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Moriya PT, de Carvalho KKT, Kishen A, Souza EM, Versiani MA. Dynamic Photoelastic Analysis of Stress Distribution in Simulated Canals Using Rotary Instruments with Varied Tip and Taper Sizes: A Quasi-3D Approach. J Endod 2024; 50:1151-1158. [PMID: 38796056 DOI: 10.1016/j.joen.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 05/28/2024]
Abstract
INTRODUCTION To compare the stress produced on the walls of simulated canals by rotary instruments with varied tip and taper sizes. METHODS Ninety isotropic transparent blocks, each containing a 60-degree curved canal, were distributed into 18 groups (n = 5) based on the instrument tip (sizes 10, 15, 20, 25, 30, and 35) and taper (sizes 0.02, 0.04, and 0.06). The blocks were fixed in a circular polariscope setup for dark field analysis. A digital camera was employed to capture the real-time birefringence patterns generated by each instrument. Digital image frames, corresponding to the instrument reaching the end of each canal third, were extracted and evaluated by 2 independent observers for the stress generation on canal walls. The data analysis employed a semi-quantitative scale ranging from 0 to 5. Cohen's Kappa coefficient test was used to determine the inter-observer agreement while the results were compared using Kruskal-Wallis test followed by an all-pairwise posthoc procedure (α = 5%). RESULTS Inter-observer agreement was 0.95. A significant influence of the tip size on stress was observed across the coronal (P = .011), middle (P = .006), and apical (P = .026) thirds. In contrast, taper size did not affect the stress induced at the coronal (P = .509), middle (P = .958), or apical (P = .493) thirds. The variations in tip and taper sizes did not result in a significant stress differences among the thirds (P = .181). CONCLUSIONS The stress significantly increased across all canal thirds with larger tip sizes of rotary instruments, whereas the taper sizes did not influence the stress when compared to the canal thirds.
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Affiliation(s)
| | | | - Anil Kishen
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Erick M Souza
- Department of Dentistry II, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - Marco A Versiani
- Dental Specialty Center, Brazilian Military Police, Minas Gerais, Brazil.
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2
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Dioguardi M, Dello Russo C, Scarano F, Esperouz F, Ballini A, Sovereto D, Alovisi M, Martella A, Lo Muzio L. Analysis of Endodontic Successes and Failures in the Removal of Fractured Endodontic Instruments during Retreatment: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis. Healthcare (Basel) 2024; 12:1390. [PMID: 39057533 PMCID: PMC11276083 DOI: 10.3390/healthcare12141390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/06/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
This study presents a systematic review with meta-analysis to evaluate the success rates of endodontic retreatments in teeth where separated instruments are located within the roots. The search and selection of studies were conducted across two databases, SCOPUS and PubMed, as well as the Cochrane Library registry, yielding a total of 1620 records. Following the selection process, 11 studies were included in the systematic review. Overall, out of 1133 retreated teeth, there were 172 failures in instrument removal and 55 perforations. The meta-analysis results indicate that failures are more frequent when instruments are located in the apical third, with a failure rate of 21%, compared to an 8.8% failure rate in the middle/coronal third. The anatomy of the root canals, particularly the location of the separated instruments, significantly influences the success rates.
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Affiliation(s)
- Mario Dioguardi
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.D.R.); (F.S.); (F.E.); (A.B.); (D.S.); (L.L.M.)
| | - Corrado Dello Russo
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.D.R.); (F.S.); (F.E.); (A.B.); (D.S.); (L.L.M.)
| | - Filippo Scarano
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.D.R.); (F.S.); (F.E.); (A.B.); (D.S.); (L.L.M.)
| | - Fariba Esperouz
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.D.R.); (F.S.); (F.E.); (A.B.); (D.S.); (L.L.M.)
| | - Andrea Ballini
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.D.R.); (F.S.); (F.E.); (A.B.); (D.S.); (L.L.M.)
| | - Diego Sovereto
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.D.R.); (F.S.); (F.E.); (A.B.); (D.S.); (L.L.M.)
| | - Mario Alovisi
- Department of Surgical Sciences, Dental School, University of Turin, 10127 Turin, Italy;
| | - Angelo Martella
- DataLab, Department of Engineering for Innovation, University of Salento, 73100 Lecce, Italy;
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.D.R.); (F.S.); (F.E.); (A.B.); (D.S.); (L.L.M.)
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Aminsobhani M, Hashemi N, Hamidzadeh F, Sarraf P. Broken Instrument Removal Methods with a Minireview of the Literature. Case Rep Dent 2024; 2024:9665987. [PMID: 38919975 PMCID: PMC11196850 DOI: 10.1155/2024/9665987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 03/24/2024] [Accepted: 05/16/2024] [Indexed: 06/27/2024] Open
Abstract
Instrument fracture in the root canal system is an unpleasant incident that may occur during root canal treatment. Comprehensive cleaning of the root canal system is often impossible in the presence of a broken instrument. Therefore, it is often imperative to remove the broken fragment from the root canal system. To date, various methods have been proposed for the removal of broken instruments from the root canal system. However, no consensus has been reached on a safe technique with a high success rate for broken instrument removal. This case series reports six cases of successful removal of broken instruments using different methods including the ultrasonic, tube-and-glue, tube-and-wire, tube-and-internal shaft, and the forceps techniques and also provides a brief review of the relevant literature.
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Affiliation(s)
- Mohsen Aminsobhani
- Department of EndodonticsSchool of DentistryTehran University of Medical Sciences, Tehran, Iran
- School of DentistryAJA University of Medical Sciences, Tehran, Iran
| | - Nasim Hashemi
- Department of EndodonticsSchool of DentistryTehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hamidzadeh
- Department of EndodonticsSchool of DentistryTehran University of Medical Sciences, Tehran, Iran
| | - Pegah Sarraf
- Department of EndodonticsSchool of DentistryTehran University of Medical Sciences, Tehran, Iran
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Park DM, Seok WH, Yoon JY. Factors Influencing Non-Surgical Root Canal Treatment Outcomes in Mandibular Second Molars: A Retrospective Cone-Beam Computed Tomography Analysis. J Clin Med 2024; 13:2931. [PMID: 38792472 PMCID: PMC11122081 DOI: 10.3390/jcm13102931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/12/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: This study aimed to investigate the influence of the root canal morphology and various treatment variables on the outcomes of root canal treatments (RCTs) in mandibular second molars, assessed through cone-beam computed tomography (CBCT) imaging. Methods: A total of 150 CBCT images were examined, comprising 100 cases of persistent endodontic infections and 50 of previously treated root canals with normal apices in the mandibular second molars. CBCT was utilized to evaluate the root canal configuration, the radiographic quality of coronal restorations and treated canal systems, and the presence of periapical lesions. Statistical analyses were performed to explore the correlations between these factors. Results: The presence of a C-shaped root canal configuration did not demonstrate a significant correlation with periapical lesions (p = 0.05). Factors influencing endodontic treatment outcomes included missing canals (p = 0.018), underfilling or overfilling (p = 0.045), and inadequate coronal restoration (p = 0.006). Missing a canal was identified as the variable most significantly associated with periapical lesions (OR = 3.103). Inhomogeneous root canal obturation was more commonly observed in C-shaped root canals (p < 0.001). Conclusions: Regardless of the root canal morphology of mandibular second molars, successful RCT depends on thorough disinfection to eliminate any untreated canals, precise three-dimensional filling of the canals at the correct working length, and a securely sealed coronal restoration to prevent leakage.
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Affiliation(s)
- Da-Min Park
- Department of Conservative Dentistry, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea;
| | - Woo-Hyun Seok
- Department of Public Health Administration, Yanggugun Public Health Center, Yanggu-gun 24522, Republic of Korea;
| | - Ji-Young Yoon
- Department of Conservative Dentistry, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea;
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Özel B, Barut G, Baser Can ED. Surface roughness and cyclic fatigue resistance of a novel shaping system: An in-vitro study. PLoS One 2024; 19:e0302551. [PMID: 38696475 PMCID: PMC11065293 DOI: 10.1371/journal.pone.0302551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/05/2024] [Indexed: 05/04/2024] Open
Abstract
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.
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Affiliation(s)
- Beliz Özel
- Endodontics, Academic Center for Dentistry, Amsterdam, Netherlands
| | - Güher Barut
- Endodontics, Yeditepe University Faculty of Dentistry, Istanbul, Türkiye
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Hariprasad R, Joy B, Kuriakose F, Sudhakar AS, Soumya TS, Pathrose SP. Electrochemical dissolution and retrieval of broken NiTi endodontic files from root canal using chloride based isotonic fluids as electrolytes - An in vitro study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S1539-S1543. [PMID: 38882790 PMCID: PMC11174267 DOI: 10.4103/jpbs.jpbs_1225_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 06/18/2024] Open
Abstract
Objective The electrochemical dissolution method of instrument retrieval emphasizes on the dissolution of the instrument rather than sacrificing dentine. Most of the studies conducted for electrochemical dissolution used fluoride-containing electrolytes and were performed inside a beaker. In this study, we used chloride-based fluids as electrolytes. Materials and Methods Fifty extracted mandibular first premolars were divided into five groups based on the electrolytes used. Canals were enlarged to ProTaper Universal F2, and files were intentionally broken inside the canal. These specimens were subjected to electrochemical characterization by applying the potential of 9V for 20 min. Optical images were taken to assess the change in surface topography. The results were analyzed statistically by one-way analysis of variance (analysis of variance [ANOVA]). Results The rate of dissolution based on the electrolyte used decreased in the following order, viz. Tyrode's solution>artificial saliva>normal saline>Ringer's lactate/physiological serum. Conclusion Apart from fluoride, chloride-based electrolytes could be an efficient alternative.
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Affiliation(s)
- R Hariprasad
- Consultant Endodontist and Restorative Dentist, Department of Conservative Dentistry and Endodontics, Karunya Multispeciality Dental Clinic, Pulincunnoo, Alappuzha, Kerala, India
| | - Basil Joy
- Department of Conservative Dentistry and Endodontics, Mar Baselios Dental College, Kothamangalam, Affiliated to Kerala University of Health Sciences, Ernakulam District, Kerala, India
| | - Feby Kuriakose
- Department of Conservative Dentistry and Endodontics, Mar Baselios Dental College, Kothamangalam, Affiliated to Kerala University of Health Sciences, Ernakulam District, Kerala, India
| | - Aswathy S Sudhakar
- Department of Periodontics and Oral Implantology, Azeezia College of Dental Science and Research, Affiliated to KUHS (Kerala University of Health Sciences), Kollam, Kerala, India
| | - T S Soumya
- Department of Endodontics, Soumya's Dental Speciality Centre, Peeceeyen Complex, Parasaran, Thiruvananthapuram, Kerala, India
| | - Sonia P Pathrose
- Department of Conservative Dentistry and Endodontics, Mar Baselios Dental College, Kothamangalam, Affiliated to Kerala University of Health Sciences, Ernakulam District, Kerala, India
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Moriya PT, de Carvalho KKT, Kishen A, Souza EM, Versiani MA. Quasi-3D dynamic photoelastic analysis of stress distribution during preparation of simulated canals with 13 mechanical preparation systems. Int Endod J 2023; 56:1399-1411. [PMID: 37566206 DOI: 10.1111/iej.13961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/12/2023]
Abstract
AIM The aim of this study is to compare the stress produced on the internal walls of simulated canals by nine rotary and four reciprocating systems. METHODOLOGY Sixty-five isotropic transparent blocks containing a 60° curved and tapered simulated canal were selected and distributed into 13 groups (n = 5) according to the preparation system: BioRace, HyFlex EDM, iRaCe, Mtwo, One RECI, ProTaper Next, RaCe EVO, Reciproc, Reciproc Blue, R-Motion, VDW.ROTATE, XP-Endo Rise Shaper, and XP-Endo Shaper. Each resin block was mounted in a vice and a digital camera recorded the entire sequence of each preparation system through a circular polariscope set for dark field analysis. The video frames when each instrument reached the end of the coronal, middle, and apical thirds of the canal were extracted from the recordings and analysed by two independent observers regarding the stress generated on the canal walls using a semi-quantitative evaluation on a 0-5 scale. Intra- and inter-observer agreement were subjected to the Cohen's Kappa coefficient test, whilst the experimental results were compared using Kruskal-Wallis test post hoc pairwise comparisons with Bonferroni correction (α = 5%). RESULTS The inter- and intra-observer agreement were 0.98 and 1, respectively. Most instruments demonstrated acceptable performance (scores ≤ 2) in all thirds. Other instruments, such as the HyFlex EDM 25.12 (coronal and middle thirds), Reciproc Blue R25 and Reciproc R25 (coronal and apical thirds), R-Motion 30.04 (apical third), and VDW.ROTATE 20.05 (apical third) showed scores higher than 3. Statistical analysis revealed a significant difference amongst the tested systems at the coronal, middle, and apical thirds (p < .05). CONCLUSION None of the canal instrumentation protocols were stress-free, showing varying levels of stress concentrations. Various factors seemed to influence the magnitude of stress and its distribution pattern on the canal walls. Overall, instruments characterized by a larger taper, lower speed, reciprocating motion, and made of heat-treated NiTi alloy exhibited higher patterns of stress distribution.
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Affiliation(s)
| | | | - Anil Kishen
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Erick M Souza
- Department of Dentistry II, Federal University of Maranhão, São Luís, Brazil
| | - Marco A Versiani
- Dental Specialty Centre, Brazilian Military Police, Minas Gerais, Brazil
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Silva EJNL, Alcalde MP, Martins JNR, Vieira VTL, Vivan RR, Duarte MAH, Belladonna FG, Braz-Fernandes FM, Versiani MA. To flat or not to flat? Exploring the impact of flat-side design on rotary instruments using a comprehensive multimethod investigation. Int Endod J 2023; 56:1301-1315. [PMID: 37594701 DOI: 10.1111/iej.13960] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/19/2023]
Abstract
AIM To assess the influence of a flat-side design on the geometry, metallurgy, mechanical performance and shaping ability of a novel nickel-titanium rotary instrument. METHODOLOGY Sixty-five new 25-mm flat-side rotary instruments (size 25, taper 0.04) and their nonflat-side prototypes (n = 65) were assessed for major deformations and examined regarding macroscopic and microscopic design, determination of nickel and titanium elements ratio, measurement of phase transformation temperature and evaluation of mechanical performance parameters including time/cycles to fracture, maximum torque, angle of rotation, maximum bending and buckling strengths and cutting ability. Additionally, unprepared canal areas, volume of hard tissue debris and percentage reduction of dentine thickness were calculated for each tested instrument after preparing mesial canals of mandibular molars (n = 12), using micro-CT imaging. Statistical analyses were performed using the U-Mann-Whitney test and independent Student t-test (α = 5%). RESULTS The number of spirals (n = 8) and blade direction (clockwise) were similar between both flat and nonflat instruments, whilst the helical angles were equivalent (⁓25°). Flat-instruments showed inconsistencies in the homogeneity of the gold colour on the flat-side surface, blade discontinuity, and incomplete and variable S-shaped cross-sections. The titanium-to-nickel ratios were equivalent, but significant differences in the R-phase finish and austenitic start phase transformation temperatures were observed between the flat and nonflat-side instruments. The flat-side instruments demonstrated superior cutting ability compared to the nonflat instruments, as well as, significantly lower values for time to fracture, rotation to fracture and maximum torque to fracture (p < .001). No statistical difference was observed between tested instruments regarding angle of rotation (p = .437), maximum bending (p = .152) and buckling load (p = .411). Preparation protocols using flat and nonflat instruments did not show any statistically significant differences (p > .05). All flat-side instruments exhibited deformation after shaping procedures. CONCLUSIONS The flat-side instrument showcased enhanced cutting ability compared to its nonflat counterpart. However, it exhibited inferior performance in terms of time, rotation and maximum torque to fracture, along with distinct phase transformation temperatures. No differences were observed in the titanium-to-nickel ratios, angle of rotation, maximum bending, buckling load, preparation time, percentage of untouched canal walls, volume of hard tissue debris and percentage reduction of dentine thickness.
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Affiliation(s)
- Emmanuel J N L Silva
- Department of Endodontics, Fluminense Federal University, Rio de Janeiro, Brazil
- Department of Endodontics, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Endodontics, Grande Rio University, Rio de Janeiro, Brazil
| | - Murilo P Alcalde
- Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Jorge N R Martins
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
- Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
- Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
| | - Victor T L Vieira
- Department of Endodontics, Grande Rio University, Rio de Janeiro, Brazil
| | - Rodrigo R Vivan
- Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Marco A H Duarte
- Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Felipe G Belladonna
- Department of Endodontics, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Francisco Manuel Braz-Fernandes
- CENIMAT/I3N, Department of Materials Science, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
| | - Marco A Versiani
- Dental Specialty Center, Brazilian Military Police, Minas Gerais, Brazil
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Thakur VS, Kankar PK, Parey A, Jain A, Jain PK. Health prediction of reciprocating endodontic instrument based on the machine learning and exponential degradation models. Proc Inst Mech Eng H 2023; 237:1202-1214. [PMID: 37668014 DOI: 10.1177/09544119231196285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
This study proposes an intelligent health prediction and fault prognosis of the endodontic file during the root canal treatment. Root canal treatment is the procedure of disinfecting the infected pulp through the canal with the help of an endodontic instrument. Force signals are acquired with the help of a dynamometer during the canal preparation, and statistical features are extracted. The extracted features are selected through the window-wise feature extraction process. Characteristic features for endodontic file prognostics include time-domain features of the signals are evaluated. The extracted feature has inappropriate information, that is, noise between the signals; hence the smoothing of the feature is required at this stage to observe a trend in the signals. Based on the smoothing feature and post-processing of the feature, defined the health index to calculate the health condition of the endodontic instruments. A machine learning algorithm and exponential degradation model are used to predict the health of the endodontic instrument during the root canal treatment. This model is used to forecast the degradation of the endodontic file so that actions can be taken before actual failures happen. The proposed methodology can analyze the failures and micro-crack initiation of the endodontic instruments. Endodontics practitioners can use the machine learning models as well as an exponential model for estimating the health condition of the endodontic instrument. This study may help the clinician to progress the efficiency of the root canal treatment and the competence of the endodontic instruments.
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Affiliation(s)
- Vinod Singh Thakur
- System Dynamics Lab, Department of Mechanical Engineering, Indian Institute of Technology Indore, Indore, Madhya Pradesh, India
| | - Pavan Kumar Kankar
- System Dynamics Lab, Department of Mechanical Engineering, Indian Institute of Technology Indore, Indore, Madhya Pradesh, India
| | - Anand Parey
- Solid Mechanics Lab, Department of Mechanical Engineering, Indian Institute of Technology Indore, Indore, Madhya Pradesh, India
| | - Arpit Jain
- Department of Oral Medicine and Radiology, College of Dental Science and Hospital, Rau, Indore, Madhya Pradesh, India
| | - Prashant Kumar Jain
- PDPM Indian Institute of Information Technology, Design and Manufacturing, Jabalpur, Madhya Pradesh, India
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Coaguila-Llerena H, Lazo-Quezada G, Teves A, Zevallos-Chávez M, Faria G. Removal of separated instruments from unfavourable locations: Case reports using the HBW ultrasonic ring or a surgical approach. AUST ENDOD J 2023; 49:358-364. [PMID: 35932460 DOI: 10.1111/aej.12673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 02/05/2023]
Abstract
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.
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Affiliation(s)
- Hernán Coaguila-Llerena
- Department of Restorative Dentistry, Araraquara School of Dentistry, São Paulo State University - UNESP, Araraquara, Brazil
| | | | - Abel Teves
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo - USP, Bauru, Brazil
| | - Marco Zevallos-Chávez
- Department of Endodontics, Catholic University of Santa Maria - UCSM, Arequipa, Peru
| | - Gisele Faria
- Department of Restorative Dentistry, Araraquara School of Dentistry, São Paulo State University - UNESP, Araraquara, Brazil
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ALTUNBAŞ D, AKPINAR KE, KAYA F. Kök Uçları Farklı Açılarda Rezeke Edilmiş Dişlerin Cerrahi Olmayan Yeniden Tedavilerinde 3 Elektronik Apeks Bulucunun Doğruluğu: In-Vitro Çalışma. CUMHURIYET DENTAL JOURNAL 2022. [DOI: 10.7126/cumudj.1103606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim: The accuracy of three electronic apex locators (EALs) during retreatment of root-end resected teeth with different resection bevel angles were evaluated in the present study.
Materials and Methods: Forty mandibular premolar teeth were divided into two groups regarding resection bevel angle after root canal filling. In the first group, the apical 3 mm of each specimen was resected at a 0-degree bevel angle using a diamond bur. The resection bevel angle was approximately 45-degree in the second group. Electronic length measurements were obtained with a size 15 K-file advanced apically in dissolved gutta percha using Dentaport ZX, Propex Pixi, and Apit 15. The filling materials were then completely removed from the root canals, and the actual lengths up to the resection region were determined. The actual length was subtracted from the electronic length measurements for each specimen. Measurements were analyzed statistically using independent sample t-test, repeated-measures analysis of variance, and Bonferroni tests. The level of statistical significance was defined as P
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Affiliation(s)
| | | | - Fatma KAYA
- Kayseri Private Uzmandent Dental Hospital
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12
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Yadav S, Nawal RR, Talwar S. Nonsurgical Management of a Large Periapical Lesion Following Instrument Retrieval From the Apical Third: A Case Report With a Three-Year Follow-Up. Cureus 2022; 14:e24995. [PMID: 35719824 PMCID: PMC9191266 DOI: 10.7759/cureus.24995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/15/2022] Open
Abstract
Instrument separation in the apical third of the tooth, which is associated with a large periapical lesion, presents an arduous task for the clinician. This case report presents nonsurgical endodontic management of a maxillary central incisor associated with a large periapical lesion and a separated instrument in the apical third of the root canal. A 28-year-old male patient presented with pain and labial swelling in the left maxillary central incisor region. Pulp sensibility testing showed no response. The radiograph revealed the presence of a separated instrument in the apical third of the root canal and periapical radiolucency. A diagnosis of previously initiated therapy with acute apical abscess was made. In the first visit, instrument retrieval was done using ProUltra Endo tips (Dentsply Sirona, York, Pennsylvania) under a dental operating microscope. In the subsequent visit, obturation was done as the patient was asymptomatic. The patient was recalled for follow-up at six, 12, 18, 24, and 36 months. Complete healing of the periapical tissues was evident on the radiograph, and the tooth remained functional for the entire follow-up period of three years. The successful outcome seen in this case shows that even large periapical lesions can be managed conservatively by nonsurgical endodontic treatment
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13
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A Rare Case of Orthograde Retrieval of Extruded Instrument following Periapical Tissue Healing. Case Rep Dent 2022; 2022:2589021. [PMID: 35127180 PMCID: PMC8808125 DOI: 10.1155/2022/2589021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/06/2022] [Indexed: 11/24/2022] Open
Abstract
The ideal retrieval protocol of separated instruments reverts the case to the initial situation prior to the fracture incidence while preserving the tooth hard tissue and the integrity of the supporting structures. When a patient presented for emergency treatment of tooth #37 diagnosed with acute suppurative apical periodontitis, radiographic examination revealed a fractured instrument extruded into the periapex. The treatment options for retrieval were limited to replantation. The initial emergency treatment which consisted of orthograde pus drain, radicular disinfection, and intracanal calcium hydroxide dressing completely resolved patient's symptoms. The follow-up radiographs revealed an interesting finding: gradual shift in the separated fragment position into the radicular space allowing a successful nonsurgical removal of the broken instrument. In conclusion, the reaction of periodontal tissues to an extruded instrument fragment remaining in situ may be favourable; thus, a risk and benefit analysis approach is essential to fractured instrument retrieval.
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14
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Schäfer E, Bürklein S, Donnermeyer D. A critical analysis of research methods and experimental models to study the physical properties of NiTi instruments and their fracture characteristics. Int Endod J 2021; 55 Suppl 1:72-94. [PMID: 34862796 DOI: 10.1111/iej.13673] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/03/2021] [Indexed: 11/27/2022]
Abstract
The aim of this review is to provide a critical overview of the physical properties (surface hardness, cutting efficiency, bending properties, flexibility and cyclic fatigue resistance) of NiTi instruments. Frequently used experimental models regarding these aspects will be presented and discussed with regard to their strengths and weaknesses. For all these aspects, a plethora of experimental models have been described. Based on a critical appraisal and especially taking the appropriate translation of experimental findings to clinical endodontics into account, suggestions for future research based on clearly defined and valid experimental methodologies will be provided. Up to now, very few attempts have been made to assess which particular physical properties of NiTi instruments exert an impact on the clinical outcome of root canal treatment. Departure from merely focusing on physical properties and fracture characteristics towards more biological aspects in terms of treatment outcome is essential.
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Affiliation(s)
- Edgar Schäfer
- Central Interdisciplinary Ambulance in the School of Dentistry, Münster, Germany
| | - Sebastian Bürklein
- Central Interdisciplinary Ambulance in the School of Dentistry, Münster, Germany
| | - David Donnermeyer
- Department of Periodontology and Operative Dentistry, Westphalian Wilhelms-University, Münster, Germany
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15
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Persic Bukmir R, Paljevic E, Vidas J, Glazar I, Pezelj-Ribaric S, Brekalo Prso I. Is Coronal Restoration a Predictor of Posttreatment Apical Periodontitis? Eur J Dent 2021; 16:386-395. [PMID: 34753188 PMCID: PMC9339940 DOI: 10.1055/s-0041-1735909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives
To investigate the posttreatment apical periodontitis (AP) in endodontically treated teeth through a multivariate approach and to analyze the relative importance of quality and type of coronal restoration as predictors of periapical disease.
Materials and Methods
The present study sample was drawn within 2-year period from the 1,072 consecutive patients older than 18 years, first time attending the Dental Clinic of the Clinical Hospital Center Rijeka, Croatia. A total of 1,350 endodontically treated teeth were included in the study. For each tooth, the periapical status, root filling quality, intracanal post, separated file presence, marginal bone loss, and quality and type of coronal restoration were recorded.
Statistical Analysis
Chi-square tests were used to analyze the variations in the periapical status, quality of root canal filling, and quality of coronal restoration in different tooth types. The effect of explanatory variables on periapical status was explored using univariate and multivariate logistic regression models. The outcome variable was set as the presence versus absence of AP in the tooth.
Results
Multivariate logistic regression analysis revealed statistically significant associations and increased risk for AP presence in molars (odds ratio [OR] = 2.15;
p
< 0.001), teeth positioned in mandible (OR = 1.49;
p
= 0.007), teeth with short length of root filling (OR = 4.08;
p
< 0.001), overfilled teeth (OR = 2.99;
p
= 0.001), and teeth with inadequate density of root filling (OR = 4.14;
p
< 0.001). Considering variables related to coronal restoration, neither coronal restoration type nor quality was found to be predictive for posttreatment AP. Merely, the presence of intracanal post significantly increased the odds of AP presence (OR = 1.57;
p
= 0.009).
Conclusion
The results of the present study did not indicate that type or quality of coronal restoration may be predictors of posttreatment AP. Periapical disease was significantly associated with molars, mandibular teeth, substandard quality of root fillings, and intracanal post presence.
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Affiliation(s)
- Romana Persic Bukmir
- Department of Endodontics and Restorative Dentistry, Faculty of Dental Medicine, University of Rijeka, Rijeka, Croatia
| | - Ema Paljevic
- Department of Endodontics and Restorative Dentistry, Faculty of Dental Medicine, University of Rijeka, Rijeka, Croatia
| | - Jelena Vidas
- Department of Endodontics and Restorative Dentistry, Faculty of Dental Medicine, University of Rijeka, Rijeka, Croatia
| | - Irena Glazar
- Department of Oral Medicine and Periodontology, Faculty of Dental Medicine, University of Rijeka, Rijeka, Croatia
| | - Sonja Pezelj-Ribaric
- Department of Oral Medicine and Periodontology, Faculty of Dental Medicine, University of Rijeka, Rijeka, Croatia.,Department of Dental Medicine, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Ivana Brekalo Prso
- Department of Endodontics and Restorative Dentistry, Faculty of Dental Medicine, University of Rijeka, Rijeka, Croatia.,Department of Dental Medicine, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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16
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Bürklein S, Zupanc L, Donnermeyer D, Tegtmeyer K, Schäfer E. Effect of Core Mass and Alloy on Cyclic Fatigue Resistance of Different Nickel-Titanium Endodontic Instruments in Matching Artificial Canals. MATERIALS 2021; 14:ma14195734. [PMID: 34640131 PMCID: PMC8510035 DOI: 10.3390/ma14195734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022]
Abstract
Instrument failure during root canal preparation is still a concern among endodontists. However, it remains unclear whether the use of more martensitic alloys or the cross-sectional design parameters (i.e., core mass) significantly improve fracture resistance. The aim of the study was to evaluate the impact of core mass and alloy on dynamic cyclic fatigue resistance of nickel-titanium endodontic instruments in matching artificial canals at body temperature. Two groups were tested. (A) taper 0.04: F360 (Komet, Lemgo, Germany), Twisted file (Sybron Endo, Glendora, CA, USA) (=TF), JIZAI (Mani, Tochigi, Japan) (=J_04) (all size #25) and the variable tapered TruNatomy (Dentsply, Ballaigues, Switzerland) (size #26) (=TN). (B) size #25; taper 0.06: (Mtwo (VDW, Munich, Germany), JIZAI (Mani) (=J_06), and variable tapered Hyflex EDM OneFile (Coltene Whaledent, Altstätten, Switzerland) (=HF). Time, number of cycles to fracture (NCF), and number and length of fractured fragments were recorded and statistically analysed using ANOVA Student-Newman-Keuls, Kruskal–Wallis or Chi-square test (significance level = 0.05). (A) TN showed the significantly shortest time until fracture, followed by TF, F360 and J_04 which also differed significantly, while NCF showed the following order: F360 < TN < TF < J_04 (p < 0.05). Only one J_04 but all instruments of the other groups fractured within the test-limit of 10 min. (B) Mtwo was significantly inferior concerning time until fracture and NCF, compared to J_06 and HF (p < 0.05), which did not differ significantly (p > 0.05). While all Mtwo instruments fractured, only four instruments failed in the other groups (p < 0.05). Within the limitations of this study, alloy and cross-sectional design (i.e., core mass) were critical factors regarding instrument failure, but none of these factors could be determined as a main parameter for increased or decreased time, and cycles to fracture. Rather, it seemed to be the interaction of multiple factors (e.g., longitudinal and cross-sectional design, alloy, and rotational speed) that was responsible for differences in the time and cycles to fracture. Nonetheless, all instruments had lifetimes that allow safe clinical use. However, the superiority or inferiority of an instrument with regard to cyclic fatigue based on laboratory results—even when identical trajectories are guaranteed—may be considered questionable, as the characteristics and design parameters of the instruments vary considerably, and the experimental setups lack additional clinical parameters and thus clinical relevance.
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Affiliation(s)
- Sebastian Bürklein
- Albert-Schweitzer-Campus 1, Central Interdisciplinary Ambulance in the School of Dentistry, Westphalian Wilhelms-University, Building W 30, 48149 Münster, Germany;
- Correspondence: ; Tel.: +49-251-834-7051; Fax: +49-251-834-7894
| | | | - David Donnermeyer
- Albert-Schweitzer-Campus 1, Department of Periodontology and Operative Dentistry, Westphalian Wilhelms-University, Building W 30, 48149 Münster, Germany; (D.D.); (K.T.)
| | - Karsten Tegtmeyer
- Albert-Schweitzer-Campus 1, Department of Periodontology and Operative Dentistry, Westphalian Wilhelms-University, Building W 30, 48149 Münster, Germany; (D.D.); (K.T.)
| | - Edgar Schäfer
- Albert-Schweitzer-Campus 1, Central Interdisciplinary Ambulance in the School of Dentistry, Westphalian Wilhelms-University, Building W 30, 48149 Münster, Germany;
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17
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Evaluation of usage-induced degradation of different endodontic file systems. Sci Rep 2021; 11:9027. [PMID: 33907252 PMCID: PMC8079699 DOI: 10.1038/s41598-021-88570-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/12/2021] [Indexed: 11/09/2022] Open
Abstract
To evaluate structural profiles and mechanical behaviour of WaveOne Gold (WOG), Twisted File Adaptive (TFA) and XP-endo shaper (XPS) instruments after root canal preparation. Standardized in vitro shaping was performed in presence of 5.25% sodium hypochlorite. File morphology was analyzed using scanning electron microscopy; X-ray diffraction analysis was performed before and after use along with Raman spectroscopy. Nanoindentation was carried out to characterize surface topography. Ni2+ release was measured at 1, 3, 5 and 7 days. X-ray photoelectron spectroscopy (XPS) analysis was done before and after use. After allocating scan line shifts like in WOG, mechanical deformation was shown using first order polynomials. XPS file system showed minimal grooves on surface. SEM of WOG instrument showed scraping surface defects. Hardness varied from 8.11 ± 0.99 GPa in TFA system to 6.7 ± 1.27 GPa and 4.06 ± 4.1 GPa in XPS and WOG. Ni2+ concentration from WOG was 171.2 μg/L. Raman peak at 540-545 cm-1 is attributed to Cr2O3. High resolution of Ti 2p spectrum show distinctive peaks with binding energies dominating in WOG, XPS and TFA file system. XRD exhibited NiTi phases with diffraction peaks. WOG files showed more surface deterioration and less passive layer formation as compared to TFA and XPS systems.
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18
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The Effect of Taper and Apical Diameter on the Cyclic Fatigue Resistance of Rotary Endodontic Files Using an Experimental Electronic Device. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11020863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to analyze the effect of the taper and apical diameter of nickel–titanium (NiTi) endodontic rotary files on the dynamic cyclic fatigue resistance. A total of 50 unused conventional NiTi wire alloy endodontic rotary instruments were used in this study. All NiTi endodontic rotary files were submitted to a custom-made dynamic cyclic fatigue device until fracture occurred. The time to failure, the number of cycles to failure, the number of pecking movements, and the length of the fractured file tip were analyzed using the analysis of variance (ANOVA) test. In addition, the Weibull characteristic strength and Weibull modulus were also calculated. The paired t-test revealed statistically significant differences between the time to failure, number of cycles to failure, and number of cycles of in-and-out movement of both the apical diameter (p ˂ 0.001) and the taper (p ˂ 0.001) of NiTi endodontic rotary files; however, the results did not show statistically significant differences between the mean length of the fractured files regarding the apical diameter (p = 0.344) and taper study groups (p = 0.344). Increased apical diameter and taper of NiTi endodontic rotary files decreased their dynamic resistance to cyclic fatigue.
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19
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Gomes MS, Vieira RM, Böttcher DE, Plotino G, Celeste RK, Rossi-Fedele G. Clinical fracture incidence of rotary and reciprocating NiTi files: A systematic review and meta-regression. AUST ENDOD J 2021; 47:372-385. [PMID: 33410578 DOI: 10.1111/aej.12484] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 12/01/2022]
Abstract
This systematic review was registered in PROSPERO (CRD42017075917) and aimed to investigate whether the available clinical evidence supports the hypothesis that reciprocating motion results in a lower incidence of nickel-titanium files fracture compared to continuous rotation. Clinical studies that reported the incidence of fracture of engine-driven nickel-titanium files were included. The main exposure was the kinematics, and the primary outcome was the incidence of files fracture. The overall incidence of files fracture was 2.27%, with a trend for higher incidence with rotary motion (2.43%) than with reciprocating (1.0%), though without significant differences. Multiple meta-regression models revealed that the use of nickel-titanium files in more than four teeth and less proficient operators were associated with a higher incidence of file fracture. There was no difference in the clinical incidence of fracture of nickel-titanium instruments between reciprocating and rotary motions; however, other factors were identified.
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Affiliation(s)
- Maximiliano Schünke Gomes
- Pontifícia Universidade Católica do Rio Grande do Sul, School of Health and Life Sciences, Graduate Program in Dentistry, Porto Alegre, Brazil
| | - Rosângela Mello Vieira
- Pontifícia Universidade Católica do Rio Grande do Sul, School of Health and Life Sciences, Graduate Program in Dentistry, Porto Alegre, Brazil
| | - Daiana Elisabeth Böttcher
- Pontifícia Universidade Católica do Rio Grande do Sul, School of Health and Life Sciences, Graduate Program in Dentistry, Porto Alegre, Brazil
| | - Gianluca Plotino
- Private Practice, Grande, Plotino & Torsello - Studio di Odontoiatria, Rome, Italy
| | - Roger Keller Celeste
- Department of Preventive and Social Dentistry, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Giampiero Rossi-Fedele
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
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20
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The Influence of NiTi Alloy on the Cyclic Fatigue Resistance of Endodontic Files. J Clin Med 2020; 9:jcm9113755. [PMID: 33233442 PMCID: PMC7700305 DOI: 10.3390/jcm9113755] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/20/2020] [Accepted: 11/20/2020] [Indexed: 11/19/2022] Open
Abstract
Background: The aim of this study was to analyze the influence of NiTi alloy in endodontic rotary instruments on cyclic fatigue resistance. Methods: One hundred and sixty-four (164) sterile endodontic rotary files were selected and distributed into the following study groups: A: 25.08 F2 ProTaper Universal (PTU) (n = 41); B: 25.06 X2 ProTaper Next (PTN) (n = 41); C: 25.08 F2 ProTaper Gold (PTG) (n = 41), and D: 25.06 ProFile Vortex Blue (PVB) (n = 41). A cyclic fatigue device was designed to conduct the static cyclic fatigue tests with stainless steel artificial root canals systems with 250 µm apical diameter, 60° curvature angle, 5 mm radius of curvature, 20 mm length, and 6% (25.06) and 8% taper (25.08). Failure of the endodontic rotary instrument was detected by a single operator through direct observation and was also filmed to allow measurement of the exact time to failure. Results were analyzed using the ANOVA test and Weibull statistical analysis. Results: All pairwise comparisons presented statistically significant differences between the time to failure for the NiTi alloy study groups (p < 0.001), except between the PTN and PVB study groups (p = 0.379). In addition, statistically significant differences between the number of cycles to failure for the NiTi alloy study groups (p < 0.001) were also observed. Conclusions: The NiTi CM-Gold wire alloy of the ProTaper Gold endodontic rotary files resulted in greater resistance to cyclic fatigue than ProFile Vortex Blue, ProTaper Next, and ProTaper Universal endodontic rotary files.
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21
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Mechanical Tests, Metallurgical Characterization, and Shaping Ability of Nickel-Titanium Rotary Instruments: A Multimethod Research. J Endod 2020; 46:1485-1494. [DOI: 10.1016/j.joen.2020.07.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 11/23/2022]
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22
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Uslu G, Gundogar M, Özyurek T, Plotino G. Cyclic fatigue resistance of reduced-taper nickel-titanium (NiTi) instruments in doubled-curved (S-shaped) canals at body temperature. J Dent Res Dent Clin Dent Prospects 2020; 14:111-115. [PMID: 32908652 PMCID: PMC7464224 DOI: 10.34172/joddd.2020.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/12/2020] [Indexed: 11/09/2022] Open
Abstract
Background. This study was conducted to compare the cyclic fatigue resistance of VDW.ROTATE, TruNatomy Prime, HyFlex CM, and 2Shape nickel-titanium (NiTi) rotary instruments in double-curved canals in a simulated clinical environment. Methods. Eighty NiTi files were used for the fatigue testing in stainless steel canals compatible with instrument sizes until fracture occurred (n=20): VDW.ROTATE (04./25#), TruNatomy Prime (04./26#), HyFlex CM (04./25#) and 2Shape TS04./25#( 1). For each instrument, the number of cycles to fracture (NCF) was calculated, and the fractured fragment length (FL) was measured. To verify that the files were fractured due to cyclic fatigue, the fractured surfaces of the files were evaluated under a scanning electron microscope. Data were statistically analyzed using the Kruskal-Wallis and Student's t-tests at the %95 confidence level. Results. The failure of the files due to cyclic fatigue was first seen in the apical curvature before the coronal curvature (P<0.05). The highest fatigue resistance was observed in VDW.ROTATE and HyFlex CM files in both curvatures (P<0.05). There were no significant differences in the fatigue resistance between the HyFlex CM and VDW.ROTATE files or between the 2Shape and the TruNatomy files (P>0.05). There was no difference in the fractured lengths of the files between the apical and coronal curvatures (P>0.05). Conclusion. In artificial S-shaped root canals, VDW.ROTATE and HyFlex CM files exhibited higher fatigue resistance compared to 2Shape and TruNatomy files.
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Affiliation(s)
- Gülşah Uslu
- Department of Endodontics, Faculty of Dentistry, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Mustafa Gundogar
- Department of Endodontics, Faculty of Dentistry, Istanbul Medipol University, İstanbul, Turkey
| | - Taha Özyurek
- Department of Endodontics, Faculty of Dentistry, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
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23
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Patnana AK, Chugh A, Chugh VK, Kumar P. The incidence of nickel-titanium endodontic hand file fractures: A 7-year retrospective study in a tertiary care hospital. J Conserv Dent 2020; 23:21-25. [PMID: 33223636 PMCID: PMC7657430 DOI: 10.4103/jcd.jcd_254_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/07/2020] [Accepted: 07/14/2020] [Indexed: 12/29/2022] Open
Abstract
Aim: The present retrospective cross-sectional study aims to evaluate the incidence and factors associated with nickel-titanium hand file fractures in root canal-treated teeth in a tertiary care hospital of western India. Methodology: The diagnostic records of intraoral periapical (IOPA) radiographs were analyzed to check for file fractures in the root canal-treated teeth. As a part of standardized departmental protocol, Hand ProTaper Universal file system (Dentsply, India) was used for chemomechanical preparation for root canal treatment. The file fractures were analyzed with reference to age group, type of teeth, curvature of the canal, site of file fracture in the canal, length of file fracture, level of file fracture, distance of the file fracture from the apex, and obturation status of the file-fractured tooth. Chi-square test was applied to assess the significance difference between the tested groups. Results: A total of 19,810 IOPA X-rays were screened and 2728 root canal-treated teeth were found and of these 2728 cases, 109 file-fractured teeth were observed. Conclusion: The total incidence of file fractures was 3.9/100 root canal-treated cases, and mandibular molars with severely curved canals (>25°) had shown the maximum incidence of file fractures.
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Affiliation(s)
- Arun Kumar Patnana
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ankita Chugh
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vinay Kumar Chugh
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pravin Kumar
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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24
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Removing Fractured Endodontic NiTi Instruments with a Tube Technique: Influence of Pre-Treatment with Various Agents on Adhesive Forces In Vitro. MATERIALS 2019; 13:ma13010144. [PMID: 31905873 PMCID: PMC6981515 DOI: 10.3390/ma13010144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/20/2019] [Accepted: 12/27/2019] [Indexed: 01/04/2023]
Abstract
The aim of the study was to evaluate the adhesive forces for removing iatrogenically fractured endodontic nickel-titanium instruments using a modified tube technique with various pre-treatment agents in combination with a light-curing composite. 120 Nickel-Titanium-Mtwo instruments were cut at its parallel shaft and fixed in a vise with an overlap of 2 mm. The surfaces were treated with different agents: A) GC Metalprimer; B) Prime and Bond active; C) NaOCl (3%); D) citric acid (15%); E) phosphoric acid (37%) and group (F) was not pretreated (control). One end of a matching microtube, filled with light-curing composite, was placed over the instrument and a transmitting glass fiber inserted from the opposite side guaranteed polymerization. Pull-out tests (1 mm/min) were performed and failure load was measured digitally. Data were statistically analyzed using the ANOVA and Student–Newman–Keuls tests. Interfaces were subjected to SEM analysis. Prime and Bond active created significant higher pull-out values (mean 30.5 N) compared to all other groups (p < 0.001) and Metalprimer (18.5 N) was significantly superior to the untreated (12.6 N) and NaOCl (11.7 N) group (p < 0.05). No significant differences were obtained between the other groups (p > 0.05). Thus, adhesives improved bonding to fractured NiTi instruments.
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25
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Hülsmann M. Research that matters: studies on fatigue of rotary and reciprocating NiTi root canal instruments. Int Endod J 2019; 52:1401-1402. [PMID: 31506965 DOI: 10.1111/iej.13194] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Michael Hülsmann
- Department of Preventive Dentistry, Periodontology and Cariology, University Medicine Göttingen (UMG), Göttingen, Germany
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26
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Hülsmann M, Donnermeyer D, Schäfer E. A critical appraisal of studies on cyclic fatigue resistance of engine-driven endodontic instruments. Int Endod J 2019; 52:1427-1445. [PMID: 31267579 DOI: 10.1111/iej.13182] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 06/30/2019] [Indexed: 11/29/2022]
Abstract
The endodontic literature contains a plethora of studies on static and dynamic cyclic fatigue resistance tests performed on a large array of rotary or reciprocating nickel-titanium endodontic instruments. It was the aim of this review to summarize the currently available evidence to point out the different outcomes from static versus dynamic tests and to assess whether cyclic fatigue tests provide useful data and information for clinical practice. An electronic literature research in the database PubMed was performed using appropriate search terms, and the titles and abstract were screened for relevance. Language was restricted to English. The review reveals marked differences between the results obtained in static and dynamic tests, and also, the results for the same instruments assessed either under static or dynamic experimental conditions are widely inconsistent. Between the lowest and the highest value for one and the same pathfinding instrument was a factor of about 123 when cyclic fatigue was assessed either under static or dynamic experimental conditions. Moreover, standard deviations of up to 30% have been reported. Environmental temperature has a 500% impact on the lifetime of instruments. In conclusion, fatigue resistance tests conducted under room temperature should be regarded as having little meaning and the scientific and clinical benefits of fatigue resistance tests are very limited. These data should be provided by the manufacturer of the instruments.
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Affiliation(s)
- M Hülsmann
- Department of Preventive Dentistry, Periodontology and Cariology, University Medicine Göttingen (UMG), Göttingen, Germany
| | - D Donnermeyer
- Department of Periodontology and Operative, Westphalian Wilhelms-University, Münster, Germany
| | - E Schäfer
- Central Interdisciplinary Ambulance, Westphalian Wilhelms-University, Münster, Germany
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Generali L, Borghi A, Lusvarghi L, Bolelli G, Veronesi P, Vecchi A, Consolo U, Becce C, Bertoldi C, Sassatelli P. Evaluation of the usage-induced degradation of Genius and Reciproc nickel-titanium reciprocating instruments. Odontology 2019; 107:473-481. [PMID: 30924034 DOI: 10.1007/s10266-019-00423-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/31/2019] [Indexed: 11/30/2022]
Abstract
The aim of this study was to characterize the main features and the usage-induced degradation of the Genius file after four severely curved root canal instrumentations and to compare their properties to the Reciproc files. Brand new and ex vivo used files were analysed by scanning electron microscopy (SEM) with energy-dispersive X-ray spectrometry (EDS), differential scanning calorimetry (DSC), X-ray diffraction (XRD), optical metallography, and nano-indentation to disclose their morphological, chemical, mechanical, thermal, and phase composition features. Nano-indentation data were statistically analysed using the Student's t test for normal distribution or the Kolmogorov-Smirnov test for not-normal distributions. SEM analysis showed the presence of micro-cracks near the tip on both files after ex vivo usage test. EDS analysis confirmed that both files are manufactured from an almost equiatomic NiTi alloy. DSC analysis revealed that the transition temperature of the Genius is below 20 °C, while that of the Reciproc is above 20 °C. XRD analysis of Genius files identified cubic B2 austenite with minor peaks of residual monoclinic B19 martensite, while the contemporaneous presence of martensite, austenite and hexagonal R-phase was observed in the Reciproc files. Significant differences in nanohardness and modulus of elasticity (P < .05) were observed in both Genius and Reciproc files before and after use. The collected results showed that both instruments can be safely used as single-use files.
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Affiliation(s)
- Luigi Generali
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy.
| | - Alessia Borghi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Lusvarghi
- Department of Engineering Enzo Ferrari (DIEF), University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Bolelli
- Department of Engineering Enzo Ferrari (DIEF), University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Veronesi
- Department of Engineering Enzo Ferrari (DIEF), University of Modena and Reggio Emilia, Modena, Italy
| | | | - Ugo Consolo
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
| | | | - Carlo Bertoldi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Sassatelli
- Department of Engineering Enzo Ferrari (DIEF), University of Modena and Reggio Emilia, Modena, Italy
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Ni N, Ye J, Wang L, Shen S, Han L, Wang Y. Stress distribution in a mandibular premolar after separated nickel-titanium instrument removal and root canal preparation: a three-dimensional finite element analysis. J Int Med Res 2019; 47:1555-1564. [PMID: 30678508 PMCID: PMC6460611 DOI: 10.1177/0300060518823630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This study used finite element analysis (FEA) to assess the von Mises stresses of a mandibular first premolar after removing a separated instrument with an ultrasonic technique. Methods FEA models of the original and treated mandibular first premolar were reconstructed, and three models (the original canal, size 30/taper 0.04 canal, and separated instrument removal canal) were created. Two-direction (vertical and lateral) loading patterns were simulated with a 175-N force. The maximum von Mises stresses of the models within the roots from the apex to the cervical region were collected and summarized. Results Under vertical and lateral loads, all maximal values in the three models were localized in the straight-line access region. Compared with the original model (model 1), the treated models (models 2 and 3) had greater maximum stress values from the apex to the cervical region. Greater differences in the maximum von Mises stresses between models 2 and 3 were present in the straight-line access region. Conclusions Separated instrument removal caused changes in stress distribution and increases in stress concentration in the straight-line access region of roots.
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Affiliation(s)
- Na Ni
- 1 Department of Stomatology, Tianjin Hospital, Hexi District, Tianjin, China.,2 Department of Endodontics, Tianjin Stomatological Hospital, Heping District, Tianjin, China
| | - Jing Ye
- 1 Department of Stomatology, Tianjin Hospital, Hexi District, Tianjin, China
| | - Liyuan Wang
- 2 Department of Endodontics, Tianjin Stomatological Hospital, Heping District, Tianjin, China
| | - Simin Shen
- 2 Department of Endodontics, Tianjin Stomatological Hospital, Heping District, Tianjin, China
| | - Lei Han
- 3 Department of Radiology, Tianjin Stomatological Hospital, Heping District, Tianjin, China
| | - Yuxia Wang
- 2 Department of Endodontics, Tianjin Stomatological Hospital, Heping District, Tianjin, China
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Amaral CCF, Ormiga F, Boldrini LC, Miranda PG, Mendonça TA, Granjeiro JM, Gomes JACP. Evaluation of the effects of the solution used for electrochemical dissolution of nickel-titanium endodontic files on dentine structure, microhardness and cell viability. Int Endod J 2018; 51:1434-1445. [PMID: 29763971 DOI: 10.1111/iej.12950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 05/08/2018] [Indexed: 12/27/2022]
Abstract
AIM To evaluate the effects of the [NaF 12 g L-1 + NaCl 1 g L-1 ] solution used in the electrochemical dissolution process of fractured endodontic files, as well as its NiTi-containing product, on dentine hardness, topography and human fibroblast viability. METHODOLOGY Sixty single-rooted human teeth were evaluated for dentine microhardness using the Vickers hardness test and the area and number of dentinal tubules by scanning electron microscopy. The samples were divided according to the dentine surface treatment: distilled water; 17% EDTA; [NaF 12 g L-1 + NaCl 1 g L-1 ]; and 17% EDTA + [NaF 12 g L-1 + NaCl 1 g L-1 ]. Thirty-six single-rooted human teeth were divided according to the irrigation protocol: Dulbecco's Modified Eagle's Medium + 10% foetal bovine serum; 5.25% NaOCl; [NaF 12 g L-1 + NaCl 1 g L-1 ]; and [NaF 12 g L-1 + NaCl 1 g L-1 + NiTi]. The extracts in contact with the apical foramen were used in the MTT assay to evaluate human fibroblast viability, with dilutions of 100%, 50%, 25% and 12.5%. Statistical tests used were paired t-tests, one-way anova, Tukey's test, Kruskal-Wallis test and Dunn's post-test. RESULTS The [NaF 12 g L-1 + NaCl 1 g L-1 ] solution did not modify dentine microhardness or the average dentinal tubule area. However, EDTA induced changes in dentine structure and microhardness (P < 0.05). The [NaF 12 g L-1 + NaCl 1 g L-1 ] solution, and its NiTi-containing product had lower cytotoxicity than NaOCl at dilutions of 25% and 50% (P < 0.01). CONCLUSIONS The [NaF 12 g L-1 + NaCl 1 g L-1 ] solution did not alter dentine microhardness or damage the dentine structure. It also demonstrated lower cytotoxicity than NaOCl.
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Affiliation(s)
- C C F Amaral
- Department of Metallurgy and Materials, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - F Ormiga
- Department of Dental Clinic, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - L C Boldrini
- Bioengineering Laboratory, National Institute of Metrology, Quality and Technology (INMETRO), Duque de Caxias, Brazil.,Postgraduate Program in Translational Biomedicine - BIOTRANS - Unigranrio, Inmetro, Uezo, Rio de Janeiro, Brazil
| | - P G Miranda
- Bioengineering Laboratory, National Institute of Metrology, Quality and Technology (INMETRO), Duque de Caxias, Brazil
| | - T A Mendonça
- Postgraduate Program in Translational Biomedicine - BIOTRANS - Unigranrio, Inmetro, Uezo, Rio de Janeiro, Brazil.,Department of Endodontics, UNIGRANRIO - University of Grande Rio, Duque de Caxias, Brazil
| | - J M Granjeiro
- Bioengineering Laboratory, National Institute of Metrology, Quality and Technology (INMETRO), Duque de Caxias, Brazil.,Postgraduate Program in Translational Biomedicine - BIOTRANS - Unigranrio, Inmetro, Uezo, Rio de Janeiro, Brazil.,Department of Dental Technic,, Dental School, Fluminense Federal University, Rio de Janeiro, Brazil
| | - J A C P Gomes
- Department of Metallurgy and Materials, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Kwak SW, Lee JY, Goo HJ, Kim HC. Effect of surface treatment on the mechanical properties of nickel-titanium files with a similar cross-section. Restor Dent Endod 2017; 42:216-223. [PMID: 28808638 PMCID: PMC5553021 DOI: 10.5395/rde.2017.42.3.216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/27/2017] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The aim of this study was to compare the mechanical properties of various nickel-titanium (NiTi) files with similar tapers and cross-sectional areas depending on whether they were surface-treated. MATERIALS AND METHODS Three NiTi file systems with a similar convex triangular cross-section and the same ISO #25 tip size were selected for this study: G6 (G6), ProTaper Universal (PTU), and Dia-PT (DPT). To test torsional resistance, 5 mm of the straightened file's tip was fixed between polycarbonate blocks (n = 15/group) and continuous clockwise rotation until fracture was conducted using a customized device. To evaluate cyclic fatigue resistance, files were rotated in an artificial curved canal until fracture in a dynamic mode (n = 15/group). The torsional data were analyzed using 1-way analysis of variance and the Tukey post-hoc comparison test, while the cyclic fatigue data were analyzed using the Mann-Whitney U test at a significance level of 95%. RESULTS PTU showed significantly greater toughness, followed by DPT and G6 (p < 0.05). G6 showed the lowest resistance in ultimate torsional strength, while it showed a higher fracture angle than the other files (p < 0.05). In the cyclic fatigue test, DPT showed a significantly higher number of cycles to failure than PTU or G6 (p < 0.05). CONCLUSIONS Within the limitations of this study, it can be concluded that the torsional resistance of NiTi files was affected by the cross-sectional area, while the cyclic fatigue resistance of NiTi files was influenced by the surface treatment.
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Affiliation(s)
- Sang Won Kwak
- Department of Conservative Dentistry, Pusan National University School of Dentistry and Dental Research Institute, Yangsan, Korea
| | - Joo Yeong Lee
- Department of Conservative Dentistry, Pusan National University School of Dentistry and Dental Research Institute, Yangsan, Korea
| | - Hye-Jin Goo
- Department of Conservative Dentistry, Pusan National University School of Dentistry and Dental Research Institute, Yangsan, Korea
| | - Hyeon-Cheol Kim
- Department of Conservative Dentistry, Pusan National University School of Dentistry and Dental Research Institute, Yangsan, Korea
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Ramos Brito AC, Verner FS, Junqueira RB, Yamasaki MC, Queiroz PM, Freitas DQ, Oliveira-Santos C. Detection of Fractured Endodontic Instruments in Root Canals: Comparison between Different Digital Radiography Systems and Cone-beam Computed Tomography. J Endod 2017; 43:544-549. [PMID: 28216273 DOI: 10.1016/j.joen.2016.11.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/13/2016] [Accepted: 11/17/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION This study compared the detection of fractured instruments in root canals with and without filling by periapical radiographs from 3 digital systems and cone-beam computed tomographic (CBCT) images with different resolutions. METHODS Thirty-one human molars (80 canals) were used. Root canals were divided into the following groups: the control group, without fillings; the fracture group, without fillings and with fractured files; the fill group, filled; and the fill/fracture group, filled and with fractured files. Digital radiographs in ortho-, mesio-, and distoradial directions were performed in 2 semidirect systems (VistaScan [Dürr Dental, Beitigheim-Bissinger, Germany] and Express [Instrumentarium Imaging, Tuusula, Finland]) and a direct system (SnapShot [Instrumentarium Imaging]). CBCT images were acquired with 0.085-mm and 0.2-mm voxel sizes. All images were assessed and reassessed by 4 observers for the presence or absence of fractured files on a 5-point scale. The sensitivity, specificity, and accuracy were calculated. RESULTS In the absence of filling, accuracy values were high, and there were no statistical differences among the radiographic techniques, different digital systems, or the different CBCT voxels sizes. In the presence of filling, the accuracy of periapical radiographs was significantly higher than CBCT images. In general, SnapShot showed higher accuracy than VistaScan and Express. CONCLUSIONS Periapical radiographs in 1 incidence were accurate for the detection of fractured endodontic instruments inside the root canal in the absence or presence of filling, suggesting that this technique should be the first choice as well as the direct digital radiographic system. In the presence of filling, the decision to perform a CBCT examination must take into consideration its low accuracy.
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Affiliation(s)
- Ana Caroline Ramos Brito
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil.
| | - Francielle Silvestre Verner
- Division of Oral Radiology, Department of Dentistry, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Rafael Binato Junqueira
- Division of Endodontics, Department of Dentistry, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Mayra Cristina Yamasaki
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Polyane Mazucato Queiroz
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Deborah Queiroz Freitas
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Christiano Oliveira-Santos
- Division of Oral Radiology, Department of Stomatology, Public Health and Forensic Dentistry, Ribeirão Preto Dental School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Abstract
This article provides an overview of some of the issues in the assessment and management of endodontic patients which may lead to dento-legal problems. It covers assessment, the appropriate use of radiographs, special tests and the importance of following the correct consent process. It outlines why record-keeping is particularly important, and looks at problems that occur, such as perforation, fractured instruments and hypochlorite accidents.
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Affiliation(s)
- Shreeti Patel
- Practice limited to Endodontics, Dento-legal Adviser, Dental Protection, London, UK
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Lin C, Xu L, Chen YX, Liang Y, Chen XL, Lin Y, Huang XQ, Fang Y, Chen Z. A statistical model for predicting the retrieval rate of separated instruments and clinical decision-making. J Dent Sci 2015. [DOI: 10.1016/j.jds.2015.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Tang WR, Smales RJ, Chen HF, Guo XY, Si HY, Gao LM, Zhou WB, Wu YN. Prevention and management of fractured instruments in endodontic treatment. World J Surg Proced 2015; 5:82-98. [DOI: 10.5412/wjsp.v5.i1.82] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/12/2014] [Accepted: 01/12/2015] [Indexed: 02/06/2023] Open
Abstract
Intracanal instrument fracture is an unpredictable and problematic occurrence that can prevent adequate cleaning and shaping procedures and influence the prognosis of endodontic treatment. The prevalence of instrument fracture is reported to range between 0.28% and 16.2%. This article presents an overview of the prevention and management of instruments fractured during endodontic therapy on the basis of literature retrieved from PubMed and selected journal searches. Instrument fracture occurs because of reduced metal fatigue and/or torsional resistance. The reasons include canal morphology and curvature, manufacturing processes and instrument design, instrument use times and technique, rotational speeds and operator experience. With the development of various equipment and techniques, most of the retained instrument separations can be removed safely. However, in canals without associated periapical disease not every fractured separation should be removed from difficult locations because of the increased risk for root perforation and fracture. In difficult cases, either retain or bypass the fragment in the root canal and ensure regular follow-up reviews. Fractured instruments retained in the presence of periapical disease reduce significantly the prognosis of endodontically treated teeth, indicating a greater need to attempt the removal or bypass of the file separations. Apical surgery might be required in some instances, emphasizing the importance of preventing instrument fracture.
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Wefelmeier M, Eveslage M, Bürklein S, Ott K, Kaup M. Removing fractured endodontic instruments with a modified tube technique using a light-curing composite. J Endod 2015; 41:733-6. [PMID: 25747379 DOI: 10.1016/j.joen.2015.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 01/16/2015] [Accepted: 01/19/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The aim of this in vitro study was to assess an alternative method using light-curing composite for removing fractured endodontic instruments with a tube technique. METHODS Two different stainless steel endodontic instruments (ISO 20: Hedstrom files, K-files; VDW, Munich, Germany) were cut at the diameter of 0.4 mm. These fragments were fixed in a vise leaving a free end of 1 or 2 mm. Cyanoacrylate (Instant Fix; Henry Schein Dental, Melville, NY), dual-curing Rebilda DC (VOCO, Cuxhaven, Germany), and light-curing SureFil SDR (Dentsply, York, PA) were placed into microtubes (N'Durance Syringe Tips; Septodont, Saint-Maur, France) and shifted over the instruments (n = 20 in each group). After polymerization, pull-out tests were performed with a constant speed of 2 mm/min; failure load was measured digitally. Data were analyzed using the Kruskal-Wallis test followed by the Dunn test for pairwise comparison. RESULTS The median failure load was up to 62.5 N for SDR, 35.8 N for Rebilda, and 14.7 N for cyanoacrylate, respectively. Both tested composites yielded significantly higher values in pull-out tests than cyanoacrylate. The disconnecting force was highest when light-cured composite SDR was used for fixation. Removing Hedstrom files resulted in higher values than removing K-files. The median force when using SDR was 79.7 N (interquartile range, 66.0-86.8 N) in Hedstrom files and 53.3 N (interquartile range, 47.1-58.5 N) in K-files. CONCLUSIONS Within the limitations of this study, the use of light-curing composite inside of the microtube was superior compared with the use of cyanoacrylate or chemically cured composite, which are being used presently.
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Affiliation(s)
- Michael Wefelmeier
- Department of Operative Dentistry, Universitätsklinikum Münster, Münster, Germany.
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, Münster, Germany
| | - Sebastian Bürklein
- Institute of Biostatistics and Clinical Research, Münster, Germany; Central Interdisciplinary Ambulance in the School of Dentistry, Universitätsklinikum Münster, Münster, Germany
| | - Klaus Ott
- Department of Operative Dentistry, Universitätsklinikum Münster, Münster, Germany
| | - Markus Kaup
- Department of Operative Dentistry, Universitätsklinikum Münster, Münster, Germany
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Monteiro JCDC, Kuga MC, Dantas AAR, Jordão-Basso KCF, Keine KC, Ruchaya PJ, Faria G, Leonardo RDT. A method for retrieving endodontic or atypical nonendodontic separated instruments from the root canal: a report of two cases. J Contemp Dent Pract 2014; 15:770-4. [PMID: 25825106 DOI: 10.5005/jp-journals-10024-1615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIM This clinical report presents a new method for retrieving separated instruments from the root canal with minimally invasive procedures. BACKGROUND The presence of separated instrument in root canal may interfere in the endodontic treatment prognosis. There are several recommended methods to retrieve separated instruments, but some are difficult in clinically practice. CASE REPORT This study describes two cases of separated instrument removal from the root canal using a stainless-steel prepared needle associated with a K-file. Case 1 presented a fractured gutta-percha condenser within the mandibular second premolar, it was separated during incorrect intracanal medication calcium hydroxide placement. Case 2 had a fractured sewing needle within the upper central incisor that the patient used to remove food debris from the root canal. After cervical preparation, the fractured instruments were fitted inside a prepared needle and then an endodontic instrument (#25 K-file) was adapted with clockwise turning motion between the needle inner wall and the fragment. CONCLUSION The endodontic or atypical nonendodontic separated instrument may be easily pull on of the root canal using a single and low cost device. CLINICAL SIGNIFICANCE The methods for retrieving separated instruments from root canal are difficult and destructive procedures. The present case describes a simple method to solve this problem.
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Affiliation(s)
| | - Milton Carlos Kuga
- Associate Professor, Faculdade de Odontologia de Araraquara, FOAr-UNESP, Departamento de Odontologia Restauradora - 3°andar. Rua Humaitá 1680 Centro CEP 14801-903, Araraquara São Paulo, Brazil, e-mail:
| | - Andrea Abi Rached Dantas
- Professor, Department of Restorative Dentistry, Araraquara Dental School, UNESP-Univ Estadual Paulista, Araraquara, SãoPaulo, Brazil
| | | | - Katia Cristina Keine
- Postgraduate Student, Department of Restorative Dentistry, Araraquara Dental School, UNESP-Univ Estadual Paulista, Araraquara, SãoPaulo, Brazil
| | - Prashant Jay Ruchaya
- Postdoctoral Student, Department of Physiology and Pathology, Araraquara Dental School, UNESP-Univ Estadual Paulista, Araraquara, São Paulo, Brazil
| | - Gisele Faria
- Professor, Department of Restorative Dentistry, Araraquara Dental School, UNESP-Univ Estadual Paulista, Araraquara, São Paulo, Brazil
| | - Renato de Toledo Leonardo
- Associate Professor, Department of Restorative Dentistry, Araraquara Dental School, UNESP-Univ Estadual Paulista, Araraquara, São Paulo, Brazil
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Wang NN, Ge JY, Xie SJ, Chen G, Zhu M. Analysis of Mtwo Rotary Instrument Separation During Endodontic Therapy: A Retrospective Clinical Study. Cell Biochem Biophys 2014; 70:1091-5. [DOI: 10.1007/s12013-014-0027-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Outcome of endodontic treatments made by postgraduate students in the dental clinic of bretonneau hospital. Int J Dent 2014; 2014:684979. [PMID: 24778652 PMCID: PMC3979070 DOI: 10.1155/2014/684979] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/20/2014] [Accepted: 01/21/2014] [Indexed: 11/17/2022] Open
Abstract
Objective. The objective of this retrospective study is double: (1) to assess the 1–4 years of outcome of endodontic treatment performed by postgraduate students in endodontics in the Dental Clinic of Bretonneau Hospital and (2) to examine outcome predictors. Method. 363 teeth in 296 patients were treated between 2007 and 2011. 183 patients (224 teeth) were lost during the followup. 113 patients were included in the study (recall: 38%), corresponding to 139 teeth of which 8 were extracted. 131 remaining teeth (36%) were examined clinically and radiographically. Apical periodontitis (AP) was absent (PAI = 1) or present (PAI ≥ 2). Outcome was classified as “healed,” “healing,” or “diseased”. Results. The success rate was 92%. No failure was observed among the 23 initial endodontic treatments. Among the 108 retreated teeth, 80% were “healed” and 11% were “healing.” An association was found between success rate and preoperative signs or symptoms (absent 95% versus present 83%), preoperative root filling density (inadequate 93% versus adequate 57%), but not between preoperative AP status and success. Conclusion. Outcomes in this retrospective study were similar to those previously reported. However, a larger sample size is needed to assess outcome predictors more precisely.
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