Does ultraconservative access affect the efficacy of root canal treatment and the fracture resistance of two-rooted maxillary premolars?

AIM: To evaluate the influence of ultraconservative endodontic cavities (UEC) on canal shaping and filling ability, cleaning of the pulp chamber, time required to perform root canal treatment and fracture resistance of 2-rooted maxillary premolars in comparison with traditional endodontic access cavities (TEC) in extracted teeth placed in a phantom head to simulate clinical conditions. METHODOLOGY: Twenty extracted intact 2-rooted maxillary premolars were scanned in a micro-computed tomographic device, matched based on similar anatomical features of the canals and assigned to UEC or TEC groups (n = 10). Then, teeth were mounted on a mannequin head and their pulp chamber accessed. After canal preparation, filling and cavity restoration, the time required to perform root canal treatment was recorded and the specimens were loaded to fracture in a universal testing machine. The maximum load at fracture was recorded. The sample was scanned after root canal instrumentation, filling and restoration procedures. Untouched canal areas, accumulation of hard-tissue debris (AHTD), voids in root fillings and cleaning of the pulp chamber were analysed. Data were analysed statistically using Shapiro-Wilk and Student's t-tests with a significance level of 5%. RESULTS: The percentage of untouched canal area did not differ significantly between UEC and TEC groups (P > 0.05). However, UECs were associated with a greater percentage of AHTD after canal preparation (P < 0.05). No differences were observed in terms of voids in root fillings between the groups (P > 0.05). Nonetheless, UEC had a greater percentage of root filling remnants in the pulp chamber after cleaning procedures (P < 0.05). The time required to perform root canal treatment was significantly longer in the UEC group (P < 0.05). There was no difference regarding the mean load at fracture between the groups (P > 0.05). Unrestorable fractures were observed in all specimens of both groups. CONCLUSIONS: There was no true benefit associated with ultraconservative endodontic cavities. UEC resulted in more AHTD remaining inside the root canals. UEC did not influence the quality of root fillings; however, UEC made the cleaning procedure of the pulp chamber more difficult, thus increasing the total time required to perform root canal treatment. Moreover, UEC were not associated with an increase in fracture resistance of root filled 2-rooted maxillary premolars.

Mechanical characteristics of counterfeit Reciproc instruments: a call for attention.

AIM: To report the main differences seen by direct visual inspection between original and counterfeit Reciproc instruments, together with an evaluation of instrument bending resistance, cyclic fatigue, surface finish, Vickers microhardness and chemical composition. METHODOLOGY: The visual aspects of original Reciproc R25 (VDW, Munich, Germany) and counterfeit Reciproc R25 instruments (claimed to be original, supposedly with dimensions similar to those of Reciproc R25 files, bought at www.mercadolivre.com.br) were evaluated under direct observation, stereomicroscopy and scanning electron microscope. The flexibility of original and counterfeit Reciproc R25 was determined via 45° bending tests according to the ISO 3630-1 specification. Instruments were also subjected to cyclic fatigue resistance, measuring the time to fracture in an artificial stainless steel canal with a 60° angle and 5-mm radius of curvature. The fracture surfaces of all fragments were examined under a scanning electron microscope. Roughness of the instruments was quantified using a profilometer, and the microhardness test was carried out using a Vickers hardness tester. Energy-dispersive X-ray microanalysis (EDX) was also carried out. Results were analysed statistically using the Student's t-test at a significance level of P < 0.05. RESULTS: Although the packaging of the original and counterfeit instruments was similar, a number of differences were observed such as ISO colour coding, measurement marks, stopper and morphologic characteristics. Original Reciproc instruments had significantly longer cyclic fatigue life and significantly lower bending resistance than counterfeit Reciproc instruments (P < 0.05), as well as significantly lower microhardness and roughness (P < 0.05). EDX results revealed differences in the chemical composition of the instruments (P < 0.05), indicating that the instruments were manufactured with different raw material. CONCLUSION: Original Reciproc files outperformed counterfeit instruments in all tests. It is thus important that identification strategies for these counterfeit instruments be developed, thereby preventing their inadvertent use.

Extended cyclic fatigue life of F2 ProTaper instruments used in reciprocating movement.

AIM: To evaluate the cyclic fatigue fracture resistance of engine-driven F2 ProTaper instruments under reciprocating movement. METHODOLOGY: A sample of 30 NiTi ProTaper F2 instruments was used. An artificial canal was made from a stainless steel tube, allowing the instruments to rotate freely. During mechanical testing, different movement kinematics and speeds were used, which resulted in three experimental groups (n = 10). The instruments from the first group (G1) were rotated at a nominal speed of 250 rpm until fracture, whilst the instruments from the second group (G2) were rotated at 400 rpm. In the third instrument group (G3), the files were driven under reciprocating movement. The time of fracture for each instrument was measured, and statistical analysis was performed using parametric methods. RESULTS: Reciprocating movement resulted in a significantly longer cyclic fatigue life (P < 0.05). Moreover, operating rpm was a significant factor affecting cyclic fatigue life (P < 0.05); instruments used at a rotational speed of 400 rpm (approximately 95 s) failed more rapidly than those used at 250 rpm (approximately 25 s). CONCLUSIONS: Movement kinematics is amongst the factors determining the resistance of rotary NiTi instruments to cyclic fracture. Moreover, the reciprocating movement promoted an extended cyclic fatigue life of the F2 ProTaper instrument in comparison with conventional rotation.