The effect of root canal morphology on canal shape following instrumentation using different techniques

Multimethod Assessment of the Cyclic Fatigue Strength of ProGlider, Edge Glide Path and R-Pilot Endodontic Instruments

Background: The aim of this study was to comprehensively evaluate the cyclic fatigue strength of ProGlider, Edge Glide Path, and R-Pilot instruments. Methods: Sixty-three instruments were submitted to a multimethod evaluation. Their design was analyzed by stereomicroscopy and scanning electron microscopy, including the number of blades, helical angle means, cross-sectional design, surface finishing, and symmetry. Energy-dispersive X-ray spectroscopy was used determine the nickel/titanium elements ratio, and differential scanning calorimetry determined the instruments’ phase transformation temperatures. The cyclic fatigue tests were conducted in an artificial canal with a 6 mm radius and 86 degrees of curvature. The Mood’s median test and one-way ANOVA were used to determine differences, with the significance level set at 0.05. Results: The ProGlider presented the highest number of blades (n = 21), while R-Pilot had the highest helical angles (26.4°). Differences were noted in the instruments’ cross-sections and surface finishing. The ProGlider and R-Pilot showed some similarities regarding the phase transformation temperatures but differed from the Edge Glide Path. All alloys showed an almost equiatomic nickel/titanium ratio. The R-Pilot instruments showed a significantly higher (p < 0.05) time to fracture than both the other files. Conclusion: Reciprocating R-Pilot instruments showed a higher cyclic fatigue time to fracture than the ProGlider and Edge Glide Path rotary files.

Comparison of Canal Transportation and Centering Ability of One-G, EdgeGlidePath, and Neolix: A MicroComputed Tomography Study of Curved Root Canals

Aims

A glide path is created prior to root canal instrumentation by nickel-titanium (NiTi) rotary files to increase the efficiency and safety of cleaning and shaping. This study aimed to assess root canal transportation in use of different glide path files in curved canals.

Materials and Methods

30 sound mesiobuccal root canals of mandibular molars with 20° to 40° curvature were selected and randomly assigned to 3 groups of EdgeGlidePath (EGP, EdgeEndo), One-G (Micro-Mega), and Neolix (Neoniti). The specimens were scanned before and after glide path creation by microcomputed tomography (micro-CT). The pre- and postoperative micro-CT scans were superimposed, and the degree of canal transportation and centering ratio were measured at 1, 3, 5, and 7 mm distances from the apical foramen. Statistical Analysis. The data were analyzed by two-way and one-way ANOVA.

Results

The effects of distance from the apical foramen and instrument type and the interaction effect of the two were not significant on the centering ability of the files or canal transportation.

Conclusion

EdgeGlidePath, One-G, and Neolix files fabricated from the conventional NiTi alloy or heat-treated M-Wire alloy showed similar performance regarding centering ability and canal transportation in glide path preparation in curved canals.

Methods for measurement of root canal curvature: a systematic and critical review

The assessment of root canal curvature is essential for clinical and research purposes. This systematic review presents an overview of the published techniques for the measurement of root canal curvature features using imaging and to provide a critique of their clinical application. A database search in PubMed, PubMed Central, Embase, Scopus, EBSCO Dentistry & Oral Sciences Source and Virtual Health Library was conducted, using appropriate key words to identify measurement methods for root canal curvatures. The search strategy retrieved 10594 records in total, and 31 records fulfilled the inclusion criteria. From 2D image acquisitions, eleven studies measured exclusively the angle of curvature, an additional thirteen measured other curvature features (level, height, radius, length and shape). Seven reports described methods from 3D imaging (CBCT, μCT). Root canal curvatures should be measured, for clinical proposes, to facilitate endodontic treatment planning, and in research, to reduce the risk of selection bias. This review has revealed that there are many methods described in the literature; however, no consensus exists on which method should be used. Some of the methodologies have potential clinical translation, whereas others are suitable for research purpose only, as they require a specific software or radiographic exposure in the mesiodistal direction.

Shaping ability of four root canal instrumentation systems in simulated 3D-printed root canal models

Introduction

The aim of this study was to compare the shaping ability of four root canal preparation systems in newly developed 3D-printed root canal models.

Materials and methods

For this study, 1080 3D-printed acrylic resin blocks with nine different root canal configurations were produced. They were prepared with Reciproc R25 (#25), F6 SkyTaper (#25 and #30) F360 (#25 and #35) and One Shape (#25) (N = 30 per system). Pre- and post-instrumentation images were superimposed for evaluation of the centering ratio of the different systems. Ledges, instrument fractures and preparation times were also recorded. Analysis of variance (ANOVA) and post-hoc Tukey tests were conducted, comparing the mean canal centering ratios and the mean preparation times.

Results

There were significant differences between all systems regarding the centering ratios in the different root canal configurations (ANOVA p < 0.001). The root canal configuration had considerable effect on the centering ratio of the instruments. The best overall mean centering ratios were achieved with F6 SkyTaper #25 instruments especially in canal configurations with big curvature angles and radii, while F360 #35 was least centered especially in canals with small curvature angles and radii. Most ledges occurred with OneShape, while it was the significantly (p < 0.001) fastest preparation system (86.7 s (SD 13.53)) and Reciproc the significantly (p < 0.001) slowest (103.0 s (SD 20.67)).

Conclusion

3D-printed root canals are suitable to produce challenging canal configurations and to investigate the limitations of root canal instruments. We found that all instruments caused canal transportations. However, F6 SkyTaper #25 files had better overall centering ratios than the other instruments. In canal configurations with small curvature radii, the centering ratio of some instruments is low and the probability for ledges is increased.

Ledge Formation: Review of a Great Challenge in Endodontics

Failure to grasp the rationale behind cleaning and shaping concepts can increase the occurrence of needless complications, such as ledges. A ledge is created when the working length can no longer be negotiated and the original pathway of the canal has been lost. Extension of the access cavity to provide unobstructed access to the root canals, precurving and not forcing instruments, using NiTi files, using passive step-back and balanced force techniques, and instrumenting the canal to its full length will all help to prevent ledge formation. Initial negotiation and bypassing the ledge can be achieved using a small file with a distinct curve at the tip, whereas a slight rotation motion of the file combined with a ''picking'' motion can often help advance the instrument. A review of the literature and a discussion of the options for prevention, recognition and managing the ledge are presented.

Current Challenges and Concepts in the Preparation of Root Canal Systems: A Review

Nickel-titanium rotary instruments are important adjuncts in endodontic therapy. This review attempts to identify factors that influence shaping outcomes with these files, such as preoperative root-canal anatomy and instrument tip design. Other, less significant factors include operator experience, rotational speed, and specific instrument sequence. Implications of various working length definitions and desired apical widths are correlated with clinical results. Despite the existence of one ever-present risk factor, dental anatomy, shaping outcomes with nickel-titanium rotary instruments are mostly predictable. Current evidence indicates that wider apical preparations are feasible. Nickel-titanium rotary instruments require a preclinical training period to minimize separation risks and should be used to case-related working lengths and apical widths. However, and despite superior in vitro results, randomized, clinical trials are required to evaluate outcomes when using nickel-titanium instruments.

In Vitro Comparison of Shaping Abilities of ProTaper and GT Rotary Files

This study analyzed the abilities of ProTaper and GT Rotary files to shape the curved canals of extracted mandibular molars. Twenty mesial canals with curvatures ranging from 23 to 54 degrees (Weine analysis) were radiographically selected from a group of 58 molars. The specimens, divided into two groups, were instrumented using the two systems according to the manufacturer's guidelines. Using a radiographic platform and a contrast medium, reproducible preinstrumentation and postinstrumentation radiographs were taken. A computer analysis allowed magnification and superimposition of the images to measure the preparation asymmetry and the linear amount of dentin removal at five points along the canals and to detect canal aberrations. Instrument failures, working time, and working length changes were recorded. The dentin removal and the mean asymmetry showed no significant differences between the two systems. Neither aberrations nor significant changes in working length resulted, but two instruments separated in each group. Working time was shorter for ProTaper files (p < 0.05).

ProTaper rotary root canal preparation: assessment of torque and force in relation to canal anatomy

AIM

To investigate physical parameters for ProTaper nickel-titanium (NiTi) rotary instruments whilst preparing curved canals in maxillary molars in vitro.

METHODOLOGY

A novel torque-testing platform was used to prepare root canals in 15 extracted human maxillary molars with ProTaper rotary instruments. Peak torque and force was registered along with numbers of rotations required to shape the canals. Canals were divided into 'wide' and 'constricted' groups depending on canal volumes assessed by micro computed tomography. Mean scores for each instrument type were calculated and statistically compared using anova and Scheffé posthoc tests.

RESULTS

Mean torque varied between 0.8 +/- 0.5 and 2.2 +/- 1.4 N cm whilst mean force ranged from 4.6 +/- 2.6 to 6.2 +/- 2.7 N. Mean numbers of rotations totalled up to 21. All three variables registered were significantly correlated to preoperative canal volumes (P < 0.001) and differed significantly between 'wide' and 'constricted' canals (P < 0.001).

CONCLUSIONS

Whilst high forces were used in some cases, no ProTaper instrument fractured when a patent glide path was present. There were significant positive correlations between canal geometry and physical parameters during shaping.

Cervical shaping in curved root canals: comparison of the efficiency of two endodontic instruments

The aim of this study was to determine the removal of dentin produced by number 25 (0.08) Flare files (Quantec Flare Series, Analytic Endodontics, Glendora, California, USA) and number 1 e 2 Gates-Glidden burs (Dentsply - Maillefer, Ballaigues, Switzerland), in the mesio-buccal and mesio-lingual root canals, respectively, of extracted human permanent inferior molars, by means of measuring the width of dentinal walls prior and after instrumentation. The obtained values were compared. Due to the multiple analyses of data, a nonparametric test was used, and the Kruskal-Wallis test was chosen. There was no significant difference between the instruments as to the removal of dentin in the 1st and 2nd millimeters. However, when comparing the performances of the instruments in the 3rd millimeter, Flare files promoted a greater removal than Gates-Glidden drills (p > 0.05). The analysis revealed no significant differences as to mesial wear, which demonstrates the similar behavior of both instruments. Gates-Glidden drills produced an expressive mesial detour in the 2nd and 3rd millimeters, which was detected trough a statistically significant difference in the wear of this region (p > 0.05). There was no statistically significant difference between mesial and lateral wear when Flare instruments were employed.

A comparison of stainless steel hand and rotary nickel-titanium instrumentation using a silicone impression technique

BACKGROUND

Root canal preparation using rotary nickel-titanium instruments has been reported to be superior to hand instrumentation in terms of root canal shape, centring and frequency of procedural errors. The purpose of this study was to evaluate canal preparations using a sequential silicone impression technique to assess root canal morphology.

METHODS

Pre-operative canal impressions were obtained from 24 extracted single-rooted premolars. Canals were randomly assigned to be firstly, instrumented with stainless steel K-type files or rotary nickel-titanium instruments (Profile), then further apically enlarged with rotary nickel-titanium instruments (Profile or Lightspeed). Post instrumentation impressions were taken and digitally photographed in a bucco-lingual and mesio-distal orientation at low-power magnification. Images were evaluated for procedural defects, changes in canal curvature, canal enlargement and canal rounding at 1, 3 and 7mm from the working length.

RESULTS

Silicone impressions could accurately reproduce the detailed root canal morphology of single-canal premolars. Repeated impressions of each canal using a standardized procedure allowed a detailed comparison of instrumentation techniques at various stages. Hand instrumentation incurred more errors than rotary nickel-titanium instrumentation (Profile). Further apical enlargement using Lightspeed instruments incurred fewer errors than with Profile instruments. Differences among techniques were highly significant (p<0.005). All techniques resulted in slight canal straightening, as well as rounder and enlarged canals particularly in the apical third.

CONCLUSIONS

Rotary nickel-titanium instrumentation, especially Lightspeed, may produce better canal shape by reducing procedural errors.

A comparison of the shaping characteristics of two nickel-titanium endodontic hand instruments

AIM

The purpose of this study was to compare the shaping characteristics of Ni-Ti K-files and Ni-Ti S-files manipulated by hand.

METHODOLOGY

A total of 60 extracted human roots were embedded in resin blocks. The embedded roots were divided into three groups: (i) roots with straight; (ii) apically curved; and (iii) continuously curved canals. Each of the three groups was randomly divided into two subgroups; one subgroup in each group was prepared with Ni-Ti K-files and the other with Ni-Ti S-files. The files were used with a step-back technique and enlarged so that the master apical file was size 30, and the canals were stepped back to size 40. The performance of the files was assessed by the superimposition of projected radiographs taken in bucco-lingual and mesio-distal directions before and after the preparation. The results were analysed statistically using analysis of covariance and Duncan's multiple range test.

RESULTS

Although canal preparation using Ni-Ti K-files was quicker, there were no statistically significant differences between file types. The Ni-Ti S-file removed significantly more material at the most coronal level (P < 0.05). There were minor differences between instruments at the apical level. Only in the proximal view of apically curved canals prepared with Ni-Ti S-files was significantly more dentine removed from the outer aspect of the curvature (P < 0.05). At the middle level (wide danger zone) the Ni-Ti S-files removed more dentine from the inner aspect of the curvature in those roots with apically curved canals.

CONCLUSIONS

Under the conditions of this study, preparation with Ni-Ti K-files produced more appropriate shapes in roots with apically curved canals than Ni-Ti S-files.