Endodontic Instrumentation Techniques 2010

Objectives and Goals

  • Describe and understand the evolution of the standardized and the step-back preparation techniques.
  • Understand the rationale and technique for alternative canal enlargement methods to include the Schilder, anticurvature, crown down, and balanced force methods.
  • Describe the action of various instrument types on the shape of the finished canal preparation.
  • Understand the causes, prevention and relative occurrence rates of extruded apical debris that forms as a result of various instrumentation techniques.
  • Understand and desribe the principles, uses and limitations of sonic, ultrasonic and other adjunctive cleaning and shaping techniques and devices.

Cleaning and Shaping of the Root Canal System.  Peters OA, Peters CI.  In Pathways of the Pulp eds. Cohen S & Hargreaves KM.  Ninth Edition 2006:290-357         


Schneider SW.  A comparison of canal preparations in straight and curved root canals.  Oral Surg 32:271. 1971.


Schilder H.  Cleaning and shaping the root canal. DCNA18:269. 1974. Read p.288-96


Walton RE.  Histologic evaluation of different methods of enlarging the pulp canal space.  J Endodon 2:304. 1976.


Morgan LF, Montgomery S.  An evaluation of the Crown-Down Pressureless Technique.  J Endodon 10:491. 1984.


Roane JB, Sabala CL, Duncanson MG.  The "Balanced Force" concept for instrumentation of curved canals.  J Endodon 11:203. 1985.


Archer R, Reader A, Nist R, Beck M, Meyer WJ.  An in vivo evaluation of the efficacy of ultrasound after step-back preparation in mandibular molars.  J Endodon 1992;18:549-532


Luiten DJ, Morgan LA, Baumgartner JC, Marshall JG.  A comparison of four instrumentation techniques on apical transportation.  J Endodon 1995;21:26-32

Al-Omari MAO, Dummer PMH.  Canal blockage and debris extrusion with eight preparation techniques.  J Endodon 1995;21:154-158


Short JA, Morgan LA, Baumgartner JC. A comparison of canal centering ability of four instrumentation techniques.  J Endodon 1997;23:503-507


Dalton BC, Orstavik D, Phillips C, Pettiette M, Trope M. Bacterial reduction with nickel-titanium rotary instrumentation.  J Endodon 1998;24:763-767

Reddy SA, Hicks ML.  Apical extrusion of debris using two hand and two rotary instrumentation techniques.  J Endodon 1998;24:180-183


Siqueira JF, Lima KC, Mahalhaes FAC, Lopes HP, de Uzeda  M. Mechanical reduction of the bacterial population in the root canal by three instrumentation techques.  J Endodon 1999;25:332-335.

Jensen SA, Walker TL, Hutter JW, Nicoll BK.  Comparison of the cleaning efficacy of passive sonic activation and passive ultrasonic activation after hand instrumentation in molar root canals.  J Endodon 1999;25:735-738.       


Ferraz CCR, Gomes NV, Gomes BPFA Zaia AA, Teixeira FB, Souza-Filho FJ.  Apical extrusion of debris and irrigants using two hand and three engine-driven instrumentation techniques.  Int Endod J 2001;34:354-358


Card SJ, Sigurdsson A, Orstavik D, Trope M.  The effectiveness of increased apical enlargement in reducing intracanal bacteria.  J Endodon 2002;28:779-783

Wu MK, Barkis D, Roris A, Wesselink PR.  Does the first file to bind correspond to the diameter of the canal in the apical region?  Int Edod J 2002;35:264-267


Sabins RA, Johnson JA, Hellstein JW.  A comparison of the cleaning efficacy of short-term sonic and ultrasonic passive irrigation after hand instrumentation in molar root canals.  J Endodon 2003;29:674-678


Usman N, Baumgartner JC, Marshall JG.  Influence of instrument size on root canal debridement.  J Endodon 2004;30:110-112

Albrecht LJ, Baumgartner JC, Marshall JG.  Evaluation of apical debris removal using various sizes and tapers of ProFile GT files.  J Endodon 2004;30:425-428


Baugh D, Wallace J.  The role of apical instrumentation in root canal treatment: A review of the literature.  J Endodon  2005;31:333-340


Tanalp J, Kaptan F, Sert S, Kayahan B, Bayirl G.  Quantitative evaluation of the amount of apically extruded debris using 3 different rotary instrumentation systems.  Oral Surg Oral Med Oral Radiol Endod 2006;101:250-257


Haga CS.  Microscopic measurements of root canal preparations following instrumentation.  J Brit Endo Soc 2:41. 1968.

Vessey RA.  The effect of filing versus reaming on the shape of the prepared root canal.  Oral Surg 27:543. 1969.            

Jungmann CL, Uchin RA, Bucher JF.  Effect of instrumentation on the shape of the root canal.  J Endodon 1:66. 1975.

Lim KC, Webber J.  The effect of root canal preparation on the shape of the curved root canal.  Int Endo J 18:233. 1985.

Barnett F, Trope M, Khoja M, Tronstad L.  Bacteriologic status of the root canal after sonic, ultrasonic and hand instrumentation. 

Endo Dent Traumatol 1:228. 1985.

Tronstad L, Niemczyk SP.  Efficacy and safety tests of six automated devices for root canal instrumentation.  Endo Dent Traumatol 2:270. 1986.

Southard DW, Oswald RJ, Natkin E.  Instrumentation of curved molar root canals with the Roane technique.  J Endodon 13:479. 1987.

Walmsley,AD.  Ultrasound and root canal treatment: the need for scientific evaluation.  Int Endo J  20:105. 1987.

Sjogren U, Sundqvist G.  Bacteriologic evaluation of ultrasonic root canal instrumentation.  Oral Surg 63:366. 1987.

Kielt LW,  Montgomery S.  The effect of endosonic instrumentation in simulated curved root canals.  J Endodon 13:215. 1987

Ahmad M, Pitt-Ford TR, Crum LA.  Ultrasonic debridement of root canals: acoustic streaming and its possible role.  J Endodon 13:490. 1987.

Leseberg DA, Montgomery S.  The effects of Canal Master, Flex-R and K-Flex instrumentation on root canal configuration.  J Endodon 17:59. 1991.

Lim KC, Webber J.  The validity of simulated root canals for the investigation of the prepared root canal shape.  Int Endo J 18:240. 1985.

Lev R, Reader A, Beck M, Meyers W.  An in vitro comparison of the step-back technique versus a step-back/ultrasonic technique for 1 and 3 minutes. J Endodon 13:523. 1987

Levy G.  Cleaning and shaping the root canal with a Nd:Yag laser beam:a comparative study.  J Endodon 1992:18;123-127      

Baumgartner JC, Martin H, Sabala CL, Strittmatter EJ, Wildey WL, Quigley NC. Histomorphometric comparison of canals prepared by four techniques.  J Endodon 1992;18:530-534.

Tucker DM, Wenckus CS, Bentkover SK.  Canal wall planing by engine-driven nickel J Endodon 1997;23:170-173

Lumley PJ, Wamsley AD, Walton RE, Rippin JW. Cleaning of oval canals using ultrasonic or sonic instrumentation.  J Endodon 1993;19:453-457

Walmsley AD, Lumley PJ, Laird WRE.  The oscillatory pattern of sonically powered endodontic files.  Int Endo J  22:125. 1989.

Goodman A, Reader A, Beck M, Melfi R, Meyers W.  An in vitro comparison of the efficacy of the step-back technique versus a step-back/ultrasonic technique in human mandibular molars.  J Endodon 11:249. 1985.

Glosson CR, Haller RH, Dove SB, del Rio CE.  A comparison of root canal preparations using Ni-Ti hand, Ni-Ti engine-driven, and K-Flex endodontic instruments.  J Endodon 1995;21:146-151

Calhoun G, Montgomery S.  The effect of four instrumentation techniques on root canal shape.  J Endodon 14:273. 1988.

Cimis GM, Boyer TJ, Pelleu GB.  Effect of three file types on the apical preparations of moderately curved canals.  J Endodon 14:441. 1988.

Haikel Y, Allemann C.  Effectiveness of four methods for preparing root canals: a scanning electron microscopic evaluation.  J Endodon 14:340. 1988.

Ahmad M, Pitt-Ford TR.  Comparison of two ultrasonic units in shaping simulated curved canals.  J Endodon 14:457. 1988

Buchanan LS.  Management of the curved root canal. J Calif Dent Assoc 17:19. 1989.

Tang MPF, Stock CJR.  The effects of hand, sonic and ultrasonic instrumentation on the shape of curved canals.  Int Endo J  22:55. 1989.

Walmsley AD, Williams AR.  Effects of constraint on the oscillatory pattern of endosonic files.  J Endodon 15:189. 1989.

McCann JT, Keller DL, LaBounty GL.  Remaining dentin/cementum thickness after hand or ultrasonic instrumentation.  J Endodon 16:109. 1990.

Lumley PJ, Walmsley AD, Laird RE.  Streaming patterns produced around endosonic files.  Int Endo J  24:290. 1991.     

Zmener O, Spielberg C, Olmos J.  Effectiveness of two different methods for preparing curved root canals.  Endod Dent Traumatol  1994;10:215-219

Camps J, Macouin G, Pertot WJ.  Effects of the flexogates and canal master U on root canal configuration in sumulated curved canals.  Int Endo J.  1994;27:21-25

Saunders WP, Saunders EM.  Comparison of three instruments in the preparation of the curved root canal using the modified double-flare technique.  J Endodon 1994;20:440-444

Esposito PT, Cunningham CJ.  A comparison of canal preparation with nickel-titanium and stainless steel instruments.  J Endodon 1995;21:173-176

Machida T, Wilder-Smith P, Arrastia AM, Liaw LHL, Berns MW.  Root canal preparation using the second harmonic KTP:YAG laser: a thermographic and scanning electron microscopic study.  J Endodon 1995;21:88-91

Zmener O, Banegas G. Comparison of three instrumentation techniques in the preparation of simulated curved root canals.  Int Endodon J 1996;29:315-319

Samyn JA, Nicholls JI, Steiner JC.  Comparison of stainless steel and nickel-titanium instruments in molar root canal preparation. J Endodon 1996;22:177-181

Lloyd A, Jaunberzins A, Dhopatkar A, Bryant S, Dummer PMH.  Shaping ability of the M4 handpiece and safety hedstrom files in simulated root canals.  Int Endo J  1997;30:16-24

Poulsen WB, Dove SB, del Rio CE. Effect of nickel-titanium engine -driven instrument rotational speed on root canal morphology.  J Endodon 1995;21:609-612

Coffae KP, Brilliant JD.  The effect of serial preparation versus nonserial preparation on tissue removal in the root canals of extracted mandibularhuman molars.  J Endodon 1:211. 1975.

Weine FS, Kelly RF, Lio PJ.  The effect of preparation procedures on original canal shape and on apical foramen shape. J Endodon 1:255. 1975.

Bystrom A, Sundqvist G.  Bacteriologic evaluation of the efficacy of mechanical root canal instrumentation in endodontic therapy.  Scand J Dent Res 89:321. 1981

Ahmad M, Pitt-Ford TR, Crum LA.  Ultrasonic debridement of root canals: an insight into the mechanisms involved.  J Endodon 13:93. 1987.

Reynolds MA, Madison S, Walton RE, Krell KV, Rittman BRJ.  An in vitro histological comparison of the step-back, sonic,and ultrasonic instrumentation techniques in small, curved root canals.  J Endodon 13:307. 1987.

Haidet J, Reader A, Beck M, Meyers W.  An in vivo comparison of the step-back technique versus a step-back/ultrasonic technique in human mandibular molars.  J Endodon 15:195. 1989.          

Metzler RS, Montgomery S.  The effectiveness of ultrasonics and calcium hydroxide for the debridement of human mandibular molars.  J Endodon 15:373. 1989.

Siqueira JF, Araujo MCP, Garcia PF, Fraga RC, Saboia Dantas CJ.  Histological evaluation of the effectivenes of five instrumentation techniques for cleaning the apical third of root canals.  J Endodon 1997;23:499-502.

Kosa DA, Marshall G, Baumgartner JC.  An analysis of canal centering using mechanical instrumentation techniques.  J Endodon 1999;25:441-445.

Weller PJ, Svec TA, Powers JM, Ludington JR, Suchina JA.  Remaining dentin thickness in the apical 4 mm following four cleaning and shaping techniques.  J Endodon 2005;31:464-467

Vande Visse JE, Brilliant JD.  Effect of irrigation on the production of extruded material at the root apex during instrumentation.  J Endodon 1975;1:243-246.

Fairbourn DR, McWalter GM, Montgomery S.  The effect of four preparation techniques on the amount of apically extruded debris.  J Endodon 13:102. 1987.

Ruiz-Hubbard EE, Gutmann JL, Wagner MJ.  A quantitative assessment of canal debris forced periapically during root canal instrumentation using two different techniques.  J Endodon 13:554. 1987.

McKendry DJ.  Comparison of balanced forces, endosonic, and step-back filing instrumentation techniques: quantification of extruded apical debris.  J Endodon 16:24. 1990.

Myers GL, Montgomery S.  A comparison of weights of debris extruded apically by conventional filing and Canal Master techniques.  J Endodon 17:275. 1991.

Iqbal MK, Maggiore FM, Suh B, Edwards KR, Kang J, Kim S.  Comparison of apical transportation in four Ni-Ti rotary instrumentation techniques.  J Endodon 2003;29:587 591

Coldero LG, McHugh S, MacKenzie D, Saunders WP.  Reduction in intracanal bacteria during root canal preparation with and without apical enlargement.  Int Endod J 2002;35:437-446

Tan BT, Messer HM.  The quality of apical canal preparation using hand and rotary instrumenets with specific criteria for enlargement based on initial apical file size.  J Endodon 2002;28:658-664

Lussi A, Messerli L, Hotz P, Grosrey J. A new non-instrumental technique for cleaning and filling root canals.  Int Endodon J 1995;28:1-6