Brazilian Dental Journal (2016) 27(1): 22-27 ISSN 0103-6440

http://dx.doi.org/10.1590/0103-6440201600334

Safe Mechanical Preparation with

1Department of Health, UEFS -
Universidade Estadual de Feira de
Santana, Feira de Santana, BA, Brazil
Reciprocation Movement without 2Department of Endodontics, Health

Sciences Center, UNIGRANRIO

G l i d e Pa t h C r e a t i o n : R e s u l t – Universidade do Grande Rio,
Rio de Janeiro, RJ, Brazil
from a Pool of 673 Root Canals 3Department of Restorative Dentistry,

UFMA – Universidade Federal do

Maranhão, São Luis, MA, Brazil

Evaldo Rodrigues1, Gustavo De-Deus2, Erick Souza3, Emmanuel João Correspondence: Dr. Emmanuel
João Nogueira Leal Silva, Rua
Nogueira Leal Silva2 Erotides de Oliveira 61/902 – Icaraí
242.302-30 Niterói, RJ, Brasil.
Tel: +55-21-98357-5757. e mail
nogueiraemmanuel@hotmail.com
The aim of the present study was to prospectively assess the frequency of teeth in which the
Reciproc instruments were able to reach the full working length (WL). This case series study
enrolled 277 consecutive teeth requiring primary endodontic treatment performed with
the Reciproc system (VDW) without a previous glide path by 3 experienced endodontists.
Instruments R25, R40 or R50 were selected, respectively, for narrow, medium and large
canals, according to the preoperative radiographs, as per manufacturer recommendation.
Canals were instrumented and classified as reaching the full WL (RFWL) and not reaching
the full WL (NRFWL), according to the ability of the Reciproc instrument to reach without
a glide path the full electronically determined WL. Finally, canals were filled using a single
matched cone technique. Pearson’s squared-chi test compared the frequency distributions
of canals classified as RFWL and NRFWL. From a total pool of 673 root canals, Reciproc
instruments reached the FWL in 96.28% of cases and 3 fractures occurred. For narrow
canals the percentage of RFWL was 95.37% with 3 fractures. For medium and large
canals, the R40 or R50 instruments reached the FWL in 98.51% and 97.62% of the cases
respectively, with no fracture. Enlarging of root canals using the Reciproc instruments
up to the FWL without a glide path is successful in a great percentage of cases. This case
series suggests the possibility of using a single instrument to enlarge the root canal space Key Words: Reciproc,
of teeth by a simpler approach without an a priori glide path procedure. instruments, glide path.

Introduction glide path became a mandatory transoperative procedure

From an endodontic standpoint, reciprocation can be due to its ability to minimize the risk of torsional fracture
defined as the sequence of repetitive and imbalanced back- of NiTi rotary systems (11-13).
and-forth movements (1), which mechanically drive a given The possibility of using motor-driven NiTi instrument
instrument. The recent introduction on the market of two without the mandatory glide path requirement raises
reciprocation-based systems has raised new perspectives an interesting educational perspective inasmuch as the
for the mechanical preparation of the root canal space. creation of an adequate, reproducible and smooth glide
Reciprocating movement somehow mimics the manual path is universally well-known as a technically demanding
movement (1) and to some extent, as recent studies procedure, in which the difficulty degree is directly
showed, it outperformed conventional continuous rotary related to the curvature, atresia and length of the root
NiTi preparation (2-10). An interesting point addressed by canal and, not less important, to the experience of the
one reciprocating system (Reciproc system, VDW, Munich, operator (14,15). Besides the potential no need for a
Germany) is the claim that it is able to prepare most glide path, the idea of using a single-file to safely create
root canals with no previous hand filing as, not rarely, a final shape, which resembles a 25/.08 dimension, has a
the Reciproc file is able to swimmingly advance towards further educational appeal: the learning curve might be
the apex (http://www.vdw-reciproc.de/en.html). This considerably reduced due to technique and endodontic
effortless and efficient inward advance toward the apex armamentarium simplification.
can be regarded as the result of the interplay between the A recent in vitro study demonstrated the possibility to
instrument’s cross-sectional design and flexibility, as well as enlarge straight and moderately curved mandibular molar
the features of the reciprocating movement itself. In short, root canals using a reciprocating system up to the working
this means that the Reciproc system does not necessarily length without a glide path (7). The in vitro insight of this
require the creation of a smooth and reproducible glide study points out to the clinical possibility of preparing a
path for the majority of cases (http://www.vdw-reciproc. large number of ordinary root canals from molars without
de/en.html). This is an innovative feature as creation of a glide path; however, there is no clinical study demonstrating
 Braz Dent J 27(1) 2016

the possibility of safely using a reciprocating single-file up maxillary molars routinely referred for primary endodontic
to the working length without a previous glide path. This treatment. The exclusion criteria were as follows: (i)
sort of clinical evidence is powerful to enable professionals retreatment cases, (ii) accesses through prosthetic crowns,
taking more predictable decisions. (iii) case with incomplete root formation, (iv) patients
The aim of this study was to assess the frequency of younger than 16 years, and (vi) those who did not agree to
cases in which the Reciproc instruments were able to reach participate in this study. However, no exclusion restriction
the full working length (WL) without a glide path, when was set regarding apical curvature, narrowness degree
the selection of the Reciproc instruments is based on an or partial radiographic visualization of root canal space,
assessment of the preoperative radiograph, according to and teeth with former orthodontic treatment or dental
the manufacturer’s recommendation. The null hypothesis traumatic injury history.
tested was that the Reciproc instruments in reciprocating A pool of 277 teeth (172 molars, 79 premolars and 26
motion would reach the FWL without a glide path in a anterior) (151 maxillary and 126 mandibular) with root
lower frequency. canal treatment indication was included in this report.
Three experienced operators (ER, GD and ES), specialists in
Material and Methods endodontics with more than 15 years of practice, performed
Ethical Issues, Subject Enrollment and Inclusion/ all treatments in their private practice.
Exclusion Criteria
Approval for the project was obtained from the Treatment Procedures
University Research Board on Human Subjects (677.33), After crown openings, the shaping procedure of the
and informed consent was obtained from all participants. root canals was performed by a pecking motion using a

Safe mechanical preparation with Reciproc

After approaching potentially appropriate patients, the dedicated reciprocating motor (VDW Silver) adjusted to
practitioners carefully explained the purpose of the study the manufacturer’s preset configuration “Reciproc ALL”.
and the patients were formally invited to participate. The Reciproc instruments were chosen according to the
The clinical procedures were then explained, along with manufacturer’s recommendation, based on an adequate
the risks and benefits related to the treatment. Patient’s pre-operative radiograph, as previously described (16). Thus,
doubts were clarified when raised and written informed if the canal was partially or completely invisible on the pre-
consent was obtained. operative radiograph (Fig. 1A), the canal was considered as
The main inclusion criterion was first or secondary narrow and the Reciproc 25 was selected. In the other cases,

Figure 1. Case 1. A: Preoperative radiograph showing a partially invisible canal. The R25 file was indicated for this case; B: Transoperative
radiograph showing the R25 at WL; C: Gutta-percha cones adapted to the WL; and D: Final radiograph.

Figure 2. Case 2. A: Preoperative radiograph showing visible canal. After a size 30 hand instrument passively reached the WL, without filing
action, an R50 file was indicated for the case; B: Transoperative radiograph showing two R50 files at WL in the MB and MB2 canal; and C: Final
radiograph.
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where the radiograph showed the canal clearly from the attempted till a perceived resistance in file advance, if so,
pulp chamber to the apex, three possible situations where was observed. All cases in which the Reciproc instrument
met: if a size 30 hand instrument passively reached, without was able to reach the full electronically determined WL,
filing action, the WL, the canal was considered large (Fig. were classified as “Reaching the full WL” (RFWL) (Figs. 1B,
2A), and Reciproc 50 was selected for canal preparation. If 2B and 3B). When some considerable resistance was found
a size 20 hand instrument passively reached, without filing and the Reciproc instrument could not continue its natural
action, the WL, the canal was considered medium (Fig. 3A), advance toward the apex, the reciprocating preparation
and Reciproc 40 was selected for canal preparation. If a was stopped and the root canal was classified as “Not
size 20 hand instrument did not reach the WL passively, Reaching the full WL” (NRFWL) (Figs. 4A and 4B), and the
Reciproc 25 was selected. canal preparation was concluded with hand files.
After irrigating the root canal with 1 mL of 5.25% NaOCl,
the selected Reciproc instrument was advanced in the canal Data Recording and Statistics
space until reaching 2/3 of the previously estimated WL, The number of root canals classified as RFWL and NRFWL
moved in a slow and gentle in-and-out pecking motion was recorded and tabulated in an Excel data sheet. Each
with a 3 mm amplitude limit. After three complete pecking instrument was used on a single tooth and then discarded.
movements, the instrument was removed from the canal Instrument separation was also recorded. At the end of
and its flutes were cleaned by insertion into a spoon-box. the canal preparation, matching Reciproc gutta-percha
At this point, the root canal was irrigated with 1 mL of cones (VDW, Munich, Germany) were used as a master cone
5.25% NaOCl for 1 min. An ISO 10 hand file without being when the canal preparation was completed with a Reciproc
pre-curved was gently inserted into the canal, following instrument to the WL. If increased apical enlargement was
the manufacturer’s recommendations, with the purpose of done with hand files, a standardized gutta-percha cone was
determining the FWL using an electronic apex locator. No fitted as a master cone. All cones were disinfected in the
instrumentation movement was performed with the hand 5.25% NaOCl solution for 1 min prior to the obturation.
E. Rodrigues et al.

file up to this point. In cases where the non-pre-curved ISO Single cone was selected as obturation technique, and
10 hand file reached the FWL, root canal preparation with AH Plus (Dentsply, Konstanz, Germany) used as sealer. The
the Reciproc instrument was then completed attempting gutta-percha was severed at the canal orifice with an
to reach the FWL. In the cases where the ISO 10 hand file electric heat carrier; a cold plugger was used to compact
did not reach the FWL, Reciproc instrumentation was also the softened gutta-percha in the coronal third of the root.

Figure 3. Case 3. A: Preoperative radiograph showing visible canal. The size 30 hand instrument was not able to reach the WL, then a size 20
hand instrument was used and it passively reached the WL, without filing action. Thus, a R40 file was indicated for the case; B: Transoperative
radiograph showing the R40 file at WL in the distal canal; C: Gutta-percha cones adapted to the WL; and D: Final radiograph.

Figure 4. Case 4. A: Preoperative radiograph showing visible and curved canal; B: After failure to reach WL with Reciproc file, the canal preparation
was finished with hand files. C: After root canal filling.
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 Braz Dent J 27(1) 2016

After this, final post-operative radiograph was taken (Figs. Discussion

1D, 2C and 3D) and patients were carefully oriented to This clinical study reports a high frequency of Reciproc
restore the tooth after the root canal treatment. instruments reaching the full WL without a glide path, more
The frequency distributions (%) of root canals classified than 95% for overall root canals. Therefore, the tested null
as RFWL and NRFWL were compared both to overall treated hypothesis was clearly rejected. The current result is in line
canals and for each canal classification (narrow, medium with a recent in vitro study, which showed that Reciproc
and large) using a Pearson’s squared-chi (c2) test. The R25 instrument was able to reach the FWL without glide
a-type error was set at 0.05. path in a high frequency of cases (7). To the best of the
authors’ knowledge, the current report is the first attempt
Results to evaluate the clinical possibility of preparing the root
The overall result showed that from a total pool of 673 canals with a reciprocating movement without the creation
root canals, the Reciproc instrument (R25, R40 or R50) of a conventional glide path.
reached the full WL in 96.28% of cases and only 3 fractures Beyond doubt the glide path is a technically demanding
occurred. For canals classified as narrow, the percentage maneuver, but it is also a mandatory trans-operative step
of RFWL was 95.37% with 3 fractures. As for the medium necessary in order to avoid NiTi instrument fracture by
and large canals, the R40 or R50 instruments reached the torsional failure (11,12). This procedure was previously
full WL in 98.51% and 97.62% of cases respectively, with defined as a smooth radicular tunnel from the root canal
no fracture. Table 1 summarizes the overall results. orifice to its physiological terminus with the clear role
Squared-chi tests showed that the observed of confirming that there is a free pathway for the rotary
frequencies of RFWL and NRFWL canals were significantly NiTi instrument (17). The effectiveness of the glide path

Safe mechanical preparation with Reciproc

different from the expected frequencies both to overall procedure is related to its ability in avoiding the taper-
treated canals (p=0.000, χ2=584.89) and for canal lock phenomenon, which stands for the binding of the
classifications (p=0.000, χ2=381.87 for narrow canals; instrument tip inside the root canal while its remaining
p=0.000, χ2=127.12 for medium canals and p=0.000, bulk keeps turning. Taper-lock phenomenon stress usually
χ2=76.19 for large canals ). occurs because the canal cross-section is smaller than the
instrument tip (18,19). Without a glide path, the area of
contact between the cutting edges of NiTi instruments and
Table 1. Frequency distributions (%) of cases classified as reaching the the dentinal walls may increase considerably (18,19) and
full WL (RFWL) and not reaching the full WL (NRFWL) and fractured so, torsional stress over rotary files may be dramatically
for each type of root canal
increased (12,18). These arguments explain why the lack
Canal / of a previous glide path procedure results in a significant
n RFWL NRFWL Fracture
Instrument
increase in NiTi file separation following rotary preparation
Narrow / R25 454 433 (95.37%) 18 (3.96%) 3 (0.66%) (12). In the present study, out of 673 instrumented root
Medium / R40 135 133 (98.51%) 2 (1.48)% 0 canals, only 3 fractures (0.44%) occurred in root canals
Large / R50 84 82 (97.62%) 2 (2.38)% 0
with small radius of curvature (Figs. 5A, 5B and 5C).
This very low fracture rate is an important result from a
Total 673 648 (96.28%) 22 (3.27%) 3 (0.44%)
technical standpoint, as the overall rate of NiTi instrument

Figure 5. Case 5. A: Preoperative radiograph showing a partially invisible and curved canal. R25 file was indicated for this case; B: Transoperative
radiograph showing the R25 file at WL. At this moment a fracture was observed in the apical third of root canal; C: Final radiograph. Even after
all efforts, the file was not removed and the root canal was filled with the file remaining in the apical third.
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separation in rotary movement has been reported to be (2). Furthermore, the reduced cross-sectional metal mass
markedly higher; 1.83% (20), 5% (21) and 16% (22) even plus the use of the superelastic M-wire alloy provide great
following glide path. Therefore, reciprocating movement flexibility and cutting ability specifically to the Reciproc
may play a role in preventing instrument separation even instrument, which also may help understanding the current
without a glide path, as the cyclical reversal of rotation results.
seems to drastically reduce the torsional stress over the NiTi Some concern regarding the use of an engine driven NiTi
instrument. Extended cyclic fatigue life of reciprocating file without a glide path is based on a perceived reduction in
systems when compared to rotary systems has also been the occurrence of canal modifications and anomalies when
extensively observed (2,5,6,8,10). previous glide path is performed using rotary motion (11-
It can be claimed that a “guide path” may have been 13). A recent study showed that canal modifications seem
created after the passive use of a #10 K file after coronal to be significantly reduced when glide path is performed
flaring with Reciproc instrument in this study. However, previously to the WaveOne NiTi reciprocation single-file
as reported above and previously, a true glide path implies system (25). However, there are no data on the influence of
that the root canal cross-section should be bigger than glide path on geometric canal modifications with Reciproc
the tip of the first used NiTi rotary instrument (11-13,23). files. Both reciprocating systems are made of the same NiTi
Thus, an enlargement of the root canal should be provided allow (M-wire), but they have quite different cross sections,
to a size #15 or #20, in order to consider a smooth glide taper and flexibility. Reciproc instruments have an S-shaped
path for mechanical instrumentation to be created. For cross-section with two cutting blades while WaveOne
the case of medium and large canals, where size 20 and instruments have an increased bulk with a modified convex
30 hand instruments were used to select the Reciproc triangular cross-section in the tip and a convex triangular
instrument, no manual root canal filing action has been cross-section in the middle and coronal portion. It has
performed. In these cases, in which the root canals were been reported that the larger the cross-sectional area, the
radiographically visible to the entire length, it may be higher the flexural and torsional stiffness (26). In this way,
E. Rodrigues et al.

suggested that originally wide apical canals were present. file design (e.g. cross-sectional shape, diameters of core,
This anatomical observation, however, does not imply that a etc.) could have a significant influence on the necessity of
glide path already existed. Berutti et al. (11) recommended glide path to prevent instrumentation errors. It becomes
that the root canal diameter should be at least one size apparently clear from the current study that the use of
larger than the tip of the first rotary instrument to be used Reciproc files could not be related with such errors, since
in that root canal (11). Therefore, ideally, the root canal none was clinically observed in the present study, and as
should be widened to provide the minimal enlargement earlier described, only 3 instrument fractures occurred.
and the smooth pathway required to prevent fracture by When attempting to study the frequency of a given
torsional stresses. event in a population, a control group is not necessarily
The high frequency of Reciproc instruments reaching the required, as in the case of the present study, where a
apex without a conventional glide path, as demonstrated squared-chi statistical procedure is enough to certify the
in this clinical report, may be understood as the result of significance of the observed frequency. Thus, a glide path
the interplay of three main factors: (i) the reciprocation control group was not included since the main purpose of
kinematics, (ii) the instrument cross-section and (iii) the present study was limited to observe the frequency of
the M-wire alloy. The advantages of the reciprocation RFWL canals, when the selection of the Reciproc instruments
kinematics are somehow based on the balanced force is based on an adequate preoperative radiograph, according
concept. This technique has shown its clinical relevance to the manufacturer’s recommendation. There is no doubt
in reaching the full electronically determined WL in that the Reciproc instrument was able to reach the FWL of
severely curved canals prepared with hand files (24). Thus, teeth in a high frequency of cases. Furthermore, within the
reciprocation can be considered as a mechanically driven limits of the type of the sampling in the present study, it
balanced force, which might be related to the efficacy of is reasonable to conclude that performing the glide path
the instrument in advancing toward the apex (6), reducing procedure would certainly not imply in less RFWL canals
the taper lock due to small angles of instrument cycles plus by the Reciproc instruments.
the improved cyclic fatigue resistance (2,5,6,8,10). Of note, In summary, it was observed that enlarging the root
the reciprocating movement per se was able to improve canals using Reciproc instruments up to the FWL without
the cyclic fatigue resistance of several NiTi instruments a glide path could be attained in a high frequency in
when compared to rotary motion (8), which corroborates primary treatments performed by specialists. This result
the observation of an extended cyclic fatigue life of the suggests the possibility of using only one instrument in
F2 ProTaper instrument used in reciprocating movement reciprocating motion to enlarge the root canal space of
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 Braz Dent J 27(1) 2016

 9. Koçak S, Koçak MM, Sağlam BC, Türker SA, Sağsen B, Er O. Apical
teeth by a simpler and safe approach without demanding extrusion of debris using self-adjusting file, reciprocating single-file,
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