In Vitro Assessment of Torque and Force Generated by Novel ProTaper Next Instruments during Simulated Canal Preparation

Effect of preset torque setting on torque/force generation, shaping ability and surface changes of nickel titanium rotary instrument in different root canal curvature locations: An ex vivo study

The aim of this study was to evaluate how preset torque settings influence the torque, vertical force, and root canal-centering ability of ProGlider and ProTaper NEXT nickel-titanium rotary instruments in canals with different curvature locations. Based on micro-computed tomography, mesial roots of human mandibular molars (25°-40° curvature) were allocated to the apical curvature (apical 1-5 mm) or the middle curvature (apical 5-9 mm) groups, and mandibular incisors (curvature <5°) to the straight canal group. Each group was subjected to automated instrumentation and torque/force measurement with the preset torque of 1, 2.5, or 5 N•cm. Canal-centering ratios were determined with micro-computed tomography. Instrument fracture occurred only in the 2.5 and 5 N•cm groups in curved canals. The preset torque setting and curvature location did not influence canal shaping ability.

Influence of endodontic motors on the behaviour of root canal shaping instruments: an in vitro comparative study

AIMS

The endodontic literature reports a lot of comparative study on endodontic instruments, concerning as well their geometry, instrumental dynamics, material, mechanical behavior or heat treatment. However, to our knowledge, no study has focused on the influence of endodontic motors on the shaping abilities of endodontic instruments. Thus, the aim of this study was to analyze the influence of the endodontic motors on root canal shaping instruments.

METHOD

Dual Move (MICRO-MEGA, Besançon, France), Canal Pro CL2i (COLTENE, Alstätten, Suisse), Canal Pro Jeni Motor (COLTENE, Alstätten, Suisse), Ai Motor (WOODPECKER, Guilin, China), Wave One motor (VDW, Postfach, Munich) and Smart A (WOODPECKER, Guilin, China) were pre-clinically compared in continuous rotation and reciprocating motion on a traction/compression bench using resin blocks. Canal shaping in continuous rotation and reciprocating motion were performed with One Curve and One RECI instruments (MICRO-MEGA, Besançon, France), respectively. The penetration/removal forces, making it possible to objectify the cutting effect and screwing effect of the instruments during root canal shaping, were analyzed.

RESULTS

The results showed (i) that endodontic motors influence the mechanical behavior of endodontic instruments, (ii) that the influence of the motors is essentially felt during reciprocating motion and (iii) that the reciprocating angles influence the mechanical behavior of endodontic instruments.

CONCLUSION

Only endodontic instruments are widely studied in literature while endodontic motors have a direct influence on root canal treatment. This study analyzes the influence of the endodontic motors on root canal shaping instruments. This study tends to demonstrate that Jeni Motor could optimize the mechanical behavior of endodontic instruments.

Patient discomfort levels during instrumentation procedure using nickel-titanium files with different kinetic movements

This study evaluated the perceived vibration, noise and discomfort levels associated with two nickel-titanium file systems with different kinetics; reciprocating motion (REC) using WaveOne Gold and continuous rotation motion (CON) using ProTaper NEXT. Forty roots with two canals from maxillary premolar and molar of 40 patients were included. Root canals were instrumented using each system for each canal. Patients were surveyed about the vibration, noise and discomfort experienced using visual analogue scale, and their preference. The responses were statistically analysed using Wilcoxon Signed-Rank test, Mann-Whitney U test and Spearman's rank correlation test at the 95% of significance level. The vibration, noise and discomfort experienced were significantly greater in REC than CON (P < 0.05). In REC, male subjects reported significantly higher vibration than female (P < 0.05). Majority respondents (72.5%) preferred the CON method. The perceived vibration, noise and discomfort were less apparent from the CON than the REC.

Impact of Radial Lands on the Reduction of Torque/Force Generation of a Heat-Treated Nickel-Titanium Rotary Instrument

This study investigated the impact of a one-sided radial-landed cross-sectional design of a heat-treated nickel-titanium rotary instrument (JIZAI, MANI, Japan; JZ) on torque/force generation and canal-shaping ability, using an experimental non-landed instrument (non-landed JZ) for comparison. Both instruments had tip sizes of 25 and 0.04 or 0.06 taper and were similar in metallurgy and geometry, except for the presence/absence of a radial land. Twenty J-shaped simulated resin canals were instrumented in a two-instrument single-length sequence using an automated root canal instrumentation device with a torque/force analyzing unit. Pre- and post-instrumentation images of the resin canals were analyzed for canal-centering ability at 0–3 mm from the apex. The mean centering ratio was not significantly different between JZ and non-landed JZ (p > 0.05). In the 2nd instrumentation, JZ showed a significantly smaller torque compared with the non-landed JZ (p < 0.05). Regardless of instrumentation sequence, JZ showed a significantly smaller maximum upward force, representing screw-in force (p < 0.05), and a larger maximum downward force (p < 0.05) than the non-landed JZ. JZ generated smaller screw-in forces and had similar canal-centering ability compared with the non-landed JZ.

Torque Generation of the Endodontic Instruments: A Narrative Review

As the use of nickel-titanium (NiTi) file systems for root canal therapy has become popular; hence, knowledge and understanding of the characteristics of NiTi files is essential for dentists. Unintended sudden fracture can occur during root canal shaping, and it is important to understand the conditions that may cause instrument fractures. Torque is defined as the force required to rotate the NiTi file and can be considered of as a parameter for the stress generated. The endodontic engine maintains a constant rotational speed by adjusting torque regardless of the root canal conditions. The process of root canal shaping by rotary instruments is a series of actions that requires torque and generates stress to both the teeth and the NiTi instruments. The generated stress may induce the strain accumulation on NiTi instrument and the canal wall and lead to the development of microcrack in the instrument and dentinal wall. Therefore, understanding of torque and stress generated is important to prevent the fractures to the instrument and the teeth. This stress has been measured using various experimental approaches, including microcrack observation by using a microscope or computed tomography, attaching strain gauges to the teeth, and finite element analysis. This review focuses on the stress generated to the teeth and the instrument during instrumentation under various experimental conditions. The factors related to torque generation are also discussed.

A single-file endodontic treatment: A promising endodontic concept

nema

Vertical Load and Torque during Postspace Preparation and Their Influence on Microcrack Development

PURPOSE

To investigate, in vitro, the magnitudes of vertical load and torque generated during post space preparation of root canal treated teeth and their influence on microcrack development.

MATERIALS AND METHODS

Forty extracted premolars with single canals were decoronated. The roots were prepared using ProTaper Next system (Dentsply Sirona) to X3 file, obturated, and provisionalized. After a 3-week incubation period, the roots were distributed into 2 groups according to the post drill system used (ParaPost fiber post and RelyX fiber post). During post space preparation, the vertical load, torque, and preparation time were recorded. Before and after the post space preparation, the roots were imaged with micro-computed tomography (SkyScan 1172; Bruker micro-CT) to detect new microcracks. The data were analyzed using the Mann-Whitney U-test and chi-square test.

RESULTS

In ParaPost and RelyX, the post space was prepared in 48.31 ±25.28 and 47.71 ±13.36 seconds, respectively (p = 0.360). The peak vertical load generated with ParaPost (20.23 ±7.80 N) was significantly lower than that of RelyX (29.43 ±5.82 N) (p = 0.010). The maximum torque attained with ParaPost (1.42 ±0.61 N.cm) was found to be significantly lower than that of RelyX (3.23 ±1.58 N.cm) (p = 0.000). No post drill fracture or visible deformation was noticed throughout the experiment. New microcracks were found in three ParaPost samples only.

CONCLUSIONS

The choice of postdrill influenced the loads and torques generated during postspace preparation. The ParaPost system showed favorably lower load and torque values during the postspace preparation compared with the RelyX system.

Analysis of Torque and Force Induced by Rotary Nickel-Titanium Instruments during Root Canal Preparation: A Systematic Review

The aim of this review was to provide a detailed literature analysis of torque and force generation during nickel-titanium rotary root canal instrumentation. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search was performed using in PubMed and in journals for articles published in English from 1987 to June 2020 on studies that investigated dynamic torque and force in vivo or in vitro. We assessed article titles and abstracts to remove duplicates, and the titles and abstracts of the remaining articles were screened for eligibility. Full texts were read to verify eligibility by considering predetermined inclusion and exclusion criteria. Fifty-two out of 4096 studies met the inclusion criteria, from which we identified 26 factors that influence torque or force generation. Factors associated with higher torque or force generation and supported by multiple studies with mostly consistent results included convex triangle cross-sectional design, regressive taper, short pitch length, large instrument size, small canal size, single-length preparation technique, long preparation time, deep insertion depth, low rate of insertion, continuous rotation (torque), reciprocating motion (force), lower rotational speed and conventional alloy. However, several factors are interrelated, which obscured the independent effect of each factor, and there was insufficient scientific evidence supporting the influence of some factors.

Cyclic fatigue, torsional failure, and flexural resistance of rotary and reciprocating instruments

Aim

The aim was to compare cyclic fatigue, torsional failure, and flexural resistance of NiTi endodontic files: Hyflex CM (HYF), Genius files (GEN), WaveOne Gold (WOG), and ProTaper Universal (PTU).

Materials and Methods

Fifteen files of each brand were used in cyclic fatigue test and other fifteen files for flexural test and torsional failure test. To the cyclic fatigue test, used torque limit and revolutions per minute were set according to the respective manufacturer guidelines. The test was performed under deionized water at 36°C, and all files were tested in a 3 mm radius of curvature with an angle of curvature of 60°, time of the fracture was recorded. Torsional fatigue test was performed in the torsional machine (Instron MT, USA), recording the fractured time and torque data by the machine software. Flexural fatigue test was performed in 60° of curvature. All data were statistically analyzed by one-way analysis of variance, and Tukey test for multiple comparisons.

Results

Cyclic fatigue (seconds)= HYF: 744.1 ± 231.9/GEN: 477.3 ± 220.5/WO: 278.4 ± 57.0/PTU: 152.4 ± 65.2; torsional failure (N × cm)= HYF: 6.85 ± 1.484/GEN: 6.55 ± 0.828/WOG: 5.73 ± 0.360/PTU: 4.43 ± 0.900; flexural resistance (N × mm)= HYF: 0.33 ± 0.294/GEN: 0.19 ± 0.136/WOG: 0.98 ± 0.216/PTU: 1.85 ± 0.276.

Conclusion

HYF and GEN showed the best results for cyclic fatigue, torsional failure, and flexural resistance, followed by WOG and PTU.

Endodontic Retreatment Using a Single Instrument from four Nickel-Titanium Systems - A Micro-CT Study

Abstract This study evaluated the efficiency of using a single instrument from three different rotary multi-file systems and compared them with that of a reciprocating single-file for endodontic retreatment by means of micro-CT. Sixty extracted canines were prepared using a size F2 ProTaper Universal file and obturated. After 30 days of storage at 37ºC and 100% humidity, the teeth were randomly divided into four groups (n=15) based on the type of instrument used to retreatment: ProTaper Next (PTN), ProTaper Gold (PTG), TRUShape 3D (TS), and WaveOne (WO). The canals were retreated using only the size 40 instrument from each system according to the manufacturer’s recommendations for torque and speed. The time required to remove the filling material was recorded in seconds. The amount of initial and residual filling material and the quantity of dentin removed were assessed by means of micro-CT. Data were statistically analyzed (ANOVA and Kruskal-Wallis) at a 5% significance level. TS instruments required the highest (p<0.05) amount of time (mean, 384.80 ±144.92) compared with the WO (229.67±68.16) and PTG (248.67±64.22) and not so different from PTN instruments (327.67±133.3). No differences in the amount of dentin removed, initial and residual filling volume, and percentages of filling material were observed among the groups. The use of a single rotary instrument from the PTG, TS, and PTN systems was as effective as that of the single-file reciprocating WO system. However, none of the instruments was able to remove the filling materials completely.

Comparative analysis of torque and apical force to assess the cutting behaviour of ProTaper Next and ProTaper Universal endodontic instruments

This study assessed the cutting properties of two Nickel Titanium file systems with different designs and manufacturing materials. ProTaper Next X1 and X2 (PTN; Dentsply Sirona) and ProTaper Universal S2 and F1 (PTU; Dentsply Sirona) instruments were employed. The cutting parameters, that is torque and apical forces, were determined using a specially designed bench-testing machine. Dimensional and geometric parameters were considered to evaluate the results. The average maximum torque values showed statistically significant differences (P < 0.05) among all instruments. Apical force for PTN X2 and PTU F1 instruments initially decreased and then experienced a rapid increase in the last 2 mm of the canal. For PTN X1 and PTU S2, apical force increased during the entire test. When compared to PTU files, PTN required higher torque and apical forces during the shaping procedure. The results lead us to conclude that PTN instruments demonstrated a lower cutting efficiency than PTU.

Nickel-titanium instruments in endodontics: a concise review of the state of the art

The introduction of automated instrumentation in endodontics represented a major advance in progress for this specialty, with improvements in the quality and predictability of root canal preparation and a significant reduction in procedural errors. In recent years, endodontic instruments have undergone a series of changes brought about by modifications in design, surface treatments, and thermal treatments. In addition, new movements have also been incorporated to offer greater safety and efficiency, optimizing the properties of the NiTi alloy, especially through eccentric rotary motion. An understanding of the mechanical properties of these new NiTi instruments and their effect on the clinical performance of root canal preparation is essential if dental practitioners are to select the instruments that provide optimal clinical outcomes, especially in curved or flattened canals. The objective of this literature review is to present and discuss the characteristics of the NiTi alloys used in the major instrumentation systems available in the market, as well as the influence of the metallurgical and mechanical properties of NiTi instruments and the movements that drive them, to enable more accurate and predictable planning of root canal preparation.

Vertical Force Induced with WaveOne and WaveOne Gold Systems during Canal Shaping

INTRODUCTION

The aim of this study was to evaluate the amount of vertical force induced with WaveOne (WO; Dentsply Sirona, York, PA) and WaveOne Gold (WOG, Dentsply Sirona) systems during the canal shaping of extracted teeth.

METHODS

Thirty canals in 15 maxillary premolars were divided into 2 groups: WO and WOG. The canals were gently shaped with WO/WOG Primary instruments according to the manufacturer's instructions. The vertical forces induced during canal shaping in the apical and coronal directions were recorded. The apically and coronally directed peak forces were used for analysis using the Mann-Whitney U test. The instrumentation time was analyzed using the Student t test. All statistical analyses were performed using SPSS software (Version 22.0; IBM, Armonk, NY) at a 5% significance level.

RESULTS

The force increased with the successive instrument insertions within each group. The apically and coronally directed peak forces of the WO and WOG groups ranged from 2.89-11.58 N and from 1.53-2.92 N, respectively. In the 3 insertions, WO showed higher peak forces in both directions. For apically directed peak forces, WO had significantly higher peak forces in the first and third insertions than WOG (P < .01). For coronally directed peak forces, WO had significantly higher values in the first and second insertions (P < .05).

CONCLUSIONS

The WOG system had significantly lower apically and coronally directed peak force values compared with the WO system.

Vibrations Generated by Several Nickel-titanium Endodontic File Systems during Canal Shaping in an Ex Vivo Model

INTRODUCTION

This study aimed to compare the vibration generated by several nickel-titanium (NiTi) file systems and transmitted to teeth under 2 different motions (continuous rotation motion and reciprocating motion).

METHODS

Sixty J-shaped resin blocks (Endo Training Bloc-J; Dentsply Maillefer, Ballaigues, Switzerland) were trimmed to a root-shaped form and divided into 2 groups according to the types of electric motors: WaveOne motor (WOM, Dentsply Maillefer) and X-Smart Plus motor (XSM, Dentsply Maillefer). Each group was further subdivided into 3 subgroups (n = 10 each) according to the designated file systems: ProTaper Next (PTN, Dentsply Maillefer), ProTaper Universal (PTU, Dentsply Maillefer), and WaveOne (WOP, Dentsply Maillefer) systems. Vibration was measured during the pecking motion using an accelerometer attached to a predetermined consistent position. The average vibration values were subjected to 2-way analysis of variance as well as the t test and Duncan test for post hoc comparison at the 95% confidence interval.

RESULTS

Both motor types and instrument types produced significantly different ranges of average vibrations. Regardless of the instrument types, the WOM group generated greater vibration than the XSM group (P < .05). Although PTN and PTU did not show significant differences, the WOP group showed significantly greater vibration than the other groups regardless of motor types (P < .05).

CONCLUSIONS

Under the limitations of this study design, the reciprocating NiTi file system may generate greater vibration than the continuous rotation NiTi file systems. The motor type also has a significant effect to amplify the vibrations.

A Comparative Study of Shaping Ability of four Rotary Systems

PURPOSE

This study compared the cutting area, instrumentation time, root canal anatomy preservation and non-instrumented areas obtained by F360(®), Mtwo(®), RaCe(®) and Hyflex(®) files with ISO size 35.

MATERIAL AND METHODS

120 teeth with a single straight root and root canal were divided into 4 groups. Working length was calculated by using X-rays. The teeth were sectioned with a handpiece and a diamond disc, and the sections were observed with Nikon SMZ-2T stereoscopic microscope and an Intralux 4000-1 light source. The groups were adjusted with a preoperative analysis with AutoCAD. The teeth were reconstructed by a #10 K-File and epoxy glue. Each group was instrumented with one of the four file systems. The instrumentation time was calculated with a 1/100 second chronometer. The area of the thirds and root canal anatomy preservation were analyzed with AutoCAD 2013 and the non-instrumented areas with AutoCAD 2013 and SMZ-2T stereoscopic microscope. The statistical analysis was made with Levene's Test, ANOVA, Bonferroni Test and Pearson´s Chi-square.

RESULTS

Equal variances were shown by Levene's Test (P > 0.05). ANOVA (P > 0.05) showed the absence of significant differences. There were significant differences in the instrumentation time (P < 0.05). For root canal anatomy preservation and non-instrumented areas, there were no significant differences between all systems (P > 0.05).

CONCLUSIONS

The 4 different rotary systems produced similar cutting area, root canal anatomy preservation and non-instrumented areas. Regarding instrumentation time, F360(®) was the fastest system statistically.

Cyclic Fatigue Resistance and Force Generated by OneShape Instruments during Curved Canal Preparation

OBJECTIVES

To evaluate the cyclic fatigue resistance and the force generated by OneShape files during preparation of simulated curved canals.

METHODS

Six OneShape files (the test) and six ProTaper F2 files (the control) were subject to the bending ability test. Another thirty files of each type were used to prepare artificial canals (n = 60), which were divided into 3 groups according to respective curvatures of the canals (30°, 60°, and 90°). The numbers of cycles to fatigue (NCF) as well as the positive and negative forces that were generated by files during canal preparation were recorded. The scanning electron microscopy was applied to detect the fracture surfaces.

RESULTS

Compared with ProTaper F2 files, the bending loads of OneShape files were significantly lower at deflections of 45°(P < .05), 60° (P < .05) and 75° (P < .01). No significant difference was found at 30°. OneShape files presented a higher NCF in both 60° and 90° canals than the control (P < .01). No significant difference of NCF was found between OneShape and ProTaper files in 30° canals. During the preparation of 30° canals by both files, the negative forces were dominant. With the increase of the curvature, more positive forces were observed. When the OneShape Files were compared with the control, significant different forces were found at D3 and D2 (P < .05) in 30° canals, at D2 (P < .05), D1 (P < .01) and D0 (P < .01) in 60° canals, and at D4 and D3 (P < .01) in 90° canals.

CONCLUSIONS

OneShape files possessed a reliable flexibility and cyclic fatigue resistance. According to the assessments of the forces generated by files, OneShape instruments performed in a more fatigue-resistant way during curved canal preparation, compared with the ProTaper F2 files.

Resistance to torsional failure and cyclic fatigue resistance of ProTaper Next, WaveOne, and Mtwo files in continuous and reciprocating motion: An in vitro study

Aims:

The purpose of this study was to evaluate the resistance to torsional failure and cyclic fatigue resistance of ProTaper Next (PTN), WaveOne, and Mtwo files in continuous and reciprocating motion.

Settings and Design:

Randomized control trial in a tertiary care setting.

Subjects and Methods:

A total of 10 new size 25.06 taper PTN X2, 25.06 taper Mtwo files, and 25.08 taper WaveOne primary files each was selected. A custom fabricated cyclic fatigue testing device with a 70° angle of curvature and 3 mm width; curvature starting at 6 mm from the tip was used. All instruments were rotated and reciprocated till fracture occurred and time till fracture of each instrument was recorded in seconds. For torsional failure testing 5 mm tip of each file was embedded in composite resin block and uniform torsional stresses (300 rpm, 2.0 Ncm) were applied repetitively by an endodontic motor with auto stop mode until file succumbed to torsional failure. Number of load applications leading to failure was recorded.

Statistical Analysis Used:

Data were analyzed using t-test for equality of means, Pearson correlation, and ANOVA test.

Results:

All the files showed superior resistance to cyclic fatigue in reciprocating motion when compared with continuous rotation mode. WaveOne primary files displayed maximum resistance to cyclic fatigue both in continuous and reciprocating motion. WaveOne primary files also demonstrated maximum resistance to torsional failure followed by PTN with Mtwo files exhibiting least resistance.

Conclusions:

Operating files in reciprocating motion enhances their cyclic fatigue resistance. WaveOne files showed maximum resistance to cyclic fatigue and torsional failure due to their cross-sectional diameter coupled M-Wire technology.

Efficacy of ultrasonic activation of NaOCl and orange oil in removing filling material from mesial canals of mandibular molars with and without isthmus

Objectives

The aim of this study was to evaluate the volume of remaining filling material after passive ultrasonic irrigation (PUI) of sodium hypochlorite (NaOCl) and orange oil in mesial canals of mandibular molars, with and without isthmus.

Material and Methods

Thirty mesial roots of mandibular molars were divided according to the presence or absence of isthmus. Canals were prepared and filled (Micro-CT #1). Filling was removed using rotary instruments, and specimens were sub-divided into three groups according to the irrigation procedures: Conventional – conventional irrigation with NaOCl, PUI/NaOCl – PUI of NaOCl (three activations, 20 seconds each), and PUI/orange oil – PUI of orange oil (Micro-CT#2). Specimens were enlarged using the X2 and X3 ProTaper Next instruments and submitted to the same irrigation protocols (Micro-CT #3).

Results

No differences were found between the experimental groups in each stage of assessment (P>0.05). The volume of residual filling material was similar to those in Micro-CT #2 and Micro-CT #3, but lower than those observed in Micro-CT #1 (P<0.05). When groups were pooled according to the presence or absence of an isthmus, volume of residual filling material was higher in specimens presenting isthmus (P<0.05).

Conclusions

PUI of NaOCl or orange oil did not improve filling removal. Isthmus consists in an anatomical obstacle that impairs the removal of filling material.

An in vitro analysis of separation of multi-use ProTaper Universal and ProTaper Next instruments in extracted mandibular molar teeth

This study investigated the separation incidence of reused ProTaper Universal and ProTaper Next rotary instruments and identified the location of separated fragments. The root canals of extracted human mandibular molars were prepared with 10 assorted sets of ProTaper Universal and ProTaper Next instruments. After each preparation, instrument sets were autoclaved. This arrangement was repeated until an instrument fractured. The number of prepared teeth until fracture occurred was recorded for each instrument set. Teeth in which the instruments fractured were analyzed to determine the separation grade, apical relation, and coronal position. Fracture surfaces of the instruments were examined with scanning electron microscope. ProTaper Universal instruments fractured after application to a mean of 7.3 teeth, and ProTaper Next instruments after application to a mean of 5.7 teeth (p > 0.05). In the ProTaper Universal and ProTaper Next groups, F2 and X1 were the most commonly fractured instruments, respectively. Torsional and cyclic failures were evenly distributed in both the groups. The mean lengths of the fractured fragments of the instruments showed no statistically significant difference. The distance between the tip of the fractured instruments and apical constriction was similar (p > 0.05). However, the mean distance between the root canal orifice and coronal part of the fractured instrument was shorter in the ProTaper Next group (p < 0.05). The life span of ProTaper Universal and ProTaper Next instruments was the same for preparation of mandibular molar teeth. None of the instruments were fractured in the first usage.

A review of instrumentation kinematics of engine-driven nickel-titanium instruments

Over the years, NiTi alloys have become indispensable materials in endodontic treatment. With technological advancements in metallurgy, manufacturers have attempted to produce instruments with enhanced features. In parallel with these developments, endodontic motors have undergone improvements in terms of torque control and kinematics that are adjustable in different directions. This review presents an overview of the advancements in instrumentation kinematics and the effect of instrumentation kinematics on root canal shaping procedures and instrument performance. The literature search for this narrative review was conducted in Google Scholar, Scopus, PubMed and Web of Science using the keywords 'kinematics and endodontics' and 'reciprocation and endodontics'. In addition, historical literature was searched using the keyword 'nickel-titanium and endodontics'. Overall, 143 articles were included up to 2015.