Key Topics in Restorative Dentistry

This narrative review will focus on the evolution, present and future of engine-driven root canal preparation. Root canal preparation changed drastically when Walia in 1988 introduced the use of nickel-titanium (NiTi) alloys in Endodontics. In 2013, five generations of NiTi endodontic instruments had been established based on their metallurgical, mechanical properties and design features. Since then, manufacturers have been introducing further major changes in instrument design and characteristics that have not been translated in new recognized generations of instruments. In general, those changes have demonstrated enhanced instrument properties, but it is not clear yet if all those improvements are directly translated to an improvement in clinical success. This narrative review attempts to address the present status of engine-driven instruments in terms of both evidence from laboratory-based studies and clinical data, to identify potential further generations of instruments, and last to anticipate future directions for research and development.