There are a lot of endodontic file systems — and enough styles and philosophies on canal shaping — for any practitioner to feel like they’ve treated their patients well. AGD Impact Testing the Tools columnist Ross Isbell, DMD, MBA, recently reviewed these instruments. Below is his comprehensive review.

If you are a believer in a particular taper and shaping approach, you are probably inclined to shop around for competitors that can achieve the same results as whatever system you are currently using. At one of my offices, my primary system is ProTaper Gold^® from Dentsply Sirona because I have a traditional motor without reciprocation. ProTaper^® has been one of the market leaders for a long time, but, in the last few years, multiple companies have released files that attempt to replicate and improve on the success of the ProTaper system. Since I already have the setup, I tried out a few of these competitors to see how they held up.

A Market Leader for Good Reason 

ProTaper Gold^® 
Dentsply Sirona 
dentsplysirona.com 

The ProTaper Gold^® system follows the same setup that has been used with ProTaper Universal for many years except now the nickel-titanium (NiTi) files are made with significantly advanced metallurgy to provide greater strength and flexibility. According to company data, the ProTaper Gold files have a 24% increased flexibility and 2.6× greater resistance to cyclic fatigue than ProTaper Universal. After completing root chamber access and locating the orifices with a 10 file, the file system setup starts out with a high taper but a relatively short orifice opener called the Sx file. This file is one of my favorites because of how easily it helps to find and open canals, and I have never managed to break one because of how strong the advanced taper is. With its triangular-shaped cross-section and non-cutting-tip design, I can confidently trust each file to follow the established path. Once the Sx file has gained easy access, I typically go straight to the F1, skipping the S1 and S2 unless I can’t get to working length within three to four attempts. I typically finish cleaning and shaping at F3 or F4. These files come presterilized. I order mine in blister packs so that, if I don’t need to use a certain file, it remains unopened and I can order only the sizes that I need to restock. After using this system, you’ll understand why it is so popular.

Improved Strength and Flexibility Is a Winner 

ExactTaper™ and ExactTaper DC
SS White Dental^® 
sswhitedental.com 

Like the EdgeEndo system, the ExactTaper™ system from SS White^® aims to copy the style of ProTaper while improving on the file. SS White also aims to improve upon the strength of the EdgeEndo system. The company claims that using its proprietary annealing process creates files that have 3× the cyclic fatigue strength of ProTaper with 250% more flexibility and at least a 15% increase on fatigue strength over EdgeEndo. These files have a variable taper and maximum flute diameter of 0.8 millimeters to ensure maximum dentin conservation while cleaning and shaping effectively. Using a parabolic core shape, I did not experience file separation during use of this system, either. The initial shaping system is a two-file system but also has a 20-06 and a 25-06 variable instead of an 18-02 and 20-04. So, there is a shorter path to completion, but, just in case you need a larger finisher, the system has up to a 50-size file. The price point is a little higher than EdgeEndo but still significantly less than ProTaper.

Quality at Half the Price 

EdgeTaper Platinum™ 
EdgeEndo^®
edgeendo.com 

The EdgeTaper™ system was created to be an identical system to ProTaper but at half the cost. Using heat-treated Firewire™ NiTi, the files are just as flexible as ProTaper and are also highly effective at navigating curved canals. EdgeEndo claims that its heat process creates files that can withstand twice the cyclic fatigue of ProTaper, and they definitely proved effective at cleaning and shaping without breaking in my office. I did notice a marked difference in the memory of the file after use relative to the ProTaper. Despite maintaining a curve, I did not see any transportation of canals, even with advanced curves. Price is the biggest selling point of this file, since it is about half of ProTaper.

A Great Consistent Taper 
ZenFlex™ Kerr™ 
kerrdental.com 

This last system is not as much of a copy as the other two ProTaper alternatives, but it maintains a similar file outline. Recommended for use in an 8:1 handpiece at 600 rotations per minute, ZenFlex™ by Kerr™ feels very smooth with its cutting motion, possibly because this system has a more consistent taper than the other systems. These files also have a triangular cross-section and a 1-mm maximum flute diameter that helps minimize transportation of canals and resists torsional stress. Flexibility up to 90 degrees helps with navigating difficult canals, and this system has comparable cyclic fatigue rates to the other file systems. Available in sizes up to 55-06, the ZenFlex system functions well and gives good results for a low price.

These file systems all functioned great in limited trials of five to 10 cases for me, and I found minimal difference in file performance. What I do find different is quality of support for questions, ordering and clinical advice. My Dentsply rep is very hands-on and connects me with coaching when needed or helps me to find an answer quickly. Kerr and SS White are also quite responsive, but the reps are more regional. EdgeEndo keeps product costs low by selling direct but without a traditional distribution network. While the ProTaper is the most expensive of the group, it also functions perfectly when I combine it as part of a whole system of products. Each of these file systems will get the job done and give you a great result for your patient, and you should give them each a try to find what works best for you.

Ross Isbell, DMD, MBA, currently practices in Gadsden, Alabama, with his father, Gordon Isbell, DMD, MAGD. He attended the University of Alabama at Birmingham (UAB) School of Dentistry and completed a general practice residency at UAB Hospital. Isbell has confirmed to AGD that he has not received any remuneration from the manufacturers of the products reviewed or their affiliates for the past three years. All reviews are the opinions of the author and are not shared or endorsed by AGD Impact or AGD. To comment on this article, email impact@agd.org.