Cyclic fatigue testing of nickel-titanium endodontic instruments

Understanding Cyclic Fatigue in Three Nickel-Titanium Pediatric Files: An In Vitro Study for Enhanced Patient Care

Background and Objectives: Nickel-titanium (Niti) instruments have enhanced root canal cleaning in primary teeth, but file fractures are still common. Materials and Methods: This study evaluated the cyclic fatigue resistance of 120 Niti files from four different systems, A: Kedo SG (n = 30); B: Neoendo Pedoflex (n = 30); C: Pedoflex Waldent files (n = 30); and D: Vortex Blue files (n = 30). All the files had similar tip diameters (0.25 mm) and tapers (0.4%) and underwent heat treatment during manufacturing. Cyclic fatigue tests showed notable variations in cycles to fracture (NCF) across groups. All fracture surfaces of the files were assessed through scanning electron microscopy. Results: The mean values achieved in the experimental groups (A, B, C) were less than those in the control Group D (976.90 ± 1085.19). Files in Group A demonstrated the highest NCF (697.01 ± 420.09), while Pedoflex files in Group C showed the lowest values (203.88 ± 155.46). Statistical analysis using the Mann-Whitney test revealed significant differences between Group C and Groups A, B, and D and no differences among Groups A, B, and D. Conclusions: These findings suggest that Kedo SG and Neoendo Pedoflex files offer comparable cyclic fatigue resistance to Vortex Blue files. In contrast, Pedoflex Waldent files exhibit lower resistance to fracture.

Prevalence and morphology study of distolingual root in mandibular first and second molars in Thai population: a cone-beam computed tomography analysis

BACKGROUND

To investigate the prevalence and morphological characteristics of distolingual roots in permanent mandibular molars among a Thai population using a cone-beam computed tomography (CBCT).

METHODS

This retrospective study consisted of two parts: prevalence and morphology study. A total of 5228 permanent mandibular first and second molars from 2623 Thai patients were included in the prevalence study, and CBCT images were analyzed to identify the presence of distolingual roots. Additionally, 288 teeth with distolingual roots were subjected to further analysis to assess their root morphology, canal configuration, and orifice location. Statistical analyses were performed using descriptive statistics, Pearson's chi-square test, paired t-test, and other appropriate methods.

RESULTS

The prevalence of distolingual roots in permanent mandibular molars was 9.14% among the examined teeth and 14.94% among the examined patients. The majority of distolingual roots were classified as type C according to Carlsen and Alexandersen's classification, and type III according to Song's classification. Additionally, the vast majority of teeth exhibited Vertucci type I canal configuration. Further analysis revealed that the mean interorifice distances between DB-DL, ML-DL, and MB-ML orifices were 3.01 ± 0.6 mm, 3.43 ± 0.57 mm, and 2.61 ± 0.59 mm, respectively. The angle and radius of curvature of distolingual roots in the proximal view were greater than those in the clinical view (p < 0.001).

CONCLUSIONS

This study provides comprehensive insights into the prevalence and morphological characteristics of distolingual roots in permanent mandibular molars among a Thai population. These findings emphasize the importance of thorough preoperative assessment and awareness of root morphology variations to enhance the success of endodontic treatment.

Effectiveness and safety of three NiTi systems in endodontic retreatment of MB1 and MB2 root canals: a micro-CT and CBCT combined analysis

OBJECTIVE

To evaluate the performance in endodontic retreatment and pericervical dentin preservation using ProDesign Logic (PDL), Reciproc Blue (RB), and WaveOne Gold (WOG) NiTi systems in first (MB1) and second (MB2) mesiobuccal root canals of maxillary molars, using cone-beam computed tomography (CBCT) and micro-computed tomography (micro-CT).

MATERIALS AND METHODS

MB1 and MB2 canals were prepared, filled, and randomized into four groups (n = 8). MB1 were retreated using PDL up to file 40/0.05 or RB R40 (40/0.06), while MB2 were retreated using PDL up to file 35/0.05 or WOG (35/0.06). Micro-CT scans were performed before and after retreatment to assess the remaining filling material, canal transportation, and canal centralization. Dentin removal and remaining dentin were measured at four levels below the furcation through CBCT scans analyzed with the e-Vol DX software, with micro-CT serving as the reference standard.

RESULTS

RB was more effective than PDL in removing MB1 filling material, while PDL outperformed WOG in the apical third of MB2 (p < 0.05). Overall, CBCT measurements for dentin removal were consistent with micro-CT in MB1 but occasionally underestimated in MB2 (p < 0.05). A significant reduction in MB2 danger zone dentin thickness below 0.5 mm was observed after retreatment (p < 0.05).

CONCLUSIONS

RB was more effective in retreating MB1, while PDL was more efficient in the apical third of MB2. A substantial decrease in dentin thickness in the MB2 danger zone was noted after retreatment, regardless of the NiTi system or imaging modality used. Overall, CBCT scans provided consistent assessments of dentin.

CLINICAL RELEVANCE

Selecting appropriate NiTi systems minimizes dentin removal in MB1 and MB2 danger zones, reducing the risk of perforation in the furcation area. CBCT reliably assesses dentin thickness, aiding clinical decisions and improving endodontic retreatment outcomes.

Thermal behavior and cyclic fatigue resistance of three contemporary NiTi heat-treated single-file systems: metallurgical study

BACKGROUND

This study aims to determine phase transformation temperatures of EndoSequence Reciprocating System (ESR), Wave One Gold (WOG), and Reciproc Blue (RB) via differential scanning calorimetry (DSC). Further, to evaluate the cyclic fatigue behaviors by applying static (SF) and dynamic fatigue (DF) tests.

METHODS

All files' systems were evaluated using DSC (Netzch 200 F3, Germany) with scans ranging from 80°C to -80°C to compare phase transformation. Twenty files from each file system (n = 20) were tested by cyclic fatigue in SF (n = 10) and in DF (n = 10) and the number of cycles to failure (NCF) was calculated for all groups. The files were rotated in a clockwise motion in a metal tube at 350rpm. The NCF was calculated by multiplying the time until fracture in minutes by speed (350 rpm). The NCF was analyzed statistically using a One-Way Analysis of Variance (ANOVA) to determine if there were significant differences among the experimental groups.

RESULTS

All files exhibited a single peak in the cooling curve marking martensitic transformation with RB showing martensitic transformation start temperature at around 37oC . ESR and WOG exhibited single endothermic peaks marking austenitic transformation. RB exhibited two endothermic peaks marking R-phase and austenitic transformations. In cyclic fatigue testing, WOG presented the lowest NCF in DF testing compared to ESR and RB (p < .05) with a nonsignificant difference between the latter two. In the SF, ESR showed a statistically significant larger NCF compared to RB, which also showed statistically significant larger NCF compared to WOG (p < .05).

CONCLUSIONS

RB shows martensite transformation start temperature close to body temperature. RB and ESR show improved cyclic fatigue resistance compared to WOG in the SF mode. In the DF mode, WOG showed the lowest cyclic fatigue resistance.

Evaluation of cyclic fatigue in three pediatric endodontic rotary file systems in root canals of primary molars: A finite element analysis (FEA)

Objective

The aim of this study was to evaluate the cyclic fatigue resistance of three different pediatric endodontic rotary files in the root canals of primary molars using finite element analysis (FEA). The research focuses on understanding the mechanical behavior of the files under varying canal curvatures to determine their suitability for pediatric endodontics.

Methods

Finite Element Analysis (FEA) was utilized to simulate cyclic fatigue performance in primary molar canals with curvatures of 30°, 60°, and 90°. The rotary files made up of nickel-titanium (NiTi) alloys included in this study were Kedo SG, Neoendo Pedo Flex, and Pro AF Baby. Stress distribution, maximum stress values, and cyclic fatigue resistance were evaluated to identify differences in performance. Simulations were conducted under controlled conditions to model real-world clinical scenarios. Stress distribution and the number of cycles until failure were analyzed using Goodman's fatigue model and the S-N curve.

Results

The Pro AF Baby files exhibited the highest cyclic fatigue resistance and the more favourable stress distribution across all canal profiles, due to its triangular cross-sectional geometry. Whereas, Kedo SG and Neoendo Pedo Flex demonstrated higher stress levels and lower fatigue life, particularly in severe curvatures (90°), indicating increased susceptibility to failure. Elevated stress concentrations were observed near the apical tip, correlating with reduced fatigue life as canal curvature increased.

Conclusion

Pro AF Baby B2 demonstrated better fatigue resistance and safety for endodontic procedures in primary molars with complex root canal curvatures. These findings emphasize the importance of material properties and file design in improving clinical outcomes. Future research should focus on long-term clinical validation and further optimization of rotary file systems for pediatric dentistry.

Temperature-Dependent Effects on Cyclic Fatigue Resistance in Three Reciprocating Endodontic Systems: An In Vitro Study

This study aimed to analyze the effect of 1% sodium hypochlorite (NaOCl) solution at different temperatures on endodontic file resistance to cyclic fatigue. A total of 90 files, Reciproc NiTi M-Wire® (REC) (n = 30), WaveOne Gold® (WOG) (n = 30), and Reciproc Blue® (RB) (n = 30) were activated under constant irrigation with 1% NaOCl at 5, 37, and 60 °C in a stainless-steel artificial canal (curvature angle = 60°; radius = 5 mm). The time to the fracture and the maximum and minimum load were recorded for each instrument, and data were subjected to statistical analysis. A higher number of cycles to fracture at 5 °C was observed between WOG and RB compared to the REC system (p < 0.05). The RB files were more resistant to cyclic fatigue fracture at 60 °C than WOG and REC (p < 0.05). No statistically significant differences were found between the mean values of the three file types used at 37 °C. The high temperature of NaOCl significantly affects the lifespan of endodontic files, making them more prone to fractures due to cyclic fatigue. The files manufactured with heat treatment showed a longer life than M-wire reciproc files.

Comparison of the effect of different irrigation activation systems on the amount of apical extrusion of irrigation solution in teeth with severely curved canals

OBJECTIVE

This study aims to quantitatively compare the effects of standard needle irrigation (SNI), passive ultrasonic irrigation (PUI), EDDY, photon-initiated photoacoustic streaming (PIPS), and shock wave-enhanced emission photoacoustic streaming (SWEEPS) on the apical extrusion of irrigation solutions in teeth with severe canal curvature.

MATERIALS AND METHODS

Seventy-five teeth with a single root and canal, and curvature angles ranging from 20° to 40°, were selected for this study. Root canal curvatures were measured from buccolingual and mesiodistal radiographs using ImageJ software (version 1.48v; National Institutes of Health, Bethesda, MD, USA). The samples were randomly assigned to five groups (n = 15) based on the irrigation activation methods: SNI, PUI, EDDY, PIPS, and SWEEPS. An irrigation activation procedure was performed for 90 s using a total of 6 ml of 2.5% sodium hypochlorite (NaOCl) (Wizard, Istanbul, Turkey) in all samples. The Myers-Montgomery experimental model was used to simulate periapical tissues and limit the amount of extruded solution. The extruded irrigation solution was collected from the drainage cannula using an insulin syringe.

RESULTS

The data on the amount of apical extrusion of irrigation solution were analyzed statistically using the Kruskal-Wallis and Mann-Whitney U tests, with a significance level set at P < 0.05. While the highest mean solution extrusion was observed in the SNI and PUI groups, the PIPS group showed less extrusion compared to the other groups. However, no statistically significant difference in the amount of apical extrusion of irrigation solution was found among all the irrigation activation methods tested.

CONCLUSIONS

Within the limitations of this study, all irrigation activation methods tested on teeth with severe curvature resulted in a certain amount of solution extrusion. However, no significant difference was identified among the irrigation activation methods tested.

CLINICAL RELEVANCE

When these irrigation activation methods are tested on teeth with varied canal anatomies, the amount of apical extrusion of the irrigation solution may vary.

Impact of anatomical and clinical variables on the success of endodontic instrument fragment retrieval

PURPOSE

Separation of instrument fragments can impede the progress of endodontic treatment, and effective management of this complication is crucial for treatment success. This study examined the factors that impact the success of retrieval of separated instrument fragments by postgraduate endodontic residents.

METHODS

A retrospective analysis was conducted on a total of 224 teeth associated with instrument fragment separation that were managed by postgraduate residents specializing in endodontics between January 2020 and March 2024. Data were extracted from patient records, periapical radiographs, and clinical notes. Chi-squared test and t-test were employed to identify factors significantly influencing retrieval success. Associations between successful retrieval and variables were assessed using binary logistic regression models.

RESULTS

Fragment retrieval was successful in 32% of the examined cases. Retrieval was more likely to be successful for anterior teeth than for premolars and molars (P = 0.003). Fragment separation in the coronal third of the canal had a higher retrieval success rate (P < 0.001). Longer separated fragments were also associated with increased retrieval success (t = 3.035, P = 0.003).

CONCLUSION

The study revealed that factors critically influencing the successful retrieval of separated instrument fragments included the tooth type, the level of separation within the canal, and the fragment length. These findings highlight the importance of careful case selection in order to optimize management outcomes.

The Biomechanics of Nickel Titanium Instrument Fracture in Root Canal Therapy: A Narrative Review

The use of motorized nickel titanium instruments is an essential component in contemporaneous clinical endodontics. The mechanical properties of nickel titanium are optimal for the cleaning and shaping of root canal systems. However, instrumentation carries risks, particularly instrument fracture, which may become an obstacle to achieving adequate disinfection of the canal system. Although the biomechanics of instrument fracture have been extensively investigated previously, certain facets remain unexplored, specifically torsional fatigue. This review presents a comprehensive overview of the modern understanding of the biomechanics involved in nickel titanium instrument fracture. Importantly, while research has tended to describe fatigue fracture and torsional failure as distinct and separate entities, clinical conditions are likely a combination of the two. Moreover, intracanal instrument fractures may also occur following a different mechanism, torsional fatigue. This should be taken into consideration for further research and clinical guidance.

Comparison of cyclic fatigue resistance of three different single-file systems after clinical use

BACKGROUND

Nickel titanium (NiTi) rotary files have drastically altered the treatment protocol in endodontics, allowing for faster and easier preparation and more thorough irrigation of the root canal system. Despite the advantages of the NiTi files, instrument separation still remains a major concern. The aim of this study was to compare the cyclic fatigue resistance of three different single-file NiTi systems after clinical use: WaveOne Gold (WOG, Dentsply Maillefer, Ballaigues, Switzerland), One Curve (OC, Micro Mega, Besancon, France), and Reciproc Blue (RPC Blue, VDW, Munich, Germany).

METHODS

A total of 120 patients requiring endodontic treatment to first or second mandibular molars, were randomly divided into three groups (patient n = 40) and root canals were prepared with WOG, OC or RPC Blue. Each group consists of 2 subgroups: first use (file n = 10, patient n = 10) and third use of file (file n = 10, patient n = 30). In control group, files were subjected to cyclic fatigue test without use (file n = 10). Cyclic fatigue resistance of files was assessed by groove method. The data was evaluated by two-way ANOVA, Games & Howell post hoc and Weibull reliability analyses (p < .05).

RESULTS

RPC Blue files showed the highest failure time value in all groups. In third use group, OC and RPC Blue files showed significantly higher failure time values compared to WOG files (p < .05). In general, RPC Blue files show the highest values in terms of number of cycles to fracture (NCF) in all groups, while OC and WOG files follow RPC Blue files respectively. There was statistically significant difference among groups considering the fragment length (p < .05).

CONCLUSIONS

Within the limitations of this study, RPC Blue files exhibited highest cyclic fatigue resistance after clinical use.

Investigation of four nickel titanium endodontic instruments, with cyclic fatigue resistance, scanning electron microscopy, and energy dispersive x-ray spectroscopy

The aim of this study was to compare of four different nickel-titanium (Ni-Ti) endodontic files and evaluate in terms of cyclic fatigue resistance and metallurgical properties. Four different type Ni-Ti root canal files Protaper Next X2 (PTN) (Dentsply Maillefer, Ballaigues, Switzerland), One Curve (OC) #25.06 (Micro Mega, Besancon, France), EndoPlus Flex Plus Gold X2 (EPG) (Turkuaz Dental, Denizli, Turkey), and EndoPlus Flex Plus Blue #25.06 (EPB) (Turkuaz Dental, Denizli, Turkey) files were tested for cyclic fatigue resistance (n = 20). During experiments artificial zirconia block canal was used. The artificial canal designed with curvature 60° and 5-mm radius. The number of cyclic to fracture (NCF) was noted. Fractured length (FL) parts of Ni-Ti files were recorded to assessment of fracture volumetric point. All fractured surfaces of Ni-Ti files were assessed by scanning electron microscope (SEM) to confirm the type of fractures. Descriptive evaluation become accomplished for the fundamental composition of units with the aid of using energy-dispersive x-ray spectroscopy (EDX). NCF data were evaluated via Bonferroni test with post hoc multiple comparison method. OC showed the highest NCF values (p < .05). The standardization of the study was confirmed as the FL of files was statistically similar in length (p > .05). SEM analysis confirmed that all scanned samples were fractured due to cyclic fatigue. EDX analysis confirmed that EPB established the poorest Ni content file. RESEARCH HIGHLIGHTS: The cyclic fatigue-related failure of One Curve was significantly more resistant than Protaper Next and EndoPlus files. Scanning electron microscopy images showed that One Curve and Protaper Next have round tips Energy dispersive x-ray spectroscopy showed that all four endodontic instruments mainly have Nickel and Titanium elements.

Evaluation of the shaping ability of different rotary file systems in severely and abruptly curved root canals using cone beam computed tomography

Background

When selecting an instrument for canal preparation, it is important to consider several parameters that influence the shaping efficiency, including instrument design, metallurgy, and operating motion. This study aimed to evaluate the shaping ability of the ProTaper Next (PTN), WaveOne Gold (WOG), and XP-endo Rise Shaper (XPRS) rotary systems in severely and abruptly curved root canals using cone beam computed tomography (CBCT) and ImageJ software.

Materials and Methods

Forty-eight mesial root canals of the mandibular first molars were assigned equally to three groups: PTN, WOG, and XPRS. Using ImageJ software, CBCT images were acquired pre- and post-instrumentation to assess dentin removal, remaining dentin thickness (RDT), canal transportation, and centering ratio at the coronal, middle, and apical levels. Statistical analyses were conducted on all numerical data.

Results

All rotary systems removed significantly more distocoronal dentin in the danger zone (DZ), than the mesiocoronal area. PTN removed significantly more dentin and caused less RDT than XPRS (p < 0.05). However, there were no significant differences between PTN-WOG and WOG-XPRS. In the DZ, the highest percentage of specimens with an RDT < 0.5 mm was observed when using PTN (50%), followed by WOG (31.3%), and XPRS (6.3%). Compared with PTN and WOG, XPRS demonstrated less coronal transportation. Among all rotary systems, there was no significant difference in apical transportation or centering ratio.

Conclusions

Based on our observations, all rotary instruments exhibited a tendency to remove dentin in the DZ, but to different degrees. XPRS demonstrated better results in terms of coronal transportation and dentin thickness in the DZ. Comparable centering abilities and minimal apical transportation were demonstrated using all rotary instruments.

Cyclic Fatigue Resistance of Four Heat-Treated Nickel-Titanium Files in Severely Curved Simulated Canals: An In Vitro Study

Background: Rotary Ni-Ti files are susceptible to sudden intra-canal separation due to cyclic fatigue stress, particularly in curved canals. To increase resistance to cyclic fatigue, new heat-treated files have been introduced. This study aimed to compare the performance of four heat-treated Ni-Ti files in two simulated curved root canals by evaluating the effect of the alloy, rotation speed, and diameter of the files on their resistance to cyclic fatigue. Methods: The Ni-Ti files included in the study were the ProTaper Gold® (Dentsply Sirona) F2, ProTaper Ultimate® (Dentsply Sirona) F2, FQ® (Komet) 25.06, and Blueshaper® (Zarc4Endo) Z4 25.06. Two groups of 30 files were selected for each system and were tested in two simulated canals milled in a specific metal template. One group was tested in a 60° curved canal and the other in a 90° curved canal. Results: In the 60° simulated canal, there were no instrument fractures within the 15 min time limit. In the 90° simulated canal, the Blueshaper Z4 demonstrated a lower resistance to cyclic fatigue, while FQ 25.06 showed statistically higher fatigue resistance based on both the Kruskal-Wallis and Games-Howell tests (p < 0.05). Conclusions: No differences were found between files when tested in a 60° curved canal for up to 15 min. However, in a 90° canal, the FQ® files showed significantly higher resistance to cyclic fatigue, especially compared to the Blueshaper® Z4. The ProTaper Ultimate and ProTaper Gold produced intermediate results, with the ProTaper Ultimate F2 slightly outperforming the ProTaper Gold F2.

Unveiling the fatigue life of NiTi endodontic files: An integrated computational-experimental study

Nickel-titanium (NiTi) rotary files used in root canal treatments experience fatigue and shear damage due to the complex curved geometries and operating conditions encountered within the root canal. This can lead to premature file fracture, causing severe complications. A comprehensive understanding of how different factors contribute to file damage is crucial for improving their functional life. This study investigates the combined effects of root canal curvature radius, file canal curvature, and rotational speed on the fatigue life and failure modes of NiTi endodontic files through an integrated computational and experimental approach. Advanced finite element simulations precisely replicating the dynamic motion of files inside curved canal geometries were conducted. Critical stress/strain values were extracted and incorporated into empirical fatigue models to predict the functional life of endodontic files. Extensive experiments with files rotated inside artificial curved canals at various canal curvatures and speeds provided validation. Increasing the canal curvature beyond 60∘ and shorter curvature radii below 5 mm dramatically reduced the functional life of the endodontic file, especially at rotational speeds over 360 rpm. The Coffin-Manson fatigue model based on strain amplitude showed the closest agreement with experiments. Shear stresses dominated damage at low canal curvatures, while the combined shear-fatigue loading effects were prominent at higher canal curvatures. This conclusive study elucidates how operational parameters like canal curvature radii, canal curvature, and rotational speed synergistically influence the fatigue damage processes in NiTi files. The findings offer valuable guidelines to optimize these factors, significantly extending the functional life of endodontic files and reducing the risk of intra-operative failures. The validated computational approach provides a powerful tool for virtual testing and estimation of the functional life of the new file designs before manufacturing.

Assessment of the Shaping Ability of R-Motion 30 .04 and 25 .06 in Mesial Canals of Mandibular Molars Based on Automated Computational Measurement

INTRODUCTION

The aim of this study was to evaluate changes in geometry following root canal preparation using R-Motion instruments with different apical sizes and tapers.

METHODS

Fifty-four mesial canals of mandibular molars with single curvature of angles ranging between 20° and 30° were stratified into 3 groups according to their internal anatomy (R-Motion 25/.06, 30/.04, Reciproc Blue) (n = 18 per group). Micro-computed tomography was used to standardize the samples before instrumentation and, after instrumentation, to assess canal transportation, changes in canal volume and centering ability. Canals were irrigated with 17% EDTA and sodium hypochlorite, and the final rinse included subsonic agitation of these solutions. Measurements were analyzed automatically using the Dragonfly software (Come, Montreal, Canada) and were confirmed by a technician and an endodontist, based on a previously validated methodology. The results were analyzed using the Kruskal-Wallis's and Mann-Whitney's tests. The level of statistical significance was set at 5%.

RESULTS

Significant differences were found in the coronal third for canal transportation, with Reciproc Blue R25 having greater values compared with both R-Motion instruments (P < .05) and greater changes in volume when compared with R-Motion 30/.04 (P < .05).

CONCLUSIONS

R-Motion of apical size and taper 25/.06 and 30/.04 were associated with similar changes in geometry following root canal preparation in curved mesial canals of mandibular molars, whereas Reciproc Blue was associated with greater canal transportation in the coronal root third.

Comparison of cyclic fatigue resistance of four pediatric rotary file systems at body temperature: an in vitro study

BACKGROUND

The aim of this study was to compare the cyclic fatigue resistance (CFR) of the newly developed pediatric nickel-titanium (NiTi) rotary file systems for root canal preparation of primary teeth.

METHODS

Eighty pediatric NiTi rotary file systems files were used in this study, including 20 EasyInSmile X-Baby (25/0.04), 20 Scope miniScope (25/0.04), 20 EndoArt Pedo Gold (25/0.04), and 20 EndoArt Pedo Blue (25/0.04) files. Static CFR tests; performed on a custom-made stainless steel block with an inner diameter of 1.5 mm, an angle of curvature of 60° and a curved artificial canal with a radius of curvature of 5 mm. The test system was filled with distilled water and the temperature was kept constant at 35 ± 1 °C. The files were rotated in the simulated canal until fracture occurred. The number of cycles to failure (NCF) data was recorded, and all the fracture surfaces of the files were evaluated using scanning electron microscopy (SEM). One-way ANOVA and Tukey tests were used for statistical analysis of the data, and the significance level was set at p < 0.05.

RESULTS

EndoArt Pedo Blue showed the highest NCF values (2668.10 ± 755.26), while the miniScope showed the lowest NCF values (453.65 ± 72.51), with a statistically significant difference between all the tested file systems (p < 0.05). There was no statistical difference in terms of fractured fragment lengths among all tested files (p > 0.05).

CONCLUSION

The EndoArt Pedo Blue file system showed the best CFR performance among the four file systems specifically designed for primary teeth.

Comparative Evaluation of the Cyclic Fatigue Resistance of WaveOne Gold in Reciprocation, ProGlider in Rotary Motion, and Manual Files in a Reciprocating Handpiece Within Simulated Curved Canals: An In Vitro Study

Aim This study compares the cyclic fatigue resistance of glide path files versus manual files used with a reciprocating handpiece in simulated curved canals, specifically evaluating WaveOne Gold Glider, ProGlider, stainless steel (S.S.) K files, nickel-titanium (NiTi) K files, and Flexo K files. Materials and methods Seventy-five instruments were divided into five groups of 15. Simulated canals with a 45° angle and a 5 mm radius of curvature were created using laser micromachining on S.S. blocks. A reciprocating endodontic handpiece (TEP-ER10, NSK, Japan) was used for the manual files and an X-Smart Plus endo motor for the rotary files. The time to fracture was recorded via videography. Statistical analysis was performed using analysis of variance (ANOVA) and post-hoc Tukey tests. Results Flexo files exhibited the highest mean cyclic fatigue resistance (1690.33 ± 456.97 seconds), followed by WaveOne Gold Glider (872.13 ± 210.08 seconds), NiTi K files (760.73 ± 163.86 seconds), S.S. K files (707.60 ± 257.98 seconds), and ProGlider (371.00 ± 66.02 seconds). Fragment length differences were statistically insignificant among the groups. ANOVA showed significant differences in cyclic fatigue resistance but not in fragment length. Conclusion Flexo files showed superior cyclic fatigue resistance, making them ideal for glide path formation. NiTi and S.S. K files with a reciprocating handpiece performed similarly to WaveOne Gold Glider, providing a cost-effective alternative to rotary systems, especially in resource-limited areas. ProGlider had the lowest resistance, highlighting the advantage of reciprocating motion in enhancing durability.

A SEM/EDS evaluation of debris removal of used rotary Ni-Ti endodontic files by four different cleaning solutions

Purpose

The aim of this study was to compare the efficacies levels of four cleaning solutions for removing debris from rotary Nickel-Titanium (Ni-Ti) endodontic instruments.

Materials and methods

Twelve instruments that fractured during ex vivo instrumentation were used. Fractured surfaces were investigated by SEM before and after 3, 6 and 9 min of ultrasonic cleaning in 17 % EDTA.3NaOH (Group A), 2.5 % NaOCl (Group B), Dentasept 3H Rapide (Group C) and ZymeX™ (Group D) solutions. EDS analyses of selected files from all four groups of untreated and ultrasonically cleaned samples were performed to assess the elemental composition of the alloy surfaces.

Results

SEM analysis revealed that after 9 min of ultrasonic agitation, all four investigated solutions had cleaned fractured surfaces. However, some low-atomic-number regions exhibited random distributions on the fractured surfaces. EDS analyses indicated that only C was retained on surface after 9 min of ultrasonic cleaning. This finding was common in all tested groups.

Conclusions

All four investigated solutions substantially removed debris from the surfaces of the Ni-Ti files and were considered appropriate for clinical practice.

Fracture Incidence of New Reciprocating Nickel-Titanium (NiTi) Files: A Cross-Sectional Retrospective Study

Aim This study aimed to evaluate the frequency of fractures in a new single-file reciprocating system used by endodontists. Methods Reciprocal systems were used to evaluate endodontist-treated patients' periapical radiographs and dental records. For the study, the kind of tooth, the quantity of root canals completed, the quantity of broken instruments, and the fragment's size were all recorded. A fracture risk calculation was made for every kind of tooth, root canal, and root third. The new reciprocating systems' fracture incidence was compared at a 5% significant level using the chi-squared test varied between 2 and 6 mm. Results There were a total of 5,066 root canals (2,128 teeth) from 1,818 patients. In single-file reciprocating systems, the incidence of fractured files relative to the number of instrumented canals was 22 (0.43%). The mesiobuccal root canal of mandibular molars and maxillary molars had the greatest breakage rates, which were 7 (36%) and 6 (27%), respectively. Conclusion The incidence of instrument fractures was lowered when linked to the usage of the Premium Blue reciprocating system in endodontic therapy.

Comparative Evaluation of Surface Roughness of Different Rotary Nickel-Titanium (NiTi) Files After Autoclaving: An Atomic Force Microscopic Study

Introduction Canal preparation is a critical step in endodontic therapy. Introducing nickel-titanium (NiTi) rotary instruments has significantly reduced the likelihood of errors in curved canals. However, due to their price, these instruments are often reused following autoclaving. The aim of this study is to compare and evaluate the surface characteristics of two designs of rotary NiTi files used in curved canals and subjected to multiple autoclaving cycles, utilizing an atomic force microscope for detailed analysis. Methods A total sample size of 24 files was taken, 12 files of Hyflex EDM (Coltene/Whaledent, Germany) files and WaveOne Gold (Dentsply Sirona, USA) files were then divided into four groups (n=6) as follows: Group I: Hyflex EDM control group; Group II: WaveOne Gold control group; Group III: Hyflex EDM experimental group; Group IV: WaveOne Gold experimental group. Sterilization using an autoclave was performed thrice for Groups I and II files. The files in Groups III and IV were used in simulated curved canals three times and autoclaved after each use. Atomic force microscopy was used to assess the surface roughness of the files after the first and third autoclave cycles. Results The results showed that, without statistical significance, Hyflex EDM exhibited the highest surface roughness after the first usage among the two file systems. Conclusion It can be concluded that both Hyflex EDM and WaveOne Gold files produced similar levels of surface changes when subjected to multiple usage and autoclaving cycles.

Influence of sealer and supplementary approach on filling material removal during endodontic retreatment

Both root canal sealer-based and supplementary protocols may influence removal of filling material during endodontic retreatment. Mesial root canals of extracted mandibular molars were prepared using HyFlex EDM 25/.08, and filled with a calcium silicate sealer (Bio-C Sealer), or an epoxy resin (AH Plus), using the single cone technique (n = 12). Retreatment was performed using ProDesign Logic (PDL) RT and PDL 35/.05. The specimens were randomly divided into two experimental groups (n = 12), and the sealers were distributed similarly. A supplementary protocol was performed with PDL 50/.01 or XP-endo Finisher. Root canal transportation and volume, in addition to the remaining filling material percentage were evaluated using high-resolution (5 µm voxel size) micro-CT. Statistical analysis was performed using t-tests (α = 0.05). Root canals filled with AH Plus presented high residual filling material (p < 0.05). Both protocols decreased residual volume of filling material in the apical third (p < 0.05). PDL 50/.01 increased the apical root canal volume (p < 0.05). No difference was observed between the systems regarding canal transportation (p > 0.05). In conclusion, AH Plus is more difficult to remove from the apical third than Bio-C Sealer. PDL 50/.01 and XP-endo Finisher enabled greater removal of filling materials in the apical third, in the retreatment of curved root canals, without promoting apical transport.

Shaping Efficiency of Rotary and Reciprocating Kinematics of Engine-driven Nickel-Titanium Instruments in Moderate and Severely curved Root Canals Using Microcomputed Tomography: A Systematic Review of Ex Vivo Studies

INTRODUCTION

This systematic review aimed to compare reciprocating with continuous rotary instrumentation kinematics, by means of microcomputed tomography evaluations, in extracted human permanent teeth with moderate and severe canal curvatures.

METHODS

The research protocol was registered in the International Prospective Register of Systematic Reviews and given the reference number CRD42023404035. An electronic search was undertaken in MEDLINE (PubMed), EBSCO, Scopus, Web of Science databases until December 2021. Manual screening of issues in endodontic journals and references of relevant articles were assessed individually. The risk of bias (RoB) of the included articles was evaluated with the QUIN tool (Quality Assessment Tool for In Vitro Studies).

RESULTS

Among 1640 retrieved articles, 49 were included in the qualitative synthesis. Fifteen articles had low RoB, 33 articles had medium RoB, and only 1 study was at high RoB. Continuous rotary systems had better centering ability in both moderate and severe canal curvatures and resulted in less apical transportation in severely curved root canals. None of the kinematic systems was capable of instrumenting the entire canal surface area. Reciprocating kinematics systems tended to provide higher increase in surface area of severely curved canals and produced fewer dentinal microcracks in moderately curved canals.

CONCLUSIONS

The evidence presented in this review suggests that continuous rotary system seems to be better than reciprocating system in solving the major issues encountered during root canal instrumentation of extracted teeth with moderate and severe curvatures.

Effect of different instrumentation techniques on students' performance and outcomes of nonsurgical root canal treatment

OBJECTIVES

This study compared, retrospectively, the incidence of clinical errors and effects on treatment outcomes, when students were exposed to two different instrumentation techniques: a hybrid rotary technique (HYB), consisting of both hand instrumentation with hand stainless steel and Ni-Ti files plus the use of a rotary system (Vortex Blue, Dentsply Sirona), versus a full reciprocation instrumentation technique (WaveOne Gold [WOG], Dentsply Sirona).

METHODS

A total of 368 endodontic cases (n = 184) in anterior and premolar teeth, completed by dental students at the University of Michigan School of Dentistry from 2013 to 2022, were used for the study. The groups were evaluated by two calibrated clinicians, observing the incidence of clinical errors: file separations, over-instrumentation, ledges and transportations. Treatment outcomes were also observed. Data were analyzed statistically by Fisher's exact test and Mann-Whitney U test (p < 0.05).

RESULTS

No significant difference in file separations, ledges, and transportation was observed between the two groups. However, the WOG Group experienced significantly more over-instrumentation than HYB group, although this did not significantly affect tooth survival or periapical index (PAI). Cases with PAI scores of 5 were found to have significantly less tooth survival compared to the other PAI scores.

CONCLUSIONS

It can be concluded that both techniques in our study are well suited to advancing the endodontic dental education of students and novice operators, anticipating relatively successful outcomes of tooth survival, as long as the cases selected are less severe in progression preoperatively.

An in vitro comparative evaluation of cyclic fatigue resistance of two rotary and two reciprocating file systems

Context

Root canal instrumentation is one of the important procedures for successful endodontic therapy. Unexpected fracture of files occurs during root canal instrumentation without any visible signs of deformation compromising the success of root canal treatment.

Aims

The aim of the study was to evaluate and compare cyclic fatigue resistance (CFR) of rotary and reciprocating files in simulated canals with 45°, 60°, and 90° angle of curvature.

Settings and Design

The study design was an In vitro study.

Subjects and Methods

Sixty nickel-titanium files, 30 each of rotary and reciprocating files were selected and divided into four groups (n = 15) of Neoendo Flex, ProTaper Next, WaveOne Gold (WOG), and Reciproc Blue (RPB) files. Each group was further subdivided into three subgroups containing five samples each based on their use in simulated canals with 45°, 60°, and 90° angle of curvature. To simulate root canals with 45°, 60°, and 90° angle of curvature, three artificial canals were designed in a stainless steel metal block. Each file was autoclaved, immersed in 3% sodium hypochlorite (NaOCl), and coated with 17% ethylenediaminetetraacetic acid (EDTA). Each file was tested for CFR using a torque-controlled reduction handpiece by instrumenting in a simulated canal for 10 s until fracture. The cycle of autoclaving, exposure to NaOCl, EDTA, and testing of CFR for 10 s per canal as per groups and subgroups was repeated again and again until the respective file fracture. The time taken to file fracture was recorded using a digital chronometer. The time taken for each file fracture (in minutes) was multiplied by the number of rotations per minute to attain the number of cycles to failure (NCF).

Statistical Analysis Used

The obtained results were subjected to statistical analysis using one-way analysis of variance and independent t-test.

Results

One-way ANOVA test showed a statistically significant difference between the four groups, P < 0.001. Independent "t"-test between individual subgroups showed a statistically significant difference, as P < 0.05.

Conclusions

WOG and RPB reciprocating file systems showed superior CFR, more especially in canals with abrupt 90° angle of curvature compared to both rotary file systems tested. Among rotary file systems tested, Neoendo Flex showed greater CFR than ProTaper Next.

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.

The extended finite element method in endodontics: A scoping review and future directions for cyclic fatigue testing of nickel-titanium instruments

OBJECTIVES

The present study reviews the current literature regarding the utilization of the extended finite element method (XFEM) in clinical and experimental endodontic studies and the suitability of XFEM in the assessment of cyclic fatigue in rotary endodontic nickel-titanium (NiTi) instruments.

MATERIAL AND METHODS

An electronic literature search was conducted using the appropriate search terms, and the titles and abstracts were screened for relevance. The search yielded 13 hits after duplicates were removed, and four studies met the inclusion criteria for review.

RESULTS

No studies to date have utilized XFEM to study cyclic fatigue or crack propagation in rotary endodontic NiTi instruments. Challenges such as modelling material inputs and fatigue criteria could explain the lack of utilization of XFEM in the analysis of mechanical behavior in NiTi instruments.

CONCLUSIONS

The review showed that XFEM was seldom employed in endodontic literature. Recent work suggests potential promise in using XFEM for modelling NiTi structures.

Effect of preset torque setting on torque/force generation, shaping ability and surface changes of nickel titanium rotary instrument in different root canal curvature locations: An ex vivo study

The aim of this study was to evaluate how preset torque settings influence the torque, vertical force, and root canal-centering ability of ProGlider and ProTaper NEXT nickel-titanium rotary instruments in canals with different curvature locations. Based on micro-computed tomography, mesial roots of human mandibular molars (25°-40° curvature) were allocated to the apical curvature (apical 1-5 mm) or the middle curvature (apical 5-9 mm) groups, and mandibular incisors (curvature <5°) to the straight canal group. Each group was subjected to automated instrumentation and torque/force measurement with the preset torque of 1, 2.5, or 5 N•cm. Canal-centering ratios were determined with micro-computed tomography. Instrument fracture occurred only in the 2.5 and 5 N•cm groups in curved canals. The preset torque setting and curvature location did not influence canal shaping ability.

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.

Evaluation of cyclic fatigue behavior of RACE EVO rotary Files: In-vitro comparative study

Introduction

Comparative evaluation of the newly introduced; RACE EVO file system to the currently well-performing file systems like HyFlex EDM OneFile, Vortex Blue, ProTaper Gold (PTG) with regards to the cyclic fatigue resistance.

Materials

&Methods.The endodontic rotary files under evaluation were segregated into four groups as follows:; RACE EVO, PTG, Vortex Blue, and HyFlex EDM OneFile. A detailed physical analysis of the cyclic fatigue resistance was performed in 15 files of each type (n = 60). Under the test conditions of 37 °C the test samples were subjected to continuous motion at the manufacturer recommended speed within an artificial curved canal until it fractured. For all the test samples, with the recording of time of fracture, calculation was done for number of cycles to fracture (NCF). In addition, the length of the fractured segment was determined. The fractured surface was further evaluated with scanning electron microscopic (SEM) images.

Results

Highest significance for NCF was seen in HyFlex EDM OneFile followed by the Vortex Blue, PTG, and; RACE EVO (p < 0.05) by analyzing the data statistically. Significant differences among the lengths of the fractured segments were evident among tested files, ranging between 4.73 and 6.3 mm (p < 0.05) with HyFlex EDM OneFile uniquely differentiating from the others showing the fracture at 6.3 mm. The common features of cyclic fatigue failure was further substantiated by SEM images.

Conclusions

Compared to the HyFlex EDM OneFile, Vortex Blue, and PTG files; RACE EVO demonstrated significantly lower resistance to cyclic fatigue.

Comparative evaluation of cyclic fatigue resistance of thermomechanically treated NiTi rotary instruments in simulated curved canals with two different radii of curvature: An in vitro Study

Background

This study aimed to compare the effect of heat treatment on the cyclic fatigue resistance of three different nickel-titanium rotary file systems: TruNatomy, HyFlex CM, and NeoEndo flex in simulated curved canals at two different radii of curvatures.

Materials and Methods

A total of 60 NiTi rotary files of three types were used, and the samples were divided into three groups TruNatomy, HyFlex CM, and NeoEndo flex. All the instruments were subjected to cyclic fatigue testing using a stainless steel custom-made canal model with a 60° angle of curvature and two radii of curvature 5 mm and 3 mm; the number of cycles to fracture and length of the fractured segment was measured. The separated instruments were subjected to fractographic analysis under scanning electron microscope.

Results

The number of cycles to failure to fracture a file at a 3 mm radius of curvature is significantly less as compared to a 5 mm radius of curvature (HCM > TRN > NE).

Conclusion

Within the limitation of the present study, there was a positive correlation between the radius of curvature and fatigue life of NiTi files.

Assessment of the Cyclic Fatigue Performance of the Novel Protaper Ultimate File System Used in Different Kinematics: An In Vitro Study

This in vitro study aims to assess the cyclic fatigue resistance of the Protaper Ultimate (PTU) files compared to the Protaper Gold (PTG) and the M3 UDG (M3) files using various motion kinematics in simulated canals. As far as the authors are aware, no study has previously compared the three file systems before this current investigation. Therefore, closing this information gap is the goal of the current research. Methods: A total of (60 new endodontic files were randomly divided into 6 groups (10 files per group); groups 1, 3, and 5 used continuous rotation (CR), while groups 2, 4, and 6 used forward reciprocating motion (FRM). A manufactured stainless-steel artificial canal was used to perform the cyclic fatigue testing. The results were analyzed using Student's t-test and two-way ANOVA. All pairwise comparisons revealed statistically significant differences in the time to failure (TTF) for every study group (p < 0.001), with the exception of the PTG and M3 files, which performed similarly using both CR and FRM. Conclusions: The PTU files performed better than the PTG and M3 files in terms of the TTF and number of cycles to failure (NCF) using both CR and FRM.

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 of Different Reciprocating Endodontic Instruments Using Matching Artificial Root Canals at Body Temperature In Vitro

Reciprocating motion expands the lifetime of endodontic instruments during the preparation of severely curved root canals. This study aimed to investigate the time to fracture (TTF) and number of cycles to failure (NCF) of different reciprocating instruments (n = 20 in each group) at body temperature using a dynamic testing model (amplitude = 3 mm). Reciproc Blue (RPB), size 25/.08, WaveOne Gold (WOG) 25/.07, Procodile (Proc) 25/.06, R-Motion (RM_06) 25/.06 and R-Motion (RM_04) 30/.04 instruments were tested in their specific reciprocating motion in artificial matching root canals (size of the instrument ± 0.02 mm; angle of curvature 60°, radius 5.0 mm, and centre of curvature 5.0 mm from apical endpoint). The number of fractured instruments, TTF, NCF, the and lengths of the fractured instruments were recorded and statistically analysed using the Chi-Square or Kruskal-Wallis test. Both TTF (median 720, 643, 562, 406, 254 s) and the NCF (3600, 3215, 2810, 2032, 1482 cycles) decreased in the following order RM_06 > RPB > RM_04 > Proc > WOG with partially significant differences. During testing, only six RM_06 instruments fractured, whereas 16/20 (RPB), 18/20 (Proc), and 20/20 (RM_04, WOG) fractures were recorded (p < 0.05). Within the limitations of the present study, blue-coloured RPB and RM instruments exhibited a significantly superior cyclic fatigue resistance compared to SE-NiTi and Gold-wire instruments. Heat treatment, cross-sectional design and core mass significantly influenced the longevity of reciprocating instruments in cyclic dynamic testing.

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.

Comparing Cyclic Fatigue Resistance and Free Recovery Transformation Temperature of NiTi Endodontic Single-File Systems Using a Novel Testing Setup

The aim of this study was to assess the effect of body temperature (37 °C) on the cyclic fatigue resistance of three endodontic single-file systems using a new testing setup. One Shape® new generation (OS), WaveOne™ (WO) and WaveOne® GOLD (WOG), which are made from different NiTi alloys and operated in different motions (rotation/reciprocation), were evaluated. The study design included four groups. Each group comprised 30 files, 10 files of each of the three file systems, tested at 20 ± 2 °C (group 1 and 3) and at 37 ± 1 °C (group 2 and 4). All files were tested in a custom-made metal block with artificial canals of 60° angle, and a 5 mm and 3 mm radius of curvature, respectively. A heating element was attached to replicate a temperature of 37 °C. Files were introduced 18 mm into the canals and operated until failure. Transformation temperatures of five samples of each of the tested file systems were determined via the bend and free recovery (BFR) method. With the exception of WOG in canals with a 3 mm radius of curvature (p = 0.075), all the tested file systems showed statistically significantly less time needed to fracture when operated at 37 ± 1 °C compared to at 20 ± 2 °C in canals with a 5 mm and 3 mm radius of curvature using Mann-Whitney U test (p < 0.05). All file systems showed transformation temperatures below the body temperature. We concluded that body temperature directly affects the cyclic fatigue resistance of all tested file systems. Bend and free recovery can be suitable for the determination of austenite finish temperatures (Af) of endodontic instruments as it allows testing a longer portion of the instrument.

Using manual versus mechanized glide path instruments and ProTaper Gold versus ProTaper Next systems in curved canals: micro-CT study

The aim of this study was to evaluate the root canal shaping effect of ProTaper Gold (PTG) versus ProTaper Next (PTN) instrumentation systems, and of a manual #15 K-type file (K15) versus the ProGlider (PG) mechanized instrument for glide path creation, in severely curved mesial canals. Twenty-four mandibular molars with two separate mesial canals were anatomically matched using computed tomographic scanning, and then divided into two groups (n=12) according to the glide path instrument used, either K15 or PG. In all teeth, the PTG system was used to prepare the mesiobuccal canal, and the PTN, the mesiolingual canal. The teeth were scanned by computed microtomography, before and after root canal preparation, and the values of the initial volume, final volume, volumetric variation, untouched walls, and canal transportation variables were determined. The data were analyzed using the two-way ANOVA test, and the Tukey test for multiple comparisons. There was no significant difference among the study groups regarding volumetric variation or root canal transportation, either in the cervical, middle or apical thirds, or in the entire root canal (p>0.05). In the apical third, the percentage of untouched walls was significantly higher in groups using K15 than in those using PG (p<0.05), namely 33.144% and 23.285%, respectively, irrespective of the instrumentation system. In the other regions, there was no difference between K15 and PG regarding this variable. It was concluded that PG was associated with a lower rate of untouched walls in the apical region than K15.

Assessing the cyclic fatigue resistance and sterilization effects on replica-like endodontic instruments compared to Reciproc Blue

This study aimed to evaluate the effect of the number of uses and autoclave sterilization on the cyclic fatigue resistance of four replica-like instruments RC Blue; Only One File Blue; Recip One Blue; and Micro Blue compared to the original system Reciproc Blue (VDW, Munich, Germany). The instruments were analyzed by scanning electron microscope (SEM) before being used in root canal instrumentation (baseline). Fifty molars were instrumented by ten instruments (n=10). After sterilization in an autoclave, the  instruments were analyzed by SEM. This procedure was repeated twice more using different molars, totaling 3 rounds of instrumentation, sterilization and SEM analysis. Then, ten different instruments from each brand were tested for cyclic fatigue resistance. Number of uses data were analyzed using Chi-squared analysis, and cyclic fatigue data were analyzed by one-way Anova followed by Tukey's test as the data had normal distribution. The fracture times for all systems had no significant difference, but Micro Blue had significantly lower values than the other systems (p < 0.05). The SEM analysis showed distortions in the instruments after the 3rd use. Therefore, all tested instruments except of Micro Blue have similar resistance to cyclic fatigue, and all are reliable for use in up to 2-cases.

Assessing the cyclic fatigue resistance and sterilization effects on replica-like endodontic instruments compared to Reciproc Blue

This study aimed to evaluate the effect of the number of uses and autoclave sterilization on the cyclic fatigue resistance of four replica-like instruments RC Blue; Only One File Blue; Recip One Blue; and Micro Blue compared to the original system Reciproc Blue (VDW, Munich, Germany). The instruments were analyzed by scanning electron microscope (SEM) before being used in root canal instrumentation (baseline). Fifty molars were instrumented by ten instruments (n=10). After sterilization in an autoclave, the  instruments were analyzed by SEM. This procedure was repeated twice more using different molars, totaling 3 rounds of instrumentation, sterilization and SEM analysis. Then, ten different instruments from each brand were tested for cyclic fatigue resistance. Number of uses data were analyzed using Chi-squared analysis, and cyclic fatigue data were analyzed by one-way Anova followed by Tukey’s test as the data had normal distribution. The fracture times for all systems had no significant difference, but Micro Blue had significantly lower values than the other systems (p < 0.05). The SEM analysis showed distortions in the instruments after the 3rd use. Therefore, all tested instruments except of Micro Blue have similar resistance to cyclic fatigue, and all are reliable for use in up to 2-cases.

Comparison of Curvature Severity Between Sagittal and Coronal Planes of Mesiobuccal Canals in Permanent Maxillary First Molars Using Multiple Complexity-risk Criteria: A CBCT Cross-sectional Study of a Brazilian Subpopulation

INTRODUCTION

This study aimed to compare the curvature severity of mesio-buccal (MB) canals between sagittal and coronal planes using cone-beam computed tomography.

METHODS

In a Brazilian subpopulation, untreated MB1 (n = 141) and MB2 (n = 72) with single curvatures in sagittal and coronal planes were measured to determine their angle and radius (r), plus the prevalence of S-shaped canals was recorded. Curvature severity was defined according to the American Association of Endodontists Case Difficulty Assessment form (AAE) and EndoApp (EA), as well as their modified versions that consider angle and radii (AAE-r, EA-r). Data were converted into mean angle and r, percentage of canals >30°, AAE, EA, AAE-r and EA-r categories. The influence of r on case severity was assessed. Statistical analysis was performed using t-tests and chi-squared tests. The level of significance was set as P ≤ .05.

RESULTS

For single curvatures, significantly higher mean degrees (SD) angles were found in the sagittal views in both canals (MB1 sagittal: 35 [11]; MB1 coronal: 13 [13]; MB2 sagittal: 29 [14]; MB2 coronal: 22 [15] [P < .05]). A greater percentage of angles >30° (MB1: 56.7% vs 6.4%; MB2: 44.4% vs 22.2%) in sagittal planes compared to coronal planes was also found. Conversely, a higher prevalence of S-shaped canals (MB1: 33.3% vs 7.1% MB2: 31.9% vs 15.3%) was observed in coronal planes. Significant differences between AAE and AAE-r were present with greater case severity when radii were considered (P < .05).

CONCLUSIONS

Sagittal planes were associated with more severe single curvatures, while coronal planes had a greater prevalence of S-shaped canals.

Effect of Temperatures on Cyclic Fatigue Resistance of 3 Different Ni-Ti Alloy Files

OBJECTIVE

The aim of this study was to investigate and compare the effect of temperature on the cyclic fatigue resistance of conventional (ProTaper Universal [PTU]), Gold-Wire (ProTaper Gold [PTG]), and Fire-Wire (EdgeTaper Platinum [ETP]) nickel-titanium alloy files.

METHOD

Twenty files from each system were tested for cyclic fatigue resistance in an artificial canal model. The experiments were performed at room temperature and body temperature in controlled temperature water. Magnified videos were recorded using a dental operating microscope integrated camera during testing to detect file fracture. The number of cycles to failure (NCF) was calculated. The type of failure was investigated macroscopically and microscopically with a dental operating microscope and scanning electron microscope, respectively.

RESULT

The NCF at room temperature was significantly higher compared with body temperature in each system (P < .001). Compared at the same temperature, the ETP group demonstrated the highest NCF, followed by the PTG and PTU groups (P < .001). All files demonstrated cyclic fatigue failure macroscopically and microscopically.

CONCLUSIONS

The 3 alloy files were affected by temperature. The cyclic fatigue resistance was reduced at the higher temperature and increased at the lower temperature. If the files are geometrically identical, files made of Fire-Wire are preferred compared with Gold-Wire and conventional nickel-titanium alloys based on cyclic fatigue resistance.

Influence of endodontic motors on the behaviour of root canal shaping instruments: an in vitro comparative study

AIMS

The endodontic literature reports a lot of comparative study on endodontic instruments, concerning as well their geometry, instrumental dynamics, material, mechanical behavior or heat treatment. However, to our knowledge, no study has focused on the influence of endodontic motors on the shaping abilities of endodontic instruments. Thus, the aim of this study was to analyze the influence of the endodontic motors on root canal shaping instruments.

METHOD

Dual Move (MICRO-MEGA, Besançon, France), Canal Pro CL2i (COLTENE, Alstätten, Suisse), Canal Pro Jeni Motor (COLTENE, Alstätten, Suisse), Ai Motor (WOODPECKER, Guilin, China), Wave One motor (VDW, Postfach, Munich) and Smart A (WOODPECKER, Guilin, China) were pre-clinically compared in continuous rotation and reciprocating motion on a traction/compression bench using resin blocks. Canal shaping in continuous rotation and reciprocating motion were performed with One Curve and One RECI instruments (MICRO-MEGA, Besançon, France), respectively. The penetration/removal forces, making it possible to objectify the cutting effect and screwing effect of the instruments during root canal shaping, were analyzed.

RESULTS

The results showed (i) that endodontic motors influence the mechanical behavior of endodontic instruments, (ii) that the influence of the motors is essentially felt during reciprocating motion and (iii) that the reciprocating angles influence the mechanical behavior of endodontic instruments.

CONCLUSION

Only endodontic instruments are widely studied in literature while endodontic motors have a direct influence on root canal treatment. This study analyzes the influence of the endodontic motors on root canal shaping instruments. This study tends to demonstrate that Jeni Motor could optimize the mechanical behavior of endodontic instruments.

Evaluation of cyclic fatigue and bending test for different Nickle-Titanium files

AIM

To compare cyclic fatigue resistance and bending for three different nickel-titanium (NiTi) rotary files.

MATERIALS AND METHODS

A sample of 90 NiTi instruments size (25.06) was divided into three groups with 30 files in each: Race Evo files (FKG Dentaire, Switzerland); Tia Tornado Blue files (TiaDent Inc., Texas- USA); One Curve files (Micro-Mega, France). Then each group was subdivided into two groups with 15 files in each; a bending test was performed for one group, and a dynamic cyclic fatigue test at body temperature was performed for the other group. Files fractured by cyclic fatigue were randomly picked from all tested groups for Scanning Electron Microscopy (SEM) (Jeol, Tokyo, Japan). In addition, the test included measuring the broken part of the files tested using (Electronic Micrometre Calliper with LCD Screen, Inch and Millimetre Conversion, Adoric- Taiwan). Data were statistically analyzed using a one-way ANOVA with Tukey-HSD post hoc test.

RESULTS

It was found that maximum load [gf] was less (meaning more flexible) in the group of Tia Tornado Blue with a statistically significant difference in comparison with Race Evo and One Curve. The number of cycles to fracture (NCF) in the Race Evo group was significantly higher than the groups of One Curve and Tia Tornado Blue.

CONCLUSIONS

Within the limitation of the study, it could be concluded that Race Evo files were more resistant to cyclic fatigue fracture and Tia Tornado Blue files were more flexible compared to the other tested files.

Removal of separated instruments from unfavourable locations: Case reports using the HBW ultrasonic ring or a surgical approach

Two patients were admitted to the dental clinic to evaluate two right mandibular first molars (both FDI no. 46). In Case 1, there was an accidental instrument separation, which was thought to have been bypassed; however, the instrument was located beyond the apical foramen, in the alveolar bone. The 1-week follow-up revealed that the fragment was close to the inferior alveolar nerve, thus allowing surgical removal to be performed. In Case 2, two separated instruments located in the apical third of the mesiobuccal and mesiolingual canals were removed using the HBW ultrasonic ring coupled to ISO 10 and 15 hand instruments. The 3-month and 1-year follow-ups (Case 1), and the 2-year and 3-year follow-ups (Case 2) showed a favourable evolution in both cases. It can be concluded that both the surgical approach and the HBW ultrasonic ring are viable options for the removal of separated instruments in unfavourable locations.

Effect of Additional Apical Preparation on Retreatment of Curved Root Canals Filled with Different Sealers

OBJECTIVE

 This study assessed the influence of additional apical preparation on material removal during retreatment of curved root canals filled with different sealers.

MATERIALS AND METHODS

 Twelve mesial roots of mandibular molars with two separate canals and curvature between 25 and 35 degrees were selected. The working length was established 1-mm short of the apical foramen, and all the root canals were prepared using ProDesign R (PDR) 25/0.06. After preparation, the root canals were divided in two groups (n = 12) and filled by continuous wave condensation technique with NeoMTA Plus or AH Plus. All the root canals were retreated using rotary ProDesign Logic RT 25/0.08, reciprocating PDR 25/0.06 and apical preparation with PDR 35/0.05. Additional apical preparation was performed with ProDesign Logic (PDL) 50/0.01. The samples were scanned using a Skycan 1176 micro-computed tomography (micro-CT), voxel size 8.74 µm, before and after the retreatment procedures. Percentages of remaining filling material were evaluated.

STATISTICAL ANALYSIS

 The data were submitted to paired and unpaired t-tests (α = 0.05).

RESULTS

 Percentage of remaining filling material was similar between the root canals filled with NeoMTA Plus or AH Plus sealer after retreatment using PDR 35/0.05, and after additional apical preparation using PDL 50/0.01 (p > 0.05). However, PDL 50/0.01 significantly decreased the percentage of remaining filling material in the apical third after the additional apical preparation for both sealers (p < 0.05).

CONCLUSION

 NeoMTA Plus or AH Plus did not influence the retreatment of curved root canals. ProDesign Logic 50/0.01 promoted greater filling material removal in the apical third.

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.

Cyclic Fatigue Resistance of Different Glide Path Files in Simulated Double Curved Canal in Continuous Rotary Motion: An In Vitro Study

AIM

This in vitro study aimed to compare and evaluate the resistance to cyclic fatigue of a newly developed glide path file in a simulated double curvature canal in a cyclic fatigue-testing machine.

METHODS

In this in vitro study, a static cyclic fatigue-testing machine with a simulated double curve was created and the samples were divided into the following three groups: Group I-HyFlex EDM; group II-TruNatomy file; and group III-Aurum G files and each instrument is continued to rotate in the canal and a number of cycles to failure (NCF) was calculated and Fractographic analysis was done using scanning electron microscope (SEM), and the results were statistically analyzed.

RESULTS

Statistical analysis was done using parametric methods one-way analysis of variance (ANOVA) shows statistical significance between groups and then Tukey's HSD post hoc tests were used for multiple pairwise comparisons. TruNatomy glide path files had the highest cyclic fatigue resistance when compared to HyFlex EDM and Aurum G files.

CONCLUSION

The selection of file systems in cleaning and shaping protocols is an enigma to endodontics. From the results of this study, it can be concluded that TruNatomy files had higher cyclic fatigue resistance than other glide path files are canals with double curvature, hence it is suitable for usage in root canals with extreme curvature.

CLINICAL SIGNIFICANCE

The selection of file systems in cleaning and shaping protocols is an enigma to endodontics. This in vitro study explored the selection protocols for the execution of root canal preparation. Heat treatment of nickel-titanium (NiTi) endodontic files had improved the cyclic fatigue resistance significantly enhancing the clinical life of file systems.

Comparative evaluation of canal transportation and canal centering ability in oval canals with newer nickel-titanium rotary single file systems - A cone-beam computed tomography study

Context

The purpose of this study was to evaluate and compare the centering ability and canal transportation of TruNatomy, OneCurve, and Jizai file systems to assess their performance in oval-shaped canals using cone-beam computed tomography imaging.

Materials and Methods

Forty-two fully formed single-rooted mandibular premolars were selected with a buccolingual canal size 2-2.5 times the mesiodistal size at 5 mm from the apex, with 0°-10° canal curvature with a 5-6 mm radius, at 5 mm from the apex. The teeth were divided into three groups (n = 14) and prepared with TruNatomy, OneCurve, and Jizai files based on the manufacturer's instructions. Cone-beam computed tomographic images were taken before and after instrumentation. The canal transportation and centering ability was calculated at 3, 6, and 9 mm from the apex in both mesiodistal and buccolingual directions.

Statistical Analysis

Intergroup comparison was done using Kolmogorov-Smirnov test. Intragroup comparison was done using Freidman test. A comparison of categorical variables was done using the Chi-square test.

Results

The results obtained did not present any statistically significant difference between the three groups, with TruNatomy and OneCurve showing relatively lesser canal transportation and better centering ratio when compared to the Jizai file system.

Conclusions

It can, therefore, be concluded that all three systems used in the study are capable of safely preparing root canals with minimal errors.

Advancing Nitinol: From heat treatment to surface functionalization for nickel–titanium (NiTi) instruments in endodontics

Nickel-titanium (NiTi) alloy has been extensively researched in endodontics, particularly in cleaning and shaping the root canal system. Research advances have primarily focused on the design, shape, and geometry of the NiTi files as well as metallurgy and mechanical properties. So far, extensive investigations have been made surrounding surface and thermomechanical treatments, however, limited work has been done in the realm of surface functionalization to augment its performance in endodontics. This review summarizes the unique characteristics, current use, and latest developments in thermomechanically treated NiTi endodontic files. It discusses recent improvements in nano-engineering and the possibility of customizing the NiTi file surface for added functionalization. Whilst clinical translation of this technology has yet to be fully realized, future research direction will lie in the use of nanotechnology.

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Nitinol (Nickel Titanium alloy) is widely used to clean/shape root canal system in endodontics.

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To enhance its performance, various thermo-mechanical and nano-engineering modifications have been performed.

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This comprehensive review summarizes the latest advances and future trends relating to functionalized NiTi endodontic files.

The effect of different endodontic access cavity designs in combination with WaveOne Gold and TruNatomy on the fracture resistance of mandibular first molars: A nonlinear finite element analysis

INTRODUCTION

This study evaluated the effect of traditional and conservative endodontic access cavity designs in combination with WaveOne Gold and TruNatomy instrumentation systems on the fracture resistance of mandibular first molars by means of nonlinear finite element analysis (FEA).

METHODS

Micro-CT images of 4 human mandibular first molars were used to generate representative FEA models. The mandibular first molars samples were scanned before and after endodontic access cavity preparation and instrumentation of all 3 canals. Five nonlinear static loads were applied vertically and horizontally to specific contact points on the occlusal surface of the teeth. Maximum von Mises stress before failure and distribution of von Mises strains were recorded and compared between groups.

RESULTS

Molars with conservative endodontic access cavities required similar levels of loads to reach failure compared with their control samples, whereas molars with traditional endodontic access cavities required significantly reduced loads in order to fail. According to the numerical investigation, the type of instrumentation system was found to have an insignificant effect on the fracture resistance of the teeth under study. Von Mises stress was concentrated around the cervical region and in the larger distal roots for all numerical models.

CONCLUSIONS

The fracture resistance of mandibular first molars is influenced significantly by a reduction in dental hard tissue, which was found to control the level of the ultimate failure load for each tooth.