ProFile - Instruments

The introduction of engine-driven instruments in tapers greater than the

standard 2% taper in 1992 by Dr. Ben Johnson substantially changed the way root canal

preparation was accomplished. These instruments made it possible to create an appropriately

flared canal shape without the need for time-consuming serial step back shaping procedures.

Furthermore, the use of the ProFile (Dentsply Tulsa Dental, Tulsa, OK, USA) instrument

sequence allowed greater predictability in canal shape allowing earlier and deeper penetration

of irrigating solutions and increased flow dynamics when using thermoplasticized obturation

materials, such as Thermafil (Dentsply Tulsa Dental).

Profile Family of Endodontic Instruments :

1. Profile 29 Series Rotary instruments 0.02 ,0.04, & 0.06 taper

2. Profile ISO Rotary instruments 0.02, 0.04 and 0.06

3. Profile Orifice Shaper 0.05 to 0.08 taper.

(Mandrel also available for Hand Instrumentation ).

These Series 29 ProFiles (Dentsply Tulsa Dental) were introduced in 1993 with a .04

taper, while instruments with .06 taper were added later. [24]

Instrument usage and design of the original ProFile instruments was a considerable

specification because the tip size corresponded to a uniform increase of 29% between

instruments and accordingly the nomenclature of each instrument in the series ranged from 2

to 10. The series also decreased the number of instruments used in canal preparation.

It is claimed that fewer instruments are required to enlarge to master apical file size.

Table below shows the size equivalents of series 29 instruments compared with ISO sizing.

In contrast to a 50% size increase between ISO size 10 and size 15 and a 33% increase

between size 15 and size 20, the 29% increment has the advantage of smooth transition

among the smaller sizes.

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Size Equivalents Of Profile Series 29 and Standard Iso Sizing

ProFile Series29 size ISO equivalent size (mm)

2 0.129

3 0.167

4 0.216

5 0.279

6 0.360

7 0.465

8 0.600

9 0.775

10 1.000

The use of Series 29 instruments initially presented some difficulties, with the non-

standard tip size, the change in the file numbering system and the use of metallic colours

designating size. These factors produced a system that had a steep learning curve and as such

Series 29 ProFiles were mostly the purview of specialists.

In due course, a more traditional ISO series of ProFile instruments with

conventional sizes was manufactured and marketed by Dentsply Maillefer (Ballaigues,

Switzerland) along with a series of Orifice Shapers. The latter instruments are similar to

ProFile but, in general, have large tip diameters, shorter cutting blades and greater tapers.

More recently, ProFile instruments with a .02 taper were introduced to provide a

comprehensive range of tapers that are capable of dealing with most canals shapes. [ 24, 25]

The introduction of ISO tip diameters simplified their adoption to a wider range of

general dentists and specialists. And the disadvantage with Profile 29 series is that there are

fewer instruments as the size increases thus causing more deformations.[26]

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Design character of ProFile - instruments [20,24,25]

The flutes of ProFile instruments have radial lands that cut radicular dentine with a neutral

rake angle (mild negative), planing the walls smooth and minimizing canal transportation.

The cross-section of the instrument is referred to as a U-blade design, and hence has passive

cutting ability.

The Profile poses a modified tip without transition angle. With this design the point

exercises no cutting action. It functions only as a guide, allowing easy penetration with only a

minimum of apical pressure. The risk of jamming or deviation from the canal path is

removed, and each Profile instrument can be used to the full working length, with no

modification to the original position of the foramen. A tip with no sharp transitional line

angle further enables the instrument to remain centred around canal curvature virtually

eliminating ledge formation.

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The flutes are cut deep into the core from tip to shank allowing greater flexibility at

larger cross-sectional diameters, while allowing larger amounts of debris to be removed.

Profile Series Of Instruments has Following Advantages

1. Variable Taper: The taper of Profile instruments may vary between 4% and 8%. This

much steeper than the conventional ISO angle (2%).The steeper angle of Profile®

instruments brings the following advantages: [28, ]

Effective shaping and cleaning, due to good cutting contact.

Ample irrigation, due to deep penetration of the syringe into the canal, and the

creation of a sufficiently wide flaw channel for constant renewal of the solution.

Dense, three-dimensional compacting of the gutta percha.

The pronounced taper of ProFile instruments means that the area of contact with the canal

walls is small, and therefore the contact pressure is high. This gives the instrument greater

cutting effectiveness. In addition, the extreme point of the instrument remains free, allowing

it to function as a guide.

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GOLDEN KEYS

1. Only a light pressure is needed - no heavier titan when writing with a pencil. Profile

instruments, particularly the smaller sizes, should never be forced into the canal, otherwise

"wind up" may occur, possibly to the point of breakage.

2. In and out movement: the high frequency bending caused by high-speed rotation in curved

root canals leads to fatigue of the nickel-titanium alloy used. The bending is greatest where

canal is most sharply curved (small apical hooks), but the fatigue effect can be distributed

along the length of the instrument by applying a slight in and out movement (2 to 3 mm)

while working. Each instrument is used in the root canal for a period of only about 5 to 10

seconds.

MOTOR AND SPEEDS:

For best performance and to avoid any risk of breakage, Profile instruments should be

used at a constant, stable speed between 150 and 350 r.p.m. For this it is possible to use an

independent electric motor. These motors can be set very precisely to a specified speed. They

supply high torque.

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Profile instruments may also be used directly on the dental chair unit with a high gear

reduction rate contraangle. Examples : with an electrical drive (40WO r.p.m.) a speed of

about 300 r.p.m. can be obtained with a 120:1 to 150:1 contraangle; with an air turbine

(20'000 r.p.m.) a suitable speed can be obtained with a 60:1 to 70:1 contraangle.

I.S.O ProFile® Available as :

I.S.O ProFile® Organizer

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Operational Sequence:The operational sequence described here is for the great majority of cases (molars,

upper maxillary premolars, lower incisors). However, it must be remembered that since

each case is different, this sequence will probably require slight modification, according

to the specific root canal anatomy.

The operational sequence comprises four phases :

1. Crown-down .

2. Determination of the working length

3. Apical preparation

4. Final shaping

1. Crown Down :

An estimate of the provisional working length is made on the basis of the pre-

operative X-ray. This is necessarily an approximate figure, for example between 21 and

24 mm.

The first objective of the crown down phase is to open up the root canal as far as

the minimum estimated working length less 3 mm (example : 21 mm -3 mm = 18 mm);

the first depth mark ring on Profile instruments is located at 18 mm. The working length

should be determined; then the crown down will be continued as far as the apex.

Gates–Glidden drills were supplemented or replaced with ProFile Orifice

Shapers. Orifice Shapers share the same U-blade design permitting straight-line access to

the coronal and middle thirds without encroaching on the so-called danger zone, which

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may occur with Gates – Glidden drills. The use of viscous chelating agents and Orifice

Shapers can effectively extirpate the vital pulp from the canal.

Profile O.S. #3 (.06/40)

The Profile® #3 O.S. is the first instrument in the sequence. As it is relatively

short this instrument can easily be inserted in line with the root canal, without hindrance

from the opposing teeth. With the #3 O.S. already rotating, insert it without excessive

pressure and apply a slight in and out movement, for about 5 to 10 seconds. Do not

think about the working length at this stage; simply allow the instrument to guide itself

along the canal. When progression becomes difficult, do not increase the pressure, just

withdraw the instrument and go on to the next.

Profile O.S. #2 (.06/30)

It is now the turn of the #2 O.S. since this is of a smaller diameter, it can work

more apically.

As before, when progression becomes difficult, withdraw the instrument without

increasing the pressure and go on to the next.

Profile .06/25

Has a smaller diameter than the previously used instruments, and is more flexible

due to the greater length of its cutting section. Use this instrument in the same way as

the preceding ones.

Profile .06/20

Instrument penetrates more apically than the preceding one. Use it in the same

way as before.

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Profile .04/25

Since this instrument has a less pronounced taper, it also penetrates more

apically than the preceding one. Use it in the same way as before, withdrawing as soon

as progression becomes difficult.

Profile .04/20Continue operations with this instrument up until the exact working length. This

working length is determined as described below.

Determination of the Working Length (Example : 22,5 mm) :

The exact working length is determined during the crown-down phase, by

inserting a conventional 10 or 15 K-file (2% taper). This K-File. is used after the first

Profile® has reached the minimum estimated working length less 3 mm (example : 21-3

mm = 18 mm).

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Because the K-file is completely free along practically the whole length of the root

canal, it can penetrate easily up until the apex. Its only function is that of a depth

gauge, allowing the exact working length to be determined with the help of an X-ray .

When the exact working length is known, complete he crown down procedure up until

this exact length. An apex locator can also be used to complete the crown-down

procedure to the exact working length.

Apical Preparation up until the exact working length :

Profile .04/20

Profile .04/25 ... (or a larger-diameter)

04 type Profile if necessary, according to the anatomy of the tooth.

Crown-down as far as the exact working length is now complete. The profile

with 4% taper are now used, this time from the smallest to the largest; first the .04/20

Profile, then the .04/25 Profile, each instrument up until the exact working length.

If necessitated by the particular anatomy, use increasingly large Profile

instruments (.04/30, .04/35, etc) each up until the exact working length .

Final flaring:

06/20 Profile or larger if necessary according to the anatomy of the canal. Final

flaring may he achieved by means of the Profile .06. With the Pro file .06 rotating, insert

it into the root canal without forcing, and during its progression apply a slight in and out

movement. Penetration to the exact working length is not systematically sought, except

if the root canal easily receives the .06 Profile

Summarize : Profile instruments are used in both descending order of diameter (for

crown-down, from the largest to the smallest) and in ascending order of diameter (for

preparation to the exact working length and for final flaring, from the smallest to the

largest).

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Irrigation:

For particularly difficult root canals in the early preparatory stages a lubricant

may be used.

All through the entire sequence of operations irrigate frequently and abundantly

with a syringe using a 2, 5% solution of sodium Hypochlorite (NaOCl)

In the apical preparation and the final shaping stages NaOCl and EDTA may be

used alternately.

Final cleaning and sterilizing and evacuation of dentine debris can be done by

using a #15 Endo sonic file with abundant NaOCl irrigation. OTHER SEQUENCE : [24]One sequence for preparation of medium and large canals is shown in the concept box in

Table .

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As stated earlier, alternative sequences are possible and have been advocated,

including the use of a single taper throughout, varying only the tip diameter, and using

the same tip diameter but alternating the taper. In particular the use of the five

instruments with .06 tapers, ranging from 0.4 to 0.15 mm tip diameter, is a rapid way to

shape larger and rather straight canals. In summary, ProFile instruments with the

possibility of variation in sequences allows for variations in apical anatomy, with the tip

size chosen according to the size at the terminus.

The Gold standard [24]

The ProFile series has been the most widely researched nickel–titanium rotary

instrument in endodontics over the last 10 years establishing it as the gold standard

against which others are measured. Introduction of these rotary instruments has enabled

practitioners to provide a more predictable level of care to patients in a more timely and

reproducible manner and has caused a paradigm shift in the way endodontic treatment is

accomplished and has raised the standard of care.

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