The effects of autoclave sterilization on the cyclic fatigue resistance of ProTaper Universal, ProTaper Next, and ProTaper Gold nickel-titanium instruments

Comparing the EdgeFile X3, GenEndo, HeroGold, and ProTaper Gold Rotary Instruments Regarding the Effect of Different Concentrations and Temperature of NaOCl on Cyclic Fatigue Resistance

AIM

This research was carried out with the objective of comparison between GenEndo, Protaper Gold, Hero Gold and EdgeFile X3 regarding the effect of different concentrations of NaOCl.

MATERIALS AND METHODS

About 720 study specimens were included in the study. They were divided into four groups. Each group consisted of 180 files. Group A: GenEndo, Group B: Protaper Gold, Group C: Hero Gold, Group D: EdgeFile X3. Each group of instruments were further subdivided into nine subgroups (n = 20 for each subgroup). Testing of the cyclic fatigue was carried out in artificial canals which were prepared inside the blocks of stainless steel. The stainless steel blocks with artificial canals were established in a receiver that was packed with experimental solutions like distilled water, 5.25% NaOCl and 2.5% NaOCl. The adjustment of temperature was done at 25, 37, and 60°C. The rotation of the instrument was carried out inside the artificial canal as per the instructions of the manufacturer. The instrument was rotated until it got fractured. The time taken by the instrument to fracture was recorded in seconds. The number of cycles to fracture (NCF) was analyzed with the help of the equation (NCF = time to fracture × rpm/60). Surfaces at the site of fracture were examined with the help of a scanning electron microscope (EVOLS10, ZEISS) at magnification (300x and 2000x).

RESULTS

It was noticed that there was a statistically significant increase in cyclic fatigue when sodium chloride was used as an endodontic irrigant instead of distilled water. The increase in cyclic fatigue was also observed when 5.25% sodium chloride was used instead of 2.5% sodium hypochlorite. Cyclic fatigue increased on change in temperature from 25 to 37°C and from 37 to 60°C. The difference was statistically significant (p < 0.05). It was observed that resistance against cyclic fatigue on treatment with different irrigation solutions at different temperatures was in the order of GenEndo > Protaper Gold > Hero Gold > EdgeFile X3.

CONCLUSION

The resistance against cyclic fatigue in new NiTi rotary files can be affected significantly by different concentrations of sodium hypochlorite irrigant solution and the GenEndo rotary endodontic instrument has the maximum resistance against cyclic fatigue.

CLINICAL SIGNIFICANCE

Irrigation of the root canal with irrigants, such as sodium hypochlorite (NaOCl) has been recommended strongly. NaOCl is used in the range of 0.5 and 6.5% concentration owing to its antimicrobial activity and tissue dissolution activities, particularly at higher temperatures. It has been postulated that fatigue of rotary endodontic instruments can be influenced by adjoining medium and their concentration.

Cyclic fatigue resistance of EdgeTaper Platinum, Protaper Gold, and TruNatomy Prime rotary files before and after autoclave sterilization

Background

This in vitro investigation aimed to determine the influence of multiple autoclave cycles on the cyclic fatigue resistance of three heat-treated nickel-titanium (NiTi) files: EdgeTaper Platinum (ETP), ProTaper Gold (PTG), and TruNatomy Prime (TN).

Materials

Sixty NiTi files, twenty of each NiTi file type: ETP 25/.06, PTG 25/.08, and TN 26/.04 were randomly divided into four equal subgroups (n = 5). The files for the control group were left un-autoclaved. Different autoclave sterilization cycles (one, five, and ten) were used for the other three groups. The files were then placed in a metal canal block and rotated according to the manufacturer's instructions until fracture. The length of the broken segment and the time taken for fracture were measured. The fractured surfaces were subsequently subjected to SEM imaging. The Kruskal-Wallis test was used to analyze the data, followed by Dunn-Bonferroni pairwise comparisons. Statistical significance was set at p < 0.05.

Results

ETP showed significantly greater resistance to cyclic fatigue than TN in all autoclave groups and PTG after five autoclave cycles (p = 0.014). Fatigue resistance was not affected by the number of autoclaving cycles, except for ETP. After the first and tenth autoclaving cycles, they required significantly more rotations to failure than the non-sterilized files (p = 0.039 and p = 0.021, respectively). The fractured segments of the ETP files in these two groups were also longer than those in the control group (p = 0.010).

Conclusion

The cyclic fatigue resistance of ETP was greater than that of TN in all tested conditions. Repeated autoclave cycles of sterilization improved the cyclic fatigue resistance of the ETP files only and did not affect the cyclic fatigue resistance of TN and PTG. However, the ETP files separated at a longer distance from the tip with increased autoclaving cycles.

Effect of different axial speed patterns on cyclic fatigue resistance of rotary nickel-titanium instruments

BACKGROUND

To evaluate the effect of pecking motions with faster upward speed on the dynamic cyclic fatigue resistance of nickel-titanium rotary instruments with different metallurgy.

METHODS

Forty each of ProTaper Universal F3 (PTU) and ProTaper Gold F3 (PTG) instruments (size #30/.09) were equally divided into four groups. The test was performed using an 18-mm-long stainless steel artificial canal with a 5-mm radius of curvature, a 45° canal curvature and a 2-mm canal diameter. A downward speed of 100 mm/min was employed, while the upward speed was set at 100, 150, 200 or 300 mm/min. Time to failure (Tf), number of cycles to failure (Nf) and number of pecking motions to failure (Np) were recorded. Statistical analysis was performed using Kruskal Wallis and Mann-Whitney U tests for Tf, Nf, and Np (α = 0.05).

RESULTS

The 100/300 mm/min group showed significantly higher Np values than the 100/100 mm/min group (p < 0.05), whereas there were no significant differences in Tf and Nf among the tested speed groups (p < 0.05) in either PTU or PTG. PTG exhibited significantly higher Tf, Nf, and Np than PTU (p < 0.05).

CONCLUSIONS

Under the tested conditions, the fastest upward speed group showed significantly higher cyclic fatigue resistance, as demonstrated by larger Np, than the same speed group. PTG had significantly higher cyclic fatigue resistance than PTU in all groups.

Impacts of NaOCl and Irritrol irrigation solutions with/without autoclave sterilisation on the cyclic fatigue resistance of different nickel-titanium files

This research aimed to examine the impact of NaOCl and Irritrol solutions with/without autoclave sterilisation on the cyclic fatigue resistance of ProTaper, WaveOne Gold and Reciproc NiTi files. Seventy files in every group were separated into seven subgroups (n = 10) according to irrigation solutions and sterilisation procedures. The mean and standard deviations of the time to fracture was calculated for each group, and the data statistical analysis was performed (P ≤ 0.05). Significantly higher cyclic fatigue resistance was found in Reciproc files than the other types of files. The differences between the control and other subgroups were found to be statistically insignificant (P > 0.05), except for subgroups 5 and 7 (P ≤ 0.05). Immersing NiTi files in NaOCl or Irritrol with sterilisation for three times considerably reduced the cyclic fatigue resistance of these files. Reciproc files exhibited the highest cyclic fatigue resistance in comparison with ProTaper and WaveOne Gold files.

Comparison of the fracture resistance of the teeth prepared with ProTaper Universal, ProTaper Next, and ProTaper Gold rotary files

OBJECTIVES

Root canal preparation can lead to cracks on the roots by creating stresses on the root canal walls, which decreases the fracture resistance of the tooth. The present study compared the fracture resistance of the teeth prepared by the ProTaper Universal (PTU), ProTaper Next (PTN), and ProTaper Gold (PTG) rotary file systems.

MATERIALS AND METHODS

Fifty-six single-canal premolar teeth were sectioned 14 mm from the root apex. The roots were standardized based on the buccolingual and mesiodistal diameter and randomly assigned to three experimental (n = 14) and one control group (n = 14). The teeth in three experimental groups were instrumented with PTU, PTN, and PTG rotary files. The roots in the control group were not instrumented. A vertical force was applied to each root in a universal testing machine until the root fractured. The data were statistically analyzed by one-way analysis of variance.

RESULTS

There was no significant difference in the fracture resistance of the teeth between the control, PTU, PTN, and PTG groups (p = .115).

CONCLUSIONS

Root canal preparation with ProTaper files manufactured with conventional NiTi (PTU) and heat-treated alloys (PTN and PTG) did not affect the fracture resistance of teeth.

Fracture Resistance of Heat-Treated Nickel-Titanium Rotary Files After Usage and Autoclave Sterilization: an in vitro study

INTRODUCTION

This study aimed to evaluate the dynamic cyclic fatigue resistance of heat-treated nickel-titanium (NiTi) files after usage and autoclaving.

METHODS

Two heat-treated NiTi file systems with the tip sizes of #25 of ProTaper Gold F2 (PG) and TruNatomy Prime (TN) were selected. Files in each system was divided into three experimental subgroups (n=10). For subgroup-1, new files were tested to establish baseline number of cycles to failure (NCF). For subgroup-2, files underwent canal instrumentation in a simulated J-shaped canal block with the 35-degree of curvature with 16.5-mm of length. The simulated canals were pre-enlarged using stainless-steel files, #10K and #15K. After instrumentation, the files were tested. For subgroup-3, files underwent canal instrumentation as in subgroup-2 and followed by autoclave sterilization then were tested for cyclic failure. Cyclic fatigue test was performed in dynamic pecking motion under body temperature. The time to fracture was recorded and calculated into NCF. Fracture fragments lengths were measured using digital microcaliper. Statistical analysis was conducted using independent t-test and multi-factorial analysis of variance with 95% significance. Scanning electron microscopy was used to examine the topographic characteristics after cyclic fatigue tests.

RESULTS

There were no significant differences between file systems in subgroup-1 using new files (P<.05). While PG reduced the NCF after use, TN showed significantly increased NCF (P<.05). However, after sterilization, TN showed reduced NCF than the used one (P<.05).

CONCLUSIONS

Cyclic loading by usage and heat treatment during sterilization may result in different cyclic fatigue resistance according to the geometry and alloy characteristics.

Nitinol Type Alloys General Characteristics and Applications in Endodontics

A very extensive literature review presents the possibilities and needs of using, in endodontics, the alloys commonly known as nitinol. Nitinol, as the most modern group of engineering materials used to develop root canals, is equilibrium nickel and titanium alloys in terms of the elements’ atomic concentration, or very similar. The main audience of this paper is engineers, tool designers and manufacturers, PhD students, and students of materials and manufacturing engineering but this article can also certainly be used by dentists. The paper aims to present a full material science characterization of the structure and properties of nitinol alloys and to discuss all structural phenomena that determine the performance properties of these alloys, including those applied to manufacture the endodontic tools. The paper presents the selection of these alloys’ chemical composition and processing conditions and their importance in the endodontic treatment of teeth. The results of laboratory studies on the analysis of changes during the sterilization of endodontic instruments made of nitinol alloys are also included. The summary of all the literature analyses is an SWOT analysis of strengths, weaknesses, opportunities, and threats, and is a forecast of the development strategy of this material in a specific application such as endodontics.

Cleaning of endodontic files with and without enzymatic detergent by means of the manual method versus the ultrasonic method: An experimental study

Aim

The aim of this article is to evaluate the cleanliness level achieved with and without the application of enzymatic detergent for the manual method versus the ultrasonic method, applied to Flexoreamer K-type files No. 25, No. 30, and No. 35.

Materials and Methods

192 K-type Flexoreamer files were divided into four categories: A1 (ultrasonic method with enzymatic detergent), A2 (ultrasonic method without enzymatic detergent), B1 (manual method with enzymatic detergent), and B2 (manual method without enzymatic detergent). Each category was randomly distributed in three groups of 16 files each (No. 25, No. 30, and No. 35). The files were used for biomechanical instrumentation of the root canal in premolars. The active part of the files was examined under a stereomicroscope, considering four cleaning levels: 4 (100% cleanliness), 3 (95-99% cleanliness), 2 (85-94% cleanliness), 1 (75-84% cleanliness), and 0 (less than 75% cleanliness). For hypothesis testing, the Mann-Whitney U-test was used to differentiate between techniques, and the Kruskal-Wallis multiple comparison test was used to compare pairs of files within each cleaning method.

Results

When using enzymatic detergents, the manual and ultrasonic methods did not show significant differences when comparing each group of the files analyzed (P > 0.05). However, when comparing the cleaning level without enzymatic detergent between the manual and ultrasonic methods, we observed that it obtained a superior result when compared with the manual method for each type of file: No. 25 (P = 0.021), No. 30 (P < 0.001), and No. 35 (P < 0.001). Both methods achieved a significantly higher level of cleaning with the application of the enzymatic detergent (P < 0.05) than without applying it.

Conclusion

The ultrasonic cleaning method proved to be the most effective method for the removal of biologic waste when compared with the manual method using a nylon brush. However, there was no significant difference between these two methods when enzymatic detergent was used.

Effect of number of uses and sterilization on the instrumented area and resistance of reciprocating instruments

Objectives

This study evaluated the effect of repeated uses and autoclaving in the instrumented area, fracture resistance, and time of instrumentation of thermally treated nickel-titanium reciprocating systems.

Materials and Methods

Two hundred simulated canals were instrumented using Reciproc Blue and WaveOne Gold. Each file was used up to 10 times or until fracture. The instrumented area was measured in pre- and post-operative images, using ImageJ software. Kaplan-Meier survival analysis evaluated the number of uses of instruments before fracture. Instrumented area and time of instrumentation were analyzed by Mann-Whitney U test and Kruskal-Wallis. Correlations among the number of uses and instrumented area were measured. The level of statistical significance was set at p < 0.05.

Results

Reciproc Blue presented a higher estimated number of uses in comparison with WaveOne Gold (p = 0.026), but autoclaving did not affect the resistance to fracture of instruments (p > 0.05). The instrumented area was different among the evaluated groups (p = 0.039), and the instrumented area along the uses of both tested instruments was reduced. With the time of instrumentation, there was also a significant difference among the evaluated groups; the groups without sterilization cycles were faster, in comparison to those submitted to autoclaving (p = 0.010).

Conclusions

Reciproc Blue was more resistant than WaveOne Gold, suffering later fracture. Additionally, the sterilization cycles did not influence the estimated number of uses of thermally treated reciprocating instruments, but the instrumented area of root canals was reduced along with the repeated uses of both instruments.

Effects of repeated sterilization cycles on the surface alterations of ProTaper Next, TF Adaptive, HyFlex CM, and 2Shape instruments

Background. This study aimed to evaluate the effects of repeated sterilization cycles on the surface alterations of various nickel-titanium instruments, including ProTaper Next (PTN), TF Adaptive (TFA), HyFlex CM (HCM), and 2Shape (2S). Methods. Twenty-four new NiTi files of four different alloys were selected. The instruments in each group were divided into two equal groups, as follows: control and sterilization. The first group was chosen as the control without applying any sterilization procedure, while in group 2, five cycles of sterilization procedures were applied. The surface topographies were evaluated using scanning electron microscope (SEM) and atomic force microscope (AFM). The root mean square (RMS) and maximum height (MH) values and three-dimensional images were recorded. The data were analyzed with the Shapiro-Wilk test, one-way ANOVA, and post hoc Tukey tests. The statistical significance level was set at P ≤ 0.05. Results. Before the experiment, HCM demonstrated the highest RMS value, and 2S showed the lowest. After the procedures, the RMS and MH values deteriorated on the surface of PTX, TFA, and 2S (P < 0.001). The HCM was not affected by sterilization processes (P > 0.05). Conclusion. The initial irregularity on the surface did not affect the rate of alteration. The HCM files demonstrated superior surface properties after several cycles of sterilization. The PTN, TFA, and 2S presented similar surface responses after five cycles of autoclave sterilization.

The Influence of NiTi Alloy on the Cyclic Fatigue Resistance of Endodontic Files

Background: The aim of this study was to analyze the influence of NiTi alloy in endodontic rotary instruments on cyclic fatigue resistance. Methods: One hundred and sixty-four (164) sterile endodontic rotary files were selected and distributed into the following study groups: A: 25.08 F2 ProTaper Universal (PTU) (n = 41); B: 25.06 X2 ProTaper Next (PTN) (n = 41); C: 25.08 F2 ProTaper Gold (PTG) (n = 41), and D: 25.06 ProFile Vortex Blue (PVB) (n = 41). A cyclic fatigue device was designed to conduct the static cyclic fatigue tests with stainless steel artificial root canals systems with 250 µm apical diameter, 60° curvature angle, 5 mm radius of curvature, 20 mm length, and 6% (25.06) and 8% taper (25.08). Failure of the endodontic rotary instrument was detected by a single operator through direct observation and was also filmed to allow measurement of the exact time to failure. Results were analyzed using the ANOVA test and Weibull statistical analysis. Results: All pairwise comparisons presented statistically significant differences between the time to failure for the NiTi alloy study groups (p < 0.001), except between the PTN and PVB study groups (p = 0.379). In addition, statistically significant differences between the number of cycles to failure for the NiTi alloy study groups (p < 0.001) were also observed. Conclusions: The NiTi CM-Gold wire alloy of the ProTaper Gold endodontic rotary files resulted in greater resistance to cyclic fatigue than ProFile Vortex Blue, ProTaper Next, and ProTaper Universal endodontic rotary files.

Novel Electronic Device to Quantify the Cyclic Fatigue Resistance of Endodontic Reciprocating Files after Using and Sterilization

Background: The aim of this study was to analyze the effects of the time of use (TU) and sterilization cycles (SC) of endodontic reciprocating files on cyclic fatigue resistance. Methods: One-hundred-and-twenty (120) Procodile NiTi endodontic reciprocating instruments were selected at random and distributed into the following study groups: A: 0 sterilization cycles/0s time of use (n = 10); B: 0/60 (n = 10); C: 0/120 (n = 10); D: 1/0 (n = 10); E: 1/60 (n = 10); F: 1/120 (n = 10); G: 5/0 (n = 10); H: 5/60 (n = 10); I: 5/120 (n = 10); J: 10/0 (n = 10); K: 10/60 (n = 10); and L: 10/120 (n = 10). A dynamic cyclic fatigue device was designed using computer-aided design/computer-aided engineering (CAD/CAE) technology and created with a 3D printer to simulate the pecking motion performed by the clinician. Failure of the endodontic rotary instrument was detected by a light-emitting diode-light-dependent resistor (LED-LDR) system controlled by an Arduino driver complex and management software. The results were analyzed using the ANOVA test. Results: All pairwise comparisons presented statistically significant differences between the time to failure, number of cycles to failure and number of cycles of in-and-out movement for the time of use study groups (p < 0.001), but not in the number of sterilization cycles (p > 0.05). Conclusions: The time of use of NiTi endodontic reciprocating files negatively affects dynamic cyclic fatigue resistance. Dynamic cyclic resistance is not affected by the number of sterilization cycles.

Influence of autoclave sterilization procedures on the cyclic fatigue resistance of heat-treated nickel-titanium instruments: a systematic review

Objectives

This systematic review evaluated the influence of autoclave sterilization procedures on the cyclic fatigue resistance of heat-treated nickel-titanium (NiTi) instruments.

Materials and Methods

A systematic search without restrictions was conducted in the following electronic databases: PubMed, Scopus, Web of Science, ScienceDirect, Cochrane, and Open Grey. The hand search was also performed in the main endodontic journals. The eligible studies were submitted to the methodological assessment and data extraction.

Results

From 203 abstracts, a total of 10 articles matched the eligible criteria. After reading the full articles, 2 were excluded because of the absence of the heat-treated instruments in the experimental design and 3 due to the lack of a control group using heat-treated instruments without autoclave sterilization. From the 5 included studies, 1 presented a low risk of bias, 3 presented moderate and 1 high risk. It was observed heterogeneous findings in the included studies, with autoclave sterilization cycles increasing, decreasing or not affecting the cyclic fatigue life of heat-treated NiTi instruments. However, the retrieved studies evaluating the cyclic fatigue resistance of endodontic instruments presented different protocols and assessing outcomes, this variability makes the findings less comparable within and also between groups and preclude the establishment of an unbiased scientific evidence base.

Conclusions

Considering the little scientific evidence and considerable risk of bias, it is still possible to conclude that autoclave sterilization procedures appear to influence the cyclic fatigue resistance of heat-treated NiTi instruments.

Management of Instrument Sterilization Workflow in Endodontics: A Systematic Review and Meta-Analysis

Endodontic treatment consists of different working procedures, such as the isolation of the operating field, pulp chamber access, and cleaning and shaping phases with at last the need of a three-dimensional filling of the canals. Each step requires a series of single-use or sterilizable instruments. We have performed a systematic review of different sterilization and disinfection procedures aiming at drawing up a disinfection and sterilization procedure to be used on endodontic instruments. A search on PubMed and Scopus was carried out using the following keywords: “endodontic sterilization,” “endodontic autoclave,” “decontamination dental bur,” “sterilization dental burs,” and “gutta-percha points sterilization.” Eligible articles were included in the qualitative and quantitative analysis. Results of the meta-analysis showed that the most effective method in sterilization is autoclaving. The qualitative analysis showed that the use of single-use or first-use instruments requires presterilization or sterilization procedures, and for reusable tools, attention must be paid to the removal of debris deposited on the blades, not easy to remove manually.

Effect of autoclave sterilization on cyclic fatigue and torsional fracture resistance of NiTi rotary instruments

The purpose of this study is to assess the effect of autoclave sterilization on the cyclic fatigue and torsional fracture resistance of ProTaper Universal (PTU), K3XF, HyFlex EDM (EDM), and TF adaptive (TFA). Sixty instruments from each file type were divided into two categories for cyclic fatigue group (CGr) and torsional fracture group (TGr). CGr and TGr were divided into three subgroups, respectively, consisting of ten instruments from each file type. Cyclic fatigue fracture test was performed using artificial canal made of stainless steel, and the mean number of cycles to failure (NCF) were determined. CGr1, the files were tested to establish baseline for NCF; CGr2, the files were tested cyclic fatigue after 10 cycles of autoclave; CGr3, instruments were autoclaved after being cycled to 25, 50, and 75% of corresponding NCF determined in CGr1, followed by cyclic fatigue test. The torsional fracture test was performed without autoclave (TGr1), after 3-cycle autoclave (TGr2), and 7-cycle autoclave (TGr3), respectively, which evaluated maximum torque and angular deflection. NCF, maximum torque and angular deflection were compared using one-way ANOVA with Bonferroni test. Two-way ANOVA was performed to determine the interaction between 'autoclave treatment' and 'type of NiTi file'. EDM showed highest NCF within the same autoclave treatment. TFA presented the lowest maximum torque and the highest angular deflection, and PTU presented the lowest angular deflection. Within the same NiTi file systems, most of NCF, maximum torque and angular deflection of tested files were not significantly influenced by autoclave condition.