Role of the Flat-Designed Surface in Improving the Cyclic Fatigue Resistance of Endodontic NiTi Rotary Instruments

To flat or not to flat? Exploring the impact of flat-side design on rotary instruments using a comprehensive multimethod investigation

AIM

To assess the influence of a flat-side design on the geometry, metallurgy, mechanical performance and shaping ability of a novel nickel-titanium rotary instrument.

METHODOLOGY

Sixty-five new 25-mm flat-side rotary instruments (size 25, taper 0.04) and their nonflat-side prototypes (n = 65) were assessed for major deformations and examined regarding macroscopic and microscopic design, determination of nickel and titanium elements ratio, measurement of phase transformation temperature and evaluation of mechanical performance parameters including time/cycles to fracture, maximum torque, angle of rotation, maximum bending and buckling strengths and cutting ability. Additionally, unprepared canal areas, volume of hard tissue debris and percentage reduction of dentine thickness were calculated for each tested instrument after preparing mesial canals of mandibular molars (n = 12), using micro-CT imaging. Statistical analyses were performed using the U-Mann-Whitney test and independent Student t-test (α = 5%).

RESULTS

The number of spirals (n = 8) and blade direction (clockwise) were similar between both flat and nonflat instruments, whilst the helical angles were equivalent (⁓25°). Flat-instruments showed inconsistencies in the homogeneity of the gold colour on the flat-side surface, blade discontinuity, and incomplete and variable S-shaped cross-sections. The titanium-to-nickel ratios were equivalent, but significant differences in the R-phase finish and austenitic start phase transformation temperatures were observed between the flat and nonflat-side instruments. The flat-side instruments demonstrated superior cutting ability compared to the nonflat instruments, as well as, significantly lower values for time to fracture, rotation to fracture and maximum torque to fracture (p < .001). No statistical difference was observed between tested instruments regarding angle of rotation (p = .437), maximum bending (p = .152) and buckling load (p = .411). Preparation protocols using flat and nonflat instruments did not show any statistically significant differences (p > .05). All flat-side instruments exhibited deformation after shaping procedures.

CONCLUSIONS

The flat-side instrument showcased enhanced cutting ability compared to its nonflat counterpart. However, it exhibited inferior performance in terms of time, rotation and maximum torque to fracture, along with distinct phase transformation temperatures. No differences were observed in the titanium-to-nickel ratios, angle of rotation, maximum bending, buckling load, preparation time, percentage of untouched canal walls, volume of hard tissue debris and percentage reduction of dentine thickness.

Pattern of Endodontic Lesions of Maxillary and Mandibular Posterior Teeth: A Cone-Beam Computed Tomography Study

The pattern of expansion of endodontic lesions in the jaws has been less commonly addressed in the literature. For this reason, the aim of this study is to assess the pattern of endodontic lesions of maxillary and mandibular posterior teeth using cone-beam computed tomography (CBCT). This cross-sectional study was conducted on 317 endodontic lesions of posterior teeth on CBCT scans retrieved from a radiology center in Qazvin, Iran, from 2020 to 2022. Endodontic lesions were assessed on sagittal, coronal, and axial sections by an endodontist and dental student using the Romexis software. The largest lesion diameter was measured occluso-apically, mesiodistally, and buccolingually. Lesion size was analyzed based on age, gender, jaw, tooth type, and presence/absence of root filling by independent samples t-tests and a one-way Analysis Of Variannce (ANOVA). The largest diameter of lesions in the maxilla and mandible was recorded in the occluso-apical dimension followed by buccolingual and mesiodistal dimensions (p > 0.05). The pattern of lesions was the same in teeth with and without endodontic treatment, but it was significantly different in maxillary and mandibular endodontically treated teeth in the occluso-apical and buccolingual dimensions (p < 0.05). No significant correlation was noted with tooth type or jaw except for maxillary and mandibular first molar lesions, which were significantly different in the occluso-apical dimension (p < 0.05). Lesion size in all three dimensions was significantly greater in males than females (p < 0.05), and was the highest in the occluso-apical dimension in both genders. In the maxilla, the mean lesion size significantly decreased in the mesiodistal dimension with age (p < 0.05). In conclusion, the largest lesion diameter in the maxilla and mandible was found in the occluso-apical dimension, indicating the role of bone density in the pattern of lesions.

Modern Approaches and Innovations on Methods and Imaging Protocols of the Maxillofacial District

In recent years, improvements in imaging techniques have profoundly changed the diagnosis of pathologies of the maxillofacial district [...].

Ultrasound Imaging in Dentistry: A Literature Overview

(1) Background: the frequency with which diagnostic tests are prescribed with exposure to ionizing radiation, a cause of biological damage, has been studied, and with much more attention, patients are subjected to these diagnostic tests for diagnosis and follow-up. This review aimed, given the recent developments of this technology, to evaluate the possible use of ultrasound in different branches of dentistry. The possibility of applying ionizing-radiation-free diagnostic exams in dentistry, overcoming the limits of this application, has led scientific research in this area to obtain interesting results that bode well for the future. (2) Methods: a search for articles on the application of ultrasounds in dentistry was performed using the PubMed electronic database. (3) Results: only 32 studies were included, and these clearly stated that this examination is widely usable and in great progress. (4) Conclusions: regarding the modern application techniques of this diagnostic test, it is essential to consider technological evolution as an objective to reduce the damage and side effects of necessary diagnostic tests. The use of ultrasound in dentistry can represent a valid radiation-free alternative, in certain contexts, to the other most used exams.

Role of the Crystallographic Phase of NiTi Rotary Instruments in Determining Their Torsional Resistance during Different Bending Conditions

The aim of this study was to assess the role of the crystallographic phase of Nickel-titanium (NiTi) rotary instruments in determining their torsional resistance during different bending conditions, such as different degrees and angles of curvature. 200 F-One 20.04 instruments (Fanta Dental, Shanghai, China) were used, 100 austenitic instruments and 100 martensitic instruments. Each group was divided in 5 subgroups according to the different bending conditions (straight canal, 90° or 60° of curvature degrees and 3 mm or 5 mm of radius of curvature). The static torsional test was performed by using a device composed of an electric motor capable of recording torque values (N·cm); a vice used to secure the instruments at 3 mm from the tip; and artificial canals, which allow instruments to remain flexed during test. Each instrument was rotated at 500 rpm with a torque limit set to 5.5 Ncm until its fracture. Torque at Fracture (TtF) was registered. A scanning electron microscopy (SEM) observation was conducted. The collected data confirm that an increase in the angle of curvature and a decrease in the radius of curvature of the artificial canals lead to an increase of TtF values with a statistically significant difference (p < 0.05), both in the austenitic and martensitic groups. Regarding the comparison between austenitic and martensitic groups in the same bending condition, a statistically significant difference was found only when the torsional test was performed in the canals with the degrees of curvature of 90° and the radius of curvature of 3 mm and 5 mm, with the austenitic instruments showing a higher TtF than the martensitic ones. In conclusion, it can be stated that the crystallographic phase influences the maximum torque at fracture when the instruments are subjected to severe bending and that the radius of curvature significantly influences their torsional resistance.

Effect of Core Mass and Alloy on Cyclic Fatigue Resistance of Different Nickel-Titanium Endodontic Instruments in Matching Artificial Canals

Instrument failure during root canal preparation is still a concern among endodontists. However, it remains unclear whether the use of more martensitic alloys or the cross-sectional design parameters (i.e., core mass) significantly improve fracture resistance. The aim of the study was to evaluate the impact of core mass and alloy on dynamic cyclic fatigue resistance of nickel-titanium endodontic instruments in matching artificial canals at body temperature. Two groups were tested. (A) taper 0.04: F360 (Komet, Lemgo, Germany), Twisted file (Sybron Endo, Glendora, CA, USA) (=TF), JIZAI (Mani, Tochigi, Japan) (=J_04) (all size #25) and the variable tapered TruNatomy (Dentsply, Ballaigues, Switzerland) (size #26) (=TN). (B) size #25; taper 0.06: (Mtwo (VDW, Munich, Germany), JIZAI (Mani) (=J_06), and variable tapered Hyflex EDM OneFile (Coltene Whaledent, Altstätten, Switzerland) (=HF). Time, number of cycles to fracture (NCF), and number and length of fractured fragments were recorded and statistically analysed using ANOVA Student-Newman-Keuls, Kruskal–Wallis or Chi-square test (significance level = 0.05). (A) TN showed the significantly shortest time until fracture, followed by TF, F360 and J_04 which also differed significantly, while NCF showed the following order: F360 < TN < TF < J_04 (p < 0.05). Only one J_04 but all instruments of the other groups fractured within the test-limit of 10 min. (B) Mtwo was significantly inferior concerning time until fracture and NCF, compared to J_06 and HF (p < 0.05), which did not differ significantly (p > 0.05). While all Mtwo instruments fractured, only four instruments failed in the other groups (p < 0.05). Within the limitations of this study, alloy and cross-sectional design (i.e., core mass) were critical factors regarding instrument failure, but none of these factors could be determined as a main parameter for increased or decreased time, and cycles to fracture. Rather, it seemed to be the interaction of multiple factors (e.g., longitudinal and cross-sectional design, alloy, and rotational speed) that was responsible for differences in the time and cycles to fracture. Nonetheless, all instruments had lifetimes that allow safe clinical use. However, the superiority or inferiority of an instrument with regard to cyclic fatigue based on laboratory results—even when identical trajectories are guaranteed—may be considered questionable, as the characteristics and design parameters of the instruments vary considerably, and the experimental setups lack additional clinical parameters and thus clinical relevance.

Experimental Study of the Effects of Torsional Loading on Three Types of Nickel-Titanium Endodontic Instruments

In modern endodontics, nickel-titanium (NiTi) rotary instruments are used on a large scale for root canal shaping. Nevertheless, the separation of an instrument is a serious concern during shaping. The aim of this study is to determine and compare the torsional fracture characteristics of three types of NiTi endodontic instruments, each with different cross-section designs and movements performed during root canal shaping: Endostar E3 (Endostar, Poldent Co. Ltd., Warsaw, Poland); Reciproc R25 (VDW, Munich, Germany); and Protaper Next X2 (Dentsply Maillefer, Ballaigues, Switzerland). Fifteen instruments are used in this study, divided in three groups (n = 5): Group Endostar, Group Reciproc and Group Protaper. For testing, each instrument is used to shape five simulated root canals, following which its torsional stress to failure is measured. The fracture lengths of all three groups are roughly between 2 and 3 mm from the tip. Higher values of the moment of torsion in fracture, and smaller values of the maximum twisting angle are observed for Group Endostar, as well as closer to circular cross-sections. However, the values of the shear tension are similar for all three groups, because the disadvantage given by the fracture section shape for Groups Reciproc and Protaper is compensated either by size or by intrinsic properties of the instrument material. For the shear tension the Endostar values are insignificantly increased (Kruskal–Wallis test, p = 0.207), and in the case of the maximum twist angle the Protaper values are insignificantly increased (Kruskal–Wallis test, p = 0.287). Because of the instruments shape and conicity, the analysis had to be carried out separately with regard to the length of the fractured tip. Rules-of-thumb are extracted from the study for current practice: if a blockage of the first 2 to 3 mm part of the tip can be anticipated (by the excessive curving of the instrument), the handpiece must be adjusted to torque values that do not exceed 1.5 to 2.5 N · cm for Endostar and 1 to 2 N · cm for Reciproc and Protaper instruments.

Angle of Insertion and Torsional Resistance of Nickel-Titanium Rotary Instruments

Previously published studies have investigated the influence of instrument access on cyclic fatigue resistance. However, no studies have evaluated the relationship between angulated access and torsional resistance. The aim of this study was to investigate the influence of the angle of access on the torsional resistance of endodontic instruments. One hundred and eighty instruments were selected: 90 F-One Blue 25/04 and 90 HeroShaper 25/04 instruments. Three subgroups (n = 30) for each instrument type (A and B) were established according to the angle of insertion of the instruments inside the artificial canal (0°, 10° and 20°). The tests were performed using a custom-made device consisting of the following: a motor that can record torque values of 0.1 s; interchangeable stainless-steel canals with different curvature (0°, 10° and 20°) that allow the instrument’s angulated insertion and keep it flexed during testing procedures; and a vise used to secure the instrument at 3 mm from the tip. Torque limit was set to 5.5 Ncm, and each instrument was rotated at 500 rpm until fracture occurred. Torque to fracture (TtF) was registered by the endodontic motor, and the fragment length (FL) was measured with a digital caliper. Fractographic analysis was performed using a scanning electron microscopy (SEM) evaluation to confirm the cause of failure. TtF values and fragment length (FL) values were statistically analyzed using one-way analysis of variance (ANOVA) test and the Bonferroni correction for multiple comparisons across the groups with significance set to a 95% confidence level. Regarding the F-One Blue instruments, the results showed a higher TtF for group A3 (20°) than for group A1 (0°) and group A2 (10°), with a statistically significant difference between group A3 and the other two groups (p < 0.05), whereas no statistically significant difference was found between group A1 and group A2 (p > 0.05). Regarding the HeroShaper instrument, the results showed the highest TtF for group B3, with a statistically significant difference between the three subgroups B1, B2 and B3 (p < 0.05). The results showed that the torsional resistance increases as the angle of instrument access increases with a varying intensity, according to the crystallographic phase of the instrument selected.

Influence of shaft length on torsional behavior of endodontic nickel-titanium instruments

Torsional stresses are one of the most frequent causes of intracanal separation of nickel–titanium endodontic instruments, which represents a great concern of endodontists. For this reason, torsional resistance of rotary instruments has been deeply investigated by determining all parameters that can influenced it, that can be summarized in: (1) Tooth-related factors, (2) Strategy-related factors and (3) Instrument-related factors. This study was conducted to examine the influence of shaft length on torsional resistance of a nickel–titanium rotary instrument and if it should be considered as an Instrument-related factor. With this aim, 120 Twisted Files Adaptive M-L (TFA M-L) NiTi instruments (SybronEndo, Orange, CA, USA) were divided into 6 experimental groups (n = 20), according to instruments length and size: Group 1, 20 TFA M-L1 25/08 23 mm; Group 2, 20 TFA M-L1 25/08 27 mm; Group 3, 20 TFA M-L2 35/06 23 mm; Group 4, 20 TFA M-L2 35/06 27 mm; Group 5, 20 TFA M-L3 50/04 23 mm; and Group 6, 20 TFA M-L3 50/04 27 mm. All instruments were submitted to a static torsional test, blocking each instrument at 3 mm from the tip and rotating it until its fracture. Torque to Fracture (TtF) and fragments length were registered and all data were statistically analyzed. Results showed that Groups 2, 4 and 6 had a higher TtF, respectively, than Groups 1, 3 and 5, which differ from the former just for shaft length. Group 6 showed the highest torsional resistance (1.31 ± 0.08 Ncm), whilst Group 1 the lowest (0.40 ± 0.08 Ncm). According to that, it can be stated that the longer the instrument, the higher the torsional resistance is, proving that shaft length should be considered as an important factor about torsional resistance.

Effect of Flexural Stress on Torsional Resistance of NiTi Instruments

INTRODUCTION

Previously published studies have deeply investigated the characteristics of flexural and torsional resistance of nickel-titanium rotary instruments, but none of them investigated the relationship between the 2 stresses. The objective of the present study was to evaluate the influence of flexural stresses over torsional resistance.

METHODS

Sixty S-One 20.04 files (Fanta Dental, Shanghai, China) were used in the present study (N = 60) and divided into 3 test groups of 20 files. A customized device made of a mobile structure with a connection that holds the handpiece and the artificial canal was used for the experiment to make the measurements repeatable. The artificial canals were created with a 90° curvature, a 60° curvature, and lastly a straight canal. Each file was rotated at 300 rpm with a maximum torque value of 5.5 Ncm with the apical 2 mm firmly secured in a vise. The torque at fracture and the time to fracture were recorded by the software integrated in the handpiece and evaluated through statistical analysis.

RESULTS

Statistical analysis found significant differences in the values of torque to fracture (TtF) between these 3 groups (P < .05). The 90° curved canal group showed the highest TtF value, and the 60° curved canal group showed a higher TtF value than the straight canal group.

CONCLUSIONS

The results of the present study demonstrated a positive influence of flexural stresses over torque at fracture of rotary files. When nickel-titanium instruments were used in a 90° or 60° curvature, the values of torque at fracture increased compared with the same instruments that rotated in the straight canal.

A New Device to Test the Bending Resistance of Mechanical Endodontic Instruments

The aims of the present study were to propose a new machine for testing the bending behavior of an instrument at multiple specific points along the cutting surface and to compare the influence of proprietary heat treatment on the bending ability of EdgeTaper (ET), Protaper Universal (PTU), EdgeTaper Platinum (ETP), and Protaper Gold (PTG). A total of 320 instruments were examined in the present study: 80 ET, 80 PTU, 80 ETP, and 80 PTG. The bending ability of all instruments was tested at a 45° angle and on three different portions of the instrument at 3, 6, and 9 mm from the tip using a customized device. Statistical analysis showed significant differences among each single instrument of the series and between ET and PTU as well as ETP and PTG. The bending behavior of a nickel–titanium rotary instrument is its ability to bend without any plastic deformation. This feature, according to the results of the present study, is variable along the cutting surface; therefore, it should be evaluated. Due to the present testing device, it would be possible to obtain reliable and trustworthy information about an instrument’s bending ability.

Assessment of Real-Time Operative Torque during Nickel–Titanium Instrumentation with Different Lubricants

The aim of the present study is twofold: to assess ex vivo the role of different lubricants on real-time torque generated during intracanal instrumentation and to check whether two different kinds of torque parameters, operative torque (OT) and average peak torque (APT), could produce similar results. Forty extracted single-rooted teeth were selected for the present study and divided into four equal groups (n = 10): Group A, NaCl 0.2%; Group B, NaOCl 5%; Group C, ethylenediaminetetraacetate (EDTA), and Group D, EDTA and hydrogen peroxide. Afterwards, Edge Taper F2 (Edge Endo, Albuquerque, New Mexico) were rotated clockwise at 300 rpm with 3 Ncm maximum torque by an endodontic torque recording motor. In each sample, mean OT and mean APT were recorded and statistically analyzed with one-way ANOVA and a post hoc Bonferroni between groups (p < 0.05). EDTA (12.11 ± 4.45 Ncm) showed statistically significant (p < 0.05) lower values compared with the other tested irrigant for both parameters. Overall, the two different parameters were both able to differentiate between the influence of lubricants on torsional loads.

Influence of Different Heat Treatments on Torsional and Cyclic Fatigue Resistance of Nickel–Titanium Rotary Files: A Comparative Study

Protaper Universal (PTU), Protaper Gold (PTG) (Maillefer, Ballaigues, CH), EdgeTaper (ET), and EdgeTaper Platinum (ETP) (Albuquerque, NM, USA) were tested for both torsional and flexural resistance. The aim of the present study was to evaluate the influence of proprietary heat treatment on the metallurgical properties of the aforementioned instruments. Four groups of 30 different instruments (size 20.07) were tested, then divided into two subgroups of 15 instruments—one for the cyclic fatigue test in a curved canal (90°—2 mm radius) at 300 rpm and 2.5 Ncm. The time to fracture (TtF) and fragment length (FL) were recorded. The other subgroup was subjected to the torsional test (300 rpm, 5.5 Ncm). The torque to fracture and TtF were recorded. All the instruments underwent a SEM analysis. The heat-treated instruments showed a significantly higher fatigue resistance than the non-heat-treated instruments (p < 0.05). No significant differences were found in the torsional resistance between the ET and PTU, and the ETP and PTG. However, when comparing all the groups, the heat-treated instruments showed less torsional resistance. The improvement from heat treatment was mainly found in the cyclic fatigue resistance.

Torque Range, a New Parameter to Evaluate New and Used Instrument Safety

The aim of the present study is to evaluate operative torque, torque at failure and the difference between these two values—the “torque range”—of two different NiTi files. We also sought to evaluate and compare these parameters for new and used files. Forty S-One 20.06 and forty M-Two 20.06 were tested, divided in four equal groups (n = 10) for each brand. Ten instruments from each brand performed three root canal treatments each on standardized extracted single-rooted teeth. Afterwards, each group was subjected to the following two tests: operative torque and torsional resistance. Mean values for all the tested groups were calculated. The results for new instruments showed that S-One developed significantly higher operative torque, but higher torsional resistance. The results for used instruments showed that the S-One 20.06 developed less operative torque and higher mean torsional resistance value compared to the M-Two. Moreover, the percentage reduction of both values was significantly higher for M-Two. The results of the present study showed a safer torsional behavior of the S-One. These results could be related to the heat treatment and the manufacturing process.