Comparative Evaluation of Potential Dentinal Microcracks Related to Instrumentation alongside Bypassed Broken Instruments: An In Vitro Study.

AIM AND OBJECTIVE: To investigate the occurrence of microcracks in the canals containing broken instruments in the middle and apical thirds after instrumentation with various systems. MATERIALS AND METHODS: One-hundred and fifty mature mandibular premolars with single straight canal were collected and stored in distilled water. Samples were checked out from any preexisting deformation or cracks, and then standardized in length. Thirty teeth were never instrumented (NI) as a control group, 60 teeth have received a broken instrument in the middle third, and 60 ones at the apical third. Teeth were placed in resin blocks with simulation of periodontal ligaments. After bypassing the instruments, samples were divided into four groups n = 30; first group was prepared manually MN until 25/0.02, while the other three groups were prepared until 25/0.04 using three different rotary systems; Race RC-2Shape TS-Hyflex CM HCM. Roots were cut transversely at levels of broken instruments and examined under 40× microscopic magnification. RESULTS: All the rotary groups produced microcracks. No significant difference of the partial cracks was observed among all groups at the middle and apical levels p >0.05. TS produced more complete cracks compared to each of NI, MN, RC at middle level and NI, MN at apical level; p <0.05. No significant differences of microcracks incidence were observed between two middle and apical levels among the five groups. CONCLUSION: Dentinal microcracks could be obviously resulted after rotary instrumentation alongside broken instruments, while manual shaping was less likely to cause microcracks. CLINICAL SIGNIFICANCE: Manual files were less likely to induce microcracks alongside broken instruments in comparison with rotary files which could be considered much safer.

Moisture content of root canal dentine affects detection of microcracks using micro-computed tomography.

AIM: To evaluate the effect of moisture content in root canal dentine on detection of microcracks using micro-computed tomography. METHODOLOGY: Ten roots with and without craze lines or cracks (each n = 5) were selected and scanned six times with different moisture conditions of root dentine using a micro-CT scanner at a high resolution of 10.5 µm. Scanning conditions were as follows: (i) after 30-day wet storage, (ii) after 2-h dry time, (iii) after 48-h wet storage, (iv) after 24-h dry time, (v) after 48-h wet storage, (vi) after 2-h dry time. From each scan, cross-sectional images were obtained at intervals of 1 mm (total n = 708) and evaluated for the presence of dentinal microcracks twice by five calibrated blinded observers. Statistical analysis was performed by nonparametric analysis of variance for longitudinal data (P < 0.05). RESULTS: Intra-rater percentage agreement ranged between 92% and 98%, whereas inter-rater percentage agreement was 81% and 83%, respectively. No significant differences between all wet groups as well as between both groups with 2-h dry time were detected (P > 0.05). Almost no cracks were observed after wet storage with a significant increase of cracks after 2-h dry time (P < 0.001). Significantly more microcracks were identified after 24 h than after 2-h dry time (P < 0.004). CONCLUSIONS: Moisture content of dentine influenced detection of microcracks when evaluated using micro-CT. Scanning should be performed on dried specimens to allow reliable identification of dentinal defects. Formation of new cracks during dry periods up to 24 h was disproved.

Effects of ultrasonic removal of fractured files from the middle third of root canals on dentinal cracks: a micro-computed tomography study.

AIM: To evaluate the frequency of dentinal microcracks after ultrasonic removal of fractured files from the middle third of root canals using micro-computed tomography (micro-CT). METHODOLOGY: Eighteen bilaterally matched pairs of human mandibular incisors extracted for periodontal reasons were included. The matched pairs of teeth were then divided into a control group and an experimental group, with one member of each pair assigned to each group. In the control group, the canals were instrumented using the ProTaper Next (PTN) system. In the experimental group, size 20 K-files were fractured in the middle third of the root canals, followed by their ultrasonic removal. Subsequently, the canals were instrumented with the PTN system. All teeth were scanned using high-resolution micro-CT before (preoperative) and after (intraoperative) file removal and after (postoperative) root canal preparation. Pre-, intra-, and postoperative cross-sectional images of the roots were screened to identify the presence of dentinal defects. Two experienced observers evaluated the images twice in a blinded manner. The incidence of dentinal microcracks was noted and statistically analysed using Fisher's exact and McNemar's tests (P = 0.05), with the root cross-section and the tooth root as the units of analysis, respectively. RESULTS: All fractured files in the experimental group were removed successfully. New microcracks were detected in 0.56% (93/16 472) cross-sections (8/18 specimens) generated after file removal in the experimental group. These microcracks were detected 4-6 mm below the root canal orifice and exhibited a width and length of 12-36 µm and 48-72 µm, respectively. They did not disappear or propagate after canal preparation. No new dentinal microcracks were observed in the control group. There was a significant difference in the incidence of new microcracks between the two groups (P < 0.05). CONCLUSIONS: Ultrasonic removal of fractured files from root canals resulted in the formation of short microcracks in a small number of cross-sections in approximately half the specimens. Further studies are necessary to determine the cause and consequences of this finding.

Effect of reciprocating file motion on microcrack formation in root canals: an SEM study.

AIM: To compare dentinal microcrack formation whilst using Ni-Ti hand K-files, ProTaper hand and rotary files and the WaveOne reciprocating file. METHODOLOGY: One hundred and fifty mandibular first molars were selected. Thirty teeth were left unprepared and served as controls, and the remaining 120 teeth were divided into four groups. Ni-Ti hand K-files, ProTaper hand files, ProTaper rotary files and WaveOne Primary reciprocating files were used to prepare the mesial canals. Roots were then sectioned 3, 6 and 9 mm from the apex, and the cut surface was observed under scanning electron microscope (SEM) and checked for the presence of dentinal microcracks. RESULTS: The control and Ni-Ti hand K-files groups were not associated with microcracks. In roots prepared with ProTaper hand files, ProTaper rotary files and WaveOne Primary reciprocating files, dentinal microcracks were present. There was a significant difference between control/Ni-Ti hand K-files group and ProTaper hand files/ProTaper rotary files/WaveOne Primary reciprocating file group (P < 0.001) with ProTaper rotary files producing the most microcracks. No significant difference was observed between teeth prepared with ProTaper hand files and WaveOne Primary reciprocating files. CONCLUSION: ProTaper rotary files were associated with significantly more microcracks than ProTaper hand files and WaveOne Primary reciprocating files. Ni-Ti hand K-files did not produce microcracks at any levels inside the root canals.

Unveiling the correlation between in vivo endodontic reciprocate instrumentation and crack formation.

INTRODUCTION: Dentinal microcracks have been supposedly associated with unrestorable vertical root fractures and consequently long-term treatment failure. This study aimed to investigate whether in vivo root canal instrumentation in mandibular incisors with vital pulps causes dentinal microcracks using two different irrigating solutions. METHODS: Five patients with four vital mandibular incisors indicated for extraction were included. In vivo root canal preparation was performed using Reciproc R40 (tip #40 and taper 0.06). From these, two teeth were randomly assigned for root canal instrumentation irrigated with 5.25 % sodium hypochlorite irrigation (n = 10) or 2 % chlorhexidine gel with saline solution irrigation (n = 10). In sequence, all teeth were carefully extracted, stored in saline solution until microtomography (µCT) scan. Images were reconstructed and assessed for the presence or absence of dentinal microcracks where microcracks originating from the root canal lumen would be considered. All reconstructed samples were analysed dynamically and rendered in videos through the entire extension of the teeth, evaluating the axial cuts considering each third separately from the apex to the enamel-dentinal junction. Teeth were analysed using the DataViewer software at 100 % magnification without filters by three examiners blinded to the condition allocation. RESULTS: No complete dentinal microcracks were observed after root canal instrumentation of mandibular incisors with vital pulps using Reciproc R40 regardless the irrigating solutions, 5.25 % sodium hypochlorite or 2 % chlorhexidine gel. CONCLUSIONS: In vivo root canal instrumentation of mandibular incisors with vital pulps and bone/periodontal insertion does not cause dentinal microcracks and the irrigating solutions tested did not influence this occurrence. Microcrack evaluation must be performed in vivo conditions of dental tissue moist and periodontal support to avoid dryness dentinal alterations after extraction provoking false positive results. CLINICAL RELEVANCE: Reciprocating instrumentation performed in vivo is safe and do not induce dentinal microcracks in mandibular incisors.

Formation of dentinal microcracks after root canal preparation with four kinds of mechanical nickel-titanium files.

OBJECTIVES: This study aimed to compare the differences among four kinds of mechanical Ni-Ti files including T-Flex, Reciproc Blue (RB), ProTaper Gold (PTG), and ProTaper Universal (PTU) in dentinal microcrack generation after root canal preparation in vitro by using micro-computed tomography (micro-CT) analysis. METHODS: A total of 32 freshly extracted double-root-canal premolars with an angle not exceeding 10° were selected and established as root canal preparation models in vitro. Then, the specimens were randomly assigned to four experimental groups (n=8) according to the different Ni-Ti systems used for root canal preparation: group T-Flex, group RB, group PTG, and group PTU. The voxel size of the micro-CT was set at 17.18 µm. Pre- and post-operative cross-sectional images of roots (n=56 940) were scanned and analyzed to identify the presence of dentinal microcracks. The results of each group were expressed by the quantity and percentage of sectional images with microcracks. McNemar test was used to determine whether a significant difference existed in the existence of dentinal microcracks before and after instrumentation. The level of significance was set at P<0.05. RESULTS: Overall, 11.04% of the images presented dentinal defects (n=6 288). Dentinal microcracks were observed in 9.82%, 10.79%, 12.27%, and 11.25% of the post-instrumentation images from groups T-Flex, RB, PTG, and PTU, respectively. However, all these dentinal microcracks were already present in the corresponding pre-operative images. No new microcrack of premolars were generated after the root canal preparation utilizing the aforementioned systems. CONCLUSIONS: Denti-nal microcracks already existed in advance in extracted teeth before root canal preparation. Root canal preparation using the T-Flex, RB, PTG, and PTU systems did not induce the formation of new dentinal microcracks on the straight root canals of premolars.

Comparative Evaluation of Fracture Resistance of Endodontically Treated Bicuspids Instrumented With Hand Files, TruNatomy, ProTaper Next, ProTaper Gold, and WaveOne - An In vitro Study.

Aim: The study aims to compare and evaluate the fracture resistance of endodontically treated bicuspids instrumented with Hand Files, TruNatomy (TRN), ProTaper Next (PTN), ProTaper Gold (PTG), and WaveOne (WO). Materials and Methods: In total, 45 extracted single-rooted human premolar teeth were selected and sectioned at or below the cementoenamel junction to obtain roots 15 mm long. The samples were divided into four experimental groups and one control group (n = 9): instrumentation with nickel-titanium (NiTi) Hand Files (control group), instrumentation with TRN files, instrumentation with PTN files, instrumentation with PTG files, and instrumentation with WO files. The samples were obturated by lateral compaction technique using gutta-percha points and AH Plus sealer. A vertical load was applied to the tooth using the universal testing machine (Tecsol-TSI-BDS-2Kn-Sr No. 170710) for the fracture resistance test. Statistical analysis was performed. Results: The study reported that teeth instrumented with NiTi hand files exhibited the highest fracture resistance when compared to all the rotary and reciprocating file systems. Among rotary and reciprocating instruments, root prepared with TRN files showed the most significant resistance to fracture compared with PTN, PTG, and WO files. Conclusion: Within the limitations of this study, it can be concluded that minimally invasive instrumentation of the system preserves more pericervical dentin, which may increase the resistance to fracture. Results of this study and other studies support the use of minimally tapered instruments to improve the fracture resistance of endodontically treated teeth.

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

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

Micro-computed tomography evaluation of dentinal microcracks following canal preparation with thermomechanically heat-treated engine-driven files.

This study aimed to evaluate and compare the frequency of microcracks and its severity at different root canal dentin locations, after preparation with thermomechanically heat-treated engine-driven nickel-titanium instruments. Forty mandibular premolars were assigned to four experimental groups (n = 10): ProTaper Next, ProTaper Gold, WaveOne Gold and Reciproc Blue. After pre-instrumentation micro-computed tomography scans, the root canals were prepared to size 25. Following post-instrumentation scans, pre- and post-instrumentation scanned images were analysed for the presence and extent of dentinal defects. A total of 56 500 cross-sectional images were obtained, showing that less than 2.3% with pre-existing dentinal microcracks. No new microcracks were identified during the post-instrumentation analyses. No significant association was found between the types of dentinal defects, file motions and sequences. Thermomechanically heat-treated rotary files did not induce the formation of new microcracks. There was also no association between the kinematic motions and sequences of the rotary instruments to the types of dentinal defects.

Influence of obturating techniques on root dentin crack propagation: A micro-computed tomography assessment.

AIM: The aim is to assess and compare the microcrack formation in radicular dentin after obturating the root canals with cold lateral condensation (CLC), warm vertical condensation (WVC), and injectable gutta-percha (IGP) techniques using micro-computed tomography (CT). MATERIALS AND METHODS: Human extracted mandibular premolar teeth (n = 60) were haphazardly assigned based on the obturation technique into three experimental groups (n = 20 each). Root canals are cleaned and shaped with M Two rotary files and 3% sodium hypochlorite irrigant. Cross-sectional images were taken with Micro-CT to record the baseline defects present on root samples. After root canal obturation either with CLC or WVC or injectable obturation techniques, micro-CT images were captured again to analyze the increase in the number and type of dentinal defects. Statistical analysis of data was performed using the Mann-Whitney U test and the Mcnemar test at 5% significance level. RESULTS: An increase in the number of radicular micro-cracks was identified in samples obturated with lateral condensation technique (1.66%). No change in the percentage of micro-cracks was recorded after obturation with warm vertical or injectable guttapercha (IGP) techniques (P > 0.05). The three obturation techniques were not statistically different in the occurrence of micro-cracks after obturation. CONCLUSION: The three obturating techniques tested showed no significant increase in radicular dentin defects' occurrence or propagation.

Synchrotron radiation-based micro-computed tomographic analysis of dentinal microcracks using rotary and reciprocating file systems: An in vitro study.

BACKGROUND: Advances in both X-ray sources and X-ray optics have dramatically improved the feasibility of these techniques in various fields. AIMS: We aimed to evaluate the frequency of dentinal microcracks observed after root canal preparation with ProTaper Gold (PTG), Hyflex electrodischarge machining (HEDM), Reciproc (RPC), and WaveOne Gold (WOG) using synchrotron radiation-based micro-computed tomographic (SR-µCT) analysis. SUBJECTS AND METHODS: Forty mandibular molars were assigned to 4 experimental groups (n = 10) according to the file system used for the root canal preparation: Group 1: PTG (25/0.08), Group 2: HEDM (25/0.08), Group 3: RPC (25/0.08), and Group 4: WOG (25/0.07). The specimens were scanned on SR-µCT system before and after root canal preparation. The pre- and postoperative cross-sectional images (N = 183,200) of the mesial roots were screened to identify the presence of dentinal microcracks. The number of microcracks was determined as a percentage for each group. STATISTICAL ANALYSIS: There was no necessity of statistical analysis in the present study. The number of microcracks was determined as a percentage for each group. RESULTS: Among the four file systems tested, HEDM (0.9%) has shown a fewer number of new dentinal microcracks. CONCLUSIONS: SR-µCT can be used as a reliable diagnostic tool for further implications.

Morphologic Changes of Apical Foramen and Microcrack Formation after Foraminal Enlargement: A Scanning Electron Microscopic and Micro-computed Tomographic Analysis.

INTRODUCTION: The aim of the present study was to evaluate the morphologic changes on the apical foramen and the formation of dentinal microcracks after foraminal enlargement in straight and curved root canals using scanning electron microscopic (SEM) and micro-computed tomographic (micro-CT) analyses. METHODS: Sixty teeth were selected and divided into 2 experimental groups: GI (incisors/straight group, n = 30) and GM (molars/curved group, n = 30). Each group was divided into 2 subgroups (n = 15) according to the analysis performed: SEM or micro-CT analysis. The incisors and mesiobuccal canal of molars were instrumented with Reciproc Blue R25 instruments (VDW, Munich, Germany) using standardized shaping procedures in the apical foramen and 1 mm beyond. The occurrence of foraminal deformation was analyzed by scanning electron microscopy. The z test was used for statistical analysis (P < .05). Micro-CT imaging was used to observe the presence of microcracks in the root apical third. Afterward, pre- and postoperative cross-sectional images were screened to identify the presence of dentinal defects. RESULTS: The curvature of the canal did not influence the occurrence of foraminal deformation either for instrumentation in the foramen or for instrumentation beyond the foramen (P > .05). It was also observed that the increase in the working length did not influence the appearance of new deformations in the GI/SEM and GM-SEM groups (P > .05). Qualitative micro-CT analysis showed the presence of dentinal defects in 0.8% (112) and 1.5% (208) of the cross sections of incisors and molars, respectively, from a total of 13,987 slices. All dentinal defects identified in the analysis of any postoperative scans were already present in the corresponding preoperative images. Therefore, no new microcracks were observed after root canal preparation. CONCLUSIONS: The preparation of straight and moderately curved root canals with Reciproc Blue, regardless of the working length, did not influence the occurrence of apical foramen deformations and did not cause the formation of dentinal microcracks.

Detection of Dentinal Microcracks in Radicular Dentin after Shaping with XP-endo Shaper, Neoendo Flex Files, and Hero Shaper Using Scanning Electron Microscope: An In Vitro Study.

The study aimed to compare the extent of dentinal microcracks in the radicular dentin using hand K files and various types of rotary nickel-titanium (NiTi) file systems. Forty mandibular incisor teeth (human) were grouped for the study. The root apices were closed, and the canals were straight (<5°). The samples were divided into four groups (n = 10). Group 1-Hand K file system (SybronEndo, SA), Group 2-XP-endo Shaper (FKG Dentaire, La Chaux-de-Fonds, Switzerland), Groups 3-Neoendoflex file (Neoendo, Orikam, India), and Group 4-Hero Shaper files (Micro-Mega, Becacon, France). Sectioning was done at 3, 6, and 9 mm from the apex, perpendicular to the long axis using a diamond disc under water coolant. The cut samples were then observed through a scanning electron microscope at ×50 enlargement. The control group showed no microcracks except one sample in the coronal third, which was less significant. The difference in the amount of crack detected on comparing the different groups was significant. In the experimental groups, XP-endo Shaper group showed significantly less number of cracks than the Neoendo flex, and Hero Shaper groups. Within the limitations of this study, all the system, except hand K files, produced remarkable dentinal microcracks. Least cracks were seen in canals instrumented with XP-endo Shaper. It can also be noted that single file system causes less number of microcracks.

Hermetic Seal in Obturation: An Achievable Goal with Recently Introduced Cpoint.

AIM AND OBJECTIVES: To evaluate and compare the dentinal microcrack formation after obturation using CPoint and gutta percha as root canal filling materials. MATERIALS AND METHODS: Forty orthodontically extracted single-rooted premolars were selected. The teeth were decoronated and were then divided into four groups (n = 10). In group I, samples were left unprepared and unfilled (negative control), in group II, samples were prepared and left unobturated (positive control), in group III, samples were prepared and obturation was done with Cpoint (F3) and endosequence bioceramic sealer, and in group IV, samples were prepared and obturation was done with Protaper gutta percha (F3) and endosequence bioceramic sealer. Then, the samples were kept for 1 week at 37°C and 100% humidity. All roots were then sectioned at 2 mm from the apex. Additional cross sections at a 4 mm level were made in groups III and IV. Then, the sections were observed under a scanning electron microscope and the presence of dentinal microcracks was checked. RESULTS: There was statistically nonsignificant difference for a mean number of microcracks in the samples after obturation with CPoint and gutta percha. CONCLUSION: CPoint can be used as an alternative to gutta percha as it provides better seal because of its lateral hygroscopic expansion without causing significant damage to the dentinal microstructure. CLINICAL SIGNIFICANCE: In spite of gutta percha being the gold standard in obturating material, still the desired hermetic seal could not be achieved. To achieve this attainable goal, a new material CPoint had been introduced, which has the ability to undergo hygroscopic expansion within the root canal. HOW TO CITE THIS ARTICLE: Somani R, Jaidka S, Singh DJ, et al. Hermetic Seal in Obturation: An Achievable Goal with Recently Introduced Cpoint. Int J Clin Pediatr Dent 2019;12(5):410-413.

Comparison of newly formed microcracks after instrumentation using protaper next, reciproc and self-adjusting file systems.

PURPOSE: The purpose of the present study is to assess the rate of newly formed microcracks comparatively during root canal instrumentation by using ProTaper Next, Reciproc, and Self-Adjusting File systems using micro-computed tomography. SUBJECTS AND METHODS: Thirty mesial roots of mandibular molars were randomly assigned to 3 experimental groups (n = 10) as follows, ProTaper Next, Reciproc and Self-Adjusting File system. Preoperative and postoperative scans were obtained at the isotropic resolution of 13.68 µm. Cross-section images were examined to identify the presence of newly formed dentinal microcracks. RESULTS: The Self-Adjusting File and Reciproc systems caused a higher rate of new microcrack formation than the ProTaper Next group (p<0.001). There were also significant differences in the new microcrack formation between Reciproc and Self-Adjusting File groups (p<0.001). CONCLUSION: Reciproc and Self-Adjusting File systems caused a higher rate of newly formed microcraks compared to ProTaper Next system.

Detecting Dentinal Microcracks Using Different Preparation Techniques: An In Situ Study with Cadaver Mandibles.

INTRODUCTION: This study assessed the frequency of dentinal microcracks using a cadaver mandible model in teeth instrumented with TRUShape (TS; Dentsply Sirona, York, PA), WaveOne Gold (WO, Dentsply Sirona), or K-files (KF) compared with an uninstrumented control group (CG). METHODS: Fifteen human mandibles with 95 single-rooted teeth were randomly distributed into the following groups: CG (no preparation, n = 11), TS (n = 28), WO (n = 28), and KF (step-back preparation with K-Flex-o-files [Dentsply Sirona], n = 28). Teeth were prepared to apical sizes of #25/.06 or #25/.07; overlying bone was removed, and then teeth were lifted out of the socket and sectioned at 3, 6, and 9 mm from the apex using a low-speed saw. Resulting slices were photographed at 20× and 25× magnification. Three independent and blinded evaluators assessed the images for the presence of dentinal microcracks and their extension, direction, and location. The chi-square test was used for statistical analysis (P < .05). RESULTS: In the final sample of 83 teeth for the 4 groups, microcracks were found in 10 of 33, 13 of 66, 16 of 69, and 21 of 81 sections for CG, TS, WO, and KF, respectively. There were no significant differences in the frequency of microcracks among the CG, TS, WO, or KF instruments overall or when comparing section levels (3 mm [P = .9], 6 mm [P = .18], or 9 mm [P = .69], respectively, from the apex). There were also no significant differences in the extension, direction, or location of the dentinal microcracks among all groups (P > .05). CONCLUSIONS: There was no difference in the frequency of microcracks among the experimental groups instrumented with TS, WO, and KF or uninstrumented controls.

Preexisting Dentinal Microcracks in Nonendodontically Treated Teeth: An Ex Vivo Micro-computed Tomographic Analysis.

INTRODUCTION: This study evaluated the prevalence, location, and pattern of preexisting dentinal microcracks in roots of extracted teeth without endodontic treatment in patients from 2 age groups using micro-computed tomographic imaging. METHODS: Six hundred thirty-three nonendodontically treated teeth extracted using an atraumatic procedure because of reasons unrelated to this study were collected and divided based on the patient age. Teeth were scanned with micro-computed tomographic imaging (resolution of 26.7 µm) to examine the presence of preexisting dentinal microcracks in roots. The characteristic features of preexisting dentinal microcracks determined were location, extent, length, and coronoapical distribution. Chi-square bivariate analysis was performed to assess the association between various parameters. RESULTS: Forty-five of 633 nonendodontically treated teeth exhibited preexisting microcracks in roots with a prevalence of 7.1%. The prevalence of preexisting microcracks was found to be 8.3% in older patients (40-70 years) compared with 3.7% in younger patients (20-39 years) (P < .050). A significant association was found between the preexisting microcracks in mandibular teeth (10.3%) when compared with maxillary teeth (2.9%) (P < .001). All preexisting microcracks were located mesiodistally; 66% occurred in the cervical and middle thirds of root. Only 33% of the preexisting microcracks were complete in nature, showing canal involvement. Complete dentinal microcracks exhibited a mean length of 6.9 mm, whereas incomplete cracks had a mean length of 3.75 mm (P < .001). CONCLUSIONS: Preexisting dentinal microcracks in roots of nonendodontically treated teeth occurred more often in older patients (40-70 years) in the mesiodistal direction. They were predominantly found in the cervical and middle thirds of root and were more likely to be incomplete in nature.

Micro-computed Tomographic Evaluation of Dentinal Microcrack Formation after Using New Heat-treated Nickel-titanium Systems.

INTRODUCTION: The aim of the present study was to evaluate the frequency of dentinal microcracks observed after root canal preparation with HyFlex CM (Coltène/Whaledent, Altstätten, Switzerland), HyFlex EDM (Coltène/Whaledent), Vortex Blue (Dentsply Tulsa Dental Specialties, Tulsa, OK), and TRUShape (Dentsply Tulsa Dental Specialties) systems using micro-computed tomographic (micro-CT) analysis. METHODS: Forty human mandibular incisors with 1 and straight root canals were randomly assigned to 4 experimental groups (n = 10) and 1 control group for root canal preparation: group 1, HyFlex CM; group 2, HyFlex EDM; group 3, Vortex Blue; and group 4, TRUShape. The specimens were scanned using high-resolution micro-CT imaging before and after root canal preparation. Afterward, preoperative and postoperative cross-sectional images of the teeth were screened to identify the presence of dentinal defects. The number of microcracks was determined as a percentage for each group. RESULTS: Before and after canal preparation, 36,152 cross-sectional images were examined. Four thousand four hundred fifty-two (12.31%) dentinal defects were observed. No new microcracks were observed after root canal instrumentation with the tested systems. CONCLUSIONS: Root canal preparation with the HyFlex CM, HyFlex EDM, Vortex Blue, and TRUShape systems did not induce the formation of new dentinal microcracks on straight root canals of mandibular incisors.

Influence of root canal preparation on formation of dentinal microcracks: a systematic review

Abstract The effect of root canal preparation technique on microcrack initiation is a controversial issue. This systematic review aimed to assess the role of root canal preparation techniques with different kinematics (manual, rotary, reciprocating, adaptive, self-adjusting file) on microcrack initiation. In vitro and in situ studies comparing the influence of at least two different root canal preparation techniques on the initiation of dentin microcracks were searched in PubMed/MEDLINE and SCOPUS up to June 5, 2018 without language and period restriction. Two authors independently reviewed all identified titles and abstracts for eligibility. Tables were generated to summarize the included studies, and the included studies were assessed for bias. Fifty-four (n=54) articles met the eligibility criteria. The results were classified according to the method used for microcrack evaluation, and most studies that used micro-computed tomography showed no formation of new cracks after root canal preparation. In general, the instrumentation techniques induced microcrack formation when the methods were destructive, irrespective of kinematics. In relation to the apex region, when the preparation working length was set as the root canal length subtracted of 1 mm, the risk of microcrack initiation reduces. The majority of the included studies had low risk of bias for all assessed domains. Our results seem to indicate that the various root canal preparation techniques considered in this study will not cause damage to the dental structure when adequately employed and the proper methodology is applied.

Resumo O efeito da técnica de preparo do canal radicular na iniciação e/ou propagação de microfissuras dentinárias é um tema controverso. Essa revisão sistemática teve como objetivo avaliar o papel das técnicas de preparo do canal radicular com diferentes cinemáticas (manual, rotatória, reciprocante, adaptativa e self-adjusting file) na iniciação e/ou propagação de microfissuras dentinárias. Estudos in vitro e in situ comparando a influência de pelo menos duas técnicas diferentes de preparo do canal radicular foram identificados no PubMed/MEDLINE e SCOPUS até 05 de junho de 2018 sem restrição de idioma e tempo. Dois autores revisaram de maneira independente todos títulos e resumos para elegibilidade dos estudos. Tabelas foram criadas para sumarizar os estudos incluídos e os estudos foram avaliados quanto ao risco de viés. Cinquenta e quatro (54) estudos enquadraram-se nos critérios de elegibilidade. Os resultados foram classificados de acordo com o método utilizado para avaliação das microfissuras. A maioria dos estudos que utilizaram micro-tomografia não demonstraram formação de novas microfissuras após preparo do canal radicular. Em geral, técnicas de instrumentação induziram formação de microfissuras quando os métodos de avaliação foram destrutivos, independente da cinemática. Em relação a região do ápice, quando comprimento de trabalho foi definido como o comprimento do canal menos 1 mm, o risco de indução de microfissuras é reduzido. A maioria dos estudos incluídos apresentaram baixo risco de viés para todos os domínios apresentados. Nossos resultados parecem indicar que as diferentes técnicas de preparo do canal radicular não causam danos a estrutura dental quando adequadamente utilizadas e a metodologia adequada é utilizada.

Lack of causal relationship between dentinal microcracks and root canal preparation with reciprocation systems.

INTRODUCTION: This study aimed to evaluate the frequency of dentinal microcracks observed after root canal preparation with 2 reciprocating and a conventional full-sequence rotary system using micro-computed tomographic analysis. METHODS: Thirty mesial roots of mandibular molars presenting a type II Vertucci canal configuration were scanned at an isotropic resolution of 14.16 µm. The sample was randomly assigned to 3 experimental groups (n = 10) according to the system used for the root canal preparation: group A-Reciproc (VDW, Munich, Germany), group B-WaveOne (Dentsply Maillefer, Baillagues, Switzerland), and group C-BioRaCe (FKG Dentaire, La-Chaux-de-Fonds, Switzerland). Second and third scans were taken after the root canals were prepared with instruments sizes 25 and 40, respectively. Then, pre- and postoperative cross-section images of the roots (N = 65,340) were screened to identify the presence of dentinal defects. RESULTS: Dentinal microcracks were observed in 8.72% (n = 5697), 11.01% (n = 7197), and 7.91% (n = 5169) of the cross-sections from groups A (Reciproc), B (WaveOne), and C (BioRaCe), respectively. All dentinal defects identified in the postoperative cross-sections were also observed in the corresponding preoperative images. CONCLUSIONS: No causal relationship between dentinal microcrack formation and canal preparation procedures with Reciproc, WaveOne, and BioRaCe systems was observed.