Endod Dent Traumatol 2000; 16: 95–100 Copyright C Munksgaard 2000

Printed in Denmark . All rights reserved

Endodontics &
Dental Traumatology
ISSN 0109-2502

Review article

Rationale for the use of low-torque

endodontic motors in root canal
instrumentation
Gambarini G. Rationale for the use of low torque endodontic G. Gambarini
motors in root canal instrumentation. Endod Dent Traumatol Department of Periodontics-Endodontics, Dental
2000; 16: 95–100. C Munksgaard, 2000. School, University of Rome ‘‘La Sapienza’’, Roma,
Italy

Abstract – Fracture of nickel-titanium rotary files is an iatrogenic

error which can seriously jeopardize root canal therapy. If a high-
torque motor is used, the instrument-specific limit-torque (fracture
limit) is often exceeded, thus increasing the risk of intracanal fail-
ure. A possible solution to this problem is to use a low-torque endo-
dontic motor which operates below these values. If the torque is
set just below the limit of elasticity for each instrument, the risk of
fracture is likely to be markedly reduced. The purpose of this paper
was to discuss mechanical properties of NiTi rotary instruments,
the rationale for selecting low torque values, and to use clinically a
new endodontic motor (step-motor) which operates below the limit Key words: nickel-titanium alloy; root canal
of elasticity of each rotary file. The step-motor was found to be instrumentation; root canal preparation
helpful in reducing the risk of instrument fracture. Irreversible ma- Gianluca Gambarini, Circonvallazione Casilina 124,
terial damage (plastic deformation) and instrument fracture were 00176 Rome, Italy.
rarely seen. Low-torque instrumentation also increased tactile sense e-mail: ggambarini/tim.it
and, consequently, mental awareness of rotary instrumentation. Accepted January 4, 2000

Endodontic preparation of curved canals represents a The main problem with NiTi rotary instrumen-
considerable problem for practitioners. When stain- tation techniques probably is instrument failure. In-
less steel instruments are used, there is a tendency for tracanal instrument fracture is an iatrogenic error
all preparation techniques to transport the prepared which can seriously jeopardize root canal therapy.
canal away from its original axis. Deviation from the Pruett et al. (4) have shown that the continuous cycle
original curvature can lead to procedural errors, such of tensile and compressive forces to which engine-
as ledge formation, zipping, stripping or perforations. driven instruments are subjected, produces a very de-
As a consequence, new endodontic instruments and structive form of loading. Moreover, mechanical
techniques have been introduced which serve to mini- stress on NiTi rotary instruments is proportional with
mize these risks. More flexible nickel-titanium (NiTi) the motor torque. If a high-torque motor is used, the
instruments for use in slow-speed high-torque hand- instrument-specific limit-torque (fracture limit) is
pieces have been developed and found to be efficient often exceeded, thus increasing the risk of intracanal
(1–2). The superelasticity of NiTi alloy allows these fracture. A possible solution to this problem might be
instruments to flex far more than stainless steel instru- to use a low-torque endodontic motor which operates
ments before exceeding their elastic limit, allowing below the maximum permissible limit-torque of each
easier instrumentation of curved canals while minim- rotary instrument. If the torque is set just below the
izing canal transportation (3). limit of elasticity (E) for each instrument, the risk of

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Gambarini

increasing the applied load (Fig. 2). This explains why

NiTi instruments require a certain amount of torque
and rotation to overcome the linear elastic response
of the initial structure and reach the martensite start
clinical stress (Ms). The figure also explains why NiTi
rotary instruments should be operated with constant
speed and torque (constant load) when the martensite
start clinical stress is reached, to maximize efficiency
and minimize iatrogenic errors. Andreasen & Mor-
row (6) have demonstrated that stainless steel wires
undergo a much larger charge in force compared to
the charge in force of NiTi wires when deflected an
equivalent amount (spring rate). Clinically, this means
that NiTi is more flexible, requires less force to under-
go a change in deflection (i.e. when negotiating a
Fig. 1. Typical loading and unloading behaviour of superlastic NiTi curved canal), and consequently, requires low recov-
(stress-strain curve) when subjected to tensile stress.
ery loads, thus reducing the tendency of straightening
the root canals.
Martensite is the more deformable, lower tempera-
fracture is likely to be reduced to an extent far below ture phase present in NiTi, which is able to absorb
what has been possible until now. up to 8% recoverable strain. Upon minimal further
The purpose of the present paper was to discuss deformation there is a small linear elastic response up
mechanical properties of NiTi rotary instruments, the to the elastic limit (E) , caused by the elastic deforma-
rationale for selecting lower torque values, and to tion of the self-accommodated martensitic product in
clinically evaluate a new endodontic motor (step-mo- which a small amount of slip and dislocation motion
tor) which operates below the limit of elasticity of is apparent. Further deformation results in plastic de-
various types and sizes of instruments. formation and final failure (Fig. 1). In clinical prac-
tice, plastic deformation of NiTi rotary instruments
Superelastic NiTi rotary instruments
Shape memory alloys, such as nickel-titanium, under-
go a phase transformation in their crystal structure
when cooled from the stronger, high temperature
form (austenite) to the weaker, low temperature form
(martensite). This inherent phase transformation is
the basis for the unique properties of these alloys, in
particular shape memory effect and superlasticity (5).
This latter property is important for the endodontic
use. NiTi alloys can show a superlastic behaviour if
deformed at a temperature which is slightly above
their transformation temperatures. This effect is
caused by the stress-induced formation of some mar-
tensite above its normal temperature. Because it has Fig. 2. Superlastic behaviour of NiTi alloy.
been formed above its normal temperature, the mar-
tensite reverts immediately to undeformed austenite
as soon as the stress is removed. This process elicits
a springy, ‘‘rubberlike’’ elasticity from the alloy. The
typical loading and unloading behaviour of superlas-
tic NiTi (stress-strain curve) when subjected to tensile
stress is shown in Figure 1.
The superelastic behaviour is typically represented
by the martensitic yeald plateau within which the
stress remains approximately constant until the mar-
tensite finish (Mf) transformation stress, a value which
is slightly lower than the elastic limit, is reached. This
plateau is clinically useful, because it allows easy and Fig. 3. Suggested low-torque setting (safety), slightly lower than the
efficient instrument deformation without significantly limit of elasticity.

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 Low-torque endodontic motors

should be avoided, because it may easily lead to frac- efficient load (14). However, this range is small and
ture. As shown in Figure 1 the range of deformation difficult to determine. With good approximation it
allowed by the plastic field is twice as small as that can be defined to be slightly lower than the limit of
allowed by the elastic field. elasticity. The elastic and fracture limits of NiTi ro-
Extensive tension testing of NiTi wires has been tary instruments are obviously dependent on design,
done in the last few decades. Researchers have found dimensions and taper. This means that the right
that compression, torsion and flexural loading of NiTi torque value for each individual instrument must be
wires result in similar constitutive behaviour to that calculated by the manufacturers to obtain optimum
observed in tension. However, the critical stress in cutting performance while minimizing risks of failure.
torsion is much smaller than the stress observed in Moreover, motors must have a very precise, fine-ad-
tension or compression, while the recovery strains are justed control of torque values, in order to take ad-
much greater (7). NiTi endodontic instruments have vantage of these concepts of not exceeding the limit
been thoroughly investigated (8–10). Walia et al. (3) of elasticity and consequently avoiding plastic de-
reported that no. 15 nickel-titanium files have two or formation and intracanal breakage.
three times more elastic flexibility and superior resis- Conventional endodontic motors are not able to
tance to torsional fracture when compared with no.15 allow precise and/or low-torque settings for different
stainless steel files manufactured by the same process. reasons. For example, if not electronically controlled
Wolcott & Himel (9) have evaluated torsional prop- the low-speed range of conventional motors is be-
erties of 0.04 tapered nickel-titanium rotary files ac- tween 2000 and 4000 rpm, and the maximun speed
cording to ANSI/ADA specification number 28. is approximately 40 000 rpm. To permit operation
From the results of their study, torque at fracture for at the optimum speed range for NiTi rotary instru-
sizes no. 15, no. 25 and no. 35 were, respectively: ments (i.e. 200–300 rpm) a large reduction factor is
0.22, 0.49 and 1.27 (Ncm). These are still low values, used. This reduces the speed, but the torque in-
despite the superior resistance to torsional fracture of creases proportionally to the reduction ratio. The
the alloy. possibility of calibrating the handpieces is another
important issue, which has recently been brought to
the attention of the endodontists. Depending on the
manufacturers and the condition of the handpieces
Slow speed, low-torque (right-torque) motors
(i.e. old or new) each single handpiece has a differ-
The previously mentioned values are interesting if we ent degree of effectiveness, which results in different
consider that the majority of conventional endodontic torque losses, which are very difficult to define.
motors for NiTi rotary instrumentation are used at a Some of the new motors, however, compensate for
higher torque setting (smallest values ranging approxi- these losses by means of a calibration routine. The
mately from 1 to 3.5 Ncm). This means that consider- programmed torque is therefore always available as
able stress is usually exerted on rotary instruments. the operating torque.
This high stress is not clinically important in straight A step-motor with computer-controlled electronics,
canals where the resistance of dentin removal is low. which allows fine adjustment of the torque values for
On the contrary, in curved and/or calcified canals each and every instrument of different brands, is pres-
the resistance is high and the instrument may become ently available as prototype (EndoStepper, SET, Em-
blocked near the tip. In these situations the high mering, Germany). The maximum torque values for
torque provided by the motor might immediately lead the individual instruments can be adjusted and pro-
to fracture of the blocked instrument, especially since grammed such that the elastic limit is not exceeded.
the clinician usually has no time to stop or retract the All data for each instrument (including operating
instrument. speed, limit of elasticity, maximum torque and angle
The use of slow-speed high-torque NiTi rotary in- of rigth-left motion) are stored in the computer mem-
strumentation has been accepted in the last decade ory. If the motor is loaded right up to the instrument-
by manufacturers, clinicians and researchers (11–13), specific limit-torque, the motor stops momentarily
leading to many iatrogenic errors. Ideally it should and attemps to start again. If the externally required
now be changed to slow-speed low-torque or, prefer- torque (determined by anatomic complexities and
ably, right-torque motors, since each instrument has hardness of dentin) is so high that the motor cannot
a specific ideal (right) torque.The values are usually start automatically, by means of a pedal function, the
low for the smaller and less tapered instruments, and motor executes a precisely defined left-right motion,
high for the bigger and more tapered ones. which succeeds in safely freeing the blocked instru-
To minimize the risk of intracanal breakage the in- ment. Once the instrument is released the motor ro-
struments should be operated in a range between the tates in the usual, programmed direction. This safety
martensite start clinical stress values and the marten- mechanism was developed to reduce the risk of instru-
site finish clinical stress values, which is a safe and ment fracture.

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Fig. 4. (a) Pre-operative radiograph of mandibular premolar. The referring dentist was not able to locate and negotiate both root canals.
(b) Intraoperative radiograph showing the working files placed to the apex in two different canals. (c) Final obturation shows proper shape.
The canal preparation was performed using only NiTi rotary instrumentation.

Fig. 5. (a) Inappropriate endodontic therapy which needs retreatment. (b) Obturation and ledge were bypassed and canal successfully
negotiated to the apex using NiTi rotary instruments, which developed a continuously tapering canal preparation. (c) Retreatment com-
pleted. Multiple portals of exit were obturated using warm gutta-percha and zinc-eugenol based sealer.

Clinical evaluation
to do all the work (passive instrumentation). The in-
creased tactile awareness was also important in re-
The EndoStepper motor has been used for six months treatment cases, i.e. when iatrogenic errors such as
in clinical endodontic practice by the author. ProFile ledges were encountered. The low-torque instrumen-
instruments (Maillefer, Baillagues, Switzerland) and tation was helpful in detecting canal blockage without
the crown-down instrumentation technique were used the risk of intracanal fracture, since the instruments
to prepare root canals in everyday practice. More were backed out when a medium-low resistance was
than 300 teeth were instrumented using the step-mo- encountered. Fig. 5 a–c show a 0.04 tapered no. 20
tor. The motor provided many advantages. The main rotary instrument bypassing the small ledge and the
advantage was to dramatically increase tactile and canal preparation was successfully completed by ro-
mental awareness of rotary instrumentation. This was tary instruments. The enhanced tactile awareness was
a fundamental step in reducing the risk of instrument also helpful in mantaining the original canal path
fracture to a minimum. Moreover, an improved feel while sequentially instrumenting the ledge.
for the mechanics and limitations of NiTi rotary files Figures 6 and 7 show similar cases, i.e. premolars
was quickly developed. Low torque values mean low with a curvature in the apical thirds, but with import-
applied pressure on the root canal instruments. Vi- ant differences. The lower premolar presented a nor-
brations and motor noise were negligible, and the in- mal working length (20 mm) and the curvature was
struments gently and efficiently negotiated the root not severe (Fig. 6). Thus, the stress induced by ana-
canals within a reasonable period of time and with tomic complexities on the rotary instruments was not
minimal mechanical stress (medium-easy canals). The so high. It was possible to safely and efficiently nego-
instruments followed the curved canals (Fig. 4 a–c). tiate the canal to the apex, using passive instrumen-
No forcing was necessary, and the preselected values tation and low torque values. The upper premolar on
of torque and speed allowed the nickel-titanium files the other hand was a long tooth (working lengthΩ26

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 Low-torque endodontic motors

Among the possible disadvantages it should be

mentioned that with the use of the low-torque motor
the cutting efficiency was reduced. This modification
was the greatest for the smallest rotary files, when
compared to traditional endodontic motors. Although
this might not be a major problem, it could be irritat-
ing at first in that excessive resistance was felt in the
canal, so that instrument penetration to the apex was
blocked. In these cases, the usual operative sequences
had to be modified. Usually additional crown-down
enlargement was necessary before the apex could be
reached. Coronal enlargement always decreases the
overall canal curvature, and consequently reduces the
mechanical stress on the instruments in the apical
area. The case shown in Figures 8 a and 8 b) is an
Fig. 6. Immediate post-treatment radiograph of curved lower pre- example how one can safely and efficiently prepare
molar. Appropriate instrumentation with NiTi rotary instruments the delicate apical area by rotary instrumentation, fol-
safely and efficiently developed a smoothly tapered canal. lowing the above-described guidelines. Instrumen-
tation time is not significantly increased, and the basic
concept of using rotary files is not changed. The step-
motor only gives the clinician a warning that caution
should be exercised, and that a different operative se-

Fig. 7. Final obturation of upper premolar with a severe apical

curvature. Coronal enlargement was performed using NiTi rotary
files. Apical preparation was completed by hand instrumentation.
The apical constricture was kept small and in its original position.

mm), and also the curvature was more severe. Low

torque values were selected, as in the previous case.
However, the rotation inside the long, severe curva-
ture induced much greater mechanical stress and the
motor stopped. This safety feature was important,
since it avoided plastic deformation and, probably,
fracture of the rotary instruments. The canal prepara-
tion of the apical curvature was successfully com-
pleted with precurved, stainless steel hand-files, using
great care.
The use of the step-motor was felt to be helpful in
developing a new and more acute tactile sense. More-
over, when the motor stopped, it clearly was a warn- Fig. 8. (a) The third molar to be treated endodontically for fixed
ing that the instrument was subjected to high, possibly bridge restoration. (b) Post-treatment radiograph shows proper root
dangerous mechanical stress, and that continued use canal preparation (continuously tapering form) through crown-
would be counter-productive. down NiTi rotary instrumentation and recapitulations.

99
Gambarini

quence must be selected to avoid excessive stress on and K-flex endodontic instruments. J Endod 1995;
the instrument. 21:146–51.
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