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JOURNAL OF ENDODONTICS
Copyright 9 1985 by The American Association of Endodontists
preparation of the associated pulp canal system becomes difficult. In fact, curvature introduces such complexity that total instrumenting concepts have been
developed to deal with the curved canal (1-5). Even with
these, it is commonplace for a canal located within a
curved root to be enlarged to a smaller final diameter
than it would be if it were located within a straight root.
Justification for such alteration is simply the fact that a
curvature introduces factors into preparation which, if not
controlled during enlargement, will cause transpor-tation,
ledge formation, and even perforation (1-4, 6, 7). The
more severe the curvature of the root, the more one
tends to reduce the intended preparation diameter in an
effort to prevent irreversible damage of the canal wall.
Reducing the preparation size under such circumstances appears to be logical for two reasons: (a)
smaller diameter preparation means less cutting of the
canal walls and consequently a lesser likelihood for
expression of undesirable cutting effects and (b) small
diameter files are more flexible and therefore less likely
to cause transportation during enlargement.
The curvature problem appears to be solved by small
preparation diameters until one examines what that
solution sacrifices in canal debridement and reliability of
the final seal. Smaller preparation diameters reduce the
amount of mechanical and chemical cleansing of the
canal space. Several studies appear to indicate less
complete removal of debris when small nonflared preparations are used (8-10) while others relate to the
flushing effect of irrigants and indicate that irrigants are
not effective in washing debris from a small diameter
canal (11-13). Finally, Allison et al. (14)indicate that
preparation size/design has an influence upon the final
seal. They found that the best seal was achieved when
a stepback preparation was used.
The goals of an endodontic treatment are to remove
the canal'ssoft tissue contents as completely as possible, eliminate as completely as physically possible any
microbial elements, and create a situation within the
204
Roane et al.
Journal of Endodontics
RATIONALE
The balanced force concept was derived from the
physical law which states: for every action there is an
equal and opposite reaction. To develop the concept,
this law was used to identify and define actions and
reactions that occur during canal preparation in order
to study them and attempt to define a sequence of
events and motions that could be used to control
endodontic
instruments
during
preparation.
Successful motions were retained and a preparation
method de-fined which directed high magnitude
forces against small magnitude forces to develop a
balance of action to reaction, making it possible to
ignore curvature dur-ing canal preparation.
To understand the balanced force concept it is necessary to study the design of preparation instruments,
develop a thorough knowledge of their characteristics,
and learn to recognize their complete capabilities as
well as their specific behavior during movement. With
this accomplished that knowledge may be used to
select an instrument which provides enough variation
in capabilities to allow the user a means of instrument
control when canal curvature is encountered.
Clinical usage and subsequent physical analysis indicate that it is best to select a triangular cross-section
K-type file. This type of preparation instrument offers
several advantages over other cross-sectional designs
and instrument types, when a balance of forces is being
sought. Most importantly, the K-type design provides
cutting edges with identical rake and clearance angles
(15) reg~dless of the direction of movement. Since these
angles remain unchanged by direction of ap-
206
Roane et al.
Journal of Endodontics
Overextension is generally considered to be undesirable and the consequences of leverage are best managed by modification of the instrument tip in order to
gain balance through the removal of the terminal cutting
points.
Modification of the instrument'stip is a recent innovation and has produced perhaps the most dramatic
change in instrument response within the concepts of
balanced forces. It entails removal of the cutting surfaces that primarily express the static restoring force and
therefore the surfaces that are primarily responsible for
canal transportation. Proper removal of these cut-ting
points provides better instrument control than any
previously recognized method, including canal access
preparation (Fig. 5). The modified instrument is not
presently available on a commercial scale. A photograph of the modification is presented in Fig. 6 along
side that of a normal tip to emphasize the terminal
points. These points cut in response to a restoring force
produced when the curvature deflects the file
FiG 4. Presented are four cases that were prepared using the balanced force concept. The minimum apical preparation diameter was 0.45
mm. The second molar in A was completed using standard files and tip overextension whereas the other three cases were completed using
modified instruments.
64 TE$
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A
FtG 5. This graphic representation A and actual molar canal access B illustrate how an access preparation alters the curvature'seffect upon
enlarging instruments. B and C are the areas of dentin removal which are responsible for angular change. The change in instrument entry
angle before and after canal access is illustrated as the angle a and represents a reduction in the arc of the canal'scurvature. Space created
by the access allows the canal curvature to be expressed in the instrument as though the radius of the curve had been increased. The curve
becomes more generalized and distributes throughout the canal length, thereby decreasing the curvature-related forces and their expression.
208
Roane et al.
Journal of Endodontics
s,," A
//
FIG 8. Presented are two acrylic canal models which have been
enlarged from an original diameter of size 20 through a file size 55
using the balanced force concept. Sample A was prepared with
standard instruments using 0.5-mm stepbacks every other file size.
It was the best of a series and shows slight outward transportation
apically. Sample B was prepared using modified files and no
stepback. It is typical of the series as no apical transportation was
seen in the entire group. Enlargement appears to have been
accomplished along both its inner and outer wall to the foramen.
pow , /
MOVEMENT
FIG 9. This illustration indicates the reactions which occur along
the blade inclines of a K-type file during clockwise and
counterclockwise rotation. Dentin strikes the incline opposite the
rotating force, debris is reflected to the dentin side, while a portion
of the torque is vectored causing the instrument to move into the
canal when the torque is clockwise and out of the canal when the
torque is counterclockwise. Inward movement is labeled power and
is used to place the instru-ment into canals. Outward movement is
labeled control. It is used to incrementally disengage the cutting
edges and may be opposed by the operator pushing inwardly to
produce a finite control over the cutting force.
with the canal wall along the blade inclines. The resultant forces move the instrument into the canal when the
torque is applied clockwise and as the instrument moves
inwardly its standardized taper forces the cut-ting blades
deeper into the canal walls. In other words, at a given
point within a canal, the cutting radius increases as the
file moves inwardly. Conversely that radius decreases
as the file moves outwardly. Inward movement is a result
of clockwise instrument rotation while outward
movement is a result of counterclock-wise instrument
rotation (Fig. 9). Hence, not only does the operator
sense the full load while rotating the instrument
counterclockwise but a load of dentin too great to shear
will cause the file to move outwardly and that movement
will simultaneously decrease the depth of cutting edge
penetration into the dentin. The de-crease in penetration
depth continues until the opera-tor's applied inward
pressure exceeds the shear strength of the total
engaged dentin and a cut results. This relationship
finitely adjusts applied force against
210
Journal of Endodontics
Roane et al.
DISCUSSION
Utilization of the concept of balanced forces enables
one to produce enlargement of canals past severe
curvatures without compromise of enlargement concepts or preparation diameters. Examples of clinical
cases completed using the methodology described are
presented in Fig. 4. Without modified tips it is necessary
to extend the instrument slightly beyond the apex in
order to prevent transported walls and ledge formation.
When over extension is used, the tip must be retracted
to lie within the canal space at least one or two instrument sizes before completing the desired preparation
diameter in order to ensure establishment of a constriction or ledge. In those cases, the ledge created by the
last one or two instruments becomes the apical stop and
serves to prevent overextension of gutta-percha during
the filling procedure. Figure 4A presents a case
completed in this fashion. This process is neither completely accurate nor clinically desirable and it may be
eliminated in the future through the use of the modified
instruments. Extensive clinical trials of the modified files
have demonstrated this conclusion to be true. Several
cases are presented in Fig. 4 (B to D) which reveal the
clinical value of file tip modification.
CONCLUSIONS
The balanced force concept of instrumentation is
simply an expansion of the concept of reaming canals. It
differ~ primarily in that the cutting motion is intention-
B a l a n c e d Force Concept
211
References
1. Mullaney TP. Instrumentation of finely curved canals. Dent CUn
North Am 1979;23:575-92.
2. Weine FS, Kelly RF, Lio PJ. The effect of preparation procedures on
1979;23:593-616.
7. Weine FS, Kelly RF, Bray KE. Effect of preparation with endodontic
handpieces on original canal shape. J Endodon 1976;2:298-303.
12.
14. Allison DA, Weber CR, Walton RE. The influence of the method
of canal preparation on the quality of apical and coronal obturation. J
Endodon 1979;5:298-304.
15. Phillips RW. Mechanics of cutting with dental burs. Skinner'sscience
of dental materials. 8th ed. Philadelphia: WB Saunders, 1982:565,
16. Felt RA, Moser JB, Heuer MA. Flute design of endodontic
instruments; its influence on cutting efficiency. J Endodon 1982;8:253-9.