Cutting efficiency of endodontic hand instruments. Part 4. Comparison of hybrid and traditional instrument designs

A new device to test cutting efficiency of mechanical endodontic instruments

BACKGROUND

The purpose of the present study was to introduce a new device specifically designed to evaluate the cutting efficiency of mechanically driven endodontic instruments.

MATERIAL AND METHODS

Twenty new Reciproc R25 (VDW, Munich, Germany) files were used to be investigated in the new device developed to test the cutting ability of endodontic instruments. The device consists of a main frame to which a mobile plastic support for the hand-piece is connected and a stainless-steel block containing a Plexiglas block against which the cutting efficiency of the instruments was tested. The length of the block cut in 1 minute was measured in a computerized program with a precision of 0.1mm. The instruments were activated by using a torque-controlled motor (Silver Reciproc; VDW, Munich, Germany) in a reciprocating movement by the "Reciproc ALL" program (Group 1) and in counter-clockwise rotation at 300 rpm (Group 2). Mean and standard deviations of each group were calculated and data were statistically analyzed with a one-way ANOVA test (P<0.05).

RESULTS

Reciproc in reciprocation (Group 1) mean cut in the Plexiglas block was 8.6 mm (SD=0.6 mm), while Reciproc in rotation mean cut was 8.9 mm (SD=0.7 mm). There was no statistically significant difference between the 2 groups investigated (P>0.05).

CONCLUSIONS

The cutting testing device evaluated in the present study was reliable and easy to use and may be effectively used to test cutting efficiency of both rotary and reciprocating mechanical endodontic instruments.

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.

Measurement of the cutting efficiency of endodontic instruments: a new concept

The cutting efficiency of endodontic instruments was measured using an original experimental technique that incorporates new concepts to simulate clinical conditions. Five designs of #ISO 030 endodontic instruments, K-reamer (Maillefer), Flexofile (Maillefer), Helifile (Micro-mega), K-flex (Kerr), and Unifile (De Trey), were chosen and their cutting efficiency assessed at their full working length of 16 mm on two Plexiglas parallelepipeds tilted to follow the 2% conicity of the instruments. For each instrument, four series of 25 cuts were carried out and each cut made on a new flat, smooth Plexiglas surface with an even hardness of 33 VHN. Instruments were tested under a simulated clinical condition of a quarter clockwise turn ROTARY MOTION followed by a PULL ACTION at 16 mm/s rate, with a fixed load on the instrument of 325 g. Water irrigation at a rate of 85 ml/s was supplied before each procedure. Cutting efficiency was evaluated in terms of mass of Plexiglas cut (using a Mettler analytic balance with accuracy of 3 x 10(-5) g) per unit of energy used by the instrument, i.e. mg/J. Unifile was found to have the best cutting efficiency of 0.80 +/- 0.01 (Mean +/- SD) and lowest cutting efficiency loss followed by Flexofile 0.70 +/- 0.03 then Helifile 0.36 +/- 0.01 then K-flex 0.51 +/- 0.07. K-reamer was found to have the lowest cutting efficiency of 0.16 +/- 0.05.

Cutting efficiency of K-files manufactured with different metallic alloys

The aim of this study was to compare, in vitro, the machining efficiency of different triangular cross-section K-files made of nickel titanium (Nitiflex, Naviflex), titanium (Microtitane), and stainless steel (Flexofile, Flex-R). Ten instruments of each K-file from size 25 to 40 were tested. The cutting efficiency was assessed in a linear motion using an indentation caliper to measure the depth of grooves. The load applied (in grams) was equal to the ISO file size. Each file was allowed to do 100 back-and-forward movements. Files made of stainless steel were the most effective, in particular Flexofile. There were statistically significant differences between Flexofile and Flex-R in all sizes. In the group of nickel titanium instruments, Nitiflex was significantly more efficient than Naviflex in all sizes. The machining ability of titanium files was higher than that of Naviflex but lower than that of Nitiflex and stainless steel files.

Cutting efficiency of Hedstrom, S and U files made of various alloys in filing motion

The cutting efficiency for sizes 25 and 35 stainless steel Hedstrom S and U files from 10 manufacturers, and titanium-alloy Hedstrom S and U files from five manufacturers, tested for linear (filing) motion under standardized conditions were determined. Special plastic samples having well-defined abrasive properties were used as the substrate and constant pressure was applied until the instruments were blunt. The depth of the groove achieved by filing was used to measure cutting efficiency. For both sizes there were significant differences in the cutting efficiency of files made by the various manufacturers (P < 0.001). Hedstrom files made of stainless steel, made by VDW, gave the best cutting efficiency for sizes 25 and 35. Overall, under the conditions of this study. Hedstrom files had better cutting efficiency than S or U files. Likewise, stainless steel files provided better cutting efficiency than instruments made of titanium alloys.

Properties of endodontic hand instruments used in rotary motion. Part 1. Cutting efficiency

Cutting efficiency of 24 different types of endodontic hand instruments, which are primarily designed for a rotary (reaming) working action, was investigated under standardized conditions. With a computer-driven testing device, resin specimens with simulated cylindrical canals were instrumented using a defined working motion simulating the clinical use of the instruments. Maximum penetration depth was the criterion for cutting efficiency. Sample size was 12 instruments for each type and size (#25 and #35). Nitinol K-files showed the least cutting efficiency. Stainless steel reamers and especially K-files showed better cutting efficiency than Nitinol K-files. Flexible stainless steel instruments displayed the best results. With regard to cutting efficiency, flexible stainless steel instruments were clearly superior to stainless steel reamers and K-files, and especially to Nitinol K-files.

Root canal instruments for manual use: cutting efficiency and instrumentation of curved canals

The cutting efficiency of different endodontic hand instruments and the effects of instrumentation on curved canal shape were investigated under standardized experimental conditions using an automatic testing device. Cutting efficiency in rotary motion was assessed by determination of the maximum penetration depth of the instruments into a cylindrical canal in a special resin block (size 25 and size 35 instruments). Changes in canal shape were determined by instrumentation of standardized canals (42 degrees curvature) incrementally from size 15 to size 35. Except in the case of one instrument, size 35, in both sizes tested flexible instruments reached significantly (P < 0.05) greater maximum penetration depths than conventional reamers or K-files. Changes in the canal shape differed significantly between the different instruments in 13 of the 14 measuring points. Drastic undesirable changes in the canal shape (e.g. straightening or zip and elbow) occurred after instrumentation with reamers and K-files, but these changes were less noticeable after instrumentation with flexible instruments with conventional tips. After instrumentation with flexible instruments with modified tips there were few undesirable changes in shape. The conclusion could be drawn that flexible instruments, especially those with modified tips, were clearly superior to conventional reamers and K-files with regard to cutting efficiency and instrumentation of curved canals.

Comparison of six files to prepare simulated root canals. 1

A total of 300 simulated root canals of various angles and positions of curvature in clear resin blocks were prepared by hand using either K-files, K-Flex files, Flexofiles, Flex-R files, Hedstrom files or Unifiles. Each file type was used to prepare 50 canals employing a linear filing motion and an anticurvature stepback technique. Part 1 of this two-part report describes the efficacy of the files in terms of preparation time, instrument failure, loss of canal length and weight loss from the blocks. Two-way analysis of variance confirmed that there was significant variation for each parameter between instruments, between canal types, and with interaction between instruments and canal types. Overall, preparation with Hedstrom files was significantly quicker than with any other file, whilst preparation with K-files and K-Flex files took significantly longer. Fracture and deformation of instruments occurred substantially less often with Flex-R and Hedstrom files, but significantly more often with Unifiles. Loss of working distance occurred with all file types, but was significantly greater in canals prepared with K-files. Unifiles and Hedstrom files were responsible for significantly more weight loss than the other files, whilst K-files produced significantly less weight loss. Canals with rough undulating walls were created most often by Hedstrom files and Unifiles. Overall, under the conditions of this study, Flexofiles, Flex-R files and Hedstrom files appeared to be substantially more effective than K-files, K-Flex files and Unifiles.

Dynamic fracture of hybrid endodontic hand instruments compared with traditional files

The purpose of this study was to analyze in vitro the dynamic fracture of some endodontic hand instruments. The K file and H file were tested as reference traditional files; the K-Flex, Flexofile, Unifile, and Helifile were tested as newly developed hybrid instruments. The files were mounted in a lathe and rotated with cyclical axial motion in the lumen of a curved tempered steel groove until failure occurred. The results showed that the life span of instruments, the distance between the instrument tip and the rupture point, and the resistance to fracture were dependent on the size and design of the instruments. Moreover, scanning electron microscopic photographs revealed two types of breakage patterns. The K file, H file, Unifile, and Helifile showed a distinct fracture starting point with crack striations and ductile fractures. The K-Flex and Flexofile showed only plastic deformations and axial fissures.

High precision, simulated cutting efficiency measurement of endodontic root canal instruments: influence of file configuration and lubrication

A high precision method is presented for measurement of root canal instrument cutting efficiency in pure, linear movements. Operator-independent instrumentation is achieved by means of an automatic, mechanical test rig mounted as an accessory in an Instron tensile testing machine. It is now possible to do reliable cutting simulation that closely represents clinical motions. Cutting efficiency is assessed via "wear" volume measurement by means of three-dimensional surface mapping on bovine bone serving as a dentin substitute. A volume precision of 3 x 10(-3) mm3 is achieved which is equivalent to a weight resolution better than 10 micrograms. In particular, cutting efficiency data for K-type and H-type files is presented showing an enhanced performance (by roughly a factor of 3) in the latter case. Lubrication is also shown to increase the cutting efficiency (+200% for the K file and +30% for the H file). Water and 2.5% sodium hypochlorite solutions have equivalent effects.

A comparison of the ability of K-files and Hedstrom files to shape simulated root canals in resin blocks

A total of 50 simulated root canals in clear resin blocks with various degrees and positions of curvature were prepared by either K-files or Hedstrom files. Each file type was used to prepare 25 canals employing an in/out circumferential filing motion. The efficacy of the files was assessed by instrumentation time, deformation and fracture of instruments, and loss of working distance. The shape of the prepared canals was assessed by direct observation and from composite photographic prints produced by superimposing negatives of the canals obtained before and after preparation. Overall, canal shaping with Hedstrom files was quicker and more effective. Both file types prepared straight canals in an appropriate manner but the majority of prepared curved canals were hourglass in shape. In general, K-files created zips which were wider and thus more pronounced than those produced by Hedstrom files. Wide 'danger zones' were also regularly created. The location of the aberrations depended largely on the original shape of the canal and in particular on the position of the beginning of the canal curve. Under the conditions of this study, the manipulation of K-files and Hedstrom files in a simple in/out circumferential filing motion proved an unsatisfactory method of shaping simulated curved root canals in resin blocks.