Basic ResearchTechnology

The Effect of Three Rotational Speed Settings on Torque and Apical Force with Vortex Rotary Instruments In Vitro
Sean Bardsley, DDS,* Christine I. Peters, DMD, and Ove A. Peters, DMD, MS, PhD
Abstract
Introduction: Both the number of rotations in curved canals and torque are related to fracture resistance of nickel-titanium rotaries via the respective mechanisms of brittle and exural failure. Increased rotational speed (rotations per minute [RPM]) may lead to higher cutting ability and could overcompensate for increased fatigue. The impact of three RPM settings on peak torque (Nmm) and apically directed force (N) during root canal preparation were investigated in vitro. Methods: S-shaped canals in plastic blocks (n = 12/group) were instrumented with Vortex rotaries (Dentsply Tulsa Dental, Tulsa, OK) sizes #15 to 30 with a .04 taper. Rotaries were used in a manufacturer-recommended sequence: #30, 25, and 20 in a crown-down approach progressively deeper into the canal, #15 to the working length, and apical enlargement with sizes 20 and 25 to WL. A total of 216 preparation procedures were performed using a custom testing platform. RPM was set at 200, 400, or 600; automated axial feed mirrored clinical handling, resulting in two in-and-out movements, each to preset insertion depths. Torque and apical force were continuously recorded and peak values statistically contrasted using analysis of variances. Results: No le fractures were observed in any of the three experimental groups. Peak torques and forces varied by instrument size and were highest at 200 RPM for all sizes; torque and force were reduced by 32% and 48%, respectively, at 400 RPM (P < .001). Increasing RPM to 600 did not result in further reductions. The number of discernible peaks for torque (threshold: 0.3 Nmm) and force (threshold: 0.2 N) signicantly decreased from 200 RPM to 400 RPM and did not decrease further with 600 RPM. Conclusions: Under the present experimental conditions, rotational speed had a signicant impact on preparation with Vortex rotaries, with instruments at 400 RPM generating less torque and force compared with 200 RPM. (J Endod 2011;37:860864)

Key Words
Force, nickel-titanium, rotations per minute, torque, vortex

From *Private Practice, San Mateo; and the Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacic, San Francisco, California. Address requests for reprints to Dr Ove Peters, University of the Pacic, Arthur A. Dugoni School of Dentistry, 2155 Webster Street, San Francisco, CA 94115. E-mail address: opeters@ pacic.edu 0099-2399/$ - see front matter Copyright 2011 American Association of Endodontists. doi:10.1016/j.joen.2011.01.022

he use of engine-driven nickel-titanium (NiTi) root canal instruments has many advantages over hand instrumentation, including less canal transportation, less blockage, and more dentin-conserving canal shapes (1). In order to minimize the incidence of instrument fractures, two parameters are of importance: apically directed force and torque (force required to rotate the instrument during contact with root canal walls) (2, 3). Instrument separation may occur as torsional (ductile) and fatigue (brittle) fracture (4) or caused by a combination of the two effects (5). Although a multitude of rotary techniques are advertised on the dental market, one of the best documented instruments is ProFile (Dentsply Tulsa Dental, Tulsa, OK), which was rst introduced in 1994 as ProFile Series 29 rotary instruments (6, 7). Recently, the design of ProFile instrument was updated, and the system is now available under the name of ProFile Vortex rotaries (Dentsply Tulsa Dental). Vortex les are manufactured from modied NiTi raw material, also known as M-wire. M-wire was introduced in 2008 and is produced by applying a series of heat treatments to wire blanks. Preliminary evidence suggested that using M-wire increased the fatigue lifespan of rotary instruments while maintaining the same torsional properties as traditionally ground instruments (8). However, the increased fatigue life of instruments manufactured from M-wire is equivocal (9, 10). Vortex rotaries have a triangular crosssection without radial lands and a specic helical angle. The manufacturer suggests that this geometry promotes a more efcient cutting behavior and less threading-in effect. Another factor that inuences cutting efcacy is speed (rotations per minute [RPM]). Recommendations given in textbooks for rotary speed vary from instrument to instrument (11); the manufacturer suggests that Vortex les be operated at up to 500 RPM (12). Various reasons exist to keep speed with NiTi rotaries low (eg, below 300 RPM) including longer time to fatigue failure (5) and less incidence of taper lock (13). However, a recent article advocates higher RPM with Vortex instruments based on the assumption that higher cutting efciency would more than compensate for these disadvantages (14). The authors concluded that the heat-treated NiTi alloy, M-wire, with its extended fatigue resistance, used to manufacture Vortex rotaries would be particularly suited for higher RPM. Currently, no data are available on physical parameters (eg, torque and apically directed force) for Vortex rotaries in simulated clinical use. Moreover, it is as yet unclear what the changes in such physical parameters are when RPM is increased. Therefore, the aim of the present in vitro study was to investigate the impact of three RPM settings on peak torque and apically directed force during root canal preparation.

Materials and Methods

New sets of Vortex .04 taper rotary instruments (Dentsply Tulsa Dental) sizes #15, 20, 25, and 30 were used in this study. Each set was used to instrument two simulated canals. A total of 36 plastic blocks with S-shaped canals (A0177S; Dentsply Maillefer, Ballaigues, Switzerland) were mounted on scanning electron microscopy (SEM) carriers and distributed into three groups in which canals were shaped with 200, 400, and 600 RPM, respectively.

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Following manufacturer recommendations, simulated root canals were negotiated to their terminus with stainless steel K-les and the balanced force technique (15). Between instruments, canals were lubricated with liquid soap (16). This was intended to mimic clinical conditions in which irrigants are present as closely as possible. In particular, the generation of frictional heat was avoided. The working length (WL) was established at 16.5 mm using a size #15 K-le. Patency was conrmed with a size #10 K-le to 1 mm past the canal terminus. Canals were then prepared using a custom torque bench that has been described in detail previously (5, 17), with automatic axial feed simulating clinical instrument use. To determine correct settings for insertion depth, pilot trials in a separate batch (n = 6) of the plastic blocks were performed to establish time and speed needed to advance Vortex rotaries in a crown-down approach into an S-curved canal in 2 in-and-out insertions (Fig. 1A). The rst instrument, size #30, was to reach the area just before the curve, and each subsequent rotary would reach progressively deeper into the canal until size #15 arrived at the WL. In order to achieve this goal, programming was set so that sizes #30, 25, and 20 reached 11 mm, 13 mm, and 15 mm, respectively. Finally, Vortex sizes #20 and 25 were used for a second time in each canal to the WL and working in two in-and-out insertions. This sequence is in line with the manufacturers recommendation for small canals. The initial positioning of each plastic block for centered le insertion was accomplished manually, and then all steps of canal shaping were produced automatically. Care was taken to set insertion depth limits in a manner as to avoid overloading individual instruments and to adequately distribute forces among rotaries in the set. Force was generated from the vertical drive of the torque bench in order to accomplish the desired movement. Three variables were continuously measured during each 10-second-long instrumentation run (Fig. 1A) using the sensors built into the torque bench. Torque was registered between the motor and the instrument with an in-axis sensor (MTTRA 2 with amplier Microtest; Microtec Systems, Villingen, Germany; accuracy 0.1 Nmm), force was measured with a strain gauge (A&D 30; Orientec, Tokyo, Japan; accuracy 0.1 N), and insertion depth was controlled by a linear potentiometer (Lp-100; Midori, Osaka, Japan; accuracy 0.1 mm). Data were digitized at 20 samples per second (20 Hz, PCI-MIO-16XE; National Instruments, Austin, TX) and fed into a computer (G3 Power Mac; Apple, Cupertino, CA). Peaks in torque and force records were detected with thresholds of 0.3 Nmm and 0.2 N, respectively, and tabulated. Data for peak torque and force were normally distributed, and, consequently, statistical analysis was performed by parametric procedures. Torque and apically directed force were contrasted at various rotational speeds using one-way analysis of variance and Scheff post e hoc tests, whereas categoric data were compared using chi-square tests. The level of signicance was set at P < .05.

Torque Mean torque was always higher for peak 2 compared with peak 1 (Fig. 1A) and tended to increase towards the apical enlargement phase compared with the crown down (Fig. 1B). Overall, a signicant decrease by 32% was measured after changing operational speed from 200 to 400 RPM (P < .001), but only a slight further reduction was noted after switching from 400 to 600 RPM (Fig. 1B and C and Fig. 2). However, for several sizes, such torque reduction only occurred after the change from 200 to 400 RPM. A further increase to 600 RPM produced no consistent change and, in fact, a rise in torque for Vortex instruments used for further apical enlargement (Fig. 1B). Force All instruments were used in an in-and-out motion to simulate clinical movements. The rst application of each rotary le into an articial canal did not reach the designated WL, but the second preparation phase did. Forces were highest for the initial instrumentation in the crown-down phase compared with apical enlargement (Fig. 1C). Apically directed force was then plotted against torque for the three speed settings used. Overall, peak force during preparation decreased signicantly by 48% when comparing 200 with 400 RPM (P < .001). However, raising RPM from 400 to 600 caused a variable reaction for force, a slight increase for peak 1 and a slight reduction for peak 2 (Fig. 2); similarly, forces increased for the apical preparation phase (Fig. 1C). Detection Limit of Testing Platform The registered torque values for Vortex instruments were typically below 10 Nmm, but Vortex rotaries frequently generated 2 Nmm and less at 200 RPM. Along with an increase in speed, there was also a significant increase in incidence of subthreshold measurements (ie, values of <0.3 Nmm for torque or less than 0.2 N for force). At a setting of 200 RPM, 63 of 72 and 62 of 72 insertions were within the detection limits for torque and force, respectively; when instruments rotated at 400 revolutions, corresponding numbers were 52 of 72 and 40 of 72. Finally, at 600 RPM a similar number of usages fell below the detection limit with 53 of 72 (torque) and 40 of 72 (force). The increase in the incidence of subthreshold data was signicant only for 200 versus 400 RPM (P < .05 and .001 for torque and force, respectively).

Discussion
If torque during root canal preparation exceeds the strength of a given engine-driven instrument at a given cross-section, the instrument will fracture inside the root canal, a situation that clinicians like to avoid (4, 1719). During each rotation, an instrument in a curved canal is bent repeatedly, and so-called cyclic loading occurs with alternating tension and compression zones. Manufacturing aws along the surface can act as points of fracture initiation and will lead to crack propagation across the le diameter (20). Clinically, buildup of torsional (twisting) and exural (bending) stresses occurs simultaneously. The amount of cyclic fatigue stress depends on instrument diameter as well as on cross-sectional design (5). For exural stress, the lifespan of an engine-driven instrument is dependent on the time it was used in wall contact inside a canal and duration until fracture will be shortened by using higher working speeds (21, 22). In contrast, torsional stress may be reduced at higher RPM via higher cutting efcacy (23). A drop in resistance (torque) that is caused by a higher operating speed may compensate or override any negative effect this increased speed has on cyclic fatigue (14). 861

Results
No Vortex rotary fractured at any speed during testing. Figure 1A shows a representative original experiment with a size #25 rotary le used to the designated length at 200 RPM. Torque, force exerted, and insertion depth were recorded against time. Time courses for torque and force were similar for all le sizes and show two torque peaks concomitant with the two insertions of the le (compare upper and lower traces in Fig. 1A). Positive force was needed to introduce the rotaries into the canal and negative force was generated when withdrawing the rotary against frictional resistance.
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Figure 1. Simulated root canal preparation with Vortex rotaries using an automated torque platform. (A) Original records with size #25 .04 to 4.5 mm shorter than the WL run at 200 RPM. Note the peaks for both torque and force in phase with the two instrument insertions. (B and C) Bar diagrams of mean ( SEM) peak torque and peak force, respectively, for three different RPM settings (n = 12).

Two design features for Vortex rotaries have been mentioned to improve cutting behavior and fatigue resistance: a variable helical angle (higher towards the tip) and the use of a special NiTi alloy (M-wire). In this investigation, we used a torque-testing device that has been validated earlier for ProFile and ProTaper rotaries (5, 17), which tend to generate higher working torque that the Vortex rotaries used in the present experiment. In fact, torque values were occasionally as low as 0.3 Nmm, which is approaching the detection limit of the torque sensor used. Static fracture loads determined at D3 according to ISO3630-1/ANSI No 28 were 1 Nmm and higher (data not shown); taken together with torques during canal preparation measured in the present study, this suggests a safety quotient $3 for Vortex 862
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rotaries (24). In other words, torsional fracture of Vortex les operated under the present conditions is unlikely and in fact no instrument fractured during the course of the study. Plastic blocks with standardized simulated root canals were used in the present experiment, which is similar to previous studies (17). Plastic blocks have been used for many years not only for the assessment of shaping capabilities (25) but also for the cutting behavior of NiTi rotaries (26); however, cutting of dentin varies from cutting plastic material, and, therefore, caution should be exercised in directly taking these in vitro data into the clinic. We tested Vortex rotary les at three different settings, 200, 400, and 600 RPM, to assess the inuence of these speed settings on torque and
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Figure 2. Scattergrams of torque and force at (A) peak 1 and (B) peak 2 at three different RPM settings. Overall means ( SEM) are included. Note the number of data points with less than 72 points stemming from subthreshold data for torque, force, or both.

apical force inside articial root canals. This selection of RPM settings was based on previous data assessing the effect to rotational speed on rotary breakage (13, 14, 27), including values that are both below and above the recommended RPM for Vortex rotaries. We found that raising RPM from 200 to 400 may be benecial for Vortex instruments because it reduced torque and did not lead to fatigue or fractures. However, raising RPM to 600 did not provide any added benet. Lopes et al (27) studied the effect of increasing from 300 to 600 RPM on cyclic fatigue of ProTaper instruments. In their study, elevating speed caused a 29% decrease in the number of cycles to fracture and a 65% decrease in the working time until fracture. Cheung et al (28) microscopically investigated clinically used ProTaper rotaries and found that 25 of 27 instruments fractured because of
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exural (fatigue) fracture. They stated that raising the number of rotations increases the strain rate of rotary les and reduces the time for either stress relaxation or crystalline grid transformation. This may lead to the initiation of supercial microcracks in the NiTi alloy that can quickly propagate to cause complete instrument failure (29). Apical force was also measured in the present experiment. The reduction in force followed a similar pattern compared with the reduction in torque, with the exception that initial shaping in the crown-down phase required more force that the nal step, which is apical enlargement. This observation is in line with data from Prole .04 instruments obtained in a similar experiment (17). The lack of benet for 600 RPM may be explained by the particular design of Vortex blades, potentially reaching a cutting optimum at 400 863

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RPM in plastic blocks. Another unresolved question is the potential for heat generation and subsequent conformational changes during preparation, which may impact cutting behavior. Tobushi et al (30) showed that higher strain rates lead to structural changes in NiTi alloys with exothermic reaction and, thus, elevated temperatures; Lopes et al (27) had suggested that such temperature raises might lead to faster fatigue with higher RPM. However, it is unlikely that clinical procedures, with cooling via intracanal irrigants, lead to substantial temperature raises. There is still a lot of information to be gathered about NiTi R-phase (31) and, for example, exact annealing temperatures associated with the production of M-wire are not known. However, one can extrapolate from annealed conventional NiTi that likely temperature during canal preparation of 150 C would be required for the alloy to forget all prior deformation (32). In addition to purely a mechanistic approach, clinical effects with higher RPM such as an elevated potential for taper lock should be considered (13); it has been argued that lower speeds may be safer for NiTi rotaries (33, 34). In conclusion, under the present experimental conditions, rotational speed had a signicant impact on preparation with Vortex rotaries, with instruments at 400 RPM generating less torque and force compared with 200 RPM. An additional RPM increase to 600 did not provide any further benet.
11. Peters OA, Peters CI. Cleaning and shaping of the root canal system. In: Hargeaves KM, Cohen S, eds. Pathways of the Pulp. 10th ed. St. Louis, MO: Mosby Elsevier; 2011:288348. 12. Prole Vortex Rotary Files with M-Wire NiTI: directions for use. Available at: www. tulsadental.com/lit2/pdfs/Vortex%20System%20DFU%204-14-10.pdf. Accessed January 4, 2011. 13. Yared GM, Bou Dagher FE, Machtou P. Inuence of rotational speed, torque and operators prociency on ProFile failures. Int Endod J 2001;34:4753. 14. Gao Y, Shotton V, Wilkinson K, Phillips G, Johnson WB. Effects of raw material and rotational speed on the cyclic fatigue of ProFile Vortex rotary instruments. J Endod 2010;36:12059. 15. Roane JB, Sabala CL, Duncanson MG Jr. The balanced force concept for instrumentation of curved canals. J Endod 1985;11:20311. 16. Peters OA, Boessler C, Zehnder M. Effect of liquid and paste-type lubricants on torque values during simulated rotary root canal instrumentation. Int Endod J 2005;38: 2239. 17. Peters OA, Barbakow F. Dynamic torque and apical forces of ProFile .04 rotary instruments during preparation of curved canals. Int Endod J 2002; 35:37989. 18. Barbakow F, Lutz F. The Lightspeed preparation technique evaluated by Swiss clinicians after attending continuing education courses. Int Endod J 1997;30: 4650. 19. Yared GM, Bou Dagher FE, Machtou P. Failure of ProFile instruments used with high and low torque motors. Int Endod J 2001;34:4715. 20. Alapati SB, Brantley WA, Svec TA, Powers JM, Mitchell JC. Scanning electron microscope observations of new and used nickel-titanium rotary les. J Endod 2003;29: 6679. 21. Haikel Y, Serfaty R, Bateman G, Senger B, Allemann C. Dynamic and cyclic fatigue of engine-driven rotary nickel-titanium endodontic instruments. J Endod 1999;25: 43440. 22. Pruett JP, Clement DJ, Carnes DL. Cyclic fatigue testing of nickel-titanium endodontic instruments. J Endod 1997;23:7785. 23. Daugherty DW, Gound TG, Comer TL. Comparison of fracture rate, deformation rate, and efciency between rotary endodontic instruments driven at 150 rpm and 350 rpm. J Endod 2001;27:935. 24. Blum JY, Machtou P, Ruddle C, Micallef JP. Analysis of mechanical preparations in extracted teeth using ProTaper rotary instruments: value of the safety quotient. J Endod 2003;29:56775. 25. Lim KC, Webber J. The validity of simulated root canals for the investigation of the prepared root canal shape. Int Endod J 1985;18:2406. 26. Schfer E, Oitzinger M. Cutting efciency of ve different types of rotary nickela titanium instruments. J Endod 2008;34:198200. 27. Lopes HP, Ferreira AA, Elias CN, Moreira EJ, de Oliveira JC, Siqueira JF Jr. Inuence of rotational speed on the cyclic fatigue of rotary nickel-titanium endodontic instruments. J Endod 2009;35:10136. 28. Cheung GS, Peng B, Bian Z, Shen Y, Darvell BW. Defects in ProTaper S1 instruments after clinical use: fractographic examination. Int Endod J 2005;38:8029. 29. Alapati SB, Brantley WA, Svec TA, Powers JM, Nusstein JM, Daehn GS. SEM observations of nickel-titanium rotary endodontic instruments that fractured during clinical use. J Endod 2005;31:403. 30. Tobushi H, Shimeno Y, Hachisuka T, Tanaka K. Inuence of strain rate on superelastic properties of TiNi shape memory alloy. Mech Mater 1998;30:14150. 31. Gong C, Li Y, Wang Y, Yang D. Ab initio study for electronic and crystal structure of NiTi R-phase. Mat Sci Eng A-Struct 2006;14:339. 32. Duerig T. Some unresolved aspects of Nitinol. Mat Sci Eng 2006;438:6974. 33. Dietz DB, Di Fiore PM, Bahcall JK, Lautenschlager EP. Effect of rotational speed on the breakage of nickel-titanium rotary les. J Endod 2000;26:6871. 34. Gabel WP, Hoen M, Steiman HR, Pink FE, Dietz R. Effect of rotational speed on nickel-titanium le distortion. J Endod 1999;25:7524.

Acknowledgments
The authors deny any conicts of interest related to this study.

References
1. Peters OA. Current challenges and concepts in the preparation of root canal systems: a review. J Endod 2004;30:55997. 2. Blum JY, Machtou P, Micallef JP. Location of contact areas on rotary Prole instruments in relationship to the forces developed during mechanical preparation on extracted teeth. Int Endod J 1999;32:10814. 3. Schrader C, Peters OA. Analysis of torque and force during step-back with differently tapered rotary endodontic instruments in vitro. J Endod 2005;31:1203. 4. Sattapan B, Nervo GJ, Palamara JEA, Messer HH. Defects in rotary nickel-titanium les after clinical use. J Endod 2000;26:1615. 5. Ullmann C, Peters OA. Effect of cyclic fatigue on static fracture loads in ProTaper nickel-titanium rotary instruments. J Endod 2005;31:1837. 6. Thompson SA, Dummer PM. Shaping ability of ProFile .04 taper series 29 rotary nickel-titanium instruments. Part 1. Int Endod J 1997;30:17. 7. Thompson SA, Dummer PM. Shaping ability of ProFile .04 taper series 29 rotary nickel-titanium instruments. Part 2. Int Endod J 1997;30:815. 8. Johnson E, Lloyd A, Kuttler S, Namerow K. Comparison between a novel nickeltitanium alloy and 508 nitinol on the cyclic fatigue life of ProFile 25/.04 rotary instruments. J Endod 2008;34:14069. 9. Kramkowski TR, Bahcall J. An in vitro comparison of torsional stress and cyclic fatigue resistance of ProFile GT and ProFile GT Series X rotary nickel-titanium les. J Endod 2009;35:4047. 10. Larsen CM, Watanabe I, Glickman GN, He J. Cyclic fatigue analysis of a new generation of nickel titanium rotary instruments. J Endod 2009;35:4013.

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