Remaining dentine thickness of root canals prepared with K-3 and ProTaper rotary systems

OBJECTIVE

To compare the remaining dentine thickness of root canals prepared with K-3 and ProTaper files..

METHODS

This in-vitro experimental study was conducted from 1st April-30th September 2015 at the dental clinics of Aga Khan University Hospital, Karachi, and comprised human teeth. Extracted human premolars and molars were included in the study using non-probability consecutive sampling. Canals were randomly allocated into two groups i.e. K-3 and ProTaper. Changes in inner and outer walls of canals were measured using Vixwin software at 1mm, 4mm, 7mm and 10mm from the apex. SPSS 20 was used for data analysis.

RESULTS

Of the 214 canals, 107(50%) were assigned to each group. No statistically significant difference was found in the remaining dentine thickness at 1mm, 4mm, 7mm and 10mm from the apex of the teeth prepared with in K-3 versus ProTapers system (p>0.05).

CONCLUSIONS

The remaining dentine thickness of the root canals prepared with K-3 files was similar to that of canals prepared with ProTaper files.

Development and Evaluation of an Endodontic Simulation Model for Dental Students

The aims of this study were to develop an endodontic simulation model able to implement the electronic method of working length determination (electronic apex locators, EALs) in a dental school, to evaluate the practicality of this tool for dental students, and to compare the accuracy of working length measurements achieved by the EAL and the radiographic method. A new simulation model was constructed by embedding extracted human teeth in a self-cured resin, along with a conductive medium. After radiographic and electronic working length determinations, root canal instrumentation was performed by students at a dental school in Austria according to the working lengths obtained from the EAL. Subsequently, root apices (n=44) were longitudinally sectioned using a diamond coated bur. Measurements of the distance between the anatomical root apex (ARA) and the apical constriction (AC) as well as between ARA and the ascertained apical point of endodontic instrumentation were performed using digital photography and a 3D computer-assisted design software. The distance between ARA and the radiologic (ARA-R) or electrometric (ARA-EL) readings of the apical point of endodontic instrumentation was compared with the actual distance ARA-AC. The accuracy of both methods was determined. The difference between the actual distance ARA-AC and the targeted radiological distance was statistically significant (p=0.0001), as was the measured distance between ARA-R and ARA-EL (p=0.016). The electronic method seems to be more precisely referring to the AC (R(2)=0.0198) than the radiographic method (R(2)=0.0019). These results suggest that the endodontic simulation model described in this study can be successfully used in preclinical dental education.

Accuracy of three different apex locators and visual exam in primary teeth with and without root resorption in vitro

AIM

The aim of this study was to evaluate the accuracy and reliability of three apex locators (EndoMaster, Raypex, DentaPort ZX) and visual assessment in primary molar teeth in vitro.

MATERIALS AND METHODS

Twenty-four extracted human primary molar teeth with and without root resorption were used in this study. After endodontic access preparation, root canal length was visually measured by means of a K file; then the teeth were embedded into alginate and the roots were measured again by mans of the three apex locators. The results were collected in SPSS 15.0 and statistical evaluations were completed by one-way ANOVA and Kruksal-Wallis test.

RESULTS

The measurements closest to the visually determined length were obtained with EndoMaster. No statistically significant differences were found between visual and apex locators lengths (p>0.05).

CONCLUSION

Within the limitations of this study, the use of apex locators would be useful in the endodontic treatment of primary teeth.

An in vivo evaluation of different methods of working length determination

OBJECTIVE

The purpose of this in vivo study was to compare the ability of digital tactile, digital radiographic and electronic methods to determine reliability in locating the apical constriction.

MATERIALS AND METHODS

Informed consent was obtained from patients scheduled for orthodontic extraction. The teeth were anesthetized, isolated and accessed. The canals were negotiated, pulp chamber and canals were irrigated and pulp was extirpated. The working length was then evaluated for each canal by digital tactile sensation, an electronic apex locator (The Root ZX) and digital radiography. The readings were then compared with post-extraction working length measurements.

RESULTS

The percentage accuracy indicated that EAL method (Root ZX) shows maximum accuracy, i.e. 99.85% and digital tactile and digital radiographic method (DDR) showed 98.20 and 97.90% accuracy respectively.

CLINICAL SIGNIFICANCE

Hence, it can be concluded that the EAL method (Root ZX) produced most reliable results for determining the accurate working length.

A retrospective clinical study of incidence of root canal instrument separation in an endodontics graduate program: a PennEndo database study

This study investigated the incidence of hand and rotary instrument separation (IS) in the endodontics graduate program at the University of Pennsylvania between 2000 and 2004. In 4,865 endodontic resident cases the incidence of hand and rotary IS was 0.25% and 1.68%, respectively. The odds for rotary IS were seven times more than for hand IS. The probability of separating a file in apical third was 33, and 6 times more likely when compared to coronal and middle thirds of the canals. The highest percentage of IS occurred in mandibular (55.5%) and maxillary (33.3%) molars. Furthermore, the odds of separating a file in molars were 2.9 times greater than premolars. Among the ProFile series 29 rotary instruments, the .06 taper # 5 and # 6 files separated the most. There was no significant difference in IS between the use of torque controlled versus nontorque controlled handpieces, nor between first and second year residency.

A clinical radiographic retrospective assessment of the success rate of single-visit root canal treatment

AIM

To determine retrospectively the clinical and radiographic success rate of single-visit root canal treatment performed in a busy endodontic practice using contemporary techniques of canal cleaning, shaping and obturation.

SUMMARY

Seven hundred and sixty-eight single-visit cases, of which 223 presented for a re-examination appointment ranging from 6 months to 4 years from the day of treatment, were considered. Four endodontists provided examinations for both root canal treatment and re-examinations. Clinical and radiographic data were used to form an overall impression of the outcomes for each case at the time of re-examination. Available demographics and treatment information of these 223 cases were compiled for comparison. The number of treatment visits was not determined by a pretreatment diagnosis or a re-assessment of the pulp status upon entry into the tooth; therefore both vital and necrotic cases, as well as those with and without periradicular pathosis, were included. Statistical analysis was carried out using Chi-square tests and considered variations in failure rates based on gender, provider, tooth type, position and arch. A t-test was used to evaluate data on age. The overall success rate was 89.2%. No statistically significant differences were seen based on gender, age, arch or provider. Statistically, anterior teeth were more successful than posterior teeth.

Root canal treatment performed by Flemish dentists. Part 1. Cleaning and shaping

AIM

To gather information on root canal treatment carried out by dentists working in Flanders (Belgium).

METHODOLOGY

A questionnaire was handed to 312 dentists attending peer review sessions organized by the Flemish Universities. Basic information (age, gender, year of graduation, practice profile) and information on various issues relating to the cleaning and shaping of root canals was collected.

RESULTS

A total of 310 questionnaires were returned. The majority (85.7%) of respondents categorized themselves as general practitioners; 25.7% mentioned a clinical interest or speciality in practice. Most practitioners (64.5%) did not use rubber dam routinely during root canal treatment and performed treatment over two visits irrespective of the number of root canals. The majority of respondents (82.4%) used sodium hypochlorite as an irrigant, but 10.6% did not know the concentration they used; EDTA was used by 61.6%. The vast majority exposed a radiograph with an instrument of known length in situ to gauge the working length; only 3.6% relied on tactile sense; electronic root canal length determination was seldom used. Amongst the root canal instruments, K-files were used solely or in combination with other instruments by 60.3% of the respondents, reamers were used solely or in combination with other instruments by 55.4%. The stepback technique was used by 31.2% of the participants, a combination of stepdown and stepback by 26.4%, a reaming technique by 26.1% and the step-down technique by 14.7%. The majority were familiar with mechanical root canal Instruments. Almost half of the practitioners believed their preparation technique could be improved: only 1.3% felt that their procedures were poor.

CONCLUSIONS

The results of this study indicate that the theoretical knowledge of dentists working in Flanders is good. However, the use of rubber dam remained low, half believed their preparation technique could be improved.

Residual dentin thickness in mandibular premolars prepared with gates glidden and ParaPost drills

STATEMENT OF PROBLEM

The main factor that determines the prognosis of restored pulpless teeth is preservation of sound dentin.

PURPOSE

This study evaluated the residual dentinal thickness (RDT) of mandibular premolars after preparation of post space with Gates Glidden and ParaPost drills.

MATERIAL AND METHODS

Twelve extracted single canal mandibular premolars were embedded in clear polyester resin to the cementoenamel junction (CEJ) in a muffle device. Three horizontal sections were made 1, 3, and 5 mm apical to the CEJ. Mesiodistal (MD) and faciolingual (FL) axes were carefully marked and the RDT was measured for each slice. Each tooth slice was reassembled in the muffle device with orientation pins, then secured with stabilizing pins. This procedure was repeated after enlarging the root canal to K-40 file and preparing the coronal root canal space with Gates Glidden drills and ParaPost drills Nos. 3, 4, and 5.

RESULTS

Residual dentinal thickness in a MD direction was 3.77 +/- 0.51 mm in the unprepared upper slice and 2.23 +/- 0.31 mm in the No. 5 ParaPost drill prepared lower slice, for a difference of 41%. The corresponding values for the FL direction were 4.35 +/- 0.51 mm and 4.08 +/- 0.46 mm, respectively (6%).

CONCLUSION

The average dentinal thickness 5 mm below the CEJ in the mesial and distal directions after post space preparation approached the accepted minimal 1 mm. A conservative approach to post space preparation was advocated.

A comparison of the effects of two burs on endodontic access in all-ceramic high lucite crowns

OBJECTIVE

The purpose of this study was to examine and compare the effects of diamond and tungsten carbide burs with respect to the preparation of access through all-ceramic crowns.

STUDY DESIGN

Thirty extracted maxillary premolars were restored with all-ceramic crowns. Each specimen was assigned to one of two groups: (1) access opening prepared with a round diamond bur; (2) access opening prepared with a carbide fissure bur. Access preparations were scanned by means of scanning electron microscopy; observed were defects categorized as edge chipping, microcracks, and fractures.

RESULTS

Edge chipping around the access was universal. Significant chipping (x > or = 0.1 m) was seen in 43% of access peripheries. Eleven percent of the crowns fractured. chi(2) analysis (P <.05) demonstrated no statistical difference between the bur groups. Results of a t test revealed no statistical difference in edge chipping between the two bur types.

CONCLUSIONS

All-ceramic crowns bonded to extracted maxillary premolars may experience edge chipping, microcracks, and fractures at equal rates whether access is prepared with a round medium coarse diamond bur or a tungsten carbide fissure bur.

Effect of experience on quality of canal preparation with rotary nickel-titanium files

OBJECTIVE

The purpose of this study was to compare inexperienced third-year dental students and experienced dentists with respect to their ability to use rotary nickel-titanium files, specifically with respect to root canal shape and instrument fracture.

STUDY DESIGN

A total of 102 simulated endodontic plastic blocks were used. Twelve untrained dental students and 12 practitioners prepared 3 blocks each, and an endodontist and a trained student completed 15 blocks each. Blocks were filmed before instrumentation and then prepared to ISO 35; they were filmed again after canal preparation. Before-preparation images and after-preparation images were then superimposed. The canal deviation during preparation was measured at 9 levels, beginning at the apex.

RESULTS

In total, 16 of 170 instruments fractured (9.4%). Nearly all preparations (98%) exhibited good taper, smooth walls, and definite apical stops. Material removal on the outer aspect of the canal was greatest near the apex (levels 1-4: 0.11-0.24 mm). The inner aspect of the canal was most instrumented at level 6 (0.23-0.27 mm).

CONCLUSIONS

These findings show that both students lacking endodontic experience and experienced dentists used the rotary nickel-titanium files with success and achieved good root canal geometry.

Influence of several factors on the success or failure of removal of fractured instruments from the root canal

The influence of several factors on the success rate of removal procedures of fractured endodontic instruments was evaluated postoperatively. In 105 teeth with 113 fragments removal attempts were undertaken using a wide range of techniques and instruments. All cases were analyzed with special regard to the following factors: type of tooth and root canal, site of fragment in relation to root canal curvature, length of fragment, and type of fractured instrument. Success of treatment was defined as removal or complete bypassing of the fragment. Of 82 instruments in molars (maxillary: 32, mandibular: 50), 56 were removed or bypassed (max.: 26, mand.: 30). Of 16 fragments in premolars (max.: 12, mand.: 4), 8 could be removed or bypassed (max.: 6, mand.: 2). Of 14 fragments in canines and incisors (max.: 7, mand.: 7), 13 could be removed completely (max.: 6, mand.: 7). When the fragment was localized before the curvature 2 of 18 cases failed, when localized inside the curvature 13 of 31 cases failed and when localized beyond the curvature 15 of 33 cases failed. Anatomical factors favorable for removal were: straight canals, incisors and canines, localization before the curvature, length of fragment more than 5 mm, localization in the coronal or mesial third of the root canal, reamer or lentulo spirales. In molars removal procedures were most successful in the palatal canals of maxillary molars.

Precurving of nickel-titanium files affects transportation in simulated canals

Instrumentation studies comparing nickel-titanium with stainless-steel files have been performed without precurving the nickel-titanium files. It is unknown what influence the precurving of nickel-titanium files would have on transportation in small curved canals of varying curvatures. One hundred-sixty resin blocks with simulated canals were used. Eighty blocks had gradual (gradual curve (GC)) 30-degree curves; the remainder had abrupt (abrupt curve (AC)) 30-degree curves. Ten blocks for each curvature and for each degree of precurving (0, 15, 20, 25, 30, 35, 40, and 45) were instrumented with a machine that imparted only an in and out motion. Simulated canals were a size 30 at the apex, and size 30 nickel-titanium files were used to instrument the canals. A transportation "t" index was determined at two levels: T1 (1 mm from the apex) and TB (a line bisecting the curve of the canal). For GC at T1 and TB, 45- and 25-degree curved instruments, respectively, produced significantly less transportation (p < 0.0001). For AC at T1 and TB, 35- and 0-degree curved instruments, respectively, produced significantly less transportation (p < 0.0001). Comparing GC and AC, the transportation for GC was significantly less (p < 0.0015).

Relative efficiency of solvents used in endodontics

A root canal model was used to test the relative efficiency of various commonly used endodontic solvents including eucalyptol, eucalyptus oil, orange oil, chloroform, and xylene to dissolve or soften gutta-percha and several different types of sealers (Proco-Sol, AH26, and Sealapex). There was no significant difference in the ability of the solvents to dissolve gutta-percha and the zinc oxide-eugenol-based sealer Proco-Sol. The resin-based sealer, AH26, was only dissolved in chloroform and took considerable time (> 30 min). The calcium hydroxide-based sealer, Sealapex, could not be tested because it was found not to set at all unless in contact with air. All of the solvents for both Proco-Sol and gutta-percha produced clinically acceptable dissolving times.

Comparison of debris extruded apically in straight canals: conventional filing versus profile .04 Taper series 29

The purposes of this study were to determine quantitatively the amount of debris and irrigant forced in an apical direction, the frequency of apical plug development, and the time required to prepare canals when a step-back technique using K-files was compared with the .04 Taper system. Sixty-nine extracted teeth with straight canals were divided into four statistically similar groups. Two groups were instrumented either 1 mm short of the apical foramen or to the apical foramen with K-files. The other two groups were instrumented to the same levels using .04 Taper files. The extruded debris and irrigant were collected in preweighed vials. The weight of the debris and volume of irrigant extruded using both techniques were compared and analyzed using paired t test and one-way ANOVA. Tukey's Multiple Comparisons Procedure showed K-files used to the apical foramen extruded significantly more debris than the other three groups (p < 0.01). The .04 Taper files used 1 mm short extruded less debris than the other groups. Significantly more irrigant was extruded when filing was performed to the apical foramen (p < 0.007), regardless of the technique used. More apical plugs were created in teeth filed short of the apical foramen, but the difference between the two preparation techniques was not statistically significant. It took significantly less time to instrument canals with the .04 Taper system than with K-files (p < 0.002).

Analysis of forces developed during root canal preparation with the balanced force technique

The aim of this study was to examine the forces and torque developed during root canal preparation with the balanced force technique using a recently described force-analyser device. A tooth was placed in a holder within the Endograph and forces and torques exerted were recorded. These parameters, which can be studied during preparation (on-line) or stored and examinated subsequently (off-line) generated endograms, which showed the forces generated with time. In addition, the endograms of preparations performed by students and endodontists, as well as deliberately induced failures in preparation technique (broken instruments), were compared. The values for the forces and torques depended on the size of the instruments and were related to the phase of the preparation. For the endodontists, the vertical and horizontal forces varied, respectively, from 0.08 +/- 0.01 kg for a size 15 to 0.65 +/- 0.10 kg for a size 45, and from 0.01 +/- 0.005 kg for a size 15 to 0.4 +/- 0.1 kg for a size 40. The torque varied from 0.08 +/- 1 kg mm-1 for a size 15 to 1.6 +/- 0.4 kg mm-1 for a size 45. With the endograms used as a reference, the relation between the developed vertical forces and the torque became more similar between the groups of endodontists and students. The Endograph provides a new approach to the analysis of preparation technique because it depicts the relationships between the different parameters of the preparation.

Comparison of two endodontic handpieces during the preparation of simulated root canals

The objective of this in vitro study was to compare and assess two endodontic handpieces during the preparation of simulated root canals. One hundred and sixty simulated root canals in clear resin blocks, of two angles and positions of curvature, were prepared using either Shaper files activated by the MM1500 Sonic Air handpiece (Micro-Mega, Besançon, France) or Excalibur files activated by the W & H Excalibur 969 handpiece (W & H, Bürmoos, Austria). Files of 21-mm or 25-mm length were used. When preparing the canals, the files were used either in line with or perpendicular to the canal curvature. Preparation of the canals was carried out using a technique described in the manufacturers' literature. A variety of parameters were used to compare the handpieces, including an assessment of the canal preparation time, the deformation or fracture of instruments, loss of canal length, weight loss from the resin blocks and the overall postpreparation canal shape. Both handpieces provided an efficient and easy method of preparing and shaping the root canal with little operator fatigue. The MM1500 Sonic Air handpiece took significantly more time (P < 0.001) to prepare the canals and was associated with both more loss of working length (P < 0.05) and more loss of weight (P < 0.001). Both handpieces created a high percentage of aberrations in the shapes of prepared canals. The MM1500 Sonic Air handpiece created significantly more aberrations than the Excalibur handpiece (P < 0.05 for zip and elbow, P < 0.05 for danger zone and coronal narrow). The effects of the variables, canal curvature, file length and the plane of use of the file, on the performance of the handpieces, were also assessed.

Shaping ability of Lightspeed rotary nickel-titanium instruments in simulated root canals. Part 1

The aim of this study was to determine the shaping ability of Lightspeed nickel-titanium rotary instruments in simulated canals. Forty canals consisting of four different shapes in terms of angle and position of curvature were prepared by Lightspeed instruments using the technique recommended by the manufacturer. This report describes the efficacy of the instruments in terms of preparation time, instrument failure, canal blockages, loss of canal length, and three-dimensional canal form. Overall, the mean preparation time for all canals was 8.12 min with canal shape having no significant effect on the speed of preparation. No instruments deformed or separated during the study, and none of the canals became blocked with debris. Seventeen canals retained their original working length, but 16 gained in length and 7 lost length. There was no significant difference between the canal shapes in terms of the mean loss of distance or category of distance change. Apical stops as judged from intracanal impressions were present in 23 of the canals but they were all judged to be of poor quality. The canals were found to be smooth in the apical half of the canal in 36 specimens and in the coronal half of 24 specimens. All the canals had poor taper characteristics, and only 16 specimens showed good flow characteristics. Under the conditions of this study, Lightspeed instruments prepared canals rapidly, with no fractures, canal blockages, and with minimal change in working length. The three dimensional form of the canals was compromised as flow and taper were less than ideal, presumably as a result of an ineffective stepback procedure. The results imply that either the stepback sequence should be modified or another instrument with increased taper should be used to refine the canal walls before obturation.

In vitro evaluation of effects of ultrasonic root-end preparation on resected root surfaces

This in vitro study investigated structural alterations in resected roots that had root-end preparations made with a conventional microhead handpiece and ultrasonics at two intensity levels. Root ends were examined with fluorescence confocal microscopy. Serial histologic sections to the 2 mm levels and then at the level of 3 mm and 4 mm from the resected surface were examined. Statistical analysis of the confocal data indicated no significant difference between the groups in the number and length of the fractures. Results of the histologic data indicated that root ends prepared by ultrasonics had a statistically greater number of fractures than both the control and the conventionally prepared groups. The latter did not differ significantly from each other.

Scanning electron microscope study comparing four root canal preparation techniques in small curved canals

Various instrumentation techniques have been proposed and examined with conflicting results. They include hand and ultrasonic techniques and combinations of the two. In the present study we assessed the effectiveness of four preparation methods for cleaning small, curved root canals, using backscattered-imaging scanning electron microscopy (SEM). The methods were: (i) step-back without initial coronal flaring; (ii) step-back with coronal flaring; (iii) step-back with initial coronal flaring and finished by ultrasonic irrigation; and (iv) ultrasonics only. Eighty freshly extracted maxillary and mandibular molars were randomly placed into four treatment groups of 20 teeth each. After preparation, roots were sectioned longitudinally and examined wet by SEM. Each canal was qualitatively evaluated and the groups compared for removal of debris and smear layer, both overall and at each level (apical, middle and coronal). There were no statistically significant differences between the techniques, either overall or within any of the regions. When comparing regions (regardless of technique) the middle level was cleaner than the apical or coronal levels. In conclusion, efficacy differed little among the techniques; none of them completely removed smear layer and all left debris.

Histological evaluation of the effectiveness of five instrumentation techniques for cleaning the apical third of root canals

The efficacy of five instrumentation techniques for cleaning the apical third of curved root canals was assessed by histological examination. Mesial root canals of freshly extracted human mandibular molars were prepared by the following instrumentation methods: step-back technique using stainless steel files; step-back technique using nickel-titanium files; ultrasonic technique; balanced force technique; and Canal Master U technique and instruments. The apical portion of the root was histologically processed, and cross-sections were examined for remaining soft tissue, predentin, and debris. The results showed no significant differences among the techniques. Although the five instrumentation methods were effective in removal of major amounts of tissue from the canals, none totally debrided the entire root canal system, especially when variations in the internal anatomy were present.

Determination of the p-monochlorophenol residue in the calcium hydroxide + P-monochlorophenol combination used as an intracanal dressing in pulpless teeth of dogs with induced chronic periapical lesion

To determine the presence of p-monochlorophenol in the calcium hydroxide (Calen) + p-monochlorophenol combination after its use as intracanal dressing, periapical lesions were induced in 60 root canals of upper and lower premolars of four dogs. After biomechanical preparation, the root canals received the intracanal medication, which was removed from the apical third after 2, 4, 7, and 14 days for chemical analysis by spectrophotometry. The results showed a p-monochlorophenol loss of approximately 50.0% in the dressing after 48 h, with no further significant loss after longer periods of times. p-Monochlorophenol was still present in the medication after 14 days.

A comparison of canal centering ability of four instrumentation techniques

The purpose of this study was to compare three engine driven (nickel-titanium) NiTi instrument systems with hand files for their effect on canal transportation. Mesial roots of mature lower first molars with separate canals were paired on the basis of curvature and morphology. Canal lengths were standardized to 11 mm from orifice to apical foramen. Profile, Lightspeed, McXIM, and Flex-R hand filing techniques respectively were randomly assigned to one of the four canals of each tooth pair. The roots were mounted and sectioned at 1 mm, 3 mm, and 5 mm from working length using a modified Bramante technique. All sections were video imaged preoperatively after instrumentation to size #30 and after final instrumentation to size #40. The images were computer analyzed for changes in canal area and centering at each stage of instrumentation. Preparation time was also recorded. Data were analyzed using ANOVA. The NiTi systems remained better centered in the canal than stainless steel hand files. There were no significant differences among the NiTi systems at any level. The difference between hand filing and the NiTi techniques was more pronounced at size #40 than at size #30. The NiTi systems were all significantly faster than hand filing. No significant differences in preparation were found between the NiTi systems when canals were instrumented to the size nearest #40.

Shaping ability of NT Engine and McXim rotary nickel-titanium instruments in simulated root canals. Part 2

The aim of this laboratory-based study was to determine the shaping ability of NT Engine and McXim nickel-titanium rotary instruments in simulated root canals. A total of 40 canals with four different shapes in terms of angle and position of curve were prepared with NT Engine and McXim instruments, using the technique recommended by the manufacturer. Part 2 of this report describes the efficacy of the instruments in terms of prevalence of canal aberrations, the amount and direction of canal transportation and overall postoperative shape. Pre- and postoperative images of the canals were taken using a video camera attached to a computer with image analysis software. The pre- and postoperative views were superimposed to highlight the amount and position of material removed during preparation. No zips, elbows, perforations or danger zones were created during preparation. Forty-two per cent of canals had ledges on the outer aspect of the curve, the majority of which (16 out of 17) occurred in canals with short acute curves. There were significant differences (P < 0.001) between canal shapes in terms of the incidence of ledges. There were highly significant differences (P < 0.001) between the canal shapes in total canal width at specific points along the canal length and in the amount or resin removed from the inner and outer aspects of the curve. The direction of canal transportation at the end-point of preparation was most frequently towards the outer aspect of the curve, especially in canals with 40 degrees curves. At the beginning of the curve, transportation in the majority of canals was towards the inner aspect of the curve. Mean absolute transportation was less than 0.03 mm throughout the curve and towards the end-point, with significant differences between canal shapes occurring at the apex (P < 0.05) and at the beginning of the curve (P < 0.001). Under the conditions of this study, NT Engine and McXim rotary nickel-titanium instruments created no aberrations other than ledges and produced only minimal transportation. The overall shape of canals was good.

Comparison of ultrasonic and high-speed-bur root-end preparations using bilaterally matched teeth

The purpose of this study was to compare ultrasonic and high-speed-bur root-end preparations. Seventy-six roots from 29 bilaterally matched pairs of human teeth in cadavers were used in this study. In group 1 ultrasonic preparations were made in 38 roots and filled with amalgam. In group 2 high-speed bur preparations were made in 38 roots and filled with amalgam. The size of the bony crypt was measured and the teeth were extracted and radiographed mesial-distally and buccal-lingually. None of the root-end preparations resulted in root perforation. The mean mesial-distal minimum depth of ultrasonic and high-speed bur preparations were 2.11 mm and 1.39 mm, respectively. The mean buccal-lingual minimum depth of preparation was 2.51 mm for the ultrasonic and 2.05 mm for the high-speed bur preparations. The depth of the ultrasonic preparations was significantly greater for both measurements. A significantly greater bevel angle was associated with the bur preparations, 35.1 degrees versus 16.0 degrees for the ultrasonic preparations. The incidence of ultrasonic root-end preparations deviating from the uninstrumented canal spaces was found to be 2.6%. All bur root-end preparations were at an acute angle to the long axis of the root. The bony crypt size for bur preparations was significantly greater than that for ultrasonic preparations.

Shaping ability of NT Engine and McXim rotary nickel-titanium instruments in simulated root canals. Part 1

The aim of this study was to determine the shaping ability of NT Engine and McXim nickel-titanium rotary instruments in simulated root canals. In all, 40 canals consisting of four different shapes in terms of angle and position of curvature were prepared by a combination of NT Engine and McXim instruments using the technique recommended by the manufacturer. Part 1 of this two-part report describes the efficacy of the instruments in terms of preparation time, instrument failure, canal blockages, loss of canal length and three-dimensional canal form. Overall, the mean preparation time for all canals was 6.01 min, with canal shape having a significant effect (P < 0.01) on the speed of preparation. One instrument fractured and only four instruments deformed, with most of the failures occurring in canals with curves which began 12 mm from the orifice, that is, in short acute curves. None of the canals became blocked with debris. Following preparation, 20 canals retained their original working length but 19 lost length and one gained in length; there were significant differences (P < 0.05) between the canal shapes in terms of mean loss of distance and in the category of distance change. Apical stops as determined from intracanal impressions were present in 37 of the canals; 16 were judged to be of good quality and 21 of poor quality. The canals were found to be smooth in the apical half of the canal in 33 specimens and in the coronal half of 39 specimens. All canals had good taper characteristics and 35 had good flow characteristics. Under the conditions of this study, NT Engine and McXim instruments prepared canals rapidly, with few deformations, no canal blockages and with minimal change in working length. The three-dimensional form of the canals demonstrated good flow and taper characteristics.

Preparation of simulated root canals using the Macfile, Canal Master U and K-Flexofile

The efficacy of three different root canal instruments in maintaining the original shape of curved canals was evaluated. Acrylic blocks were prepared to simulate canals with 40 degrees and 60 degrees curvature. K-Flexofiles and Macfiles were used with a step-back technique utilizing an 'in/out' filing motion. The balanced-force technique was used with Canal Master 'U' instruments. Ten 40 degrees and 10 60 degrees canals were prepared with each instrument. The results were evaluated using superimposed photographic slides at x20 magnification to show the canals before and after the instrumentation. The width of the prepared canals was measured at their convex/concave point to determine the divergence of the instrumented canal shape from the original canal shape. The measurements were taken at the level of the apical foramen and 3 and 6 mm coronal to it. In this way it was possible to recognize all the defects created during the preparation of a canal. Among the tested instruments, the Macfile provoked minimal canal deviation (P = 0.05). The Canal Master 'U' was similarly effective (P = 0.05), but had the highest incidence of instrument fracture. The K-Flexofile demonstrated the most defects in canal preparation and canal deviation, particularly at the level of the apical foramen (P < 0.01).

Debridement by operators with varying degrees of experience: a comparative study on manikins

The treatment of periodontally diseased root surfaces with power-driven instruments is becoming increasingly important as an alternative to the use of hand instruments. Root surfaces of artificial teeth on a manikin were debrided under simulated flap operation conditions to determine if effectiveness was dependent on the instrument used (curettes or a modified sonic scaler tip) and/or the operator's degree of experience. Two quadrants were treated with each instrument. A morphometric evaluation followed. Debridement was faster with the diamond-coated sonic scaler tip than with hand instruments. With the sonic scaler, the time necessary for treatment was reduced by 30%. The experienced operators treated about 80% of the root surface, while the inexperienced operators treated only about 65%. Treatment quality depended on the operator and not on the instrument used.

A comparison of stainless steel Flexofiles and nickel-titanium NiTiFlex files during the shaping of simulated canals

The aim of this study was to compare the shaping ability of stainless steel Flexofiles and nickel-titanium NiTiFlex files during the preparation of simulated canals in resin blocks. A total of 80 canals with various angles and position of curvature were prepared by one operator using either Flexofiles or NiTiFlex files in a modified double-flared technique with balanced force method of instrument manipulation. Canal shape was assessed at two stages during the procedure, after apical enlargement to size 30 and subsequently at size 45. Pre- and post-operative images of the canals were taken with a video camera and stored and manipulated in a computer with image analysis software. The presence of canal aberrations and the amount of material removed as a result of preparation were determined from composite images of superimposed pre- and post-operative views. Canal preparation using NiTiFlex files was significantly quicker (P < 0.0001) up to size 30. More instrument failures occurred with Flexofiles (12) compared to NiTiFlex files (7) but there were no statistically significant differences between file type, instrument size or canal shape. Flexofiles created significantly more zips, perforations and ledges; there were no differences in terms of danger zones. Overall, canals prepared with Flexofiles were significantly wider because more material was removed from the outer aspect of the curve at the end-point of preparation and from the inner aspect of the curve at the apex. Under the conditions of this study, preparation with NiTiFlex files was more effective and produced more appropriate canal shapes than Flexofiles.

Shaping ability of the M4 handpiece and Safety Hedstrom files in simulated root canals

The aim of this study was to assess the shaping ability of the M4 reciprocating handpiece and Safety Hedstrom files in simulated canals. A total of 40 simulated canals of various angles and positions of curvature were prepared with an M4 handpiece using Safety Hedstrom files oriented with the ground, flattened surface towards the inner aspect of the curve. A standard regimen was adopted throughout. Pre- and post-operative longitudinal images of the canals were taken with a video camera and stored and manipulated in a computer with image analysis software. The presence of canal aberrations and the amount and location of resin material removed as a result of preparation were determined from composite images of superimposed pre- and post-operative views. Preparation time varied significantly (P < 0.001) between the canal types; overall, 20 degrees canals were prepared more quickly than 40 degrees canals. Zips and elbows were observed in 16 out of the 40 canals with most (11) being created in 40 degrees specimens. Ledges were found in 19 canals and perforations in only 1. There were no significant differences between canal shapes for these aberrations. Excessive removal of material from the inner aspect of the canal at the curve to create a danger zone was found in 20 canals, but only in those with 40 degrees curves. Significant differences in total canal width between the canal types were seen at the zips (P < 0.05), elbows (P < 0.05) and danger zones (P < 0.001). Transportation at the danger zones varied significantly (P < 0.001) between canal types. Under the conditions of this study, the M4 handpiece and Safety Hedstrom files created hour-glass preparations in a substantial proportion of canals. In reality, the Safety Hedstrom file with its one flattened surface was ineffective at reducing removal of material along the inner aspect of canal curves in severely curved specimens and clearly has the potential to create strip perforations in teeth.

Shaping ability of ProFile.04 Taper Series 29 rotary nickel-titanium instruments in simulated root canals. Part 1

The aim of this study was to determine the shaping ability of ProFile.04 Taper Series 29 nickel-titanium instruments in simulated canals. A total of 40 simulated root canals made up of four different shapes in terms of angle and position of curvature were prepared by ProFile instruments using a step-down approach. Part 1 of this two-part report describes the efficacy of the instruments in terms of preparation time, instrument failure, canal blockages, loss of canal length and three-dimensional canal form. The time necessary for canal preparation was not influenced significantly by canal shape. No instrument fractures occurred but a total of 52 instruments deformed. Size 6 instruments deformed the most followed by sizes 5, 3 and 4. Canal shape did not influence significantly instrument deformation. None of the canals became blocked with debris and loss of working distance was on average 0.5 mm or less. Intracanal impressions of canal form demonstrated that most canals had definite apical stops, smooth canal walls and good flow and taper. Under the conditions of this study, ProFile.04 Taper Series 29 rotary nickel-titanium instruments prepared simulated canals rapidly and created good three-dimensional form. A substantial number of instruments deformed but it was not possible to determine whether this phenomenon occurred because of the nature of the experimental model or through an inherent design weakness in the instruments.

The 'Lightspeed' preparation technique evaluated by Swiss clinicians after attending continuing education courses

This survey evaluated acceptance of the Lightspeed canal preparation (LS) technique by Swiss practitioners. The technique was introduced to Switzerland in June 1994 and 10 other continuing education (CE) courses were held at the Zurich Dental School by July 1995. Acceptance was assessed by posting questionnaires to the CE course attendees. Of the 305 questionnaires posted, 177 (58%) were returned. Of the CE participants 80% had used the technique with 60% finding the method easier and 43% finding it quicker than their usual preparation techniques. Of the respondents 58% used the technique on all tooth types and 76% of the LS users had fractured an instrument at least once. Amongst others, fractures were caused by too much pressure (25%), incorrect insertion angles (17%) and by a complicated root morphology (15%). Fractures occurred high up on the instrument shaft (74%) and near the tip (7%). Working lengths were claimed by 62% to be easier to maintain by LS than their usual preparation techniques. Among the respondents 52% obturated LS prepared canals more easily and quickly compared with their usual preparation techniques. Only 10% of LS users would not recommend the technique, but those who would suggested that proper tuition was necessary to minimize the risk of instrument fracture. The LS technique was positively assessed by clinicians who attended the CE courses in Switzerland where endodontics is not accepted as a specialty.

Comparison of two stainless steel files to shape simulated root canals

The aim of this study was to compare the shaping ability of two stainless steel files using simulated canals. A total of 80 simulated canals of various angles and positions of curvature were prepared by hand using either Mani K-Files or Micro Mega K-Files. Following orifice enlargement each file type was used to prepare 40 canals employing a linear filing motion and an anticurvature stepback technique. Pre- and post-operative longitudinal images of the canals were taken with a video camera and stored and manipulated in a computer with image analysis software. The presence of canal aberrations and the amount of material removed as a result of preparation were determined from composite images of superimposed pre- and post-operative views. Overall, canal preparation with Mani K-Files was significantly quicker (P < 0.005) and was associated with fewer instrument failures. Zips and elbows were observed in 70% of specimens with significantly more (P < 0.05) occurring following preparation with Micro Mega K-Files. Mani K-Files created significantly more (P < 0.01) danger zones. Micro Mega K-Files created significantly wider (P < 0.001) zips with significantly more (P < 0.01) resin removed from the outer aspect of the curves and, thus, significantly more (P < 0.01) transportation. Canal shape had a significant influence on preparation time (P < 0.001), the incidence of zips (P < 0.05) and danger zones (P < 0.005), the width of zips (P < 0.001) and transportation at the zips (P < 0.001). Under the conditions of this study, Mani K-Files were more effective than Micro Mega K-Files and produced canals with better shapes. Original canal shape had a substantial influence on the outcome of shaping procedures.

Shaping ability of ProFile.04 Taper Series 29 rotary nickel-titanium instruments in simulated root canals. Part 2

The aim of this study was to determine the shaping ability of ProFile.04 Taper Series 29 rotary nickel-titanium instruments in simulated canals. A total of 40 simulated root canals made up of four different shapes in terms of angle and position of curvature were prepared by ProFile instruments using a step-down approach. Part 2 of this two-part report describes the efficacy of the instruments in terms of prevalence of canal aberrations, the amount and direction of canal transportation and the overall postoperative shape. No zips, perforations or danger zones were created although 24 specimens (60%) had ledges on the outer wall of the canal. The incidence of ledges differed significantly (P < 0.001) between the canal shapes. At specific points along the canal length there were highly significant differences (P < 0.001) in total canal width and in the amount of material removed from the inner and outer aspects of the curve between the various canal shapes. Overall, 40 degrees canals were wider than 20 degrees canals and canals with curves which began 8 mm from the orifice were wider than 12 mm canals. The direction of canal transportation at the end-point of preparation was balanced between inner and outer in the 8 mm canals, but more often towards the outer in the 12 mm canals. At the apex of the curve, transportation was invariably towards the outer aspect of the curvature. At the beginning of the curve, transportation was more balanced between inner and outer. Mean absolute transportation, ignoring direction, was generally greater in 40 degrees canals and in those with the curve beginning 8 mm from the orifice. Of particular importance was the finding that excessive resin was removed from the outer aspect of the canal at the apex of the curve which was often associated with irregular widened areas or ledges. This is in contrast to the pattern of tissue removal found with stainless steel hand instruments where more resin is removed from the inner aspect of the canal at the apex, to create a danger zone.

Canal transportation caused by a new instrumentation technique and three standard techniques

The ability of three different enlarging techniques (balanced force concept, step-back, and recapitulation) and a prototype system to maintain the original canal path during root canal preparation were compared, in vitro, with a theoretical ideally prepared root canal. Measurements were made at the concave and convex sides of the canal at four different levels (1, 4, 5, and 7 mm from apical, respectively). Simulated root canals embedded in clear casting resin and an enlarging computer-supported device were used for this study. The results showed that none of the enlarging techniques used in this study was able to prepare a canal ideally. The prototype system, at level 1, showed an ideal amount of material removed from the concave side and less, in comparison with the other techniques, from the convex side of the canals. The same tendencies persisted at all levels, with the exception of the level 4 concave side.

Incidence of pain after biomechanical preparation: a review of 302 cases treated by dental students

Records of 302 root-filled teeth treated by dental undergraduates were reviewed by four lecturers in the Department of Conservative Dentistry, University of Malaya. Preoperative and operative factors were evaluated for their association with postoperative pain experience of patients during the visit immediately after completion of biomechanical preparation. Eighty four percent of patients did not experience any pain after biomechanical preparation whilst the remaining 16 percent only complained of slight or moderate pain. The incidence of pain after biomechanical preparation is not high even when performed by inexperienced undergraduates. Teeth with a pre-existing painful condition had a higher chances of postoperative of pain. The incidence of postoperative pain was halved when teeth were associated with a sinus tract.

[The area of dentinal diffusion at the time of the manual preparation of root canals]

In this current piece of work we study the area of dentinal diffusion obtained with various irrigating agents which eliminate the smear layer: critic acid at concentrations of 10, 25 and 50%, 15% ethylene-diamino-tetraacetic acid (EDTA), and REDTA (compound of EDTA). All the agents proved their efficiency in eliminating the smear layer, which was corroborated by use of the sweep electron microscope and objectified using computerized image analysis, thus obtaining different diffusion areas with the various irrigating solutions used.