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Immich F, de Araújo LP, da Gama RR, da Rosa WLDO, Piva E, Rossi-Fedele G. Fifteen years of engine-driven nickel-titanium reciprocating instruments, what do we know so far? An umbrella review. AUST ENDOD J 2024; 50:409-463. [PMID: 38923176 DOI: 10.1111/aej.12870] [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: 05/20/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Abstract
Numerous systematic reviews (SRs) have produced conflicting findings on engine-driven nickel-titanium reciprocating instruments (reciprocating instruments) since Yared's seminal study 15 years ago. This umbrella review analysed SRs examining the clinical and laboratory evidence regarding reciprocating instruments for root canal treatment. SRs that evaluated qualitatively and/or quantitatively the outcomes postoperative pain, oral health-related quality of life (OHRQoL), shaping ability, debris extrusion, microbial load, endotoxins reduction, cyclic fatigue, file fracture, dentinal cracks and root canal filling removal were included. The AMSTAR 2 tool was used to evaluate SRs quality, while the ROBIS tool to assess risk of bias (RoB). Forty SRs were included. The SRs revealed predominantly 'high' RoB and 'critically low' quality. Most focused on technical outcomes, exhibiting significant methodological and statistical heterogeneity. Findings suggest comparable efficacy between reciprocating and rotary instruments. However, due to the scarcity of high-quality evidence, future well-designed studies and reviews considering core outcome measures are needed.
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Affiliation(s)
- Felipe Immich
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Lucas Peixoto de Araújo
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
- School of Dentistry, Catholic University of Pelotas, Pelotas, Brazil
| | | | | | - Evandro Piva
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
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Das D, Barai S, Kumar R, Bhattacharyya S, Maity A, Shankarappa P. Comparative evaluation of incidence of dentinal defects after root canal preparation using hand, rotary, and reciprocating files: An ex vivo study. J Int Oral Health 2022. [DOI: 10.4103/jioh.jioh_136_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Versiani MA, Cavalcante DM, Belladonna FG, Silva EJNL, Souza EM, De-Deus G. A critical analysis of research methods and experimental models to study dentinal microcracks. Int Endod J 2021; 55 Suppl 1:178-226. [PMID: 34743355 DOI: 10.1111/iej.13660] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 12/30/2022]
Abstract
The purpose of this narrative review was to discuss the scientific milestones that led to the current understanding of the root dentinal microcrack phenomenon based on the interplay between the usage of micro-computed tomography (micro-CT) as an analytical tool alongside a close-to-mouth experimental model. In 2009, reports on the development of dentinal microcracks in extracted teeth after root canal preparation triggered an awareness of the potential for vertical root fractures (VRFs) of endodontically treated teeth could be developed from defects created by the mechanical stress of nickel-titanium preparation systems on dentine. This assumption was taken for granted, even though no cause-effect relationship had been scientifically demonstrated. Since then, several studies using the sectioning method with extracted teeth have been published and the large discrepancy amongst their outcomes soon become evident. Moreover, the high frequency of reported dentinal microcracks largely contrasted with the clinical incidence of VRFs, raising doubts on their methodological reliability. Using micro-CT technology, it was demonstrated by several studies that, in extracted teeth, dentinal defects already existed before the endodontic procedures, indicating that the initial reports framed a non-existing cause-effect relationship between canal preparation and dentinal microcracks. Although these new findings contributed to a better comprehension of this phenomenon, the misconception that microcracks were the starting point for VRFs was only surpassed with a new in situ approach using fresh cadavers. Surprisingly, microcracks were not identified in sound teeth. As a conclusion, dentinal microcracks in extracted teeth can be considered a non-natural occurrence observed only in a laboratory set-up as a consequence of dehydration and storage conditions. Thus, dentinal microcracks shall not be considered as the starting point for VRFs as they do not manifest in non-extracted teeth. Identifying dentinal microcracks as a laboratory phenomenon highlights the impact of recent scientific developments to disclaim the clinical relevance of laboratory-obtained outcomes.
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Affiliation(s)
| | | | | | - Emmanuel João Nogueira Leal Silva
- Department of Endodontics, Fluminense Federal University, Niterói, Brazil.,Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Duque de Caxias, Brazil
| | - Erick Miranda Souza
- Department of Dentistry II, Federal University of Maranhão, São Luís, Brazil
| | - Gustavo De-Deus
- Department of Endodontics, Fluminense Federal University, Niterói, Brazil
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Yamakami SA, Gallas JA, Petean IBF, Souza-Gabriel AE, Sousa-Neto M, Macedo AP, Palma-Dibb RG. Impact of Endodontic Kinematics on Stress Distribution During Root Canal Treatment: Analysis of Photoelastic Stress. J Endod 2021; 48:255-262. [PMID: 34699903 DOI: 10.1016/j.joen.2021.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 10/09/2021] [Accepted: 10/14/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Structural defects created by endodontic treatment are the most common cause of major dental failures. This study analyzed levels of stress produced by endodontic instruments during the root canal treatment by photoelastic analysis of stress. METHODS Twenty-four human premolars were randomly divided into 4 groups (n = 6) according to instrumentation protocol: ProTaper Next (GPT), One Shape (GOS), Wave One Gold (GWO), and TF Adaptive (GTF). The evaluation of the photoelastic model was performed at 4 dental zones: dental-crown region, cervical third of root, middle third of root, and apical third of root. Silicone molds were prepared (2 × 15 mm), and pinjets were used inside the root canals to fixate teeth. Photoelastic resin (2:1 ratio) was poured into the silicone molds to form photoelastic models. A transmission polariscope was used to analyze the positions of interest and recorded with a digital camera. Tardy's method was used to quantify the fringe order (n) and calculate the maximum stress value (τ) at each selected point. Data were analyzed with two-way analysis of variance, Tukey test (P < .05), fringe descriptive analysis. RESULTS All groups showed a significant increase in the level of stress created during biomechanical preparation of the root canals. In the quantitative analysis, there was no statistically significant difference among the groups (P > .05). In the qualitative analysis, GPT and GTF instruments achieved greater levels of stresses compared with GWO and GOS instruments. At the beginning of instrumentation, stresses were concentrated at the coronary level and the end of instrumentation at the middle and apical root level. CONCLUSIONS All endodontic systems resulted in accumulation of stress along the dental structure. Stress was found in different concentrations along the tooth and at different levels.
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Affiliation(s)
- Shelyn Akari Yamakami
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Julia Adornes Gallas
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Igor Bassi Ferreira Petean
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Aline Evangelista Souza-Gabriel
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Manoel Sousa-Neto
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Ana Paula Macedo
- Department of Dental Materials and Prosthesis, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Regina Guenka Palma-Dibb
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, SP, Brazil.
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Fráter M, Jakab A, Braunitzer G, Tóth Z, Nagy K. The potential effect of instrumentation with different nickel titanium rotary systems on dentinal crack formation-An in vitro study. PLoS One 2020; 15:e0238790. [PMID: 32903275 PMCID: PMC7480847 DOI: 10.1371/journal.pone.0238790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022] Open
Abstract
The potential mechanical impact of different rotary systems used for root canal preparation has been a matter of debate for long. The aim of this study was to explore the incidence of dentinal cracks after root canal instrumentation with various rotary systems, in vitro. One hundred and eighty intact lower central incisors were selected and randomly divided into fourteen treatment groups (n = 12/group) and a control group (n = 12). After decoronation, the root canals were instrumented with fourteen different rotary systems (E3, E3 azure, NT2, Hyflex CM, Hyflex EDM, 2Shape, OneCurve, ProTaper Next, ProTaper Gold, WaveOne Gold, Mtwo, Reciproc Blue, TF adaptive, K3XF). All roots were horizontally sectioned at 3, 6, and 9 mm from the apex with a low-speed saw under water-cooling. The slices were then examined under stereomicroscope for dentinal cracks. No cracks were found in the control group. Cracks were found in all treatment groups, predominantly in the 3 mm slices. There was no statistically significant difference in the number of cracks when comparing the different systems to each other at any section level. At 3 mm, however, five of the studied systems, namely K3XF (p = 0.004), Protaper Next (p = 0.001), Reciproc Blue (p<0.001), TF adaptive (p = 0.050), and 2Shape (p = 0.009) presented a significantly higher number of cracks than the control group. Within the limitations of this study, instrumented canals presented dentinal cracks, while uninstrumented ones presented no cracks after sectioning. There seems to be no significant difference among the tested systems regarding crack formation in the instrumented root canal wall. Crack formation occurred irrespective of the motion of the rotary system (rotational or reciprocation). Further studies are needed to clarify the factors that contribute to crack formation in the case of each individual rotary system.
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Affiliation(s)
- Márk Fráter
- Department of Operative and Esthetic Dentistry, Faculty of Dentistry, University of Szeged, Szeged, Hungary
| | - András Jakab
- Department of Operative and Esthetic Dentistry, Faculty of Dentistry, University of Szeged, Szeged, Hungary
| | | | - Zsolt Tóth
- Department of Oral Biology and Experimental Dental Research, Faculty of Dentistry, University of Szeged, Szeged, Hungary
| | - Katalin Nagy
- Department of Oral Surgery, Faculty of Dentistry, University of Szeged, Szeged, Hungary
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Assis RS, Lopes FC, Roperto R, Silva Sousa YTC, Brazão EH, Spazzin AO, Pereira GKR, Alves DM, Saquy PC, Sousa-Neto MD. Bond strength and quality of bond interface of multifilament fiberglass posts luted onto flat-oval root canals without additional dentin wear after biomechanical preparation. J Prosthet Dent 2020; 124:738.e1-738.e8. [PMID: 32694019 DOI: 10.1016/j.prosdent.2020.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 10/23/2022]
Abstract
STATEMENT OF PROBLEM An intraradicular retainer formed by multiple independent glass fiber filaments was developed aiming to allow better adaptation in flattened root canals; however, the performance of the new posts is unclear. PURPOSE The purpose of this in vitro study was to compare the bond strength (BS) and adhesive interface quality achieved in flattened root canals restored with conventional glass fiber posts (CFPs) and multifilament glass fiber posts (MFPs). MATERIAL AND METHODS The distal roots of mandibular molars with long oval root canals were endodontically treated, and the obturation material was removed and assigned to 2 groups (n=11) according to the type of retainer used: CFP (WhitePostDC#0.5; FGM) or MFP (CometTail#4; Synca). The posts were cemented with self-adhesive resin cement. The specimens were sectioned (2 slices per third). The most cervical slice in each third was used to evaluate the BS, while the adhesive interface in the apical slices was analyzed by scanning electron microscopy. BS data were analyzed by using a multilevel generalized linear model, and adhesive interface SEM data were analyzed by using a multilevel ordinal logistic regression model (α=.05). RESULTS Multilevel regression showed a statistically significant difference for the "type of retainer" factor (P=.001; CFP 2.61 ±1.30>MFP 1.59 ±1.54). No statistically significant differences were found for the "root thirds" factor (P=.346) or for the interaction of both factors (P=.114). The failure pattern was predominantly mixed or adhesive for CFP and adhesive to dentin for MFP. A better adaptation of the restorative material was observed in the cervical third for CFP and in the apical third for MFP (P<.001). CONCLUSIONS MFP resulted in lower BS values than CFP, with a higher prevalence of adhesive failures to dentin and better adaptation of the adhesive interface in the apical third.
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Affiliation(s)
- Rafael S Assis
- Postgraduate student, Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Fabiane Carneiro Lopes
- Postgraduate student, Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Renato Roperto
- Professor, Department of Comprehensive Care, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio
| | | | - Elisabeth Helena Brazão
- Postgraduate student, School of Dentistry, University of Ribeirão Preto (UNAERP), Ribeirão Preto, SP, Brazil
| | - Aloísio O Spazzin
- Professor, School of Dentistry, Meridional Faculty (IMED), Passo Fundo, RS, Brazil
| | - Gabriel K R Pereira
- Professor, School of Dentistry, Meridional Faculty (IMED), Passo Fundo, RS, Brazil
| | - Daniela Meira Alves
- Postgraduate student, School of Dentistry, Meridional Faculty (IMED), Passo Fundo, RS, Brazil
| | - Paulo César Saquy
- Professor, Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Manoel Damião Sousa-Neto
- Professor, Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil.
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Valle AD, Dotto L, Morgental RD, Pereira-Cenci T, Pereira GKDR, Sarkis-Onofre R. Influence of Root Canal Preparation on Formation of Dentinal Microcracks: A Systematic Review. Braz Dent J 2020; 31:201-220. [PMID: 32667513 DOI: 10.1590/0103-6440202002652] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 11/05/2019] [Indexed: 02/07/2023] Open
Abstract
The effect of root canal preparation technique on microcrack initiation is a controversial issue. This systematic review aimed to assess the role of root canal preparation techniques with different kinematics (manual, rotary, reciprocating, adaptive, self-adjusting file) on microcrack initiation. In vitro and in situ studies comparing the influence of at least two different root canal preparation techniques on the initiation of dentin microcracks were searched in PubMed/MEDLINE and SCOPUS up to June 5, 2018 without language and period restriction. Two authors independently reviewed all identified titles and abstracts for eligibility. Tables were generated to summarize the included studies, and the included studies were assessed for bias. Fifty-four (n=54) articles met the eligibility criteria. The results were classified according to the method used for microcrack evaluation, and most studies that used micro-computed tomography showed no formation of new cracks after root canal preparation. In general, the instrumentation techniques induced microcrack formation when the methods were destructive, irrespective of kinematics. In relation to the apex region, when the preparation working length was set as the root canal length subtracted of 1 mm, the risk of microcrack initiation reduces. The majority of the included studies had low risk of bias for all assessed domains. Our results seem to indicate that the various root canal preparation techniques considered in this study will not cause damage to the dental structure when adequately employed and the proper methodology is applied.
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Affiliation(s)
- Alânia Dalla Valle
- Graduate Program in Dentistry, Faculdade Meridional, Passo Fundo, RS, Brazil
| | - Lara Dotto
- Graduate Program in Dentistry, Faculdade Meridional, Passo Fundo, RS, Brazil
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Harandi A, Mirzaeerad S, Mehrabani M, Mahmoudi E, Bijani A. Incidence of Dentinal Crack after Root Canal Preparation by ProTaper Universal, Neolix and SafeSider Systems. IRANIAN ENDODONTIC JOURNAL 2017; 12:432-438. [PMID: 29225637 PMCID: PMC5722122 DOI: 10.22037/iej.v12i4.17597] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction: This study aimed to compare the incidence of dentinal crack formation by instrumentation with ProTaper Universal system (rotary, multi-file system), SafeSider (reciprocation movement, multi-file system) and Neolix (rotary, single-file system). Methods and Materials: In this in vitro study, 60 freshly extracted mandibular first molars were randomly divided into three experimental groups (n=15) and a control group containing unprepared teeth (n=15). Instrumentation in different groups was accomplished using either ProTaper, Neolix or SafeSider systems up to 25/0.08. The teeth were then sectioned at 3, 6 and 9 mm from the apex, and observed under a stereomicroscope for presence of dentinal cracks. Data were analyzed with Chi square test, Fisher’s exact test and Bonferroni correction. Results: Micro cracks were seen in all experimental groups (13.3% in ProTaper, 26.7% in SafeSider and 40% in Neolix). There was a significant difference between Neolix and the control groups in microcrack formation (P=0.042). Micro cracks mainly occurred in the coronal section (9 mm). No microcrack occurred in the control group. Conclusion: Neolix rotary single-file system caused more dentinal cracks compared to the unprepared roots. All the instrumentation systems increased the number of micro cracks compared to unprepared teeth.
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Affiliation(s)
- Azadeh Harandi
- Dental Materials Research Center, Institute of Health, Endodontic Department, Dental School, Babol University of Medical Sciences, Babol, IR. Iran
| | - Sina Mirzaeerad
- Dental Materials Research Center, Institute of Health, Endodontic Department, Dental School, Babol University of Medical Sciences, Babol, IR. Iran
| | - Mahgol Mehrabani
- Student Research Committee, Dental School, Babol University of Medical Sciences, Babol, Iran
| | - Elham Mahmoudi
- Dental Materials Research Center, Institute of Health, Endodontic Department, Dental School, Babol University of Medical Sciences, Babol, IR. Iran
| | - Ali Bijani
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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