Scanning electron microscopy of superficial defects in Twisted files and Reciproc nickel-titanium files after use in extracted molars

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.

In vitro study of structural and chemical changes in two reciprocating files after multiple reuses and sterilisation

To use scanning electron microscopy and energy dispersive X-ray spectroscopy to evaluate the metallurgical-chemical changes of WaveOne Gold (WOG) and R-Motion (RM), after multiple uses. The instruments were divided into groups (n = 8): WOG and RM-control groups, new instruments; WOG1 and RM1; WOG2 and RM2; WOG3 and RM3 after instrumentation of 1, 2 or 3 molars, respectively. Burrs occurred mainly in the control group and after the first use. The RM files were found to have a higher nickel content, which increased during reuse, and a decrease in oxygen content with increasing reuse, in addition to calcium impregnation, which occurred in greater amounts in the corrosion areas in the WOG files. The presence of topographic and chemical changes was demonstrated, indicating that caution should be taken when reusing endodontic instruments to avoid fractures.

A Novel Technique for Identification of Wear Values at Different Lengths after Multiple Clinical Use of Different File Systems

Introduction The purpose of this research is to assess the wearing of the rotary file system (Protaper Next) and reciprocating file systems (Reciproc Blue and WaveOne Gold) at different lengths using a novel technique after in vivo clinical use. Materials and Methods Twelve different unused samples from each brand were accepted as reference values. For three different brands, the diameters of the files were measured by taking 12 samples used once, 12 samples used twice, and 12 samples used three times. Images were taken with a USB Micron Microscope, and file diameters were measured by determining limit values with Autocad. Result Reciproc Blue system was the most worn at apical 1 mm, and WaveOne Gold system was the most worn at apical 3 mm. PTN system exhibited the least wearing at any length. Moreover, less wearing was observed in the rotation motion than in the reciprocating motion. Conclusion In clinical practice, for the guttapercha to be fully adapted to the apical construction prepared according to the determined WL, the file should not undergo any wearing and volume reduction. Wearing—especially in the apical parts of the file—causes less preparation, and this situation could lead to apically obturation failure.

Dentinal microcracks induced by endodontic procedures: A scientometric and bibliometric analysis

Background

Due to the large number of publications relating the occurrence of dental microcracks to endodontic procedures, this bibliometric study evaluated the scientific pattern and trends in literature and provided an overview of scientific production in this context.

Aim

To analyze, quantify, and characterize the scientific production and trends of published articles evaluating dentinal microcracks formation after endodontic treatment procedures between 2010 and 2020 using bibliometric indicators.

Materials and Methods

Published articles were found by the search in the Medline (PubMed) and Scopus database using the combination of the following keywords: Dentinal crack OR Dentinal Microcrack OR Crack formation OR Dentin Defect AND Endodontic treatment OR Root canal preparation OR Canal Preparation OR Root canal treatment OR endodontic procedures. The search was also conducted in the Journal of Endodontics and International Endodontic Journal. After inclusion and exclusion criteria application, data from all studies included were collected.

Results

Among the 556 results after the search, 45 studies were included and analyzed in this bibliometry. No trend was observed in terms of the increasing number of articles over time. Most of them used an in vitro design, compared the effect of different endodontic techniques/systems for root canal instrumentation on dentinal microcracks formation, and were conducted in Turkey, Brazil, and India. Journal of Endodontics and International Endodontic Journal were the main journals with a higher number of articles published. Interestingly, studies conducted with some funding did not lead to higher citation numbers. Moreover, a relevant proportion of studies did not consider the inclusion of control groups, baseline evaluation, or statistical analysis. Micro-CT was the main technique used to evaluate microcrack presence.

Conclusion

Microcrack formation after the use of different endodontic techniques/systems has been constantly evaluated in the literature. There is a pattern of methodologies used, which may explain the concentration of these studies in specific journals and countries.

PRILE 2021 guidelines for reporting laboratory studies in Endodontology: explanation and elaboration

Guidance to authors is needed to prevent their waste of talent, time and resources in writing manuscripts that will never be published in the highest-quality journals. Laboratory studies are probably the most common type of endodontic research projects because they make up the majority of manuscripts submitted for publication. Unfortunately, most of these manuscripts fail the peer-review process, primarily due to critical flaws in the reporting of the methods and results. Here, in order to guide authors, the Preferred Reporting Items for study Designs in Endodontology (PRIDE) team developed new reporting guidelines for laboratory-based studies: the Preferred Reporting Items for Laboratory studies in Endodontology (PRILE) 2021 guidelines. The PRILE 2021 guidelines were developed exclusively for the area of Endodontology by integrating and adapting the modified CONSORT checklist of items for reporting in vitro studies of dental materials and the Clinical and Laboratory Images in Publications (CLIP) principles. The process of developing the PRILE 2021 guidelines followed the recommendations of the Guidance for Developers of Health Research Reporting Guidelines. The aim of the current document is to provide authors with an explanation for each of the items in the PRILE 2021 checklist and flowchart with examples from the literature, and to provide advice from peer-reviewers and editors about how to solve each problem in manuscripts prior to their peer-review. The Preferred Reporting Items for study Designs in Endodontology (PRIDE) website (http://pride-endodonticguidelines.org/prile/) provides a link to the PRILE 2021 explanation and elaboration document as well as to the checklist and flowchart.

Impact of Endodontic Instrumentation on Surface Roughness of Various Nickel-Titanium Rotary Files

OBJECTIVES

 The aim of the present study was to evaluate the surface roughness (SR) of various nickel-titanium (NiTi) rotary endodontic instruments (ProTaper Next [PTN], WaveOne Gold [WOG], and ProTaper Gold [PTG]) before and after root canal instrumentation.

MATERIALS AND METHODS

 For each type (PTN, WOG, and PTG), the endodontic instrumentation was performed using extracted mandibular molar teeth's curved mesial root canals (curvature: 20-40 degrees) after determining the working length. Each NiTi file was cleaned, and sterilized following preparation of four root canals and characterized for surface properties before and after endodontic instrumentation using a contact-mode three-dimensional surface profiler. The data were analyzed statistically using Statistical Package for the Social Sciences for SR parameters including average surface roughness value (Sa), root mean square roughness (Sq), and peak to valley height (Sz).

RESULTS

 Preinstrumentation assessment revealed a significant difference for all the three SR variables (p < 0.05) for the cutting blade and the flute area. WOG instruments showed the highest SR values (p = 0.000). The postinstrumentation assessment revealed significant differences in SR values in the blade and the flute between the three groups (p < 0.05), with WOG and PTG exhibiting the highest values in the blade and flute sections, respectively.

CONCLUSIONS

 The SR parameters of intact PTN, WOG, and PTG NiTi files vary and that was increased following the endodontic instrumentation.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Effects of clinical use of NiTi reciprocating instruments on cyclic and torsional resistance, and on roughness

The aim of the present study was to evaluate the cyclic fatigue, torsional resistance and surface roughness of Reciproc R25 instruments in four different situations, namely as new instruments and as instruments tested after clinical preparation of one, two or three maxillary molars with four root canals. The total time required to perform each root canal preparation was recorded. Cyclic fatigue resistance was determined by the time to fracture using a customized testing device (n = 10 per group). The torsional test evaluated the torque and angle of rotation to failure according to ISO 3630-1 (n = 10 per group). The roughness of the working parts of new and used instruments was evaluated with a profilometer (n = 5 per group). Statistical analysis was performed using one-way ANOVA and Tukey's test. The level of significance was set at 5%. No fractures or deformations were observed after clinical use. Higher preparation time was needed during the third use of the instruments for all root canals (p < 0.05). There were no significant differences among the groups in regard to either cyclic fatigue or torsional resistance (p > 0.05). Regarding the roughness measurements, groove depth was higher on new and one- versus two- or three-maxillary-molar-prepared instruments (p < 0.05). It can be concluded that the clinical use of Reciproc instruments increased preparation time and decreased surface roughness. However, clinical use did not affect the cyclic fatigue or torsional resistance of the Reciproc instruments.

Surface deformation of several nickel-titanium rotary instruments after removal of the root canal filling materials: a scanning electron microscope evaluation

The aim of the present study was to investigate and compare the surface deformations of different NiTi rotary files after retreatment under scanning electron microscope (SEM). A total of 240 upper central incisor teeth were obturated with vertical compaction technique and divided into 6 groups. Root canals were retreated by ProTaper Next (PTN), Twisted File Adaptive (TFA), Reciproc (RPC), ProTaper Universal Retreatment (PTR), R-Endo and Mtwo-R NiTi rotary systems. The files investigated under SEM at different magnifications and photomicrographs were captured. The photomicrographs were classified and scored. Kruskal-Wallis and Dunn tests were performed for statistical analyze at 5% significance level. PTR and RPC groups were free of defects like file separation, curving and unwinding but PTN and TFA groups showed 50% file separation. According to the photomicrographs that were captured at high magnification; there were no statistically difference between groups at the coronal thirds of the files (P > 0.05), at the middle third PTN and TFA groups showed statistically more deformation than the other groups (P < 0.05). At the apical third Reciproc was statistically showed less deformation than the other all groups (P < 0.05). Within the limitation of this in vitro study, all NiTi files showed surface deformation in SEM observation after retreatment procedures. There was less deformation in PTR and RPC groups according to other.

Shaping effectiveness and surface topography of reciprocating files after multiple simulated uses

This in vitro study assessed morphological changes and efficiency of reciprocating files after multiple uses. Sixty standardized Endo Training Blocks and 10 ReciprocR25 files were selected (six blocks for each file). Each file was its own control (before use vs. after each instrumentation). The instruments were used according to the manufacturer's instructions, and scanning electron microscopy was used to observe fatigue cracks, metal strips/metal flash, pitting, fretting, debris, disruption of the cutting edge, and plastic deformations after each instrumentation. The presence of seven wear variables was scored semiquantitatively by viewing micrographs collected before and after use. The prepared areas in resin blocks were calculated and compared by using AutoCAD software. The control group had significantly lower values for all wear variables except fretting and plastic deformation. The presence of fatigue cracks and metal strips/metal flash significantly differed between unused instruments and instruments used four or five times, in all observed sections. The area of instrumented Endo Training Blocks significantly differed in relation to the number of instrument uses. The Reciproc files wore progressively, and repeated use affected their shaping efficiency in simulated canals.

Fracture incidence of instruments from a single-file reciprocating system by students in an endodontic graduate programme: a cross-sectional retrospective study

AIM

To assess the fracture incidence of instruments from single-file reciprocating systems when used by students in an endodontic graduate programme.

METHODOLOGY

Dental records and periapical radiographs of patients treated by students on an endodontic graduate programme using reciprocating systems were assessed. Data on tooth type, number of treated root canals, number of fractured instruments, fragment size, angle, radius, arc length and position of root canal curvature where fractures occurred were tabulated for analysis. The risk of fracture was calculated for each group of teeth, root canal and root thirds, whilst the incidence of fractures reported for the reciprocating systems was compared using the chi-squared test at 5% significance level.

RESULTS

Overall, 2056 root canals (826 teeth) from 810 patients were included. The incidence of fractured files from single-file reciprocating systems in relation to a number of instrumented canals was 0.92%. Fracture rates of 0.84% and 0.93% were found in 830 and 1226 root canals instrumented with WaveOne and Reciproc systems, respectively. No significant differences were observed between the systems. The highest fracture rate was 52.6% in the mesiobuccal root of mandibular molars. The central angle, radius and arc length of the curvature of root canals where the instruments fractured ranged from 58° to 84°, from 1.7 to 7.2 mm and from 2.4 to 7.6 mm, respectively.

CONCLUSION

The use of WaveOne and Reciproc single-file reciprocating systems in an endodontic graduate programme was associated with a low incidence of instrument fractures.

Topographic and Chemical Analysis of Reciprocating and Rotary Instruments Surface after Continuous Use

This study aimed at evaluating the changes in surface characteristics and NiTi content of reciprocating and rotary instruments after continuous use. Thirty brand-new instruments were assigned to 3 groups (n=10): PNX1 Group - ProTaper Next system - instrument X1; PNX2 Group - ProTaper Next system - instrument X2 and WO Group - WaveOne system - Primary instrument 25.08. The instruments were used to prepare 60 simulated root canals. Analysis of surface characteristics by scanning electron microscopy (SEM) and chemical analysis of Ni and Ti content by energy-dispersive spectroscopy (EDS) were performed before and after the first and third use of the instruments. Only WO Group had significant increase in the quantity of defects and deformations after the third use (p<0.05). PNX1 Group had significant decrease in Ni content after the third use, in comparison with the unused instruments (p<0.05). PNX1 Group had no decrease in Ti content throughout the time of use (p>0.05), however, in PNX2 Group, there was significant decrease in the different time interval of analysis (p<0.05). Continuous use promoted increase in defects and deformations only for WaveOne instruments. Chemical composition presented significant changes according to the time of instruments use.

The effect of root canal preparation on the surface roughness of WaveOne and WaveOne Gold files: atomic force microscopy study

Objectives

To examine the surface topography of intact WaveOne (WO; Dentsply Sirona Endodontics) and WaveOne Gold (WOG; Dentsply Sirona Endodontics) nickel-titanium rotary files and to evaluate the presence of alterations to the surface topography after root canal preparations of severely curved root canals in molar teeth.

Materials and Methods

Forty-eight severely curved canals of extracted molar teeth were divided into 2 groups (n = 24/each group). In group 1, the canals were prepared using WO and in group 2, the canals were prepared using WOG files. After the preparation of 3 root canals, instruments were subjected to atomic force microscopy analysis. Average roughness and root mean square values were chosen to investigate the surface features of endodontic files. The data was analyzed using one-way analysis of variance and post hoc Tamhane's tests at 5% significant level.

Results

The surface roughness values of WO and WOG files significantly changed after use in root canals (p < 0.05). The used WOG files exhibited higher surface roughness change when compared with the used WO files (p < 0.05).

Conclusions

Using WO and WOG Primary files in 3 root canals affected the surface topography of the files. After being used in root canals, the WOG files showed a higher level of surface porosity value than the WO files.

Comparative Evaluation of the Effect of Manufacturing Process on Distortion of Rotary ProFile and Twisted File: An in Vitro SEM Study

Background and aims. The manufacturing process of rotary Ni-Ti file can influence its resistance to fracture. The rotary ProFile (Dentsply-Maillefer, Baillagues, Switzerland) is manufactured by grinding mechanism whereas Twisted File (Sy-bron Endo, USA) is manufactured with a twisting method. The purpose of this study was to comparatively evaluate the effect of manufacturing process on distortion of rotary ProFile and Twisted files using scanning electron microscopy after in vitro use.

Materials and methods. Five sets of each type of file were used for this study -rotary ProFile (group A) and Twisted file (group B). Each set was used according to manufacturer’s instructions to prepare 5 mesial canals of extracted mandibular molars. The changes in files were observed under a scanning electron microscope at ×18, ×100, ×250 and ×500 magnifications. Observations were classified as intact with no discernible distortion, intact but with unwinding, and fractured. Group A and B were then compared for deformation and fracture using two-proportion z-test.

Results. On SEM observation, used rotary ProFile showed microfractures along the machining grooves whereas Twisted file showed crack propagation that was perpendicular to the machining marks. On statistical analysis, no significant difference was found between ProFile and Twisted file for deformation (P=0.642) and fracture (P=0.475).

Conclusion. Within the experimental protocol of this study, it was concluded that both ProFile and Twisted files exhibited visible sign of distortion before fracture. But Twisted file gained edge over ProFile because of its manufacture design and unparalleled resistance to breakage.