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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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Martins JNR, Silva EJNL, Marques D, Pinto R, Francisco H, Ajuz N, Rito Pereira M, Braz Fernandes FM, Versiani MA. Characterization of four heat-treated reciprocating instruments: Design, metallurgy, mechanical performance, and irrigation flow patterns. Int Endod J 2023; 56:1412-1428. [PMID: 37698946 DOI: 10.1111/iej.13971] [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: 07/21/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/14/2023]
Abstract
AIM To compare the design, metallurgy, and mechanical properties of four heat-treated reciprocating instruments coupled with the evaluation of the irrigation flow using an in silico model. METHODOLOGY New EdgeOne Fire Primary, Easy-File Flex Regular 25, WaveOne Gold Primary and Reciproc Blue R25 instruments (n = 124) were initially evaluated regarding their design through stereomicroscopy, scanning electron microscopy and 3D surface scanning. In addition, energy-dispersive X-ray spectroscopy was utilized to determine their elemental composition, and differential scanning calorimetry tests to evaluate their phase transformation temperatures. Their mechanical performance was further assessed through torsional and bending tests. Using scans obtained from a real tooth and the instruments, a computational fluid dynamics assessment was conducted to determine the irrigation flow pattern, apical pressure, and wall shear stress in simulated canal preparation. Mood's median and One-way anova post hoc Tukey tests were used for statistical comparisons (α = 5%). RESULTS Reciproc Blue exhibited a superior number of blades (n = 8), whereas EdgeOne Fire had the highest overall volume (4.38 mm3 ) and surface area (32.32 mm2 ). At the 3-mm axial level, EdgeOne Fire displayed the lowest core diameter (0.13 mm), while Reciproc Blue had the highest (0.16 mm). All blades were symmetrical, and the tips of the instruments were non-active but differed from each other. The most irregular surfaces were observed in EdgeOne Fire and Easy-File Flex. All instruments were manufactured from nickel-titanium alloys and exhibited distinct phase transformation temperatures. WaveOne Gold and Reciproc Blue demonstrated the highest maximum torque values (1.87 and 1.62 N cm, respectively), while the lowest was observed on EdgeOne Fire (1.21 N cm) (p < .05). The most flexible (p < .05) were EdgeOne Fire (angle of rotation: 602.6°; maximum bending load: 251.4 g.f) and Reciproc Blue (533.2° and 235.6 g.f). There were no significant differences observed in the irrigation flow among the four domains generated by the tested instruments. CONCLUSIONS Despite observing variations in the design, phase transformation temperatures, and in the torsional and bending test outcomes among the four heat-treated reciprocating instruments, no significant differences were found in the irrigation flow pattern among the different groups in the simulated root canal preparations.
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Affiliation(s)
- Jorge N R Martins
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Grupo de Investigação em Bioquimica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE)-Cochrane Portugal, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Implantologia, Lisboa, Portugal
| | - Emmanuel João Nogueira Leal Silva
- School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil
- Fluminense Federal University, Rio de Janeiro, Brazil
| | - Duarte Marques
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Grupo de Investigação em Bioquimica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE)-Cochrane Portugal, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Implantologia, Lisboa, Portugal
- LIBPhys-FCT UID/FIS/04559/2013, Lisboa, Portugal
| | - Ricardo Pinto
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Grupo de Investigação em Bioquimica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Implantologia, Lisboa, Portugal
| | - Helena Francisco
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Implantologia, Lisboa, Portugal
- Grupo de Investigação Implantologia e Regeneração Óssea (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
| | - Natasha Ajuz
- School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil
| | - Mário Rito Pereira
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
| | - Francisco Manuel Braz Fernandes
- CENIMAT/I3N, Department of Materials Science, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
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Li Y, Wang Z, Bao P, Meng T, Liu M, Li H, Shen Y, Liu D, Jia Z, Liu H. Cleaning and Disinfecting Oval-Shaped Root Canals: Ex Vivo Evaluation of Three Rotary Instrumentation Systems with Passive Ultrasonic Irrigation. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050962. [PMID: 37241194 DOI: 10.3390/medicina59050962] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Successful root canal treatment depends on the thorough removal of biofilms through chemomechanical preparation. This study aimed to investigate and compare the cleaning and disinfecting efficiency of oval-shaped root canals using XP-endo Shaper (XPS), ProTaper Next (PTN), and HyFlex CM (HCM) in combination with passive ultrasonic irrigation (PUI). Materials and Methods: Ninety extracted teeth were contaminated and randomly divided into three groups: XPS, PTN, and HCM. Each group was assigned to three subgroups: subgroup A (sterile saline), subgroup B (3% sodium hypochlorite and 17% ethylenediaminetetraacetic acid), and subgroup C (3% sodium hypochlorite, 17% ethylenediaminetetraacetic acid, and PUI). Bacterial sampling was conducted both from baseline samples and samples after chemomechanical preparation. Scanning electron microscopy (SEM) was used to evaluate the residue bacterial biofilms, hard tissue debris, and smear layers on the buccolingual walls of oval-shaped root canals. Results: When combined with sterile saline, XPS demonstrated a higher reduction of bacterial counts and was more effective in eradicating Enterococcus faecalis in the middle third of the canals compared to the other instruments (p < 0.05). Additionally, when used with antimicrobial irrigants, XPS was more effective in disinfecting the coronal third of the canals than the other instruments (p < 0.05). Furthermore, XPS reduced hard tissue debris more effectively in the middle third of canals than in the apical third (p < 0.05). Conclusions: XPS outperforms PTN and HCM in disinfecting oval-shaped root canals. Despite the fact that combining XPS and PUI improves cleaning and disinfecting, removing hard tissue debris from the critical apical area remains challenging.
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Affiliation(s)
- Ying Li
- Department of Endodontics, Tianjin Stomatological Hospital, School of Medicine, NanKai University, Tianjin 300041, China
- Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin 300041, China
| | - Zhengyang Wang
- Department of Endodontics, School of Stomatology, Tianjin Medical University, Tianjin 300070, China
| | - Pingping Bao
- Department of Endodontics, Tianjin Stomatological Hospital, School of Medicine, NanKai University, Tianjin 300041, China
- Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin 300041, China
| | - Tingting Meng
- Department of Endodontics, Tianjin Stomatological Hospital, School of Medicine, NanKai University, Tianjin 300041, China
- Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin 300041, China
| | - Meng Liu
- Department of Endodontics, School of Stomatology, Tianjin Medical University, Tianjin 300070, China
| | - Huixu Li
- Department of Endodontics, Tianjin Stomatological Hospital, School of Medicine, NanKai University, Tianjin 300041, China
- Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin 300041, China
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Dayong Liu
- Department of Endodontics, School of Stomatology, Tianjin Medical University, Tianjin 300070, China
| | - Zhi Jia
- Department of Endodontics, School of Stomatology, Tianjin Medical University, Tianjin 300070, China
| | - He Liu
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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Martins JNR, Silva EJNL, Marques D, Ajuz N, Rito Pereira M, Pereira da Costa R, Braz Fernandes FM, Versiani MA. Characterization of the file-specific heat-treated ProTaper Ultimate rotary system. Int Endod J 2023; 56:530-542. [PMID: 36508297 DOI: 10.1111/iej.13880] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
AIM To compare design, metallurgy and mechanical performance of the ProTaper (PT) Ultimate system with instruments of similar dimensions from the ProGlider, PT Gold and PT Universal systems. METHODOLOGY New PT Ultimate instruments (n = 248) were compared with instruments of similar dimensions from ProGlider (n = 31), PT Gold (n = 155) and PT Universal (n = 155) systems regarding their number of spirals, helical angle, blade symmetry, tip geometry, surface finishing, nickel/titanium ratio, phase transformation temperatures and mechanical performance. One-way anova and nonparametric Mood's median tests were used for statistical comparison (α = 5%). RESULTS All instruments had symmetrical blades without radial lands or flat sides, similar surface finishing and an almost equiatomic nickel/titanium ratio, whilst the number of spirals, helical angles and the tip geometry were different. PT Ultimate instruments showed 3 distinct heat treatments that matched with the colour of their metal wire. Slider and ProGlider instruments had similar R-phase start (Rs) and R-phase finish (Rf) temperatures. SX, F1, F2, F3 and Shaper instruments showed equivalent heat treatments (Rs ~45.6°C and Rf ~28.3°C) that were similar to their PT Gold counterparts (Rs ~47.9°C and Rf ~28.2°C), but completely distinct to the PT Universal ones (Rs ~16.2°C and Rf ~-18.2°C). Amongst the PT Ultimate instruments, the lowest maximum torques were observed in the SX (0.44 N cm), Slider (0.45 N cm) and Shaper (0.60 N cm) instruments, whilst the highest was noted in the FXL (4.90 N cm). PT Ultimate Slider and ProGlider had similar torsional (~0.40 N cm) and bending loads (~145.0 gf) (p = 1.000), whilst the other PT Ultimate instruments showed statistically significantly lower maximum torque, higher angle of rotation and lower bending load (higher flexibility) than their counterparts of the PT Universal and PT Gold systems. CONCLUSIONS The PT Ultimate system comprises instruments with 3 distinct heat treatments that showed similar phase transformation temperatures to their heat-treated analogues. PT Ultimate instruments presented lower torsional strength and superior flexibility than their counterparts, whilst maximum torque, angle of rotation and bending loads progressively increased with their sizes.
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Affiliation(s)
- Jorge N R Martins
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal.,Grupo de Investigação em Bioquimica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal.,Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE) - Cochrane Portugal, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
| | - Emmanuel João Nogueira Leal Silva
- School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil.,Fluminense Federal University, Rio de Janeiro, Brazil
| | - Duarte Marques
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal.,Grupo de Investigação em Bioquimica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal.,Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE) - Cochrane Portugal, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal.,LIBPhys-FCT UID/FIS/04559/2013, Lisboa, Portugal
| | - Natasha Ajuz
- School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil
| | - Mário Rito Pereira
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
| | | | - Francisco Manuel Braz Fernandes
- CENIMAT/I3N, Department of Materials Science, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
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Silva EJNL, Martins JNR, Ajuz NC, Dos Santos Antunes H, Vieira VTL, Braz-Fernandes FM, Belladonna FG, Versiani MA. Design, metallurgy, mechanical properties, and shaping ability of 3 heat-treated reciprocating systems: a multimethod investigation. Clin Oral Investig 2023; 27:2427-2436. [PMID: 36749411 DOI: 10.1007/s00784-023-04899-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 02/01/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study aimed to compare 3 reciprocating systems regarding design, metallurgy, mechanical properties, and shaping ability. MATERIALS AND METHODS New Reciproc Blue R25, WaveOne Gold Primary, and REX 25 instruments (n=41 per group) were analyzed regarding design, metallurgy, and mechanical performance, while shaping ability (untouched canal walls, volume of removed dentin, and hard tissue debris) was tested in 36 anatomically matched root canals of mandibular molars. Results were compared using one-way ANOVA post hoc Tukey and Kruskal-Wallis tests with a significant level set at 5%. RESULTS All instruments showed symmetrical cross sections with asymmetrical blades, no radial lands, no major defects, and an almost equiatomic nickel and titanium ratio. The highest R-phase start temperatures were observed with WaveOne Gold (46.1°C) and REX (44.8°C), while Reciproc Blue had the lowest R-phase start (34.5°C) and finish (20°C) temperatures. WaveOne Gold had the lowest time to fracture (169 s) and the highest maximum load (301.6 gf) (P <0.05). The maximum torque of Reciproc Blue (2.2 N.cm) and WaveOne Gold (2.1 N.cm) were similar (P >0.05), but lower than REX (2.6 N.cm) (P <0.05). No statistical differences were observed among instruments in the angle of rotation (P >0.05) and in the shaping ability in both mesial and distal canals (P >0.05). CONCLUSION Although the overall design, temperature transition phases and mechanical behavior parameters were different among tested instruments, they were similar in terms of shaping ability. CLINICAL RELEVANCE All tested heat-treated NiTi reciprocating systems showed similar shaping ability, without clinically significant errors.
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Affiliation(s)
- Emmanuel J N L Silva
- Department of Endodontics, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil. .,Departament of Endodontics, Fluminense Federal University (UFF), Niterói, RJ, Brazil. .,Department of Endodontics, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, 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
| | - Natasha C Ajuz
- Department of Endodontics, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
| | | | | | - Francisco Manuel Braz-Fernandes
- CENIMAT/I3N, Department of Materials Science, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
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Jiang J, Sun J, Huang Z, Bi Z, Yu G, Yang J, Wang Y. The state of the art and future trends of root canal files from the perspective of patent analysis: a study design. Biomed Eng Online 2022; 21:90. [PMID: 36566212 PMCID: PMC9789667 DOI: 10.1186/s12938-022-01060-0] [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: 09/09/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022] Open
Abstract
The goal of this review is to present a detailed and comprehensive description of the published work from the past decade regarding methods of improved material, geometric design, and additional functions in root canal files. The main improved methods of files and the most common technologies were further addressed, underlining their advantages and main limitations. Online databases (the Derwent Innovations Index) were consulted on this topic. Published work from 2010 to 2022 was collected and analyzed the relevant papers were chosen for inclusion in this review. The patent map classified the latest phase of the root canal files based on the analysis of the number of patents. The performance of the root canal files, such as materials. Directly affects the quality of the root canal therapy. We provided a thorough review of advances in the field of root canal files. In particular, three categories of improved methods were examined and compared, including material-based methods, geometry-based methods, and those based on additional functions. To understand this state of the art of different improved methods of root canal files, we conducted a literature analysis and a series of comparisons between different methods. The features and limitations of each method of root canal files were further discussed. Finally, we identified promising research directions in advancing the methods for the improved performance of root canal files. There is no perfect technology for all material/geometric design/additional functions, capable alone of fulfilling all the specificity and necessities of every patient. Although it is very promising, the material of the files remains understudied, and further work is required to make material science a pervasive technology in root canal therapy, and contribute to endodontic and periapical diseases by assisting in the subsequent development of root canal files.
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Affiliation(s)
- Jingang Jiang
- grid.411994.00000 0000 8621 1394Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, 150080 Heilongjiang People’s Republic of China ,grid.19373.3f0000 0001 0193 3564State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, 150001 Heilongjiang People’s Republic of China
| | - Jianpeng Sun
- grid.411994.00000 0000 8621 1394Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, 150080 Heilongjiang People’s Republic of China
| | - Zhiyuan Huang
- grid.19373.3f0000 0001 0193 3564State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, 150001 Heilongjiang People’s Republic of China
| | - Zhuming Bi
- grid.503846.c0000 0000 8951 1659Department of Civil and Mechanical Engineering, Purdue University Fort Wayne, West Lafayette, 46805 USA
| | - Guang Yu
- grid.12527.330000 0001 0662 3178Department of Mechanical Engineering, Tsinghua University, Beijing, 100084 People’s Republic of China
| | - Jingwen Yang
- grid.11135.370000 0001 2256 9319National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School of Stomatology, Beijing, 100081 People’s Republic of China ,grid.11135.370000 0001 2256 9319Peking University School of Stomatology, Beijing, 100081 People’s Republic of China
| | - Yong Wang
- grid.11135.370000 0001 2256 9319National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School of Stomatology, Beijing, 100081 People’s Republic of China ,grid.11135.370000 0001 2256 9319Peking University School of Stomatology, Beijing, 100081 People’s Republic of China
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A Multimethod Assessment of a New Customized Heat-Treated Nickel-Titanium Rotary File System. MATERIALS 2022; 15:ma15155288. [PMID: 35955223 PMCID: PMC9369791 DOI: 10.3390/ma15155288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 02/06/2023]
Abstract
This study aimed to compare three endodontic rotary systems. The new Genius Proflex (25/0.04), Vortex Blue (25/0.04), and TruNatomy (26/0.04v) instruments (n = 41 per group) were analyzed regarding design, metallurgy, and mechanical performance, while shaping ability (untouched canal walls, volume of removed dentin and hard tissue debris) was tested in 36 anatomically matched root canals of mandibular molars. The results were compared using one-way ANOVA, post hoc Tukey, and Kruskal−Wallis tests, with a significance level set at 5%. All instruments showed symmetrical cross-sections, with asymmetrical blades, no radial lands, no major defects, and almost equiatomic nickel−titanium ratios. Differences were noted in the number of blades, helical angles, cross-sectional design, and tip geometry. The Genius Proflex and the TruNatomy instruments had the highest and lowest R-phase start and finish temperatures, as well as the highest and lowest time and cycles to fracture (p < 0.05), respectively. The TruNatomy had the highest flexibility (p < 0.05), while no differences were observed between the Genius Proflex and the Vortex Blue (p > 0.05). No differences among tested systems were observed regarding the maximum torque, angle of rotation prior to fracture, and shaping ability (p > 0.05). The instruments showed similarities and differences in their design, metallurgy, and mechanical properties. However, their shaping ability was similar, without any clinically significant errors. Understanding these characteristics may help clinicians to make decisions regarding which instrument to choose for a particular clinical situation.
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Uslu O, Haznedaroglu F, Keskin C. Comparison of mechanical resistance and standardisation between original brand and replica-like endodontic systems. AUST ENDOD J 2022; 49:149-158. [PMID: 35703893 DOI: 10.1111/aej.12639] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/11/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022]
Abstract
This study compared the original (ProTaper Next and Reciproc) endodontic systems with their replica-like brands (X File and Only One File) in terms of standardisation, design, phase-transformation behaviour, composition and mechanical behaviour. X File showed greater taper values than ProTaper Next, while Only One File had the greatest tip diameter. Both replica-like files had an active tip and greater dimensions than their reports. There were also significant differences between the original and replica-like systems in terms of their phase-transformation behaviour and the precision of the measurement lines. Only One File showed significantly lower cyclic fatigue and torsional resistance than Reciproc (p < 0.05). There were no significant differences in the cyclic fatigue, torsional resistance and composition of NiTi between X File and ProTaper Next (p > 0.05). Although replica systems show mechanical properties that can be acceptable, they are not consistent in terms of standardisation and design.
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Affiliation(s)
- Orkun Uslu
- Department of Endodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey.,Institute of Graduate Studies in Health Sciences, Istanbul University, Istanbul, Turkey
| | - Faruk Haznedaroglu
- Department of Endodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Cangül Keskin
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey
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What meaningful information are the instruments mechanical testing giving us? A comprehensive review. J Endod 2022; 48:985-1004. [PMID: 35667567 DOI: 10.1016/j.joen.2022.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/21/2022] [Accepted: 05/26/2022] [Indexed: 11/22/2022]
Abstract
Instruments mechanical strength and flexibility are traditionally tested by running cyclic fatigue, torsional, bending, buckling and microhardness tests. Several cyclic fatigue test models have been used in endodontics, all capable of providing a curved trajectory for the instrument to rotate. The cyclic fatigue testing allowed to identify conditions that may affect the fatigue strength outcomes, such as canal radius and degree of curvature, handpiece static vs dynamic motions, test temperature, kinematics, instrument previously wear and sterilization cycles, or instrument's size and metal alloy features. Due to the international test specifications for both torsional and bending tests, the variations of their models are not as many as for cyclic fatigue. These tests have also identified conditions capable of affecting the outcomes, such as kinematics, instrument's preloading, cross-sectional diameters, or alloy heat treatments. Buckling and microhardness are less common, with the metal alloy being considered to have a major influence on the results. Instruments mechanical testing, having all these individual conditions as independent variables, allowed to understand them and moulded the way the technical procedures are performed clinically. Even though the artificiality and simplicity of these tests will hardly mimic real working situations, and independently of being capable of producing cornerstone knowledge, these tests are also associated with inconsistency, lack of reproducibility and low external validity. Several attempts have been made to increase the generalizability of the outcomes by adding test settings that intend to mimic the clinical condition. Although pertinent, these settings may also add variabilities inherent to their concepts and practical applications in the laboratory environment. Although the actual studies should be seen as laboratory mechanical tests that measure very specific parameters under very particular conditions and that by far do not mimic the clinical condition, the lower validity drawback seems to be possible to be minimized when achieving a comprehensive understanding of the instrument behaviour. A Finite Elements Method and/or a multimethod research approach may lead to superior data collection, analysis, and results' interpretation, which when associated with a reliable confounding factors control and proper study designs may be helpful tools and strategies in order to increase the reliability of the outcomes.
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Multimethod Assessment of Design, Metallurgical, and Mechanical Characteristics of Original and Counterfeit ProGlider Instruments. MATERIALS 2022; 15:ma15113971. [PMID: 35683270 PMCID: PMC9182015 DOI: 10.3390/ma15113971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/17/2022]
Abstract
A multimethod study was conducted to assess the differences between original (PG-OR) and counterfeit (PG-CF) ProGlider instruments regarding design, metallurgical features, and mechanical performance. Seventy PG-OR and PG-CF instruments (n = 35 per group) were evaluated regarding the number of spirals, helical angles, and measuring line position by stereomicroscopy, while blade symmetry, cross-section geometry, tip design, and surface were assessed by scanning electron microscopy. Energy-dispersive X-ray spectroscopy and differential scanning calorimetry were used to identify element ratio and phase transformation temperatures, while cyclic fatigue, torsional, and bending testing were employed to assess their mechanical performance. An unpaired t-test and nonparametric Mann−Whitney U test were used to compare instruments at a significance level of 5%. Similarities were observed in the number of spirals, helical angles, blade symmetry, cross-sectional geometries, and nickel−titanium ratios. Measuring lines were more reliable in the original instrument, while differences were noted in the geometry of the tips (sharper tip for the original and rounded for the counterfeit) and surface finishing with PG-CF presenting more surface irregularities. PG-OR showed significantly more time to fracture (118 s), a higher angle of rotation (440°), and a lower maximum bending load (146.3 gf) (p < 0.05) than PG-CF (p < 0.05); however, maximum torque was similar for both instruments (0.4 N.cm) (p > 0.05). Although the tested instruments had a similar design, the original ProGlider showed superior mechanical behavior. The results of counterfeit ProGlider instruments were unreliable and can be considered unsafe for glide path procedures.
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Mechanical and Metallurgical Evaluation of 3 Different Nickel-Titanium Rotary Instruments: An In Vitro and In Laboratory Study. Bioengineering (Basel) 2022; 9:bioengineering9050221. [PMID: 35621499 PMCID: PMC9137481 DOI: 10.3390/bioengineering9050221] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 11/17/2022] Open
Abstract
An in-depth evaluation of the mechanical and metallurgical properties of NiTi instruments is fundamental to assess their performance and to compare recently introduced instrument with widespread ones. According to this, since there are no data on this topic, the aim of the study was to mechanically and metallurgically evaluate an instrument recently introduced into the market (ZenFlex (ZF)), by comparing it with two well-known instruments with similar characteristics: Vortex Blue (VB) and EdgeSequel Sapphire (EES). According to this, 195 instruments were selected: 65 ZF, 65 VB and 65 EES. Each group was divided in subgroups according to the mechanical tests (i.e., cyclic fatigue resistance, torsional resistance and bending ability; (n = 20)) and the metallurgical test (differential scanning calorimetry (n = 5)). A scanning electron microscopy was performed to verify the causes of fracture after mechanical tests (cyclic fatigue and torsional tests). According to results, VB showed the highest flexibility and cyclic fatigue resistance in comparison to the other instruments, with a statistically significant difference (p < 0.05). Regarding torsional resistance, EES showed the lowest value of torque at fracture, with a statistically significant difference, whilst the comparison between ZF and VB showed no statistically significant difference (p > 0.05). DSC analysis pointed out that VB had the highest austenite start and finish temperatures, followed by ESS and then ZF. ESS sample showed the highest martensite start and finish temperatures followed by VB and ZF. Considering the results, it can be concluded that VB showed the best mechanical performance during static tests in comparison to ESS and ZF. This is fundamentally due to the interaction of parameters such as instrument design and heat-treatments that are able to enhance its mechanical performance.
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Nickel–Titanium Rotary Instruments: Mechanical and Metallurgical Characteristics. Clin Pract 2022; 12:94-96. [PMID: 35200263 PMCID: PMC8870687 DOI: 10.3390/clinpract12010012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023] Open
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Martins JNR, Silva EJNL, Marques D, Pereira MR, Vieira VTL, Arantes-Oliveira S, Martins RF, Braz Fernandes F, Versiani M. Design, Metallurgical Features, and Mechanical Behaviour of NiTi Endodontic Instruments from Five Different Heat-Treated Rotary Systems. MATERIALS 2022; 15:ma15031009. [PMID: 35160955 PMCID: PMC8840527 DOI: 10.3390/ma15031009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 12/24/2022]
Abstract
The current study aimed to compare the F1 endodontic instruments from five different heat-treated rotary systems regarding their design, metallurgical properties, and mechanical performance. Five F1 root canal shaping instruments (ProTaper Gold [PTG], Premium Taper Gold, Go-Taper Flex, EdgeTaper Platinum, and Super Files Blue)—plus, a conventional ProTaper Universal (PTU)—which were evaluated regarding their design, nickel/titanium ratio, phase transformation temperatures, microhardness, cyclic fatigue, and torsional and bending strengths. Mood's median test was used for the statistical comparison with a significance set at 5%. The instruments were similar regarding the nickel/titanium ratio and overall design. Go-Taper Flex had the closest transformation temperatures to PTG. PTU and Go-Taper Flex had the highest microhardness (408.3 and 410.5 HVN). The time to fracture of Super Files Blue was three and seven times higher than PTG and PTU, respectively. No difference was observed in the maximum torque to fracture among PTG (1.30 N·cm) and the other systems, except for the Premium Taper Gold (1.05 N·cm) and Go-Taper Flex (1.10 N·cm). Significantly lower bending loads than PTG (269.2 gf) were observed for the EdgeTaper Platinum (158.3 gf) and Premium Taper Gold (103.5 gf) instruments. Super Files Blue outperformed PTG in the cyclic fatigue test, while EdgeTaper Platinum and Premium Taper Gold were more flexible. Premium Taper Gold and Go-Taper Flex showed lower torsional strength.
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Affiliation(s)
- Jorge N. R. Martins
- Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277 Lisboa, Portugal; (D.M.); (M.R.P.); (S.A.-O.)
- Grupo de Investigação em Bioquimica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), 1600-277 Lisboa, Portugal
- Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE), 1600-277 Lisboa, Portugal
- Correspondence:
| | - Emmanuel J. N. L. Silva
- Department of Endodontics, Grande Rio University (UNIGRANRIO), Rio de Janeiro 21210-623, Brazil; (E.J.N.L.S.); (V.T.L.V.)
- Department of Endodontics, Fluminense Federal University, Niterio, Rio de Janeiro 24220-900, Brazil
| | - Duarte Marques
- Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277 Lisboa, Portugal; (D.M.); (M.R.P.); (S.A.-O.)
- Grupo de Investigação em Bioquimica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), 1600-277 Lisboa, Portugal
- Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE), 1600-277 Lisboa, Portugal
- LIBPhys-FCT UID/FIS/04559/2013, 1600-277 Lisboa, Portugal
| | - Mário Rito Pereira
- Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277 Lisboa, Portugal; (D.M.); (M.R.P.); (S.A.-O.)
| | - Victor T. L. Vieira
- Department of Endodontics, Grande Rio University (UNIGRANRIO), Rio de Janeiro 21210-623, Brazil; (E.J.N.L.S.); (V.T.L.V.)
| | - Sofia Arantes-Oliveira
- Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277 Lisboa, Portugal; (D.M.); (M.R.P.); (S.A.-O.)
- LIBPhys-FCT UID/FIS/04559/2013, 1600-277 Lisboa, Portugal
- BIOMAT, Laboratório de Biomateriais, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), 1600-277 Lisboa, Portugal
| | - Rui F. Martins
- UNIDEMI, Department of Mechanical and Industrial Engineering, NOVA School of Science and Technology, Universidade NOVA de Lisboa, 2829-516 Caparica, Portugal;
| | - Francisco Braz Fernandes
- CENIMAT/I3N, Department of Materials Science, NOVA School of Science and Technology, Universidade NOVA de Lisboa, 2829-516 Caparica, Portugal;
| | - Marco Versiani
- Dental Specialty Center, Brazilian Military Police, Belo Horizonte 30350-190, Brazil;
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Metallurgical Tests in Endodontics: A Narrative Review. Bioengineering (Basel) 2022; 9:bioengineering9010030. [PMID: 35049739 PMCID: PMC8773015 DOI: 10.3390/bioengineering9010030] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 11/17/2022] Open
Abstract
Since there are no reviews of the literature on this theme, the aim of this narrative review is to summarize the metallurgical tests used in endodontics, pointing out their functional use and their pros and cons and giving readers a user-friendly guide to serve as an orientation aid in the plethora of metallurgical tests. With this purpose, a literature search for articles published between January 2001 and December 2021 was conducted, using the electronic database PubMed to collect all published articles regarding the metallurgical tests used in endodontics for the evaluation of NiTi rotary instruments. The search was conducted using the following keywords: “metallurgy”, “differential scanning calorimetry” (DSC), “X-ray diffraction” (XRD), “atomic force microscopy” (AFM), “energy-dispersive X-ray spectroscopy” (EDS), “focused ion beam analysis” (FIB) and “Auger electron spectroscopy” (AES) combined with the term “endodontics” or “NiTi rotary instruments”. Considering the inclusion and exclusion criteria, of the 248 articles found, only 81 were included in the narrative review. According to the results, more than 50% of the selected articles were published in one of the two most relevant journals in endodontics: International Endodontic Journal (22.2%) and Journal of Endodontics (29.6%). The most popular metallurgical test was DSC, with 43 related articles, followed by EDS (33 articles), AFM (22 articles) and XRD (21 articles). Few studies were conducted using other tests such as FIB (2 articles), micro-Raman spectroscopy (4 articles), metallographic analysis (7 articles) and Auger electron spectroscopy (2 articles).
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Pawar AM, Kfir A, Metzger Z, Bhardwaj A, Yohana Y, Wahjuningrun DA, Luke AM, Pawar BA. Can Type of Instrumentation and Activation of the Final Irrigant Improve the Obturation Quality in Oval Root Canals? A Push-Out Bond Strength Study. BIOLOGY 2022; 11:biology11010059. [PMID: 35053055 PMCID: PMC8773160 DOI: 10.3390/biology11010059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022]
Abstract
Simple Summary The complete instrumentation of oval root canals remains practically unattainable. The majority of studies show that shaping oval, flat, and irregularly shaped canals is challenging, with more than half of the root canal area remaining unaltered. Furthermore, both rotary and reciprocating files compact hard tissue debris into the isthmus areas and buccal and/or lingual recesses of oval canals, impairing debridement and filling. In addition, one of the most essential variables in assessing the success of endodontic therapy is the adhesion of root canal filling material to dentin. Abstract To appraise the outcome of file systems and activation of the final irrigant on the push-out bond strength of root fillings in oval canals. Single-rooted mandibular premolars (n = 180) with oval canals were divided into three groups (n = 60) for instrumentation: ProTaper Next (PTN), WaveOne (WO), and Self-adjusting File (SAF). The specimens were further divided into subgroups (n = 20) and subjected to final irrigation with activation by EndoActivator or passive ultrasonic irrigation or without activation. Then, the specimens were again subdivided (n = 10) and obturated with gutta-percha and AH Plus (GP-AH) or C-Point with EndoSequence bioceramic sealer (C-EBC). One-millimeter-thick horizontal slices were cut from the apical third of the root, 5 mm from the apex, and subjected to push-out bond strength (BS) testing. Specimens for which SAF was used exhibited higher BS values than those for which PTN or WO was used (p < 0.05). Activation of the final irrigation did not affect the BS of the root fillings. Root fillings made of C-EBC presented a higher BS than those made of GP-AH (p < 0.05). Adhesive failure was more common with specimens instrumented using PTN and WO. Root canals instrumented with SAF, showed the highest bond strength values for both root filling materials. The C-EBC produced significantly higher bond strength values than those of the GP-AH.
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Affiliation(s)
- Ajinkya M. Pawar
- Department of Conservative Dentistry and Enododntics, Nair Hospital Dental College, Mumbai 400008, India
- Correspondence: (A.M.P.); (D.A.W.); (A.M.L.)
| | - Anda Kfir
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv 69978, Israel; (A.K.); (Z.M.)
| | - Zvi Metzger
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv 69978, Israel; (A.K.); (Z.M.)
| | - Anuj Bhardwaj
- Department of Conservative Dentistry and Endodontics, College of Dental Sciences & Hospital, Indore 453331, India;
| | - Yeyen Yohana
- Department of Conservative Dentistry, Faculty of Dental Medicine, Universitas Airlingga, Surabaya 60132, East Java, Indonesia;
| | - Dian Agustin Wahjuningrun
- Department of Conservative Dentistry, Faculty of Dental Medicine, Universitas Airlingga, Surabaya 60132, East Java, Indonesia;
- Correspondence: (A.M.P.); (D.A.W.); (A.M.L.)
| | - Alexander Maniangat Luke
- Department of Clinical Science, College of Dentistry, Ajman University, Al-Jurf, Ajman 346, United Arab Emirates
- Center of Medical and Bio-allied Health Sciences Research, Ajman University, Al-Jurf, Ajman 346, United Arab Emirates
- Correspondence: (A.M.P.); (D.A.W.); (A.M.L.)
| | - Bhaggyashri A. Pawar
- Division of District Early Intervention Centre, Department of Dentistry, Thane Civil Hospital, Thane 400601, India;
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Martins JNR, Silva EJNL, Marques D, Belladonna FG, Simões-Carvalho M, da Costa RP, Ginjeira A, Braz Fernandes FM, Versiani MA. Comparison of five rotary systems regarding design, metallurgy, mechanical performance, and canal preparation-a multimethod research. Clin Oral Investig 2021; 26:3299-3310. [PMID: 34860307 DOI: 10.1007/s00784-021-04311-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/20/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To compare the design, metallurgy, mechanical performance, and canal preparation of 5 rotary systems. MATERIAL AND METHODS A total of 735 25-mm NiTi instruments (sizes 0.17[0.18]/.02v, 0.20/.04v, 0.20/.07v, 0.25/.08v, 0.30/.09v) from ProTaper Gold, ProTaper Universal, Premium Taper Gold, Go-Taper Flex, and U-File systems were compared regarding overall geometry and surface finishing (stereomicroscopy and scanning electron microscopy), nickel and titanium ratio (energy-dispersive spectroscopy), phase transformation temperatures (differential scanning calorimetry), mechanical performance (torsional and bending tests), and unprepared canal surface (micro-CT). One-way ANOVA and Mood's median tests were used for statistical comparisons with a significance level set at 5%. RESULTS Stereomicroscopic analysis showed more spirals and high helical angles in the Premium Taper Gold system. All sets of instruments had symmetrical spirals, no radial lands, no major defects, and an almost equiatomic ratio between nickel and titanium elements, while differences were observed in their tips' geometry and surface finishing. At room temperature (20 °C), DSC test revealed martensitic characteristics for ProTaper Gold and Go-Taper Flex, and mixed austenite plus R-phase for the Premium Taper Gold, while ProTaper Universal and U-Files had full austenitic characteristics. Overall, larger instruments had higher torque resistance and bending load values than smaller ones, while a lack of consistency and mixed values were observed in the angle of rotation. The 0.25/.08v and 0.30/.09v instruments of ProTaper Universal and U-File had the highest maximum torques, the lowest angles of rotation, and the highest bending loads than other tested systems (P < .05). No significant difference was noted regarding the untouched root canal walls after preparation with the tested systems (P > .05). CONCLUSIONS Although differences observed in the overall geometry and phase transformation temperatures have influenced the results of mechanical tests, unprepared canal surface areas were equivalent among systems. CLINICAL RELEVANCE Root canal preparation systems with similar geometries might present different mechanical behaviors but equivalent shaping ability.
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Affiliation(s)
- Jorge N R Martins
- Faculdade de Medicina Dentária, Universidade de Lisboa, Cidade Universitária, 1649-003, Lisbon, Portugal.
- Grupo de Investigação Em Bioquimica E Biologia Oral, Faculdade de Medicina Dentária, Unidade de Investigação Em Ciências Orais E Biomédicas (UICOB), Universidade de Lisboa, Lisbon, Portugal.
- Centro de Estudo de Medicina Dentária Baseada Na Evidência (CEMDBE) - Cochrane Portugal, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal.
| | - Emmanuel João Nogueira Leal Silva
- Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Endodontics, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil
| | - Duarte Marques
- Faculdade de Medicina Dentária, Universidade de Lisboa, Cidade Universitária, 1649-003, Lisbon, Portugal
- Grupo de Investigação Em Bioquimica E Biologia Oral, Faculdade de Medicina Dentária, Unidade de Investigação Em Ciências Orais E Biomédicas (UICOB), Universidade de Lisboa, Lisbon, Portugal
- Centro de Estudo de Medicina Dentária Baseada Na Evidência (CEMDBE) - Cochrane Portugal, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
- LIBPhys-FCT UID/FIS/04559/2013, Lisbon, Portugal
| | | | - Marco Simões-Carvalho
- Department of Endodontics, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil
| | - Rui Pereira da Costa
- Faculdade de Medicina Dentária, Universidade de Lisboa, Cidade Universitária, 1649-003, Lisbon, Portugal
| | - António Ginjeira
- Faculdade de Medicina Dentária, Universidade de Lisboa, Cidade Universitária, 1649-003, Lisbon, Portugal
- Grupo de Investigação Em Bioquimica E Biologia Oral, Faculdade de Medicina Dentária, Unidade de Investigação Em Ciências Orais E Biomédicas (UICOB), Universidade de Lisboa, Lisbon, Portugal
| | - Francisco Manuel Braz Fernandes
- CENIMAT/I3N, Department of Materials Science, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
| | - Marco Aurélio Versiani
- Dental Specialty Center, Brazilian Military Police, Belo Horizonte, Minas Gerais, Brazil
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