Shaping Ability of F6 SkyTaper®, Hyflex® EDM One File, and One Curve®: A Micro-computed Tomographic Evaluation in Curved Root Canals

OBJECTIVE

The present study aimed to compare the shaping ability of the F6 SkyTaper® (F6S), HyFlex® EDM OneFile (HEDM), and One Curve® (OC) nickel-titanium single-file instruments using micro-computed tomography.

METHODS

Fifty-two mesiobuccal roots of maxillary first molars, with a degree of curvature between 20° and 42°, were randomised into three experimental groups (n=15 per group): F6S, HEDM, and OC, and a non-instrumented control group (n=7). All specimens were scanned by micro-computed tomography before and after instrumentation. The following parameters were evaluated: preparation time, volume of dentine removed, cutting efficiency, unshaped surfaces, and canal transportation. Cutting efficiency was analysed using an ANOVA parametric test and Tukey's multiple comparison post hoc test. Other parameters were analysed using a non-parametric Kruskall-Wallis test followed by Dunn's multiple comparison post hoc test.

RESULTS

No instrument separation occurred during instrumentation. No significant differences were found between the instrument groups with respect to all the parameters (p>0.05). All the instruments induced morphological changes in the root canal dentine (p<0.05) and tended to increase canal transportation toward the coronal portion of the root canals (p>0.05).

CONCLUSION

All instruments were able to shape curved canals and preserve their original anatomy. Single-file endodontic procedures with these instruments can be used with comparable changes in the root canal shape with minimal transportation. (EEJ-2022-01-06).

Effect of dimensional variations on the manufacturing process and the 3D shrinkage ratio of stereolithographic dental alumina ceramics

The purpose of the present study was to evaluate the influence of height and length variations of alumina ceramics manufactured by stereolithography on deformations caused by the manufacturing process and on the 3D shrinkage ratio to control the final dimensions and improve the adaptation of stereolithographic ceramic dental prostheses. Two different U-shaped models were designed with variable heights or lengths. The specimens were manufactured by stereolithography and were scanned using a microtomographic device before and after the heat treatment. Dimensional variations were measured using inspection software. The number and surface of layers of alumina ceramic influenced the reliability of the stereolithography manufacturing but did not influence the 3D shrinkage ratio. The larger the layer surface, the larger the deformation of the ceramic. Dental ceramics manufactured by stereolithography with smallest layer surface are the most reliable. This helps in the selection of the build orientation.

Isthmus morphology influences debridement efficacy of activated irrigation: A laboratory study involving biofilm mimicking hydrogel removal and high-speed imaging

AIM

Little is known about the influence of isthmus morphology on the debridement efficacy of activated irrigation. The aim of this study was to investigate the influence of isthmus morphology on the debridement efficacy of laser-activated irrigation (LAI), EDDY and needle irrigation (NI), and to explain the methods of isthmus cleaning by LAI and EDDY.

METHODOLOGY

Four root canal models (apical diameter: 0.30 mm, taper: 0.06, curvature: 23°, length: 20 mm) were produced by CAD-CAM with different isthmus morphologies: long-wide (4 mm; 0.4 mm), long-narrow (4 mm; 0.15 mm), short-wide (2 mm; 0.4 mm) and short-narrow (2 mm; 0.15 mm). The isthmuses were filled with a hydrogel containing dentine debris. The canals were filled with irrigant and models were assigned to the following irrigation protocols (n = 240): needle irrigation (NI) with a 30G needle, Eddy, and LAI (2940 nm Er:YAG-laser, 15 Hz, 40 mJ, SWEEPS, tip at the canal entrance). Standardized images of the isthmuses were taken before and after irrigation, and the amount of removed hydrogel was determined using image analysis software and compared across groups using Kruskal-Wallis test followed by Dunn's multiple comparison. Visualization of the isthmus during activation was achieved using a high-speed camera. The pattern and speed of the flow in the isthmus as well as transient and stable cavitation were analysed using imaging software.

RESULTS

Laser-activated irrigation, EDDY and NI removed more hydrogel in short-wide isthmuses than in narrow isthmuses (p < .001). LAI and EDDY removed more hydrogel than NI in every isthmus configuration (p < .001). EDDY showed eddies and stable cavitation, and LAI showed transient cavitation at each pulse, and pulsed horizontal flow with the highest particle speed in closed short isthmuses.

CONCLUSIONS

Isthmus morphology influences debridement in all irrigation groups. Short-wide isthmuses were the easiest to clean while narrow isthmuses were the most challenging to clean. Width seems to be a more critical anatomical parameter than length. LAI and EDDY resulted in the greatest biofilm removal and performed better than NI. EDDY produced eddies and stable cavitation in the isthmus, and LAI showed transient cavitation and pulsed horizontal flow.

Are the evaluation criteria used in preclinical endodontic training courses relevant? A preliminary study

This study aimed to evaluate the relevance of a conventional evaluation protocol (CEP) for preclinical endodontic training. Seven dental students performed root canal treatments on an extracted human molar which was then evaluated by CEP (clinical and radiographic observations, including preparing the access cavities, preparing and filling the root canal, and detecting iatrogenic errors). A reference evaluation protocol (REP) based on micro-computed tomographic images analysis was used as a control. The evaluation scores obtained by CEP and REP were compared using a non-parametric Wilcoxon's test. CEP was relevant for access cavity, irrigation, working length and ledge detection training but was no more effective than the REP for evaluating the apical diameter and taper of the root canals, the quality of the fillings, and the presence of perforations and fractured instruments using retro-alveolar radiographs. The conventional evaluation criteria used in preclinical endodontics should be used with care to detect 'unsafe' students.

Effect of build orientation on the manufacturing process and the properties of stereolithographic dental ceramics for crown frameworks

STATEMENT OF PROBLEM

Stereolithography (SLA) ceramic crown frameworks are suitable for clinical use, but the impact of SLA build orientation has not been identified.

PURPOSE

The purpose of this in vitro study was to investigate the effect of 3 build orientations on the physical and mechanical properties and the microstructure of SLA alumina dental ceramics.

MATERIAL AND METHODS

The physical and mechanical properties and microstructures of 3 different oriented SLA alumina ceramics (ZX, ZY, and XY) were evaluated by visual observation, hydrostatic weighing (n=10/group), Weibull analyses (n=30/group), scanning electron microscopy, 3-point flexural strength (n=30/group), fracture toughness (indentation, single-edge-V-notched-beam) (n=4/group), and Vickers hardness (n=15/group) testing. The hydrostatic weighing, 3-point flexural strength, fracture toughness, and Vickers hardness testing data were statistically analyzed (α=.05).

RESULTS

The minimum resting period of slurries between the polymerization of 2 layers was shorter for the ZY- and ZX-oriented specimens and increased with the layer surface. The density and Vickers hardness of the SLA-manufactured specimens were similar for all groups (P>.05). The 95% confidence intervals of the Weibull moduli of the ZX- and ZY-oriented specimens were higher than that of the XY-oriented specimens, with no overlap fraction. The ZY-oriented specimens displayed significantly higher 3-point flexural strength (P<.05) and fracture toughness as evaluated by the single-edge-V-notched-beam method than the ZX-oriented specimens (P<.05). They also displayed significantly higher 3-point flexural strength than the XY-oriented specimens (P<.05). The microstructural analysis showed that the texturing was heterogeneous and that the major axis of the large grains of alumina ran parallel to the orientation of the layers.

CONCLUSIONS

The ZY orientation produced a reliable dental ceramic by SLA, with the shortest general manufacturing time and the highest mechanical strength when the layers were perpendicular to the test load surface.

A novel anatomical ceramic root canal simulator for endodontic training

INTRODUCTION

Endodontic therapy is often complicated and technically demanding. The aim of this study was to develop a reproducible biomimetic root canal model for pre-clinical and postgraduate endodontic training.

MATERIAL AND METHODS

A specific ceramic shaping technique (3D printing and slip casting of a root canal mould) was developed to reproduce canal systems with the desired shape and complexity using a microporous hydroxyapatite (HAp)-based matrix. The microstructural morphology, pore size and porosity, as well as the Vickers microhardness of the ceramic simulators (CS) were assessed and were compared with natural dentin and commercial resin blocks. The reproducibility of the root canal shapes was assessed using the Dice-Sørensen similarity index. Endodontic treatments, from refitting the access cavity to obturation, were performed on the CS. Each step was controlled by radiography.

RESULTS

Many properties of the CS were similar to those of natural dental roots, including the mineral component (HAp), porosity (20%, porous CS), pore size (3.4 ± 2.6 μm) and hardness (120.3 ± 18.4 HV).

DISCUSSION

We showed that it is possible to reproduce the radio-opacity of a tooth and variations in root canal morphology. The endodontic treatments confirmed that the CS provided good tactile sensation during instrumentation and displayed suitable radiological behaviour.

CONCLUSIONS

This novel anatomic root canal simulator is well suited for training undergraduate and postgraduate students in endodontic procedures.

Stereolithography: A new method for processing dental ceramics by additive computer-aided manufacturing

OBJECTIVES

The aim of this study was to compare the physical and mechanical properties of stereolithography (SLA)- manufactured alumina ceramics of different composition to those of subtractive- manufactured ceramics and to produce suitable dental crown frameworks.

METHODS

The physical and mechanical properties of a control and six experimental SLA ceramics prepared from slurries with small (S) and large (L) particles (0.46±0.03 and 1.56±0.04μm, respectively) and three dry matter contents (70%, 75%, 80%) were evaluated by dynamic rheometry, hydrostatic weighing, three3-point flexural strength measurements, and Weibull analyses, and by the micrometrics measurement of shrinkage ratio before and after the heat treatments.

RESULTS

S75 was the only small particle slurry with a significantly higher viscosity than L70. The viscosity of the S80 slurry made it impossible to take rheological measurements. The viscosities of the S75 and S80 slurries caused deformations in the printed layers during SLA manufacturing and were excluded from further consideration. SLA samples with low dry matter content had significantly lower and densityflexural strengths. Only SLA samples with a large particle size and high dry matter content (L75 and L80) were similar in density and flexural strength to the subtractive- manufactured samples. The 95% confidence intervals of the Weibull modulus of the L80 ceramic were higher (no overlap fraction) than those of the L75 ceramic and were similar to the control (overlap fraction). The Weibull characteristics of L80 ceramic were higher than those of L75 ceramic and the control. SLA can be used to process suitable crown frameworks but shows results in anisotropic shrinkage.

SIGNIFICANCE

The hH High particle size and dry matter content of the L80 slurry allowed made it possible to produce a reliable ceramic by SLA manufacturing with an anisotropic shrinkage, and a density, and flexural strength similar to those of a subtractive-manufactured ceramic. SLA allowed made it possible to build up a dense 3D alumina crown framework with controlled shape. Further studies on the marginal adaptation and shrinkage model of alumina crown frameworks will be required to optimize the process.

Optimization and Preclinical Perception of an Artificial Simulator for Endodontic Training: A Preliminary Study

The aim of this study was to evaluate the performance of ceramic, hybrid ceramic, and commercial plastic bloc root canal simulator (RCS) as preclinical training aids in the learning phase of endodontic treatments. A previously developed hydroxyapatite ceramic RCS was improved by adding epoxy resin to the ceramic matrix to more closely mimic the organic phase of dentin and to simulate the clinical situation as realistically as possible. The sintered hydroxyapatite ceramic RCS was vacuum infiltrated with epoxy resin, and the degree of infiltration was evaluated by methylene blue staining. The suitability of the resin-infiltrated ceramic simulator (CR) for preclinical endodontic training was compared to that of a non-infiltrated ceramic simulator (C) and a commercial epoxy bloc (P) using a cohort of 30 dental students at one dental school in France. The study was conducted in 2016. The students' perceptions following the required exercises using the CR, C, and P were scored using a questionnaire. The learning outcomes were also assessed by examining the canal preparations that the students performed on extracted teeth using a master cone try-in test. The vacuum process resulted in a good degree of resin infiltration into the ceramic. The questionnaire showed that the C and CR groups generally reported greater satisfaction, especially for radiographic visualizations, than the P group. The CR group had a higher score than the P group for tactile sensation. There was no significant difference among the three groups with respect to the canal preparations using extracted teeth. Resin infiltration improved the performance of the ceramic RCS, especially with respect to perception during root canal instrumentation. A larger scale student training investigation and an assessment by experienced endodontists are required to validate the model.

Influence of heat and ultrasonic treatments on the setting and maturation of a glass-ionomer cement

PURPOSE

To compare the effect of different treatments (heat capsule, ultrasound, and dual treatments) on the setting kinetics and maturation properties of a conventional GIC (EQUIA, GC) to that of standard setting.

METHODS

The optimal durations of the heat and ultrasonic treatments were determined by monitoring changes in the COO-/COOH ratio, surface hardness, and temperature within the samples. The influence of optimal treatments on the maturation properties of the GIC (microhardness, and 3-point flexural strength) were assessed using GIC samples incubated in artificial saliva for 24 hours, 1 month, and 3 months.

RESULTS

The optimal durations of the heat and ultrasonic treatments for accelerating setting were 5 minutes and 35 seconds, respectively. The dual treatment using the optimal conditions of the individual treatments further enhanced the setting kinetics. A temperature peak (49°C) within the GIC was detected during setting. Only the dual treatment increased the mechanical properties of the GIC after 24 hours compared to the control, while no significant difference was observed after 1 and 3 months.