Analysis of Mechanical Preparations in Extracted Teeth Using ProTaper Rotary Instruments: Value of the Safety Quotient

The purpose of this study was to apply the Endographe to analyze the vertical forces and torque developed during mechanical preparations in extracted teeth. The data collected in this study may be used to calculate the safety quotient (SQ) as proposed by J.T. McSpadden. The SQ formula is defined as the torque required to break a file at D3 divided by the mean working torque required to cut dentin. The Endographe is a unique force-analyzer device equipped to measure, record, and generate graphs of the vertical forces and torque exerted during root canal preparation. All preparations were performed by endodontists in roots with narrow, more restrictive canals, larger, more open canals, or in roots sectioned in two halves. All canals, including the sectioned canals, were prepared with ProTaper files in accordance with the manufacturer's guidelines for use. For narrow canals, the mean values of the generated vertical forces (g) and torque (g.cm) varied from 80 (+/- 20) g (SX) to 232 (+/- 60) g (F2) and from 80 (+/- 24) g x cm (F1) to 150 (+/- 45) g x cm (S2), respectively. For large canals, the mean values of the generated vertical forces (g) and torque (g x cm) varied from 80 (+/- 20) g (SX) to 340 (+/- 20) g (F1) and from 31 (+/- 9) g x cm (S2) to 96 (+/- 35) g x cm (SX), respectively. The SQ varied from 0.93 to 7.95 for narrow canals and from 1.58 to 14.50 for large canals. The SQ is intended to provide values that can be analyzed to predict whether a rotary file will have a tendency to break or will work safely during clinical use. However, if the formula is going to provide useful information, it must index the "rotation to failure torque" with the "mean working torque" at a specific location along the cutting blades of a file. Additionally, this mathematical formula does not account for factors such as the concentration of forces, the way the instruments are used, or the wear of the instruments. A precise protocol for canal preparation should emphasize using small flexible stainless steel hand files to create or verify that within any portion of a root canal there is sufficient space for rotary instruments to follow. When there is a confirmed smooth, reproducible glide path, then a "secured" space exists to safely guide the more flexible terminal extent of a rotary NiTi file. Endogrammes provide an innovative approach to the analysis of mechanical preparations and suggest that the ProTaper shaping files are best used with lateral forces to decrease the coronal screwing effect. The ProTaper finishing files should be used with slow penetration and be introduced only into canals that have a confirmed smooth and reproducible glide path. When any part of the overall length of a canal has been secured, then the number of instruments, the time spent utilizing each instrument, and the overall time progressing through a sequence of instruments to shape this region of the canal is reduced.

Analysis of the endogrammes developed during obturations on extracted teeth using system B

The ability of an obturation technique to fill the root canal system tridimensionally depends partially on the timing and intensity of force applications. The aim of this study was to use the Endographe to analyze the forces and wedging effects developed in the root canal using a new obturation technique: System B. This system uses a heat plugger that simultaneously heats and pushes gutta-percha. The plugger was used to soften and move the gutta-percha apically during the down-pack stage. Two different methods, however, were used to withdraw the plugger from the compacted gutta-percha. One used the burst heat method, and the other was cold withdrawal. Five endodontists performed 50 obturations of prepared extracted teeth and 50 obturations of the "wedging effect" holder of the Endographe. The practitioner-obturation assignment was randomized. For each obturation the biggest plugger possible in relationship to the shape of the canal was chosen. For the obturation of the special holder the same tip was chosen. Endogrammes showed the force application and wedging effect sequences. The mean values for the vertical and horizontal forces and the wedging effect were, respectively, 16 +/- 2 N, 5 +/- 1 N, and 9 +/- 1 N. These results suggest that System B is one of the best techniques in terms of the developed vertical forces (low values) and the resulting wedging effect (high values) in relationship to the plasticity of the gutta-percha. The Endogrammes provide a new approach to the analysis of obturation techniques and a means to demonstrate correct and optimal manipulation of the new System B plugger.

Qualitative description of a new preparation technique: the balanced-force motion using the Endographe

The forces and torque applied during the balanced-force motion technique of root canal preparation were measured with the Endographe. Five endodontists prepared 100 extracted teeth, all straight and with similar root anatomy. The assignment of "tooth practitioner" was randomized. Gates-Glidden burs were used to prepare the coronal part and ensure apical patency for the other instruments. The balanced-force technique with conventional instruments was then used for the body of the canal. For the apical part either the watch-winding pull with conventional instruments or the reversed balanced-force technique with manual GT files was used. The Endogrammes were similar among endodontists for the coronal phase and showed low vertical forces in contrast with the lateral forces. For the body the Endogrammes were highly specific and described perfectly the different steps of instrument work. For the apical part the Endogrammes of the conventional instruments showed a lack of vertical forces. The Endogrammes of the manual GT files showed that torque was applied inversely to that of the conventional instruments. Force application was similar. In conclusion these objective data indicate the correct way of working with the different techniques incorporated into the balanced-force motion technique.

Venous blood lactate increase after vertical jumping in volleyball athletes

The aim of this study was to test the hypothesis that venous blood lactate concentrations ([La-]) would vary from the beginning of brief exercise. Maximal vertical jumping was used as a model of brief intense exercise. Eleven healthy male volleyball players, aged [mean (SE)] 18.5 (0.7) years, performed three exercise tests with different protocols, each separated by quiet seated recovery periods of 45 min. After the first test, consisting of a single maximal jump [lasting approximately equals 0.6 s for the pushing phase, and in which the subjects jumped 64 (2.2) cm], forearm venous [La-] increased significantly with respect to rest at 1 min (t1), 3 min (t3), and 5 min (t5) of recovery. The second test, comprising six maximal jumps, each separated by 20-s recovery periods, resulted in an unchanged [La-] with respect to the baseline value. After the third test [i.e., six consecutive maximal jumps that lasted a total of 7.36 (0.33) s], [La-] increased significantly at t3 and t5 with respect to the pre-test value (F= 10.3, P < 0.001). We conclude that a significant venous [La-] increase occurs after vertical jumping. This result may be explained by the activation of lactic anaerobic metabolism at the very onset of exercise, which participates in energy production and/or in the resynthesis of the phosphocreatine that was used during such brief exercise.

Effects of the Nd:YAP laser on coronal restorative materials: implications for endodontic retreatment

With new wavelengths that allow light transmission by optical fibers, the laser is now often used in endodontics either during treatment or retreatment. The aims of this study were to (i) specify the effects of laser irradiation on restorative materials in terms of topographic effects and (ii) describe different protocols for the first steps of retreatment. The laser used in this study was an optical fiber Nd:YAP (Lokki dt, Vienne, France) with a wavelength of 1.34 microns. Samples of the following restorative materials were prepared: amalgam, composite, permanent and temporary cements, and prosthodontic alloy. The handpiece of the Nd:YAP laser was fixed perpendicular to the surface of the different preparations. All trials were performed with the fiber tip either in contact with or at a distance of 2 mm from the material. The surface effects in all cases were (i) the creation of craters in the center of the lased areas, (ii) a border of fusion material at the edge of the craters, and (iii) cracks or fractures at a distance from the target areas. For the cements, amalgam and composite, the effects included a projection of material from the center to the edge of the lased area and/or the apparent photovolatization of light particles. For all materials the laser induced deeper absorption in the areas of direct contact than when it was held at a distance. This suggests that the fiber should be in contact with the restorative material for lasing in the straight part of the canal when the objective is either to pass through the material or alongside it between material and tooth. If the practitioner cannot determine the direction of the curve of the canal, lasing should be performed at a distance to weaken the material and thus permit more efficient use of an ultrasonic device. Lasing should in all cases be performed under close X-ray monitoring. Provided that sufficient caution is used, the laser may be helpful in removing restorative materials during retreatment.

Preliminary study of the forces developed by practitioners during amalgam condensation

The aim of this preliminary study was to analyze, in vitro, the forces developed by practitioners during amalgam condensation. Standardized Class II cavities were drilled into 40 freshly extracted teeth. The forces exerted during condensation were then measured by means of a new device, the Endographe, and plotted online or offline as a function of time on Endogrammes. The work techniques of the different practitioners revealed similarities. The mean values of the vertical forces (+/- SEM) were: 15 +/- 2 N for manual compaction of capsule amalgam; 8 +/- 3 N for manual compaction of amalgam with a higher mercury-to-alloy ratio; 6 +/- 4 N for mechanical compaction of encapsulated amalgam; and 4 +/- 2 N for mechanical compaction of the modified amalgam. For the horizontal components, the forces were, respectively, 5 +/- 2 N, 0.1 +/- 0.05 N, 3 +/- 1 N, and 0.7 +/- 0.2 N. The mean values of condensation time were 20 +/- 15 s for each incremental application, with a great variation in durations between the beginning and end of condensation. By visually depicting forces as a function of time, the Endographe can be used to analyze the process of amalgam insertion and condensation. Future research will study the relationship between the forces developed during condensation and the adaptation of the amalgam to the walls of the cavity.

A comparative study of four coronal obturation materials in endodontic treatment

The aim of this study was to compare, in vitro, the ability of temporary versus permanent materials to seal the access cavity. Eighty human maxillary single-canal teeth were prepared biomechanically and obturated with gutta-percha and an endodontic cement AH Plus, using the warm vertical compaction technique. All access cavities were sealed with 1 of 4 materials (Cavit, Fermit, Tetric, or Dyract). Microleakage was assessed by methylene blue dye penetration. The teeth were submitted to 100 thermocycles, with temperature varying from 0 degree to 55 degrees C. The greatest degree of leakage was observed with the temporary materials (Cavit and Fermit). There was a significant difference (p < 0.05) in leakage between all materials except between Dyract and Tetric. This suggests that it may be more prudent to use a permanent restorative material for provisional restorations to prevent inadequate canal sealing and the resulting risk of fluid penetration.

Location of contact areas on rotary Profile instruments in relationship to the forces developed during mechanical preparation on extracted teeth

AIM

The aim of this study was to locate the areas of direct instrument contact with dentine in the root canal system during rotary preparation and to analyse the relationship between these areas and the vertical forces and torque developed during the preparation.

METHODOLOGY

Canal preparations were performed by endodontists either with the step-back (SB) or the crown-down (CD) technique. In order to locate the areas of contact, the instruments were coated with two layers of gold by electro-deposition. They were photographed before and after use, and a coding system, based on mm from the instrument tip, was devised to designate areas of gold removal or instrument wear due to friction. To standarise the conditions of instrument manipulation, the teeth were fixed in the Endographe holder, and this device was used to measure vertical forces and torque.

RESULTS

The results showed that the first series of instruments used for the CD technique (taper 0.06) left 2 +/- 1 mm of the tip with the gold intact, indicating that these instruments and this step of the CD technique are the safest part of the preparation. For all other instruments (taper 0.04 series), the areas of gold removal involved the 3 mm around the tip and this finding was independent of the order of instrument use and preparation technique (SB or CD). The differences between the two techniques were significant in terms of the mean area of decolouration and the mean force and torque values. For the SB and CD techniques, the contact areas were, respectively, 10 +/- 3 and 7 +/- 2 mm. The forces and torque values were correspondingly higher for SB vs. CD; the mean values were, respectively, 19 and 21 N for vertical forces and 16 10(5) and 13 10(5) Nm for torque.

CONCLUSIONS

The recorded torque values and the location on the instruments of the areas of contact with dentine during this development of torque i.e. at or near the tip, indicate that great caution should be used with the rotary technique, particularly with the taper 0.04 instruments, regardless of preparation technique.

Analysis of forces developed during mechanical preparation of extracted teeth using Profile NiTi rotary instruments

AIM

The aim of this study was to analyse the vertical forces and torque developed in the root canal system of extracted teeth during mechanical preparation using ProFile NiTi instruments.

METHODOLOGY

Instrument wear and fracture is in great part due to the repeated application of forces and torque during the course of root-canal preparation but research into the direct relationship has been hampered by the lack of adequate measuring devices. Measurements of these forces and torque were made with a new force analyser device, the Endographe, that was equipped with a holder to record and generate graphs of the vertical forces and torque exerted during the preparations. These preparations was performed by endodontists or students either with a series of instruments of increasing size or with the crown-down pressureless technique.

RESULTS

The mean values for the endodontists of the generated vertical forces and torque varied, respectively, from 4 to 6N and from 7.105 to 12.105 Nm for the step-back technique and from 2.9 to 4.2 N and from 18.105 to 20.105 Nm for the crown-down technique. This suggested that the crown-down technique generated lower stresses (lower torque and lower vertical forces), although these findings also depend on the shape of individual canals. The students initially showed wide variations in generated forces, with significantly lower vertical force the torque values. By the end of the experimental sessions their values were similar to those of the endodontists, which indicated improvement in the efficiency of manipulation.

CONCLUSIONS

Further work is needed to investigate the relationship between the force and the torque data from this study and the incidence of instrument fracture with the two techniques, as the clinical implications are considerable. It must be noted, however, that the Endographe is unable to take into account the cutting efficiency of the instruments. The use of graphs provides a new approach to the analysis of mechanical preparation.

Effect of masticatory cycles on apical leakage of obturated teeth

This study investigated the effect of apical leakage due to masticatory cycles on root canal treatment. Twenty upper maxillary molars were first obturated using the warm vertical compaction technique. Four maxillary casts were then built, with each holding four of the sample molars. The molars were embedded in resin with the roots separated from the resin by means of a light silicon. The four remaining teeth served as controls and were not submitted to occlusal forces. A mechanical device to simulate masticatory cycles subjected the teeth to 0.5 x 10(6) cycles (group A), 10(6) cycles (group B), 2 x 10(6) cycles (group C), and 3 x 10(6) cycles (group D); the control was group E. The roots were placed in 2% methylene blue dye solution for 72 h and then sectioned longitudinally so that dye penetration could be measured. The mean values of dye penetration were: 3.70 +/- 0.69 mm, group A; 5.00 +/- 1.14 mm, group B; 6.00 +/- 1.01 mm, group C; 7.23 +/- 0.66 mm, group D; and 2.74 +/- 0.75 mm, group E. The value of dye penetration increased in correlation with the number of masticatory cycles. This in vitro study suggests the significant effect of masticatory loads on apical leakage.

Analysis of forces developed during obturations. Wedging effect: Part II

The aim of this study was to use a force analyzer device, the modified Endographe with a new cupule, to compare the forces and wedging effects developed in the root canal using four obturation techniques: warm vertical compaction, lateral condensation, thermomechanical compaction, and Thermafil condensation. The different methods--that varied in instrumentation, duration, and compaction load--were studied from graphs representing the force application sequences. In addition, the graphs resulting from modifications in technique (such as using an undersized spreader and pluggers that were either too small or too big) and deliberately induced failures in technique (by use of a too small condenser or a too small master cone) were studied. The mean values for the wedging effect for warm vertical compaction, lateral condensation, thermomechanical compaction, and Thermafil condensation were, respectively, 0.65 +/- 0.07 kg, 0.8 +/- 0.1 kg, 0.6 +/- 0.08 kg, and 0.03 +/- 0.01 kg. The use of graphs provides a new approach to the analysis of obturation techniques.

Analysis of forces developed during obturations. Wedging effect: Part I

The aim of this study was to define the "wedging effect" created by the intracanal forces developed during obturations and to measure it using a force analyzer device. In endodontics, the wedging effect is the result of, for example, a plugger pushing gutta-percha into a canal: the plugger functions much as the rod of a hydraulic jack and the vertical force applied by this rod induces in the cylinder (i.e. the canal) a hydrostatic pressure that is relatively equal in all directions. It is these forces resulting from the hydrostatic pressure that have been labeled the wedging effect. The original device, the Endographe, had a monobloc cupule for measuring the external vertical and horizontal forces developed by a practitioner, but it was unable to measure the intracanal forces. With a new cupule composed of two independent parts joined under pressure, the wedging effect was recorded and analyzed. Two obturation methods, warm vertical compaction and lateral condensation, were performed by endodontists. The forces were depicted by Endogrammes as a function of time. For all of the forces developed during the two techniques, the mean values showed a nonsignificant difference between the different practitioners. The use of graphs provides a new approach to the analysis of intracanal forces as they develop our time and permits the comparison of different obturation techniques.

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.

Study of the Nd:YAP laser. Effect on canal cleanliness

The aim of this study was to evaluate the canal cleanliness achieved by five different preparation techniques, including use of the laser. By randomization, the palatal roots of 50 maxillary molars were assigned to one of five groups. During all preparations, a sodium hypochlorite irrigant was used. The following techniques were studied: (A) manual instrumentation (serial preparation), (B) laser preparation (Nd:YAP laser), (C) manual preparation with laser as adjunct, (D) manual preparation with a subsonic device as adjunct (MM 3000 with shapers), and (E) manual instrumentation with a subsonic device and laser as adjuncts (MM 3000 with shapers, Nd:YAP laser). The canal wall surfaces were examined under a scanning electron microscope at all levels with a new method using grid incrustation on the microscope screen. Techniques A and C differed from each other only by the size of the debris particles, which were smaller for the C preparation. For laser preparation (B) there was little increase in canal diameter increase, and a substantial amount of debris was present. The differences between techniques A, C, and D were not significant. The use of the subsonic device and laser together as adjuncts (E) showed the cleanest preparation with very little debris, opened tubules, and very small particle size. This result suggests that the laser has a potential in ensuring optimal canal cleanliness.

Effect of masticatory cycles on tooth compression and resultant leakage of amalgam retrofills

This study was carried out to investigate the effect of changes in tooth structure due to masticatory cycles on amalgam retrofillings performed to different cavity depths. Forty upper maxillary first molars were tested. In the obturated palatal root apical amalgam was inserted to different depths (1.5 and 3 mm). Eight casts were built, each having four sample molars. To block the teeth, the vestibular roots were embedded in resin (palatal root was left free). The eight remaining retrofilled teeth served as controls and were not submitted to occlusal forces. A mechanical device to simulate masticatory cycles subjected the teeth to 500,000 to three million cycles. Leakage was assessed from dye penetration observations. The values of microleakage were analyzed and compared, and strain gauges were used to assess structural modifications to the tooth. The leakage of all retrofilled obturations increased in correlation with the number of masticatory cycles. At three million cycles, root length compression was 0.3 +/- 0.02%. Leakage was significantly less for the deeper cavity preparations at all stages. This in vitro study suggests a significant effect by root compression due to masticatory loads on the leakage of retrofilled amalgam obturations.

An evaluation of the bactericidal effect of the Nd:YAP laser

The aim of this in vitro study was to compare the efficacy of a classical irrigant with that of a laser in disinfecting a contaminated root canal. Thirty canals of extracted single-root teeth were prepared with files to size #20. The teeth were sterilized with Germispad (Spad, France) for 30 min and then inoculated with Streptococcus mitis ATCC 33399. By randomization, the teeth were divided into six groups of five teeth each. In the first group, teeth were neither inoculated nor prepared. This was the sterility control group (1). In the second group (2) teeth were inoculated without any preparation: as positive controls. The third group was inoculated and then hand-instrumented with files to size #30 with 5.25% NaOCl as irrigant. This was the hand instrumentation group. The other groups were prepared with hand instrumentation with files to size #30, using sterile water as an irrigant, and the canal was then lased with different frequencies as follows: group 4, frequency of 5 Hz and power of 260 mJ; group 5, frequency of 10 Hz and power of 310 mJ; and group 6, frequency of 30 Hz and power of 300 mJ. After experimentation, the residual colonies were counted. The results indicated that (i) the treatment with NaOCl and manual instrumentation effectively inhibited the growth of Streptococcus mitis ATCC 33399; and (ii) the antibacterial effect of the Nd:YAP laser depended on the frequency. Only a frequency of 30 Hz of the Nd:YAP laser inhibited the growth of Streptococcus mitis ATCC 333999.

Warm vertical compaction sequences in relation to gutta-percha temperature

The aim of this study was to analyze warm vertical compaction sequences in relation to the temperature variations of gutta-percha. Twenty-four maxillary incisors were obturated according to two different instrumentation techniques: Compaction and heating were performed with either the monomanual classical or bimanual method. To evaluate gutta-percha temperature, thermocouples (TC) were introduced into channels bored through the dentin into the root canal system or fixed on the root surface at 8 (TC8), 4 (TC4), 2 (TC2), and 0 mm (TC0) from the apex. Maximal temperature was 118 degrees C for TC8, 52 degrees C for TC4, and 44 degrees C for TC2 and TC0. At TC0, the temperature remained above 42.9 degrees C for 10 +/- 5 s. These results show the importance of heating down to a distance of 7 mm to ensure a significant increase in apical gutta-percha temperature. They further indicate that the last compaction should last more than 15 s to avoid detrimental cooling and dimensional variations. The principal differences between the monomanual and bimanual methods were the compaction time (5.07 +/- 0.2 min vs 4.02 +/- 0.3 min) and the number of compactions (8 +/- 1 vs 12 +/- 2).

Analysis of forces developed during obturations. Comparison of three gutta-percha techniques

The aim of this study was to compare the forces developed during three obturation techniques: warm vertical compaction (WVC), lateral condensation (LC), and thermomechanical compaction (TMC). A force-analyzer device allowed us to record and analyze the forces exerted during the obturations. The different methods, which varied in instrumentation, duration, and compaction load, were studied from graphs representing the force application sequences. In addition, the graphs resulting from specific modifications in the LC technique (use of a single spreader) and deliberately induced failures with TMC (with a too-small condensor or with excessive load) were analyzed. The mean values for the vertical forces for WVC, LC, and TMC were, respectively, 2.5 +/- 0.4 kg, 1.1 +/- 0.3 kg, and 1.65 +/- 0.2 kg. The mean values for the lateral forces were, respectively, 0.85 +/- 0.2 kg, 0.35 +/- 0.1 kg, and 0.5 +/- 0.2 kg. The use of graphs provides a new approach to the analysis of obturation methods and may find its greatest application in the teaching of these techniques. It also has the potential to improve research into obturation technique.

Analysis of the forces developed during obturation: warm vertical compaction

The aim of this work was to measure and analyze the forces applied by endodontists during an obturation. This was achieved by devising a system of force transducers linked to acquisition software. The software allowed us to study the obturation forces in real time or to store them. In this initial study, the forces developed by endodontists and students during a warm vertical compaction were analyzed. The vertical and frontware backware horizontal direction forces were first stored. Graphs of the compaction forces were then generated, permitting the analysis of the obturation method. Indeed, two cases of obturation failure were analyzed from these graphs. The mean values for the vertical forces applied by the endodontists and students were, respectively, 2.5 +/- 0.4 kg and 1.9 +/- 0.9 kg; the mean values for the lateral forces were, respectively, 0.85 +/- 0.2 kg and 1.4 +/- 0.6 kg. This device permits the analysis of compaction forces and may thus be highly useful in obtaining improvements in obturation techniques.