Adaptive instrumentation of root canals in primary teeth using XP-endo shaper: a case series

Dental caries is indeed the biggest cause of tooth loss, particularly in the primary dentition. In primary teeth with carious pulp involvements, endodontic intervention in the form of pulpotomy (removal of only the coronal pulp) or pulpectomy (removal of coronal and radicular pulp) is advocated. Pulpectomy can be laborious and time-consuming, especially when using traditional hand endodontic files to shape root canals. In paediatric dentistry, motorised nickel-titanium (Ni-Ti) rotary instrumentation has proved significant in enhancing the quality of pulpectomy. In primary dentition, however, these files may leave more than half of the root canals unaltered by instrumentation, just as they do in permanent dentition. The XP-endo® Shaper is a revolutionary heat-dependent endodontic file that uses an asymmetrical rotating motion to address the maximum area of the root canal space, resulting in anatomic root canal instrumentation. The case series describes the use of this novel XP-endo® Shaper file for anatomic root canal instrumentation in primary molars with irreversible pulpitis. The purpose is to demonstrate the efficacy and advantages of this cutting-edge endodontic treatment method. This case series can be an informative resource for other endodontic specialists by providing a practical illustration of how adaptable instrumentation can be utilised to successfully treat a patient. In conclusion, The use of the XP-endo Shaper® for pulpectomy demonstrated faster and instrumentation that was confined with the original shape of the canals, although further research is required to fully utilise these findings.

Effectiveness of pediatric rotary, rotary and reciprocating instrumentations on bacterial load reduction in primary molars: an ex vivo comparative study

This study aimed to evaluate the efficacy of intracanal Enterococcus faecalis reduction using pediatric rotary (EndoArt Pedo Kit Blue, EasyInSmile X-Baby and Denco Kids), rotary (ProTaper Next) and reciprocating (WaveOne Gold) file systems through microbiological analyses in primary molars. Seventy-five mandibular primary second molars were selected and divided into five instrumentation groups and a negative control group. After incubation, five roots were used to confirm biofilm formation on the root canals. Before and after instrumentation, bacterial samples were collected. The bacterial load reduction was statistically analyzed by using Kruskall-Wallis and Dunn post hoc tests at a significance level of 0.05. Denco Kids and EndoArt Pedo Kit Blue promoted higher bacterial reduction than EasyInSmile X-Baby systems. There was no difference in bacterial reduction between ProTaper Next rotary file systems and other groups. Among the single-file techniques, instrumentation with the Denco Kids rotary system showed a more significant bacterial load reduction than WaveOne Gold (p < 0.05). All systems used in the study reduced bacterial counts from root canals in primary teeth. Further studies are required to generate more information about the use of pediatric rotary file systems in clinics.

Finite Element Analysis of Stress Distribution in Root Canals When Using a Variety of Post Systems Instrumented with Different Rotary Systems

It is very important for clinicians to provide restorative treatments that provide durability for endodontically treated teeth. Trauma, occlusal premature contact, and features of teeth are some of the issues that can cause vertical root fractures (VRFs) in root canal-treated teeth. The aim of this 3-D study was to compare stress distribution on mandibular premolar teeth when using a variety of post designs instrumented with different rotary systems. Six mandibular premolar teeth were instrumented with the following tools: ProTaper Next, WaveOne (WO), Reciproc (R), ReciprocBlue (RB), F6-Skytaper, and TF-Adaptive. Teeth were scanned using cone beam computed tomography (CBCT) and the images were transferred to the Catia V5R25 software. Data were recorded in a stereolithography (STL) format. Four different post systems were used, fabricated from metal, fiber, zirconia, and titanium, respectively. Dentin, gutta, post, core, and crown models were added to the solid model. ANSYS V17.2 finite element analysis (FEA) software was used to determine stress distribution on each assembly. Finite analysis models were created that allowed for the calculation of stress distribution of 250-N loading at a 45° angle and vertical in relation to the roots. The maximum principal stress and von Mises values were higher under oblique loading on the roots. The F6-Skytaper and WO systems showed lower stress than other systems. The TF-Adaptive instrument showed higher stress distribution than the other models. Fiber and titanium posts showed lower stress than others. The F6-Skytaper, R, and RB instruments were found to be most effective in terms of displacement of the crown, resulting in the lowest stress values. Fiber and titanium posts showed better results than other post systems, while root canals instrumented with the F6-Skytaper and WO instruments were less likely to result in root fractures.

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.

Microbial Evaluation of Root Canals after Biomechanical Preparation with Manual K-files, Manual H-files, and Kedo-SG Blue Rotary Files: An In Vivo Study

Aim

The purpose of the present study was to comparatively evaluate the efficacy of Kedo-SG blue rotary files, manual K-files, and manual H-files in eliminating the root canal microflora of primary molars.

Materials and methods

Forty-five primary molars requiring pulpectomy were included in the study. Based on type of instrumentation, the teeth were randomly assigned to one of the three groups: group A: Kedo-SG blue rotary files, group B: manual H-files, and group C: manual K-files. Sterile absorbent paper points were used for sample collection and stored in sterile Eppendorf tubes containing saline as transport medium. Culturing was done on thioglycolate agar and blood agar media for the cultivation of anaerobic and aerobic microbes, respectively, and recorded as colony-forming units (CFU) using digital colony counter. Wilcoxon signed-rank test and one-way analysis of variance (ANOVA) test were performed for statistical analysis.

Results

Postinstrumentation, 93-96% reduction of aerobic and anaerobic microbial count was recorded in group A. Whereas, it was 87-91% reduction in group B and 90-91% reduction in group C. No statistically significant difference was noted between the three groups.

Conclusion

Kedo-SG blue rotary files showed a better reduction of microbes in root canals when compared to manual instrumentation. However, there was no significant difference between manual and rotary instrumentation in microbial reduction of primary root canals.

How to cite this article

Lakshmanan L, Jeevanandan G. Microbial Evaluation of Root Canals after Biomechanical Preparation with Manual K-files, Manual H-files, and Kedo-SG Blue Rotary Files: An In Vivo Study. Int J Clin Pediatr Dent 2022;15(6):687-690.

Comparison of the cyclic fatigue resistance of One Curve, F6 Skytaper, Protaper Next, and Hyflex CM endodontic files

Objectives

This study compared the cyclic fatigue resistance of One Curve (C wire) and F6 Skytaper (conventional austenite nickel-titanium [NiTi]), and 2 instruments with thermo-mechanically treated NiTi: Protaper Next X2 (M wire) and Hyflex CM (CM wire).

Materials and Methods

Ten new instruments of each group (size: 0.25 mm, 6% taper in the 3 mm tip region) were tested using a rotary bending machine with a 60° curvature angle and a 5 mm curvature radius, at room temperature. The number of cycles until fracture was recorded. The length of the fractured instruments was measured. The fracture surface of each fragment was examined with a scanning electron microscope (SEM). The data were analyzed using one-way analysis of variance and the post hoc Tukey test. The significance level was set at 0.05.

Results

At 60°, One Curve, F6 Skytaper and Hyflex CM had significantly longer fatigue lives than Protaper Next X2 (p < 0.05). No statistically significant differences were found in the cyclic fatigue lives of One Curve, F6 Skytaper, and Hyflex CM (p > 0.05). SEM images of the fracture surfaces of the different instruments showed typical features of fatigue failure.

Conclusions

Within the conditions of this study, at 60° and with a 5 mm curvature radius, the cyclic fatigue life of One Curve was not significantly different from those of F6 Skytaper and Hyflex CM. The cyclic fatigue lives of these 3 instruments were statistically significantly longer than that of Protaper Next.

Characterization of the differential efficacy of austenitic vs martensitic NiTi rotary files in non-surgical root canal retreatment: a micro-CT analysis

Aim: Our study aims to characterize the differential efficacy of martensitic and austenitic files in root canal retreatment regarding defiling ability, debris management and morphometric features. Materials and methods: A total of 10 human premolar teeth with two separate fully formed roots were selected, prepared with BioRace system (BR) up to a size BR2 (0.04/25). Root canals were filled and then divided according to the file type into two groups (n = 10). Two geometrically identical files have been used with the only difference between them is heat treatment; One Curve (OC) martensitic and One Shape (OS) austenitic. Preoperative and postoperative Micro-CT scans were done for all the samples, and the percent volume of residual filling materials was calculated. Canals reshaping and remaining debris in the canals were assessed by calculating the volume of the canals before and after retreatment using Micro-CT software. Results: The percentages of removed filling materials were similar between both groups (97.2% OC vs 97.8% OS). OS was significantly faster than OC (P < 0.05). Retreatment procedure did not significantly change volume, structure model index, surface area, and canal curvature. OS group transported the canals more than OC at the apical third (P < 0.05). There were no significant differences between both groups concerning un-instrumented surface area and accumulated hard tissue debris (AHTD) (P > 0.05). Conclusion: Under the circumstances of this study, neither file systems could completely remove the filling materials. However, OC resulted in less transportation than OS in the apical one third (P < 0.05). Also, OC resulted less AHTD than OS but with no statistical difference.

Evaluation of microcrack formation during root canal preparation using hand, rotary files and self-adjusting file in primary teeth: An in vitro study

Background. Pediatric endodontics is a field with constant evolution, resulting in the shifting of paradigms from the use of conventional hand files to rotary files for biomechanical preparation in primary teeth. Biomechanical preparation plays a crucial role in the success of root canal treatment. Primary teeth need special attention since they differ from permanent teeth in root canal morphology. Cleaning and shaping of the canals damage the root dentin, leading to dentinal cracks. Newer techniques for root canal preparation, including Ni-Ti rotary files and SAF system, have been developed for use in pediatric endodontics to overcome the drawbacks of conventional methods. The present study compared dentinal defects formed by rotary systems in primary teeth. Methods. Eighty primary teeth were included. The teeth were decoronated with a diamond disc. All the roots were inspected for any pre-existing cracks or craze lines under transmitted light under a stereomicroscope. The specimens were then divided into four groups (n=20): group 1: control, group 2: hand files (HF), group 3: ProTaper files, and group IV: SAF files. The samples were instrumented according to the group they were assigned to. Results. The HF and SAF groups exhibited fewer microcracks. Dentinal microcracks were observed in roots prepared with rotary ProTaper files. There were significant differences between HF/SAF and rotary files (P <0.05). Conclusion. Stainless steel hand K-files and SAF instruments resulted in fewer dentinal damage than the ProTaper Universal files. SAF exhibited satisfactory results with minimal or no crack formation.

Comparing the Influence of Conventional and Rotary Instrumentation Techniques on the Behavior of the Children: A Randomized Clinical Trial

Background

Pulpectomy has gained popularity in the pediatric dental practice for preserving the primary teeth in its position until exfoliation. There has been a paradigm shift from using manual instrumentation to rotary instrumentation for canal preparation in primary teeth. While studies show that there is a reduction in the instrumentation time with the use of rotary instruments which in turn influences the behavior of the child, its direct effect on the behavior of the children has not been evaluated.

Aim

To compare the behavior of the children during manual and rotary instrumentation for pulpectomy in the primary molars.

Materials and methods

A single-blinded randomized clinical trial was conducted in 88 children in any one of the mandibular primary molars indicated for pulpectomy. The canal preparation was done using manual K files and rotary ProTaper (44 children in each group). The influence of these instrumentation techniques on the children was assessed with three different scales- Frankl Behavior Rating Scale; Venham Interval Rating Scale; Wong Baker FACES Pain Scale for evaluating the behavior, anxiety, and the pain experienced by the children, respectively during canal preparation.

Results

A total of 88 participants, comprising 50 females and 38 males, participated in the study. An equal distribution of the participants with respect to age (p = 0.064), gender (p = 0.389), and teeth (p = 0.877) was observed between the groups. More cooperative behavior (p < 0.001); lesser anxiety levels (p < 0.001); lower intensity of pain (p < 0.001) were recorded in the children instrumented using Rotary files.

Conclusion

The present study concludes that it is preferable to use rotary instrumentation for primary canal preparation in pediatric practice as it has a more positive influence on the behavior of the children, which eventually determines the success of the treatment.

Clinical significance

With rise in the use of rotary files for pulpectomy in primary teeth, the present paper demonstrates the influence of rotary instrumentation technique for canal preparation during pulpectomy on the behavior of the children in a dental chair. This paper throws light for the pedodontists to effectively perform pulpectomy in children with ease without leaving a psychological impact on the children.

How to cite this article

Govindaraju L, Subramanian EMG, Jeevanandan G. Comparing the Influence of Conventional and Rotary Instrumentation Techniques on the Behavior of the Children: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2021;14(S-2):S179-S185.

Rotary Endodontics in Pediatric Dentistry: Embracing the New Alternative

Pulpectomy is one of the most important procedures in maintaining the necrotic primary teeth until physiologic exfoliation. In clinical practice, time efficacy is invaluable, especially in pediatric endodontics, where unpredictability and difficulty of root canal morphology adds to a clinician's challenge. The success of a pulpectomy procedure mainly depends upon the biomechanical preparation of the root canal systems. With the advent of NiTi rotary files, adult endodontic procedures have been rendered easy, but its popularity in pedodontic practice is limited. Therefore, the purpose of this article is to review the use of NiTi rotary files for root canal instrumentation in primary teeth.

How to cite this article

Chauhan A, Saini S, Dua P, et al. Rotary Endodontics in Pediatric Dentistry: Embracing the New Alternative. Int J Clin Pediatr Dent 2019;12(5):460-463.

Comparison between the Effectiveness of Rotary and Manual Instrumentation in Primary Teeth: A Systematic Review

Aim

To develop a scientifically current and evidence based protocol on the efficacy of rotary and hand root canal instrumentation in primary teeth.

Materials and methods

Previous randomized control trials were used for the current review. Hand search and online search engines of PUBMED and Google Scholar were used to search English language articles with human subjects published up to December 2016.

Results

After screening of the abstracts and articles, based on the inclusion and exclusion criteria a total of 13 articles were included in the systematic review.

Conclusion

Rotary instrumentation shows equivalent cleaning efficiency than hand files depending on the system of instrumentation and techniques used. However, use of rotary in primary teeth leads to improved shaping of canals providing better quality of treatment in less time.

How to cite this article

Panchal V, Jeevanandan G, et al. Comparison between the Effectiveness of Rotary and Manual Instrumentation in Primary Teeth: A Systematic Review. Int J Clin Pediatr Dent 2019;12(4):340–346.

Modalities of using endodontic nickel-titanium rotary instruments and factors influencing their implementation in dental practice

BACKGROUND

To establish the extent of using nickel titanium rotary instruments (NiTi-RIs), to identify reasons for using / not using NiTi-RIs, to explore usage modalities and to identify factors and measures that can increase implementation of NiTi-RIs in general dental practice.

METHODS

Two pilot questionnaires were conducted on academic staff members at College of Dentistry, Taibah University, general dentists (GDs) and endodontists to finalise the questionnaire. A sample size was calculated considering the expected and minimum accepted response rates (60 and 48%, respectively) and a 99.9% Confidence Level. The online-questionnaire was sent to 600 GDs and all endodontists (175) working in Saudi Arabia. A reminder was emailed after 10 weeks to encourage non-respondents to complete the questionnaire. Responses, were collected and converted into numerical data which were analysed using the Chi-square test (p = 0.05).

RESULTS

Significantly most respondents (71.9%) used NiTi-RIs (p < 0.001); with more endodontists (96.9%) than GDs (60%). Most users (62.5%) had been using NiTi-RIs for More than 3 years (p < 0001). The trend of using NiTi-RIs increased as participants' experience and the number of root-canal treatments performed per week increased (p = 0.021). While most respondents (45.3%) used NiTi-RIs because of faster root-canal preparation, the majority of non-users (85.3%) didn't do so because of high cost. The highest proportion (43.3%) reported better undergraduate education as the most important factor that can significantly increase NiTi-RIs usage. The majority (91.8%) prepared glide-path before using NiTi-RIs; especially with stainless steel hand-files (63.3%).

CONCLUSIONS

NiTi-RIs are relatively well adopted in Saudi dental practice. However, better education, especially during undergraduate training and lower cost can increase their usage. Overall, clinicians showed good awareness of NiTi-RIs usage aspects which reflected on usage modalities.