical Analysis
Mean scores and standard deviations were calculated for each
group. The paired t test (SPSS v20.0; SPSS Inc, Chicago, IL) was used
to compare changes in volume, surface area, and SMI within a group
before and after instrumentation. The independent samples t test
(SPSS v20.0) was performed to find any significant differences among
groups with regard to volume, surface area, SMI, and canal transporta-
tion. The level of significance was set at P < .05.
Results
No significant differences were found between experimental
groups regarding the volume, surface area, and SMI before instrumen-
tation (P > .05), confirming the homogeneity of the groups.
Changes in volume and surface area after instrumentation in the
mesiobuccal, distobuccal, and distal canals are presented in Table 1.
Preparation significantly increased the canal volume in both groups
(P < .05); however, no significant differences were found between
K3 and K3XF (P > .05). Similarly, all canals showed a signifi-
cantly increased surface area after preparation (P < .05), but there
were no significant differences between the instruments tested
(P > .05).
Alterations in SMI and canal transportation values in the apical
4 mm after instrumentation are shown in Table 2. Changes in SMI
were statistically significant in all canals in both groups (P < .05),
whereas no differences were found between groups (P > .05). With
reference to apical transportation, the differences between K3 and
K3XF instruments in the mesiobuccal, distobuccal, and distal canals
D surface area (mm2)
D MB ML D
0.19  0.19 1.55  1.24 1.67  1.29 3.05  2.74
0.15  0.09 1.83  1.60 1.77  1.63 1.74  1.56
.496 .608 .814 .132
JOE — Volume -, Number -, - 2015
 Basic Research—Technology
TABLE 2. Changes in Structure Model Index (SMI) and Transportation after Preparation (mean  standard deviation)
D SMI Transportation (mm)
Group N MB ML D MB ML D
K3 14 0.49  0.34 0.46  0.34 0.30  0.21 0.46  0.41 0.38  0.23 0.60  0.43
K3XF 14 0.83  0.79 0.68  0.53 0.57  0.40 0.53  0.50 0.58  0.51 0.73  0.80
P value .147 .213 .064 .674 .190 .604
D, distal; MB, mesiobuccal; ML, mesiolingual.
No significant differences between instrument types (independent samples t test, P > .05).

were not significant (P > .05); both rotary systems showed minimal ca-
nal transportation (Fig. 1A–F).
Discussion
In the present study, changes in the apical 4 mm were compared
by means of micro-CT imaging after instrumentation with K3, an in-
strument manufactured of conventional NiTi alloy, and K3XF, a heat-
treated NiTi instrument. The 2 rotary systems showed significant
changes in volume, surface area, and SMI in the mesiobuccal, disto-
buccal, and distal canals after root canal preparation; however, no
significant differences were found between instrument types. Simi-
larly, no difference was observed between the groups regarding apical
canal transportation.
According to the manufacturer, the K3XF file represents an evolu-
tion of the K3. Although the 2 instruments have a similar design, the

Figure 1. Reconstructed 3-dimensional images of mesial root canals of mandibular molars. (A–C) The K3 group and (D–F) the K3XF group. (A and D) Preop-
erative images and (B and E) postoperative images. (C and F) Superimposed cross sections of the apical third before and after instrumentation in red and green
colors, respectively.

JOE — Volume -, Number -, - 2015 Heat Treatment and NiTi Rotary Instruments 3
Basic Research—Technology
K3XF file has improved mechanical properties resulting from the heat
treatment the alloy receives during the manufacturing process. This
treatment is known as R-phase technology, in which the NiTi alloy in
the austenitic phase is transformed into an intermediate crystalline
structure of martensitic transition, called the R-phase (26). Conse-
quently, the stress-induced martensitic transition tends to present a
reduced stress level on the superelastic plateau. In this context, the pre-
sent study compared the K3 and K3XF files to evaluate the influence of
heat treatment on the preparation of root canals, considering that the
geometry and dimensions of the 2 instruments are equivalent.
Micro-CT imaging is a method that has frequently been used for the
quantitative evaluation of root canal preparations by a 3-dimensional
analysis (5,18–20, 22, 27, 28). This method of analysis allows
measurements to be made without destroying the samples and
provides more accurate image details in comparison with other
assessment methods, such as radiography (21, 23). Although micro-
CT scanners have undergone improvements in recent years, image
acquisition still takes a long time, which justifies the studies with a small
number of samples. Considering the characteristics of the image acqui-
sition, primarily related to the resolution used, caution is needed when
comparing the results with those of previous studies.
The apical region was selected as the region of interest in this study
because its cleaning and shaping are of great importance to the success
of endodontic treatment (29). Failures that occur during instrumenta-
tion in the apical region contribute significantly to an unfavorable treat-
ment outcome, resulting in the persistence of microorganisms that act
in perpetuating the pathogenic process (30).
In the present study, although root canal instrumentation resulted
in significant increases in volume, surface area, and changes in SMI,
there was no statistical difference between the rotary systems used.
Preparation with the 2 systems presented a safe and effective perfor-
mance, with a slight increase in volume and surface area of the root ca-
nal. The results of this study are in agreement with those of Zhao et al
(22), who observed that WaveOne and ProTaper Next rotary systems,
instruments that receive the heat treatment in the manufacturing pro-
cess, induced variations in the root canal geometry similar to those
that resulted from instrumentation with the ProTaper Universal system,
which does not receive heat treatment.
In this context, heat treatment of endodontic instruments does not
seem to have a direct influence on the changes in root canal geometry
after mechanical preparation. Furthermore, Marceliano-Alves et al (20)
and Marzouk and Ghoneim (31) failed to find a significant difference
regarding changes in the root canal after preparation with rotary sys-
tems that received different types of heat treatment. Marceliano-Alves
et al compared Reciproc, Twisted Files, and Hyflex CM and found
that despite their differences in cross-sectional geometry, kinematics,
and shaping technique, instrumentation resulted in similar changes
in volume, surface area, and SMI. Marzouk and Ghoneim found no sig-
nificant difference in volumetric change when they compared the
Twisted File and WaveOne systems.
In this study, canal transportation was evaluated considering the
changes in centers of gravity before and after instrumentation. Both
K3 and K3XF instruments showed reduced canal transportation values
in the apical region in all specimens evaluated, with no statistically sig-
nificant difference between the systems. These results are in disagree-
ment with the study of Zhao et al (6) in which Twisted File and
HyFlex CM systems, which receive heat treatment in the manufacturing
process, resulted in significantly lower canal transportation values in
comparison with the K3 system. This discrepancy may be related to
the different dimensions of instruments used in the apical region, which
were #25.06 and #30.04 in the present study and #30.06 in the study by
Zhao et al (6). Moreover, the instruments used by the previously cited
4 Almeida et al.
authors have different geometries, which may interfere with the values
found for apical transportation, and therefore does not allow direct
evaluation of the influence of heat treatment. The results of this study
are in agreement with the study of Olivieri et al (16), who found no sig-
nificant difference between values of apical transportation generated by
the K3 and K3XF systems by means of radiographic analysis. The results
in the 2 studies may be related to the geometry of these instruments.
Both K3 and K3XF instruments have 2 smaller radial guides to reduce
friction with the canal walls and a third full radial guide that stabilizes
and maintains the preparation more centralized (32). It should be
pointed out that the samples selected for the previously mentioned
studies had slightly curved root canals, whereas in the present study
the specimens had root canals with discrete curvature in which the flex-
ibility of the NiTi alloy did not appear to be a determining factor for the
occurrence of canal transportation in the apical region.
Conclusions
K3 and K3XF rotary systems presented similar capacity to maintain
a centralized preparation. Heat treatment of the NiTi alloy of rotary end-
odontic instruments did not influence the geometry of root canals
regarding volume, surface area, and the cross-sectional aspect after
instrumentation. Both instruments showed reduced values of apical
transportation, with no difference between the groups evaluated.
Acknowledgments
The authors deny any conflicts of interest related to this study.
References
1. Schilder H. Cleaning and shaping the root canal. Dent Clin North Am 1974;18:
269–96.
2. Gonzalez-Rodriguez MP, Ferrer-Luque CM. A comparison of Profile, Hero 642, and
K3 instrumentation systems in teeth using digital imaging analysis. Oral Surg Oral
Med Oral Pathol Oral Radiol Endod 2004;97:112–5.
3. Jeon HJ, Paranjpe A, Ha JH, et al. Apical enlargement according to different pecking
times at working length using reciprocating files. J Endod 2014;40:281–4.
4. Franco V, Fabiani C, Taschieri S, et al. Investigation on the shaping ability of nickel-
titanium files when used with a reciprocating motion. J Endod 2011;37:1398–401.
5. Junaid A, Freire LG, Bueno CE, et al. Influence of single-file endodontics on apical
transportation in curved root canals: an ex vivo micro-computed tomographic
study. J Endod 2014;40:717–20.
6. Zhao D, Shen Y, Peng B, Haapasalo M. Micro–computed tomography evaluation of
the preparation of mesiobuccal root canals in maxillary first molars with Hyflex CM,
Twisted Files, and K3 instruments. J Endod 2013;39:385–8.
7. Shen Y, Zhou HM, Zheng YF, et al. Metallurgical characterization of controlled mem-
ory wire nickel-titanium rotary instruments. J Endod 2011;37:1566–71.
8. Gutmann JL, Gao Y. Alteration in the inherent metallic and surface properties of
nickel-titanium root canal instruments to enhance performance, durability and
safety: a focused review. Int Endod J 2012;45:113–28.
9. Lopes HP, Gambarra-Soares T, Elias CN. Comparison of the mechanical properties
of rotary instruments made of conventional nickel-titanium wire, M-wire, or nickel-
titanium alloy in R-phase. J Endod 2013;39:516–20.
10. Testarelli L, Plotino G, Al-Sudani D. Bending properties of a new nickel-titanium
alloy with a lower percent by weight of nickel. J Endod 2011;37:1293–5.
11. Ebihara A, Yahata Y, Miyara K, et al. Heat treatment of nickel-titanium rotary end-
odontic instruments: effects on bending properties and shaping abilities. Int Endod J
2011;44:843–9.
12. Gambarini G, Plotino G, Grande NM, et al. Mechanical properties of nickel-titanium
rotary instruments produced with a new manufacturing technique. Int Endod J
2011;44:337–41.
13. Tsujimoto M, Irifune Y, Tsujimoto Y, et al. Comparison of conventional and new-
generation nickel-titanium files in regard to their physical properties. J Endod
2014;40:1824–9.
14. Shen Y, Zhou H, Zheng Y, et al. Current challenges and concepts of the thermome-
chanical treatment of nickel-titanium instruments. J Endod 2013;39:163–72.
15. Rodrigues R, Lopes HP, Elias CN, et al. Influence of different manufacturing methods
on the cyclic fatigue of rotary nickel-titanium endodontic instruments. J Endod
2011;37:1553–7.
JOE — Volume -, Number -, - 2015

16. Olivieri JG, St€ober E, Garcıa FM. In vitro comparison in a manikin model:
increasing apical enlargement with K3 and K3XF rotary instruments. J Endod
2014;40:1463–7.
17. Capar ID, Ertas H, Ok E, et al. Comparative study of different novel nickel-titanium
rotary systems for root canal preparation in severely curved root canals. J Endod
2014;40:852–6.
18. Gergi R, Osta N, Bourbouze G, et al. Effects of three nickel titanium instrument systems
on root canal geometry assessed by micro-computed tomography. Int Endod J 2015;
48:162–70.
19. Gergi R, Arbab-Chirani R, Osta N, Naaman A. Micro-computed tomographic evalu-
ation of canal transportation instrumented by different kinematics rotary nickel-
titanium instruments. J Endod 2014;40:1223–7.
20. Marceliano-Alves MFV, Sousa-Neto MD, Fidel SR, et al. Shaping ability of single-file
reciprocating and heat-treated multifile rotary systems: a micro-CT study. Int Endod
J 2014 Nov 14; http://dx.doi.org/10.1111/iej.12412 [Epub ahead of print].
21. Saber SE, Nagy MM, Sch€afer E. Comparative evaluation of the shaping ability of
WaveOne, Reciproc and OneShape single-file systems in severely curved root canals
of extracted teeth. Int Endod J 2015;48:109–14.
22. Zhao D, Shen Y, Peng B, Haapasalo M. Root canal preparation of mandibular molars
with 3 nickel-titanium rotary instruments: a micro-computed tomographic study.
J Endod 2014;40:1860–4.
23. El Batouty KM, Elmallah WE. Comparison of canal transportation and changes in ca-
nal curvature of two nickel-titanium rotary instruments. J Endod 2011;37:1290–2.
JOE — Volume -, Number -, - 2015
Basic Research—Technology
24. Peters OA, Laib A, Ruegsegger P, Barbakow F. Three-dimensional analysis of root ca-
nal geometry by high-resolution computed tomography. J Dent Res 2000;79:1405–9.
25. Peters OA, Laib A, G€ohring TN, Barbakow F. Changes in root canal geometry after prep-
aration assessed by high-resolution computed tomography. J Endod 2001;27:1–6.
26. Ha JH, Kim SK, Cohenca N, Kim HC. Effect of R-phase heat treatment on torsional
resistance and cyclic fatigue fracture. J Endod 2013;39:389–93.
27. Hwang YH, Bae KS, Baek SH. Shaping ability of the conventional nickel-titanium and
reciprocating nickel-titanium file systems: a comparative study using micro-
computed tomography. J Endod 2014;40:1186–9.
28. Lee KW, Kim Y, Perinpanayagam H. Comparison of alternative image reformatting
techniques in micro–computed tomography and tooth clearing for detailed canal
morphology. J Endod 2014;40:417–22.
29. Siqueira JF, R^oças IN, Ricucci D, H€ulsmann M. Causes and management of post-
treatment apical periodontitis. Br Dent J 2014;216:305–12.
30. Moreno JO, Alves F, Gonçalves LS, et al. Periradicular status and quality of root canal
fillings and coronal restorations in an urban Colombian population. J Endod 2013;
39:600–4.
31. Marzouk AM, Ghoneim AG. Computed tomographic evaluation of canal shape in-
strumented by different kinematics rotary nickel-titanium systems. J Endod 2013;
39:906–9.
32. Perez-Higueras JJ, Arias A, de la Macorra JC. Cyclic fatigue resistance of K3, K3XF,
and Twisted File nickel-titanium files under continuous rotation or reciprocating
motion. J Endod 2013;39:1585–8.
Heat Treatment and NiTi Rotary Instruments 5