A comparison of the efficacy of conventional and new retreatment instruments to remove gutta-percha in curved root canals: anex vivostudy

The efficacy of ProTaper Universal rotary retreatment instrumentation to remove single gutta-percha cones cemented with several endodontic sealers

AIM

To evaluate residual root filling material following removal of three newly developed root canal sealers used with a matched-taper single-cone root filling technique and to compare the efficacy of ProTaper Universal rotary retreatment instruments with that of a conventional manual technique.

METHODOLOGY

The canals of 120 palatal roots in maxillary molar teeth were instrumented with EndoWave nickel-titanium rotary instruments and filled using Hybrid Root SEAL, EndoSequence BC Sealer, Activ GP system or AH Plus with matched-taper single gutta-percha cones. The root fillings were then removed with ProTaper Universal retreatment rotary instruments or a manual technique. Buccolingual and proximal digital radiographs of the roots were exposed to determine the area of remaining filling material in the coronal, middle and apical thirds. The area percentages of remaining filling material in each third and total canal area were calculated. Data were analysed statistically with Kruskal-Wallis and Mann-Whitney U-tests. The level of significance was set at P<0.05.

RESULTS

Irrespective of the sealer type and retreatment technique, filling material could not be removed completely from the root canals. Significantly, more remaining filling material was observed in the apical third (P<0.05). When comparing the sealers, the only significant difference was detected between AH Plus/manual and Activ GP/manual groups with respect to residual material in the total canal area (P<0.05). There were no significant differences between manual and ProTaper groups.

CONCLUSIONS

When using gross radiographic criteria, the Activ GP was more effectively removed from root canals than AH Plus with hand instrumentation. Hybrid Root SEAL, EndoSequence BC Sealer and AH Plus were removed to a similar extent. ProTaper Universal retreatment instruments were as safe and effective as hand instruments in reaching the working length.

Efficacy of D-RaCe and ProTaper Universal Retreatment NiTi instruments and hand files in removing gutta-percha from curved root canals - a micro-computed tomography study

AIM

To compare the efficacy of two rotary NiTi retreatment systems and Hedström files in removing filling material from curved root canals.

METHODOLOGY

Curved root canals of 57 extracted teeth were prepared using FlexMaster instruments and filled with gutta-percha and AH Plus. After determination of root canal curvatures and radii in two directions, the teeth were assigned to three identical groups (n = 19). The root fillings were removed with D-RaCe instruments, ProTaper Universal Retreatment instruments or Hedström files. Pre- and postoperative micro-CT imaging was used to assess the percentage of residual filling material as well as the amount of dentine removal. Working time and procedural errors were recorded. Data were analysed using analysis of covariance and analysis of variance procedures.

RESULTS

D-RaCe instruments were significantly more effective than ProTaper Universal Retreatment instruments and Hedström files (P < 0.05). Hedström files removed significantly less dentine than the rotary NiTi systems (P < 0.0001). D-RaCe instruments were significantly faster compared to both other groups (P < 0.05). No procedural errors such as instrument fracture, blockage, ledging or perforation were detected in the Hedström group. In the ProTaper group, four instrument fractures and one lateral perforation were observed. Five instrument fractures were recorded for D-RaCe.

CONCLUSIONS

D-RaCe instruments were associated with significantly less residual filling material than ProTaper Universal Retreatment instruments and hand files. Hedström files removed significantly less dentine than both rotary NiTi systems. Retreatment with rotary NiTi systems resulted in a high incidence of procedural errors.

Removal of gutta-percha/zinc-oxide-eugenol sealer or gutta-percha/epoxy resin sealer from severely curved canals: an in vitro study

The aim of this study was to compare the cleanliness of root canal walls after retreatment using two rotary retreatment files to hand instruments in severely curved canals obturated with gutta-percha and two different sealers. Single rooted mandibular premolars (n = 90) with root curvatures were instrumented and obturated with gutta-percha and an epoxy resin (Group 1, n = 45) or zinc oxide eugenol sealer (Group 2, n = 45). Following retreatment of the specimens (n = 15 ProTaper Universal Retreatment Files (Subgroup B) or R-Endo retreatment files (Subgroup C) after 1 month, split specimens were examined under a stereomicroscope and the percentage of remaining root filling material was statistically compared using one way ANOVA with Bonferroni adjustment for multiple comparisons (P = 0.05). The R-Endo system performed significantly better than the other two file systems (P < 0.05). None of the systems used in this study cleaned root canals thoroughly. The R-Endo system did provide cleaner walls when compared to the other instruments used. The type of root filling materials had an impact on the outcomes with all techniques.

Comparison of cyclic fatigue resistance of three different rotary nickel-titanium instruments designed for retreatment

INTRODUCTION

A number of rotary nickel-titanium (NiTi) systems have been developed to provide better, faster, and easier cleaning and shaping of the root canal system, and recently, rotary NiTi systems designed for root canal retreatment have been introduced. Because the main problem with the rotary NiTi files is fracture, the aim of this study was to compare the cyclic fatigue resistance of 3 different rotary NiTi systems designed for root canal retreatment.

METHODS

Total of 60 instruments of 3 different rotary NiTi systems designed for root canal retreatment were used in this study. Twenty R-Endo R3, 20 ProTaper D3, and 20 Mtwo R (Retreatment) 25.05 instruments were tested. Cyclic fatigue testing of instruments was performed by using a device that allowed the instruments to rotate freely inside an artificial canal. Each instrument was rotated until fracture occurred, and the number of cycles to fracture for each instrument was calculated. Representative samples were also evaluated under a scanning electron microscope to confirm the fracture was flexural. Data were analyzed by using 1-way analysis of variance test.

RESULTS

R-Endo R3 instruments showed better cyclic fatigue resistance than ProTaper D3 and Mtwo R 25.05 instruments, and the difference was statistically significant (P < .05). There was no significant difference between ProTaper D3 and Mtwo R 25.05 groups.

CONCLUSIONS

The R-Endo R3 instruments were more resistant to fatigue failure than ProTaper D3 and Mtwo R 25.05.

Assessment of canal walls after biomechanical preparation of root canals instrumented with Protaper Universal rotary system

Objective:

The aim of this study was to examine the instrumented walls of root canals prepared with the ProTaper Universal™ rotary system.

Material and Methods:

Twenty mesiobuccal canals of human first mandibular molars were divided into 2 groups of 10 specimens each and embedded in a muffle system. The root canals were transversely sectioned 3 mm short of the apex before preparation and remounted in their molds. All root canals were prepared with ProTaper Universal™ rotary system or with Nitiflex™ files. The pre and postoperative images of the apical thirds viewed with a stereoscopic magnifier (×45) were captured digitally for further analysis. Data were analyzed statistically by Fisher's exact test and Chi-square test at 5% significance level.

Results:

The differences observed between the instrumented and the noninstrumented walls were not statistically significant (p<0.05).

Conclusions:

The Nitiflex™ files and the ProTaper Universal™ rotary system failed to instrument all the root canal walls.