Effect of sterilization and irrigants on the cutting ability of stainless steel files

Nitinol Type Alloys General Characteristics and Applications in Endodontics

A very extensive literature review presents the possibilities and needs of using, in endodontics, the alloys commonly known as nitinol. Nitinol, as the most modern group of engineering materials used to develop root canals, is equilibrium nickel and titanium alloys in terms of the elements’ atomic concentration, or very similar. The main audience of this paper is engineers, tool designers and manufacturers, PhD students, and students of materials and manufacturing engineering but this article can also certainly be used by dentists. The paper aims to present a full material science characterization of the structure and properties of nitinol alloys and to discuss all structural phenomena that determine the performance properties of these alloys, including those applied to manufacture the endodontic tools. The paper presents the selection of these alloys’ chemical composition and processing conditions and their importance in the endodontic treatment of teeth. The results of laboratory studies on the analysis of changes during the sterilization of endodontic instruments made of nitinol alloys are also included. The summary of all the literature analyses is an SWOT analysis of strengths, weaknesses, opportunities, and threats, and is a forecast of the development strategy of this material in a specific application such as endodontics.

What Are the Chances of Resilon to Dominate the Market Filling Materials for Endodontics?

This paper is a literature review with additional virtual analyses of the authors’ own experimental research results. Knowledge from various areas was synergistically combined, appropriately for concurrent engineering, presenting several possible methodological approaches used in research, optimizing the selection of engineering materials and the conditions of their application with particular application in endodontics. Particular attention was paid to the theoretical aspects of filling material strengths, weaknesses, opportunities, and threats SWOT analysis. Attention was paid to the original concepts of Sustainable Dentistry Development in conjunction with Dentistry 4.0, which includes endodontics as an important element. The dentists’ actions, among others, in conservative dentistry, along with endodontics, requires close cooperation with engineers and the enginering sciences. Methods of root canal preparation were described, together with selected tools, including those made of nitinol. Principles concerning the process of cleaning and shaping the pulp complex are presented. The importance of obturation methods, including the Thermo-Hydraulic-Condensation THC technique, and the selection of filling materials with the necessary sealants for the success of endodontic treatment are discussed. The experimental studies were carried out in vitro on human teeth removed for medical reasons, except for caries, for which two groups of 16 teeth were separated. After the root canal was prepared, it was filled with studs and pellets of a filling material based on polyester materials, which has gained the common trade name of resilon or, less frequently, RealSeal (SybronEndo) with an epiphany sealant. The teeth for the first group were obturated by cold lateral condensation. In the second case the obturation was performed using the Thermo-Hydraulic-Condensation technique using System B and Obtura III. The experimental leakage testing was done using a scanning electron microscope SEM and a light stereoscopic microscope LSM, as typical research tools used in materialography. The research results, in a confrontation with the data taken from the literature studies, do not indicate the domination of resilon in endodontics.

Is Gutta-Percha Still the “Gold Standard” among Filling Materials in Endodontic Treatment?

The paper is an extensive monographic review of the literature, and also uses the results of the authors’ own experimental research illustrating the noticed developmental tendencies of the filling material based on gutta-percha. The whole body of literature proves the correctness of the research thesis that this material is the best currently that can be used in endodontics. Caries is one of the most common global infectious diseases. Since the dawn of humankind, the consequence of the disease has been the loss of dentition over time through dental extractions. Both tooth caries and tooth loss cause numerous complications and systemic diseases, which have a serious impact on insurance systems and on the well-being, quality, and length of human life. Endodontic treatment, which has been developing since 1836, is an alternative to tooth extraction. Based on an extensive literature review, the methodology of qualifying patients for endodontic treatment was analyzed. The importance of selecting filling material and techniques for the development and obturation of the root canal during endodontic treatment was described. Particular attention was paid to the materials science aspects and the sequence of phase transformations and precipitation processes, as well as the need to ensure the stoichiometric chemical composition of Ni–Ti alloys, and the vacuum metallurgical processes and material processing technologies for the effects of shape memory and superelasticity, which determine the suitability of tools made of this alloy for endodontic purposes. The phenomena accompanying the sterilization of such tools, limiting the relatively small number of times of their use, play an important role. The methods of root canal preparation and obturation methods through cold side condensation and thermoplastic methods, including the most modern of them, the thermo-hydraulic condensation (THC) technique, were analyzed. An important element of the research hypothesis was to prove the assumption that to optimize the technology of development and obturation of root canals, tests of filling effectiveness are identified by the density and size of the gaps between the root canal wall, and the filling methods used and devices appropriate for material research, using mainly microscopy such as light stereoscopic (LSM) and scanning electron (SEM). The most beneficial preparations were obtained by making a longitudinal breakthrough of 48 natural human teeth, extracted for medical reasons, different from caries, with compliance with all ethical principles in this field. The teeth were prepared using various methods and filled with multiple obturation techniques, using a virtual selection of experimental variants. The breakthroughs were made in liquid nitrogen after a one-sided incision with a narrow gap created by a diamond disc using a materialographic cutter. The best effectiveness of the root canal filling was ensured by the technology of preparing the root canals with K3 rotary nitinol tools and filling the teeth with the THC thermoplastic method using the System B and Obtura III devices with studs and pellets of filling material based on gutta-percha after covering the root canal walls with a thin layer of AH Plus sealant. In this way, the research thesis was confirmed.

The Effects of Sterilization Procedures on the Cutting Efficiency of Endodontic Instruments: A Systematic Review and Network Meta-Analysis

Sterilization processes guarantee the sterility of dental instruments but can negatively affect instrument features by altering their physical and mechanical properties. The endodontic instrumentation can undergo a series of alterations, ranging from corrosion to variation in the cutting angle and then changes in the torsional properties and torsional fatigue resistance. This systematic literature review and meta-analysis aims to investigate alterations to the cutting efficiency of endodontic instruments that are induced by procedures for their disinfection and sterilization. Methodologies adopted for this investigation follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. The following were used as search terms on PubMed and Scopus: "endodontic sterilization", "endodontic autoclave", "cyclic fatigue", "torsional", "cutting efficiency", "sterilization", "surface characteristics", and "corrosion". At the end of the selection process, 36 articles were identified, and seven of them are included in this systematic review. The results of a meta-analysis conducted for the use of 10 autoclaving cycles shows a standardized mean difference (SMD) of 0.80 with a p-value equal to 0.04 with respect to effect on cutting efficiency. The network meta-analysis, through direct and indirect comparison between the different autoclave cycles (0, 1, 5, 10, and 15 cycles), revealed that treatment involving 15 autoclave cycles produced the most robust results in terms of having the greatest effects in terms of altered cutting efficiency with a probability of 57.7% and a SUCRA (surface under the cumulative ranking) of 80%. The alterations in the effects on cutting efficiency appear to be triggered after five cycles of sterilization by heat (autoclave). In conclusion, the meta-analysis of the data indicates that the autoclave sterilization protocol must not be repeated more than five times to preserve cutting efficiency. Within the limitations of this review, we can therefore establish that sterilization by autoclaving alone results in steel and NiTi instruments becoming less efficient in cutting after five cycles, as measured by a reduction in cutting efficiency.

An in vitro Comparative Evaluation of Efficacy of Disinfecting Ability of Garlic Oil, Neem Oil, Clove Oil, and Tulsi Oil with autoclaving on Endodontic K Files tested against Enterococcus faecalis

AIM

To comparatively evaluate the efficacy of disinfecting ability of garlic oil, neem oil, clove oil, and tulsi oil with autoclaving on endodontic K files tested against Enterococcus faecalis.

MATERIALS AND METHODS

Fifty endodontic K files were exposed to the test micro-organism and checked for its disinfecting ability using three different methods.

RESULT

Garlic oil, clove oil, tulsi oil and autoclave showed considerable effectiveness against E. faecalis except neem oil.

CONCLUSION

Garlic oil, clove oil and tulsi oil are an effective disinfectant and can be used as an alternative to autoclaving against the test micro-organism.

CLINICAL SIGNIFICANCE

Herbs and herbal extracts are a natural and harmless way of controlling infection. These products are readily available and comparable to gold standard, thus can have its applications in rural India.

HOW TO CITE THIS ARTICLE

Hugar S, Patel PM, Nagmoti J, Uppin C, Mistry L, Dhariwal N. An in vitro Comparative Evaluation of Efficacy of Disinfecting Ability of Garlic Oil, Neem Oil, Clove Oil, and Tulsi Oil with autoclaving on Endodontic K Files tested against Enterococcus faecalis. Int J Clin Pediatr Dent 2017;10(3):283-288.

The effect of some fluids on surface oxidation and amount of released iron of stainless steel endodontic files

Endodontic files come in contact with blood, infected pulp tissue, and irrigating solutions during root canal therapy. Some instruments such as stereomicroscopy and scanning electron microscopy are used to observe corrosion of endodontic files which are complicated and dependent on preparation methods. Having knowledge of the corrosion and ion release of endodontic files can help in drawing firm deductions as to which files would perform better in the clinical scenario. Therefore, we have used energy dispersive X-ray analysis and an atomic absorption spectrophotometer to track oxygen on the surface and iron in the exposed media to observe the oxidative rate of the media. In this study, corrosion by blood was higher than other biological fluids, but less than with sodium hypochlorite (NaOCl). Observations of energy dispersive X-ray analysis and atomic absorption spectrophotometer results demonstrated that after exposure the amount of oxygen on the surface and surrounding areas increased. Therefore, the files should be rinsed as soon as possible during and after use to hinder the oxidation rate, but blood may produce a different behavior and it might be considered as a decreased risk of broken stainless steel files remaining in the root canal after treatment.

In vitro evaluation of the antimicrobial activity of chlorhexidine and sodium hypochlorite

The aim of this study was to investigate in vitro the antimicrobial activity of 0.2%, 1%, and 2% chlorhexidine gluconate (CHX gel and CHX liquid), against endodontic pathogens and compare the results with the ones achieved by 0.5%, 1%, 2.5%, 4%, and 5.25% sodium hypochlorite (NaOCl). A broth dilution test was performed, and the timing for irrigants to kill microbial cells was recorded and statistically analyzed. Both 2.0% gel and liquid formulations eliminated Staphylococcus aureus and Candida albicans in 15 seconds, whereas the gel formulation killed Enterococcus faecalis in 1 minute. All tested irrigants eliminated Porphyromonas endodontalis, Porphyromonas gingivalis, and Prevotella intermedia in 15 seconds. The timing required for 1.0% and 2.0% CHX liquid to eliminate all microorganisms was the same required for 5.25% NaOCl. The antimicrobial action is related to type, concentration, and presentation form of the irrigants as well as the microbial susceptibility.

Chelating agents in root canal treatment: mode of action and indications for their use

Chelating agents were introduced into endodontics as an aid for the preparation of narrow and calcified root canals in 1957 by Nygaard-Østby. A liquid solution of ethylenediaminetetraacetic acid (EDTA) was thought to chemically soften the root canal dentine and dissolve the smear layer, as well as to increase dentine permeability. Although the efficacy of EDTA preparations in softening root dentine has been debated, chelator preparations have regained popularity recently. Almost all manufacturers of nickel-titanium instruments recommend their use as a lubricant during rotary root canal preparation. Additionally, a final irrigation of the root canal with 15-17% EDTA solutions to dissolve the smear layer is recommended in many textbooks. This paper reviews the relevant literature on chelating agents, presents an overview of the chemical and pharmacological properties of EDTA preparations and makes recommendations for their clinical use.

Corrosion rates of stainless-steel files in different irrigating solutions

AIM

The present study was designed to evaluate and compare the corrosion rates of the stainless-steel endodontic files when immersed in 0.2% chlorhexidine gluconate, 5.25% NaOCl, chlorinated soda with KOH, and 17% EDTA irrigating solutions.

METHODOLOGY

Corrosion rates of stainless-steel K-files in irrigating solutions were determined electrochemically by the Tafel extrapolation method. The cutting flutes of files were immersed in solutions and used as an electrode. A saturated calomel electrode (SCE) was used as a reference, and a platinum plate was used as a counter electrode. In order to determine corrosion rates, the linear part of anodic currents obtained from electrochemical current-potential curves, was extrapolated to corrosion potentials.

RESULTS

The corrosion rates of stainless-steel files in the tested solutions from the highest to the lowest were: 0.2% chlorhexidine gluconate>5.25% NaOCl>chlorinated soda with KOH>17% EDTA. The differences between the corrosion rates of files were not found to be statistically different for chlorinated soda with KOH and EDTA (P >0.05), but statistically significant differences were found amongst other groups.

CONCLUSIONS

The results of the present study indicated that 0.2% chlorhexidine gluconate, 5.25% NaOCl and chlorinated soda with KOH cause severe corrosion on the surface of selected stainless-steel files.

In vitro antimicrobial activity of several concentrations of sodium hypochlorite and chlorhexidine gluconate in the elimination of Enterococcus faecalis

AIM

The aim of this study was to assess, in vitro, the effectiveness of several concentrations of NaOCl (0.5%, 1%, 2.5%, 4% and 5.25%) and two forms of chlorhexidine gluconate (gel and liquid) in three concentrations (0.2%, 1% and 2%) in the elimination of E. faecalis.

METHODOLOGY

A broth dilution test using 24-well cell culture plates was performed and the time taken for the irrigants to kill bacterial cells was recorded. Isolated 24 h colonies of pure cultures of E. faecalis grown on 10% sheep blood plus Brain Heart Infusion (BHI) agar plates were suspended in sterile 0.85% NaCI solution. The cell suspension was adjusted spectrophotometrically to match the turbidity of a McFarland 0.5 scale. One mL of each tested substance was placed on the bottom of wells of 24-well cell culture plates (Corning, NY), including the control group (sterile saline). Six wells were used for each time period and irrigant concentration. Two mL of the bacterial suspension were ultrasonically mixed for 10 s with the irrigants and placed in contact with them for 10, 30, and 45 s; 1, 3, 5, 10, 20, and 30 min; and 1 and 2 h. After each period of time, 1 mL from each well was transferred to tubes containing 2 mL of freshly prepared BHI + neutralizers in order to prevent a residual action of the irrigants. All tubes were incubated at 37 degrees C for 7 days. The tubes considered to have positive growth were those which presented medium turbidity during the incubation period. Data were analysed statistically by the Kruskal-Wallis test. with the level of significance set at P < 0.05.

RESULTS

All irrigants were effective in killing E. faecalis. but at different times. Chlorhexidine in the liquid form at all concentrations tested (0.2%, 1% and 2%) and NaOCI (5.25%) were the most effective irrigants. However, the time required by 0.2% chlorhexidine liquid and 2% chlorhexidine gel to promote negative cultures was only 30 s and 1 min, respectively.

CONCLUSIONS

Even though all tested irrigants possessed antibacterial activity, the time required to eliminate E. faecalis depended on the concentration and type of irrigant used.

Cleaning efficacy of a new root canal irrigation solution: a preliminary evaluation

AIM

A new product, electro-chemically activated water, was compared to NaOCl for its cleaning effect on root canal walls.

METHODOLOGY

Root canal treatment was carried out on two groups of extracted teeth with one of the irrigants being used in each group. The control group received no treatment. All teeth were split and the canal walls viewed in a scanning electron microscope.

RESULTS

The canal walls of the control group were covered by debris and bacteria. Sodium hypochlorite produced clean surfaces with the dentinal tubules open in some areas and occluded by the smear layer in other areas; in some areas bacteria were visible inside or under the smear layer. Electro-chemically activated water produced markedly cleaner surfaces, removing the smear layer in large areas.

CONCLUSIONS

The cleaning efficacy of electro-chemically activated water in root canals was considered to be superior to NaOCl.

Corrosion in stainless-steel and nickel-titanium files

This study evaluated and compared the corrosion susceptibility of stainless-steel and nickel-titanium (NiTi) endodontic files immersed in sodium hypochlorite. For each of the stainless-steel files (Kerr K-Flex, Caulk Flex-O, and Union Broach Flex-R) plus the NiTi files (Union Broach NiTi and Tulsa NiTi), the cutting flutes of 24 ISO size 20 files were immersed into 5.25% sodium hypochlorite. Their open circuit potential (OCP) was recorded for 1 h on a strip chart with high impedance. The strip chart recording for each file was classified into a stability score: (i) stable, (ii) unstable, or (iii) erratic. The OCP was measured by a potentiostat and a standard calomel electrode reference. The OCP classification of unstable and erratic for the files evaluated were as follows: K-Flex (16%), Flex-R (12%), Flex-O (75%), Union Broach NiTi (62%), and Tulsa NiTi (0%). After OCP testing, each of the 120 files was inspected by light microscopy at x 25. The frequencies of visually observed corrosion were detected as follows: K-Flex (2/24), Flex-R (1/24), Flex-O (6/24), Union Broach NiTi (2/24), and Tulsa NiTi (0/24). There was a significant difference in corrosion frequency between brands when evaluated by OCP and light microscopy; however, there was no significant difference between stainless steel and NiTi.

Root canal instruments for manual use: a review

Root canal instruments can be subdivided into instruments made of different alloys (stainless steel, nickel-titanium and nickel-aluminium) and instruments with different geometric forms (e.g., instruments with short cutting segments). Several types of stainless steel and titanium-based instruments are presented and assessed by a review of the current literature. In summary, flexible stainless steel instruments with noncutting tips seem to be a decisive improvement in the development of an ideal root canal instrument. They are superior to titanium-based instruments in both cutting efficiency and instrumentation of curved root canals.

The sterilization of endodontic hand files

Several different methods of file sterilization were analyzed to determine the best method of providing complete file sterility, including the metal shaft and plastic handle. Six test groups of 15 files were studied using Bacillus stearothermophilus as the test organism. Groups were "sterilized" by glutaraldehyde immersion, steam autoclaving, and various techniques of salt sterilization. Only proper steam autoclaving reliably produced completely sterile instruments. Salt sterilization and glutaraldehyde solutions may not be adequate sterilization methods for endodontic hand files and should not be relied on to provide completely sterile instruments.

In vitro cleaning ability of root canal irrigants with and without endosonics

A variety of methods have been used to evaluate the cleanliness of root canals after endodontic preparation and irrigation. Few irrigation agents other than sodium hypochlorite (NaOCl) have been tested in conjunction with endosonics. The purpose of this study was to examine the cleaning ability of water, NaOCl, Hibiscrub and a biological washing liquid when used as intracanal irrigants, with and without endosonics. Two methods of evaluation were employed to assess the root canal cleanliness after endodontic preparation. A total of 56 teeth, divided into eight groups, were prepared manually using the step-down technique. Each irrigating agent was used in two experimental groups, with and without endosonics. Two additional teeth which received neither instrumentation nor irrigation served as the controls. The teeth were split longitudinally and the state of cleanliness of the root canal was assessed by scoring the amount of stained organic debris and smear layer. It was demonstrated that the results of debris and smear layer scoring were significantly influenced by the type of irrigant and whether endosonics had been used. All agents exhibited similar cleaning ability when introduced manually. With endosonics, NaOCl yielded significantly less stainable debris (P < 0.05) than the other groups which showed no significant difference. The ability to remove the smear layer was enhanced, but at some distance short of the working length, by endosonics for all irrigants tested. None of the solutions tested was able to produce a canal wall that was free of smear layer.

The effects of steam sterilization and usage on cutting efficiency of endodontic instruments

The effects of steam sterilization and usage on sharpness were evaluated on #25 endodontic files. Files were used to instrument 1, 5, and 10 molars. Control groups determined the effect of steam sterilization alone on cutting efficiency of unused files. A cutting efficiency test was performed on an apparatus that compares sharpness of files when used in linear motion. Scanning electron microscopic analysis was performed in each group. Significant differences were found between experimental files used to instrument 1 molar and those used for 5 or 10 molars. The difference in cutting efficiency between the second and third experimental groups was not significant, indicating that most of the decrease in sharpness occurred with use between one and five molars. No significant difference was found between the control groups, indicating no decrease in cutting efficiency by sterilization alone. The scanning electron microscopic analysis supported the statistical data.

The influence of file size, cleaning, and time on effectiveness of bead sterilizers

A controlled study was conducted to determine the influence on disinfection of cleaning endodontic files with either dry gauze or alcohol-saturated gauze prior to placement of the files into a hot bead sterilizer. File size and length of time in the hot bead sterilizer were also investigated. Findings indicated that an alcohol wipe was more effective than a dry wipe except in the largest file tested. Using an alcohol wipe and 3 seconds in a hot bead sterilizer for No. 10 files or 5 seconds for either a No. 30 or a No. 45 file was equivalent in disinfecting ability to 8 seconds and a dry wipe using the same file sizes.