Cyclic fatigue testing and metallographic analysis of nickel-titanium rotary instruments

Effects of Side Flattening on Torsional and Cyclic Fracture Resistance of Nickel-Titanium File

INTRODUCTION

The purpose of this study was to evaluate the effect of side flattening of cutting flutes on the cyclic resistance and torsional resistance of nickel-titanium files.

METHODS

Both novel flattened Platinum V.EU (PL) and standard nonflattened CC Premium V.EU (CC) rotaries were tested. For cyclic fatigue tests, all the files were rotated in an artificial root canal with a curvature of 45° and a radius of 6.06 mm at 300 rpm (n = 15 in each group). The number of cycles to failure (NCF) was calculated. For torsional tests, the files were rotated at 2 rpm clockwise until fracture occurred. The maximum torque value at fracture was measured and the toughness and distortion angle were computed. Subsequently, 5 fragments were randomly selected in each experiment, the cross-section and longitudinal direction of the fragments were photographed using a scanning electron microscope. An unpaired t-test was performed at a significance level of 95%.

RESULTS

There was a statistically significant difference in NCF between CC and PL (P < .05). CC showed higher NCF than PL. There was no statistically significant difference between CC and PL with regards to the parameters related to torsional resistance (distortion angle, ultimate strength, and toughness) (P > .05).

CONCLUSION

Within the limitations of this study, side flattening of the file did not improve cyclic resistance or torsional resistance of the files. As side flattening may reduce a file's cyclic resistance, such files should be used with caution in clinical practice.

Comprehensive Assessment of Cyclic Fatigue Strength in Five Multiple-File Nickel-Titanium Endodontic Systems

The resistance of nickel-titanium endodontic instruments against cyclic fatigue failure remains a significant concern in clinical settings. This study aimed to assess the cyclic fatigue strength of five nickel-titanium rotary systems, while correlating the results with the instruments' geometric and metallurgical characteristics. A total of 250 new instruments (sizes S1/A1, S2/A2, F1/B1, F2/B2, F3/B3) from ProTaper Gold, ProTaper Universal, Premium Taper Gold, Go-Taper Flex, and U-Files systems underwent mechanical testing. Prior to experimental procedures, all instruments were meticulously inspected to identify irregularities that could affect the investigation. Using a stereomicroscope, design characteristics such as the number of spirals, length, spirals per millimeter, and average helical angle of the active blade were determined. The surface finishing characteristics of the instruments were examined using a scanning electron microscope. Differential scanning calorimetry was employed to establish the instruments' phase transformation temperatures, while energy-dispersive X-ray spectroscopy was utilized to analyze the elemental composition of the alloy. The instruments were subjected to cyclic fatigue testing within a stainless steel non-tapered artificial canal featuring a 6 mm radius and 86 degrees of curvature. Appropriate statistical tests were applied to compare groups, considering a significance level of 0.05. The assessed design characteristics varied depending on the instrument type. The least irregular surface finishing was observed in U-Files and Premium Taper Gold files, while the most irregular surface was noted in Go-Taper Flex. All instruments exhibited near-equiatomic proportions of nickel and titanium elements, whereas ProTaper Universal and U-Files instruments demonstrated lower phase transformation temperatures compared to their counterparts. Larger-sized instruments, as well as ProTaper Universal and U-Files, tended to display lower cyclic fatigue strength results. Overall, the design, metallurgical, and cyclic fatigue outcomes varied among instruments and systems. Understanding these outcomes may assist clinicians in making more informed decisions regarding instrument selection.

Surface roughness and cyclic fatigue resistance of a novel shaping system: An in-vitro study

Recently developed Nickel-Titanium (NiTi) instruments with practical changes have resulted in safer instrumentation. In addition, topographical features on the file surface are a contributing factor to clinical durability. Therefore, this study aimed to investigate both the cyclic fatigue resistance and the roughness change of MTwo and Rotate instruments (VDW, Munich, Germany). Each instrument (n = 6/each group) was scanned with an atomic force microscopy prior to and after instrumentation. In addition, cyclic fatigue testing was conducted for each instrument (n = 11/each group) with stainless-steel blocks, including 45°-60°-90° degrees of curvature milled to the instruments' size. The roughness parameters increased for both systems after instrumentation (p<0.05). Both systems presented an increased roughness following instrumentation (p<0.05). The cyclic fatigue resistance was lowest at 90° for both systems (p<0.05), whereas the Rotate files presented a higher resistance than that of the Mtwo files (p<0.05). Compared to the Mtwo files, Rotate files presented better resistance, while the resistance decreased as the curvature increased.

Comparative study of torsional and bending stress in NiTi, graphene, and GUM metal endodontic files by finite element analysis

INTRODUCTION

This study investigates the behavior of graphene and GUM in terms of cyclic fatigue resistance and torsion through a finite element analysis on a file with an eccentric rectangular cross section and variable taper, and on a file with a centered triangular cross section, constant taper, and constant pitch.

METHODS

Root canals and endodontic files were created using Catia V5R21 software. For torsional analysis, the tip of the file was fixed at 1 and 3 mm, and a moment of 2.5 N-mm was generated at the handle. For the bending analysis in curved canals (45° and 60°), the handle was kept fixed and a force of 1 N was applied at the tip while the file was kept fixed at 9 mm.

RESULTS

GUM metal instruments showed better torsional resistance. On the other hand, NiTi and graphene performed better under the applied loads during flexion at 45° and 60°.

CONCLUSION

GUM metal is emerging as a promising material in the field of endodontic instrument design due to its physical properties.

Cyclic Fatigue Resistance of Rotary versus Reciprocating Endodontic Files: A Systematic Review and Meta-Analysis

(1) Background: The failure of nickel-titanium (NiTi) rotary files is a complication related to endodontic instruments. The aim of this study was to compare the resistance to cyclic fatigue between rotary and reciprocating file systems. (2) Methods: Specific PICO: Population (P): artificial root canals; Interventions (I): instrumentation with NiTi rotary and reciprocating files; Comparison (C): rotary versus reciprocating files; Outcome (O): cyclic fatigue resistance. Studies were identified through bibliographic research using electronic databases (Medline, Embase, Scopus, SciELO, and WOS). The studies were combined using a random effects model by the inverse variance method. The effect size was the mean of the time to fracture (TTF) and number of cycles to fracture (NCF). Heterogeneity was assessed using the p value of the Q test for heterogeneity and the I2. (3) Results: TTF for rotary files was determined in 474.5 s and 839.1 for reciprocating without statistically significant differences. NCF for rotary systems was determined in 1444.2 and for reciprocating file systems in 4155.9 with statistically significant differences (p = 0.035), making reciprocating files more resistant. (4) Conclusions: Reciprocating files have better resistance to cyclic fatigue than rotary files. When tested in double curvature canals, reciprocating files also showed higher resistance.

A review of the latest developments in rotary NiTi technology and root canal preparation

The introduction of nickel-titanium (NiTi) mechanical instruments dramatically changed clinical endodontics over the last few decades. Before NiTi, it was necessary to use more instruments to create an ideal root canal shape, and many approaches, sequences and techniques were developed over the years. Recently, NiTi endodontic instruments have undergone a series of changes brought about by modifications in design, surface treatments, and thermal treatments to improve their root canal preparation outcomes and reduce associated canal preparation risks during root canal treatment. Heat treatment is one of the most fundamental approaches to improving the fatigue resistance and flexibility of NiTi endodontic instruments. In addition, new kinematics have been developed to offer greater safety and efficiency. This narrative review describes the general properties and manufacturing of NiTi instruments, and the mechanical system evolution of NiTi instruments.

Opto-magnetic imaging spectroscopy in analyzing rotary NiTi endodontic instruments

Intra-canal fracture of rotary NiTi instruments occurs due to torsional stress, cyclic fatigue, or a combination of these two factors. Broken instruments are a serious obstacle to shaping, cleaning, and filling of the root canal and can adversely affect the outcome of endodontic therapy. The aim of this study was to examine the magnetic properties and ultrastructural changes of new, used, and fractured NiTi instruments using opto-magnetic imaging spectroscopy (OMIS). The study included three sets of different types of rotary instruments: MTwo (VDW, Munich, Germany), Pro Taper Universal (Dentsply Maillefer, Ballaigues, Switzerland), and BioRace (FKG DENTAIRE Swiss Dental Products, Le Crêt-du-Locle Switzerland). Root canal shaping was performed on root canals with different curvatures, and after intra-canal fracture, instruments of the same type (new, used, and fractured) were analyzed using OMIS at the Faculty of Mechanical Engineering, University of Belgrade. The obtained results showed a coincidence of peak localization for the used instruments that did not suffer a fracture, as well as for new, unused instruments of all examined groups. Additionally, there was a coincidence of peak intensities for new and fractured instruments in all groups. The specific treatment of electropolishing of the active surface of BioRace instruments caused a completely different electromagnetic response compared to conventional NiTi sets of tested instruments. New, unused BioRace instruments had the most pronounced positive (5.6078 n.a.u. x1000) and negative (-8.5218 n.a.u. x1000) intensity values. The analysis of NiTi instruments using opto-magnetic imaging spectroscopy indicated changes in the magnetic properties after their instrumentation.

The Use of Premixed Calcium Silicate Bioceramic Sealer with Warm Carrier-Based Technique: A 2-Year Study for Patients Treated in a Master Program

Background: Recently several calcium silicate flowable sealers have been introduced as endodontic materials for the root canal. This clinical study tested the use of a new premixed calcium silicate bioceramic sealer in association with the Thermafil warm carrier-based technique (TF). Epoxy-resin-based sealer with the warm carrier-based technique was the control group. Methodology: Healthy consecutive patients (n = 85) requiring 94 root canal treatments were enrolled in this study and assigned to one filling group (Ceraseal-TF n = 47, AH Plus-TF n = 47) in accordance with operator training and best clinical practice. Periapical X-rays were taken preoperatively, after root canal filling and after 6, 12 and 24 months. Two evaluators blindly assessed the periapical index (PAI) and sealer extrusion in the groups (k = 0.90). Healing rate and survival rate were also evaluated. Chi-square tests was used to analyze significant differences between the groups. Multilevel analysis was performed to evaluate the factors associated with healing status. Results: A total of 89 root canal treatments in 82 patients were analyzed at the end-line (24 months). The total drop-out was 3.6% (3 patients; 5 teeth). A total of 91.1% of healed teeth (PAI 1-2) was observed in Ceraseal-TF, with 88.6% in AH Plus-TF. No significant difference was observed on healing outcome and survival among the two filling groups (p > 0.05). Apical extrusion of the sealers occurred in 17 cases (19.0%). Of these, 6 occurred in Ceraseal-TF (13.3%) and 11 in AH Plus-TF (25.0%). Three Ceraseal extrusions were radiographically undetectable after 24 months. All the AH Plus extrusions did not change during the evaluation time. Conclusions: The combined use of the carrier-based technique and premixed CaSi-based bioceramic sealer showed clinical results comparable with carrier-based technique and epoxy-resin-based sealer. The radiographical disappearance of apically extruded Ceraseal is a possible event in the first 24 months.

Metallurgical Tests in Endodontics: A Narrative Review

Since there are no reviews of the literature on this theme, the aim of this narrative review is to summarize the metallurgical tests used in endodontics, pointing out their functional use and their pros and cons and giving readers a user-friendly guide to serve as an orientation aid in the plethora of metallurgical tests. With this purpose, a literature search for articles published between January 2001 and December 2021 was conducted, using the electronic database PubMed to collect all published articles regarding the metallurgical tests used in endodontics for the evaluation of NiTi rotary instruments. The search was conducted using the following keywords: “metallurgy”, “differential scanning calorimetry” (DSC), “X-ray diffraction” (XRD), “atomic force microscopy” (AFM), “energy-dispersive X-ray spectroscopy” (EDS), “focused ion beam analysis” (FIB) and “Auger electron spectroscopy” (AES) combined with the term “endodontics” or “NiTi rotary instruments”. Considering the inclusion and exclusion criteria, of the 248 articles found, only 81 were included in the narrative review. According to the results, more than 50% of the selected articles were published in one of the two most relevant journals in endodontics: International Endodontic Journal (22.2%) and Journal of Endodontics (29.6%). The most popular metallurgical test was DSC, with 43 related articles, followed by EDS (33 articles), AFM (22 articles) and XRD (21 articles). Few studies were conducted using other tests such as FIB (2 articles), micro-Raman spectroscopy (4 articles), metallographic analysis (7 articles) and Auger electron spectroscopy (2 articles).

Experimental Study of the Effects of Torsional Loading on Three Types of Nickel-Titanium Endodontic Instruments

In modern endodontics, nickel-titanium (NiTi) rotary instruments are used on a large scale for root canal shaping. Nevertheless, the separation of an instrument is a serious concern during shaping. The aim of this study is to determine and compare the torsional fracture characteristics of three types of NiTi endodontic instruments, each with different cross-section designs and movements performed during root canal shaping: Endostar E3 (Endostar, Poldent Co. Ltd., Warsaw, Poland); Reciproc R25 (VDW, Munich, Germany); and Protaper Next X2 (Dentsply Maillefer, Ballaigues, Switzerland). Fifteen instruments are used in this study, divided in three groups (n = 5): Group Endostar, Group Reciproc and Group Protaper. For testing, each instrument is used to shape five simulated root canals, following which its torsional stress to failure is measured. The fracture lengths of all three groups are roughly between 2 and 3 mm from the tip. Higher values of the moment of torsion in fracture, and smaller values of the maximum twisting angle are observed for Group Endostar, as well as closer to circular cross-sections. However, the values of the shear tension are similar for all three groups, because the disadvantage given by the fracture section shape for Groups Reciproc and Protaper is compensated either by size or by intrinsic properties of the instrument material. For the shear tension the Endostar values are insignificantly increased (Kruskal–Wallis test, p = 0.207), and in the case of the maximum twist angle the Protaper values are insignificantly increased (Kruskal–Wallis test, p = 0.287). Because of the instruments shape and conicity, the analysis had to be carried out separately with regard to the length of the fractured tip. Rules-of-thumb are extracted from the study for current practice: if a blockage of the first 2 to 3 mm part of the tip can be anticipated (by the excessive curving of the instrument), the handpiece must be adjusted to torque values that do not exceed 1.5 to 2.5 N · cm for Endostar and 1 to 2 N · cm for Reciproc and Protaper instruments.

Influence of the type of reciprocating motion on the cyclic fatigue resistance of reciprocating files in a dynamic model

Background

The aim of this study was to compare the influence of two novel reciprocating movements on the cyclic fatigue resistance of endodontic reciprocating files.

Methods

30 Procodile® (Komet Medical, Lemgo, Germany) files were selected in this study and distributed according to the following study groups depending on the movements to be performed: ReFlex Dynamic (n = 10), ReFlex Smart (n = 10) and Reciproc (n = 10) reciprocating movement. These files were fixed to a specific dynamic cyclic fatigue device designed and manufactured by 3D impression to simulate the pecking motion performed by the operator. The time to failure and the number of cycles of in-and-out of the endodontic files was registered. The results were analyzed by ANOVA and Weibull statistics.

Results

Statistically significant differences were found when the number of cycles of in-and-out movement and the time to failure of ReFlex Dynamic and Reciproc reciprocating movement (p < 0.001) and between ReFlex Smart and Reciproc reciprocating movement (p < 0.001) were compared in pairs. However, no statistically significant differences were observed between time to failure and number of cycles of in-and-out movement of ReFlex Dynamic and ReFlex Smart reciprocating movement (p = 0.253).

Conclusions

The ReFlex Smart reciprocating movement increased the cyclic fatigue resistance of endodontic reciprocating files compared with traditional reciprocating movement.

In-Depth Metallurgical and Microstructural Analysis of Oneshape and Heat Treated Onecurve Instruments

OBJECTIVE

To define surface, mechanical, microstructural and metallurgical features of conventional One-Shape (OShape) and heat-treated OneCurve (OCurve) nickel-titanium instruments.

METHODS

Instruments were analysed by scanning electron microscopy (SEM) on new instruments and after simulated clinical use (SCU). Cyclic fatigue testing was performed and the number of cycles to fracture (NCF) and the length of the fractured instruments were measured (Mann-Whitney test). Fractured instruments during cyclic fatigue testing were then inspected by SEM fractographic analysis. Field emission gun scanning scanning electron microscopy (FEG-SEM), energy-dispersive X-ray spectroscopy (EDX) and micro-Raman spectroscopy were used to assess alloy surface chemistry. Focused ion beam (FIB) was performed to analyse the oxide layer on the surface of OCurve before and after SCU. X-Ray diffraction (XRD), metallographic evaluation and differential scanning calorimetry (DSC) were used to determine martensitic/austenitic phase transformation temperatures.

RESULTS

SEM observations on new instruments revealed a smooth regular surface with flattened milling grooves. No wear features were detected after SCU. OCurve exhibited a higher cyclic fatigue resistance (P<0.05), slower crack propagation and a surface layer of TiO2. Metallographic analysis and XRD showed the prevalence of martensitic grains on OCurve instruments that were stable at body temperature as confirmed by DSC analysis. Furthermore, DSC demonstrated a shift in the temperature transformation ranges suggesting an increase of martensite phase in autoclaved OCurve instruments.

CONCLUSION

Heat treatment processes were confirmed as a valid enhancement of the properties of the new generation NiTi instruments. OCurve presented a significant improvement over OShape regarding both mechanical and metallurgical characteristics.

3D Finite Element Analysis of Rotary Instruments in Root Canal Dentine with Different Elastic Moduli

The aim of the present investigation was to calculate the stress distribution generated in the root dentine canal during mechanical rotation of five different NiTi endodontic instruments by means of a finite element analysis (FEA). Two conventional alloy NiTi instruments F360 25/04 and F6 Skytaper 25/06, in comparison to three heat treated alloys NiTI Hyflex CM 25/04, Protaper Next 25/06 and One Curve 25/06 were considered and analyzed. The instruments’ flexibility (reaction force) and geometrical features (cross section, conicity) were previously investigated. For each instrument, dentine root canals with two different elastic moduli(18 and 42 GPa) were simulated with defined apical ratios. Ten different CAD instrument models were created and their mechanical behaviors were analyzed by a 3D-FEA. Static structural analyses were performed with a non-failure condition, since a linear elastic behavior was assumed for all components. All the instruments generated a stress area concentration in correspondence to the root canal curvature at approx. 7 mm from the apex. The maximum values were found when instruments were analyzed in the highest elastic modulus dentine canal. Strain and von Mises stress patterns showed a higher concentration in the first part of curved radius of all the instruments. Conventional Ni-Ti endodontic instruments demonstrated higher stress magnitudes, regardless of the conicity of 4% and 6%, and they showed the highest von Mises stress values in sound, as well as in mineralized dentine canals. Heat-treated endodontic instruments with higher flexibility values showed a reduced stress concentration map. Hyflex CM 25/04 displayed the lowest von Mises stress values of, respectively, 35.73 and 44.30 GPa for sound and mineralized dentine. The mechanical behavior of all rotary endodontic instruments was influenced by the different elastic moduli and by the dentine canal rigidity.

Combining apical torsional load and cyclic fatigue resistance of NiTi instruments: New approach to determine the effective lifespan of rotary instruments

In the described proof-of-principle experiments, we introduced a novel testing device to investigate how different concurrent torsional loads influence the cyclic fatigue (CF) resistance of a nickel-titanium (NiTi) instrument. The device was designed to test CF resistance of NiTi files with a standardized load on the apical 5 mm; a movable cylinder controlled by a lever provided a uniform real-time load. Thirty-three NiTi instruments 25.04 (F360, Komet, Lemgo, Germany) were rotated until fracture at 30° curvature under three different torsional loads (n = 11 each); Group A: 2.5 Ncm; Group B: 5 Ncm; Group C: 10 Ncm. anova, multiple comparisons Tamhane tests, regression and Kaplan-Meyer analysis were performed to contrast means. Resistance to cyclic fatigue differed significantly among groups (P = 0.0001). Increased torsional loads led to a decrease in time to failure. An inverse correlation (r = -0.721, P = 0.001) was observed between time and torsional load, with higher torsional loads correlated to shorter times to fracture.

Influence of the Pecking Motion Frequency on the Cyclic Fatigue Resistance of Endodontic Rotary Files

Purpose: To analyze the influence of the pecking motion frequency on the cyclic fatigue resistance of endodontic rotary files. Material and Methods: Sixty PlexV 25.06 endodontic rotary files were selected and distributed into three groups: 30 movements/min (n = 20), 60 movements/min (n = 20), and 120 movements/min (n = 20). A dynamic cyclic fatigue device was designed using Computer Aided Design/ Computer Aided Engineering (CAD/CAE) technology and manufactured by 3D impressions to simulate the pecking motion performed by an operator. Failures of the endodontic rotary files were detected by a Light-Emitting Diode (LED)/Light-Dependent Resistor (LDR) system controlled by an Arduino-Driver complex and management software. Endodontic rotary files were tested on an artificial root canal manufactured by wire electrical discharge machining (EDM), with similar dimensions to those of the instrument under examination. Endodontic rotary files were used following the manufacturer’s recommendations. The results were analyzed by ANOVA and Weibull statistics. Results: All pairwise comparisons revealed statistically significant differences in all three variables, except for the difference in the number of cycles between the groups with 60 and 120 movements/min (p = 0.298). The scale distribution parameter of Weibull statistics showed statistically significant differences in all three variables, except for the differences in the number of cycles between groups with 30 and 60 movements/min (p = 0.0722). No statistically significant differences in the three variables were observed for the shape distribution parameter. Conclusion: A low frequency of pecking motion is recommended to reduce the risk of failure of endodontic rotary files associated with cyclic fatigue.

Torsional and Bending Properties of V Taper 2H, ProTaper NEXT, NRT, and One Shape

Nickel-titanium (NiTi) rotary files have enabled efficient root canal preparations that maintain the canal center with fewer aberrations compared to hand files. However, NiTi rotary files are susceptible to fracture, which can thereby compromise root canal treatment. Therefore, NiTi files have been developed to enhance fracture resistance by modifying design and thermal treatment. The objective of this study was to compare the torsional fatigue resistance and bending resistance of NiTi files manufactured from different alloys and treatments. ProTaper NEXT X2 (PTN; M-wire), V taper 2H (V2H; controlled memory wire), NRT (heat-treated), and One Shape (OS; conventional alloy) instruments of tip size #25 were compared. Torsional fatigue was evaluated by embedding the 3 mm tip of each instrument (N = 10/brand) in resin and the repetitive application of torsional stress (300 rpm, 1.0 N·cm) by an endodontic motor with autostop when the file fractured. The number of loading cycles to fracture was recorded and analyzed by Kruskal–Wallis and Mann–Whitney U tests with Bonferroni's correction. Bending resistance of the instruments was tested using a cantilever bending test to the 3 mm point from the tip (N = 10/brand). The stress was measured when deflection of 3 mm was subjected and statistically analyzed with a one-way analysis of variance and Tukey's honest significance difference test (α = 0.05). V2H withstood the highest number of load applications during torsional fatigue testing (p < 0.05), followed by NRT, PTN, and OS, where the differences between NRT and PTN (p=0.035) and between PTN and OS (p=0.143) were not statistically significant. V2H showed the lowest bending stiffness, followed by NRT, PTN, and OS (p < 0.001). Thermal treatment of NiTi wire resulted in improved mechanical properties, and controlled memory wire provided improved flexibility and torsional fatigue resistance.

Comparison between Single-file Rotary Systems: Part 2-The Effect of Length of the Instrument Subjected to Cyclic Loading on Cyclic Fatigue Resistance

INTRODUCTION

The aim of this study was to compare the cyclic fatigue resistance of XP Shaper (XP), HyFlex EDM One File (EDM), and WaveOne Gold Primary (WOG) when operated according to their manufacturers' recommendations at different lengths and to investigate the cyclic fatigue limit of XP Shaper when operated at 3000 rpm.

METHODS

One hundred fifty instruments from 4 different rotary systems (F2 Protaper Universal [PTU], WOG, EDM, and XP) were tested for their cyclic fatigue resistance in a simulated 90° curved canal at a 37°C water bath temperature at 3 different working lengths (15 mm, 17 mm, and 19 mm). The time taken for instruments to fracture was recorded, and the number of cycles to failure was calculated. Statistical analyses were performed by using Levene's test, Kruskal-Wallis test to identify specific groups with statistically significantly higher cyclic fatigue resistance at 5% significance level. Weibull analysis was performed to determine the predictability of survival for each instrument.

RESULTS

XP Shaper had the highest cyclic fatigue resistance compared with all other instruments, followed by EDM, WOG, and then PTU. There was no statistically significant difference in the number of cycles to failure between the XP operated at 3000 or 1000 rpm in any of the tested working lengths. There was a reduction in the number of cycles to failure when the working length increased from 15 to 19 mm in EDM, WOG, and PTU. Scanning electron microscopy showed ductile fractures with classic dimpled features in all samples.

CONCLUSIONS

XP has a very high resistance to cyclic fatigue compared with WOG, EDM, and F2 PTU. The time to fracture will decrease by almost one third when XP is operated at 3000 rpm. The results of both parts of this study suggest that XP appears to be safe to operate at 3000 rpm in endodontic retreatment.

Incidence of ProTaper Universal System Instrument Fractures - A Retrospective Clinical Study

Objective:

The aim of this retrospective clinical study was to evaluate the incidence of ProTaper Universal System instrument fractures, associated with observation of the arch, group of teeth, and root thirds in which these fractures occurred.

Methods:

From analysis of charts, clinical record cards and radiographs of endodontic treatments performed by postgraduate students using the ProTaper Universal System at a reference center, a total of 1031 teeth and 2355 canals were analyzed. The general incidence of instrument fractures and their frequency, considering the group of teeth, arch and root thirds, were cataloged and the data obtained were statistically analyzed (Exact Fischer test, with level of significance of 1%).

Results:

The general percentage of fractures, considering the number of teeth and number of root canals evaluated was 4.4% and 1.9%, respectively. Instrument fractures occurred more frequently in the mandibular first (8.8%) and second (9.6%) molars, however, without statistically significant difference between them (P=0.81). In the first and second maxillary molars, the incidence of fracture was 4.7% and 5.1%, respectively, also without significant difference (P=0.81). Considering the dental arches (maxillary and mandibular), the fractures occurred with significantly higher frequency in the mandibular arch (66.7%), in comparison with the maxillary arch (33.3%) (P<0.01). A significantly higher percentage of fractures occurred in the apical third (84.4%) compared with the middle third (15.6%) (P<0.01).

Conclusion:

The general percentage of fractures, considering the number of teeth and number of root canals evaluated was 4.4% and 1.9%, respectively. However, the arch (mandibular) and root third (apical) had a significant effect on the incidence of instrument fractures.

The Effect of surface topographical changes of two different surface treatments rotary instrument

Background

One of the major innovations in endodontics has been the introduction of nickel-titanium (NiTi) alloy. This study evaluated the surface topographical changes of two different surface treatments rotary instrument after instrumentation and sterilization.

Material and Methods

240 Extracted teeth were included in this study. 90 new AlphaKite and Revo-S NiTi rotary instruments were selected and divided into two groups (Group A 45 AlphaKite and group B 45 Revo-S). Each group were divided into three subgroups: (A1, B1) n=5 files were used as a control, (A2,B2) n=20 files were used to prepare three root canals using endodontic rotary motor then sterilized by autoclave for one cycle under 121°C at 15 psi for 30 minutes and (A3,B3) n=20 files were used to prepare nine root canals using the same rotary system then sterilized by autoclave for three cycles under 121°C at 15 psi for 30 minutes. Files were examined under scanning electron microscopy.

Results

On examining the AlphaKite, A1 revealed gross machining grooves on their surface with no pits, A2 showed disruption of cutting and A3 showed microcracks and deepening of the machining grooves. B1 showed a smoother surface with few machining grooves, B2 showed dulling and blunting of the cutting edges was predominant and B3 files showed plastic deformation in the form of unwinding of the flutes.

Conclusions

The defects were less distributed along the electropolished Revo-S files than the physical vapor deposition AlphaKite.

Key words:Endodontic instruments, electropolished, rotary, sterilization.

An analysis of cyclic fatigue resistance of reciprocating instruments in different canal curvatures after immersion in sodium hypochlorite and autoclaving: An in vitro study

Aim

The aim of this study is to assess the effect of sodium hypochlorite and sterilization on the cyclic fatigue resistance of two reciprocating nickel-titanium files using a rotary and a reciprocating motor.

Materials and Methods

Totally, 160 Reciproc and Wave One files were tested. The eighty files of the same brand were assigned into four groups (n = 20). These four groups were further divided into two subgroups, 1a and 1b, 2a and 2b, 3a and 3b, 4a and 4b consisting of ten files in each group. 2.5% NaOCl for 5 min, 2.5% NaOCl for 5 min + 1 cycle of autoclave sterilization, 2.5% NaOCl for 5 min + 5 cycles of autoclave sterilization, no sterilization (control). Groups 1a, 2a, 3a, and 4a were subjected to 30° and Groups 1b, 2b, 3b, and 4b were subjected to 60° canal curvature.

Results

Intergroup comparison reveals that there is an increase in cyclic fatigue resistance from the first cycle to the fifth cycle of autoclave which is statistically significant.

Conclusion

Reciproc and Wave One showed reduced cyclic fatigue resistance on immersion in NaOCl for 5 min. Multiple autoclaving cycles significantly increased the cyclic fatigue resistance of Reciproc file system in both the curvatures. There was a decrease in cyclic fatigue resistance for Wave One after multiple autoclaving at 60° curvature which was statistically significant.

Analysis of Surface Characteristics of ProTaper Universal and ProTaper Next Instruments by Scanning Electron Microscopy

Background

Many new rotary files systems have been introduced, however, limited research has been conducted related to the surface irregularities of these files and if these have any effects on the files themselves. Hence, the aim of the present study was to analyze surface irregularities of the ProTaper® Universal rotary files (PTU) and the ProTaper Next™ rotary files (PTN) before and after instrumentation in curved canals. The main objective was to investigate the nature of these irregularities and how they might influence the use and fracture of rotary files during root-canal treatments.

Material and Methods

The files were examined pre-operatively using a stereomicroscope and scanning electron microscopy(SEM) to analyze surface imperfections and the presence of particles. Mesial roots of forty extracted mandibular molars were selected. Each instrument was used to prepare one of the mesial canals. The files were then rinsed with alcohol, and autoclaved and analyzed again.

Results

Of the 80 files used in this study, five files fractured, five files unwound and seven files were curved or bent and they all belonged to the PTU group. Irregularities and debris could be visualized with the SEM on both unused PTU and PTN files. Most of the debris was found associated with deeper milling grooves and defects on the surface of the metal. Surface analysis of the files that were used and sterilized were performed and the SEM images demonstrated organic debris, metal flash, and crack formation and initiation of fractures for both file types. All files showed machining grooves, metal flash, debris, and defects on cutting edges.

Conclusions

These irregularities appear to be critical in the accumulation of debris and initiation of fatigue and crack propagation within the NiTi alloy. The accumulation of debris could be a concern due to the potential exchange of organic debris between patients.

Key words:ProTaper® Universal, ProTaper Next™, surface characteristics, SEM.

Cyclic fatigue resistance of two nickel-titanium instruments in different curving angles: a comparative study

The cyclic resistance of ProTaper Universal (size 25/08) and ProTaper Next (size 25/06) instruments was compared in artificial canals with different curvatures in this study. A total of 30 ProTaper Universal and 30 ProTaper Next instruments were divided into 6 groups (n = 10) and were operated into artificial canals with 3 different angles of curvature (45°, 60°, 90°). The canal length was kept consistent in this study. The number of cycles to fracture (NCF) was counted until file fracture occurred, at which point, the length of the fragment was measured. The data were analyzed statistically using ANOVA complemented by the Tukey test (p < 0.05). Cross sections of the fractured files were scanned by an electron microscope. In the fatigue test, the ProTaper Next displayed more resistance in 45° and 60° canals (p < 0.05), whereas ProTaper Universal exhibited a better operability in 90° canals (p < 0.05). The average length of the fragments from ProTaper Next was significantly shorter than that from ProTaper Universal in 90° canals (p < 0.05). The cross sections of the fractured surfaces became flatter when the curvature angles decreased from 90° to 45°. ProTaper Next was more reliable when shaping in curved canals, whereas ProTaper Universal was more sui for the preparation of root canals with severe curvatures.

Prevention and management of fractured instruments in endodontic treatment

Intracanal instrument fracture is an unpredictable and problematic occurrence that can prevent adequate cleaning and shaping procedures and influence the prognosis of endodontic treatment. The prevalence of instrument fracture is reported to range between 0.28% and 16.2%. This article presents an overview of the prevention and management of instruments fractured during endodontic therapy on the basis of literature retrieved from PubMed and selected journal searches. Instrument fracture occurs because of reduced metal fatigue and/or torsional resistance. The reasons include canal morphology and curvature, manufacturing processes and instrument design, instrument use times and technique, rotational speeds and operator experience. With the development of various equipment and techniques, most of the retained instrument separations can be removed safely. However, in canals without associated periapical disease not every fractured separation should be removed from difficult locations because of the increased risk for root perforation and fracture. In difficult cases, either retain or bypass the fragment in the root canal and ensure regular follow-up reviews. Fractured instruments retained in the presence of periapical disease reduce significantly the prognosis of endodontically treated teeth, indicating a greater need to attempt the removal or bypass of the file separations. Apical surgery might be required in some instances, emphasizing the importance of preventing instrument fracture.

Obturation over an S1 ProTaper instrument fragment in a mandibular molar with three years of follow-up

This case report describes root canal filling performed over a large S1 ProTaper file fragment in a second mandibular molar with irreversible pulpitis. An S1 ProTaper file was fractured during the instrumentation of the mesiobuccal canal. Approximately 10 mm of file fragment remained in the apical and middle thirds of the canal. The obturation was performed over this fragment using thermomechanically compacted gutta-percha and sealer. Radiographic findings and the absence of clinical signs and symptoms at 3-year follow up indicated successful treatment. Cone-beam computed tomography images revealed absence of periapical lesion and details of intracanal file fragment related to root fillings and apex morphology. In this case, the presence of a large intracanal fractured instrument did not have a negative impact on the endodontic prognosis during the follow up evaluation period.

The effect of glide path on the surface quality of new and used rotary and reciprocating single files: OneShape versus WaveOne

The aim of this study was to evaluate the effect of glide path preparation on the surface topography changes of WaveOne and OneShape single files using atomic force microscopy analysis. Two commercially available brands of single file systems were analyzed, including 15 specimens/brand as following: Group I; WaveOne 0.08/25 (Dentsply Maillefer, Ballaigues, Switzerland) and Group II; OneShape 0.06/25 (Micro Mega, Besançon, France). In each group, 3 new files were subjected to AFM analysis as received from manufacturer, and 12 files were analyzed after preparation of root canals. A total of 20 human maxillary molar teeth were selected. In each group, 12 files were divided into 4 subgroups according to instruments that were used in one or three root canals with or without a previous glide path (n = 3). After preparation the surface analysis of single files was performed on 11 different points located along a 3-mm section starting at the tip of each file using AFM. Root mean square (RMS) values were recorded to investigate the surface features of endodontic files. The differences between RMS values were tested by one-way ANOVA. There was no statistically significant difference between the groups (p > 0.05). Creation of a glide path did not affect the surface topography of single file systems.

Wear and metallographic analysis of WaveOne and reciproc NiTi instruments before and after three uses in root canals

Reciprocating instruments made from M-wire alloy have been proposed to reduce the risk of fracture. No information is available on the surface alteration after single and multiple uses in root canals. Two reciprocating NiTi instruments were used on extracted teeth up to three times. ESEM/EDS analysis was conducted to determine defects, alterations, and wear features of the apical third of instruments and metallographic analysis was performed on the cross-section of new and used instruments to compare alloy properties. Topography of apical portion was evaluated by AFM before and after uses. Extracted single-rooted teeth were divided into two groups and instrumented according to the manufacturer's recommendations with: (A) WaveOne Primary and (B) Reciproc R25. Each group was divided into three subgroups according to the number of canals instrumented: 1, 2, and 3, respectively. Chi square test was performed to verify homogeneity of defects distribution and GLM to evaluate the differences of RMS at baseline and after use for both groups (α level 0.05). No instrument fractured and no spiral distortions were observed under optical microscope even when the number of uses increased. Not significant differences were found for WaveOne and Reciproc. Blades presented a wrapped portion in WaveOne group and a more symmetrical feature in Reciproc group. Metallographic analysis revealed in both groups the presence of twinned martensitic grains with isolated flat austenitic areas. Both instruments demonstrated limited alteration, such as tip deformation and wear. This study confirmed the safe clinical use of both instruments for shaping multi-rooted teeth.

Evaluation of surface topography changes in three NiTi file systems using rotary and reciprocal motion: An atomic force microscopy study

AIM

To evaluate the surface topography changes in three nickel-titanium (NiTi) file systems using either rotary or reciprocal motion using atomic force microscopy (AFM), and to determine the effect of scanning area on the AFM results in this study.

METHODOLOGY

Five points on a F2 Protaper file, R25 Reciproc file, and a Primary file from WaveOne systems were scanned preoperatively in 1 × 1 and 5 × 5 µm(2) with an AFM device that can scan an intact (not sectioned) file. One standardized resin block was used for each instrument, according to the manufacturer's recommendations. Points were re-scanned postoperatively using the same AFM and settings. Root-mean-square (RMS) and roughness average (Ra) values were obtained. The preoperative and postoperative surface topographies were compared separately in terms of RMS and Ra values. The surface topography change scores were analyzed using Kruskal-Wallis and Mann-Whitney U tests using a 0.10 significance level.

RESULTS

There were no significant differences preoperatively among the NiTi file systems in 1 × 1 or 5 × 5 µm(2) areas. Postoperatively, the WaveOne Primary had more surface irregularities (significant for 5 × 5 µm(2) scan in Ra evaluation).

CONCLUSIONS

Three-dimensional AFM images of instrument surfaces showed topographic irregularities preoperatively and postoperatively. AFM results differ depending on the scanning area and file used.

Comparison of the shaping ability of GT® Series X, Twisted Files and AlphaKite rotary nickel-titanium systems in simulated canals

Background

Efforts to improve the performance of rotary NiTi instruments by enhancing the properties of NiTi alloy, or their manufacturing processes rather than changes in instrument geometries have been reported. The aim of this study was to compare in-vitro the shaping ability of three different rotary nickel-titanium instruments produced by different manufacturing methods.

Methods

Thirty simulated root canals with a curvature of 35˚ in resin blocks were prepared with three different rotary NiTi systems: AK- AlphaKite (Gebr. Brasseler, Germany), GTX- GT^® Series X (Dentsply, Germany) and TF- Twisted Files (SybronEndo, USA).

The canals were prepared according to the manufacturers’ instructions. Pre- and post-instrumentation images were recorded and assessment of canal curvature modifications was carried out with an image analysis program (GSA, Germany).

The preparation time and incidence of procedural errors were recorded. Instruments were evaluated under a microscope with 15 × magnifications (Carl Zeiss OPMI Pro Ergo, Germany) for signs of deformation. The Data were statistically analyzed using SPSS (Wilcoxon and Mann–Whitney U-tests, at a confidence interval of 95%).

Results

Less canal transportation was produced by TF apically, although the difference among the groups was not statistically significant. GTX removed the greatest amount of resin from the middle and coronal parts of the canal and the difference among the groups was statistically significant (p < 0.05). The shortest preparation time was registered with TF (444 s) and the longest with GTX (714 s), the difference among the groups was statistically significant (p < 0.05). During the preparation of the canals no instrument fractured. Eleven instruments of TF and one of AK were deformed.

Conclusion

Under the conditions of this study, all rotary NiTi instruments maintained the working length and prepared a well-shaped root canal. The least canal transportation was produced by AK. GTX displayed the greatest cutting efficiency. TF prepared the canals faster than the other two systems.

Influence of the geometry of curved artificial canals on the fracture of rotary nickel-titanium instruments subjected to cyclic fatigue tests

INTRODUCTION

This study evaluated the influence of different features of canal curvature geometry on the number of cycles to fracture of a rotary nickel-titanium endodontic instrument subjected to a cyclic fatigue test.

METHODS

BioRaCe BR4C instruments (FKG Dentaire, La Chaux-de Fonds, Switzerland) were tested in 4 grooves simulating curved metallic artificial canals, each one measuring 1.5 mm in width, 20 mm in total length, and 3.5 mm in depth with a U-shaped bottom. The parameters of curvature including the radius and arc lengths and the position of the arc differed in the 4 canal designs. Fractured surfaces and helical shafts of the separated instruments were analyzed by scanning electron microscopy.

RESULTS

The Student's t test showed that a significantly lower number of cycles to fracture values were observed for instruments tested in canals with the smallest radius, the longest arc, and the arc located in the middle portion of the canal. Scanning electron microscopic analysis of the fracture surfaces revealed morphologic characteristics of ductile fracture. Plastic deformation was not observed in the helical shaft of the fractured instruments.

CONCLUSIONS

Curvature geometry including the radius and arc lengths and the position of the arc along the root canal influence the number of cycles to fracture of rotary nickel-titanium instruments subjected to flexural load.

Study on bending behaviour of nickel-titanium rotary endodontic instruments by analytical and numerical analyses

Aim

To develop analytical models and analyse the stress distribution and flexibility of nickel–titanium (NiTi) instruments subject to bending forces.

Methodology

The analytical method was used to analyse the behaviours of NiTi instruments under bending forces. Two NiTi instruments (RaCe and Mani NRT) with different cross-sections and geometries were considered. Analytical results were derived using Euler–Bernoulli nonlinear differential equations that took into account the screw pitch variation of these NiTi instruments. In addition, the nonlinear deformation analysis based on the analytical model and the finite element nonlinear analysis was carried out. Numerical results are obtained by carrying out a finite element method.

Results

According to analytical results, the maximum curvature of the instrument occurs near the instrument tip. Results of the finite element analysis revealed that the position of maximum von Mises stress was near the instrument tip. Therefore, the proposed analytical model can be used to predict the position of maximum curvature in the instrument where fracture may occur. Finally, results of analytical and numerical models were compatible.

Conclusion

The proposed analytical model was validated by numerical results in analysing bending deformation of NiTi instruments. The analytical model is useful in the design and analysis of instruments. The proposed theoretical model is effective in studying the flexibility of NiTi instruments. Compared with the finite element method, the analytical model can deal conveniently and effectively with the subject of bending behaviour of rotary NiTi endodontic instruments.

Effect from cyclic fatigue of nickel-titanium rotary files on torsional resistance

INTRODUCTION

The aim of this study was to evaluate the effect of cyclic fatigue on the torsional resistance of nickel-titanium (NiTi) rotary instruments.

METHODS

ProFile (#25/0.06; Dentsply Maillefer, Ballaigues, Switzerland) and ProTaper (F1, Dentsply Maillefer), both of which have the same external diameter at D5, were tested using a fatigue testing machine for the mean number of cycles of failure (mNCF). Then, new files were cyclic precycled to 4 conditions (ie, 0%, 25%, 50%, and 75% of the mNCF) before the torsional resistance test was performed on these cyclic preloaded files. A uniform clockwise rotation was applied to the file in a straight state in a torsion tester. The torsional load and distortion angle were recorded during rotation until the file succumbed to the torque. The toughness was computed. The results were analyzed statistically using one-way analysis of variance and the Duncan post hoc comparison to find any differences between groups at a significance level of 95%.

RESULTS

In both ProFile and ProTaper groups, the 75% preloading groups had significantly lower torsional strength than other preloaded files. In the ProFile group, the 50% and 75% preloading groups had a smaller distortion angle until fracture than the 25% and no preloading groups. The 75% preloading group showed a lower toughness value than the 25% and no preloading groups. In the ProTaper group, all preloading groups had less distortion and toughness than the no preloading group. Fractographic examinations revealed the 75% preloaded files showed less amount of reverse-wound flute than other preloading groups.

CONCLUSIONS

Within the limitations of the methodology, it could be concluded that approximate 75% cyclic fatigue may reduce the torsional resistance of NiTi rotary instruments significantly.

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.