Comparison of the Amount of Debris Extruded From the Apex During Retreatment Procedures Using Several File Systems and to Gauge the Effect of Same and Different Taper on the Debris Extrusion: An In Vitro Study.

Background: To determine the amount of apical extrusion between various file systems during the retreatment procedure and to determine the effect of taper on the same. Materials and Method: Seventy mandibular extracted premolars were taken, and preparation was performed using a Woodpecker file (Woodpecker Medical Instrument Co., Ltd., Guilin, China) (25/0.06). The gutta-percha (GP) was removed from each specimen with H file (#40/0.02) to simulate retreatment in seven groups (n = 10) using ProTaper Next (PTN;Dentsply, Maillefer, Ballaigues, Switzerland) (PTN) (30/0.07), Reciproc (25/0.08), Hyflex CM (30/0.06), Mtwo (30/0.05), Neoendo flex (30/0.04), Neoendo hybrid (30/0.04), and Flexicon file (30/0.06). The specimens were held with the help of a rubber stopper and put in the Eppendorf tube of volume 4 mL (pre-weighed before retreatment). The debris that was on the root surface of the specimen was washed with distilled water with 1 mL volume, kept in the oven, and then again weighed after 7 days. Results: Apical extrusion was found in the following order: HYFLEX CM (LEAST) < FLEXICON < PROTAPER NEXT < RECIPROC < NEOENDO FLEX < NEOENDO HYBRID < MTWO (HIGHEST). Conclusion: W Hyflex CM and Flexicon files showed lesser extrusion of debris than others.

Effect of Coronal Flaring on Initial Apical File Size Estimation in Curved Canals Using Three Distinct Rotary Instruments: A Comparative In Vitro Study.

BACKGROUND AND OBJECTIVES: The initial size of a root canal is established by progressively introducing K-files according to the increase in the International Organization for Standardization (ISO) size in the apical region. The initial file-fit sensation is caused by coronal interferences rather than always occurring at the apex, as is commonly believed. Flaring the canal at its earliest stages enables the practitioner to accurately assess the size of the canal approaching the apex. This enables more informed judgments on the selection of the master apical file required for shaping and cleaning the apex. The aim of this in vitro study is to examine the impact of cervical flaring on the first estimation of apical file size using three distinct rotary instruments. MATERIALS AND METHODS: Sixty-four extracted permanent maxillary first molars with a curvature of between 10° and 20° were chosen. Conventional access openings were made, and the precise length of the canal was determined, leaving it 1 mm short of the apex. The apical fit was deemed to have materialized when the largest file successfully reached the apex, and further progression beyond that depth was unattainable. An initial file that exhibited tactile resistance both before and following expansion at the designated working length (WL) was observed. The initial file that elicited a sensation of being securely attached was affixed using methacrylate into the root canal. A diamond sectioning disc was used to horizontally cut the apical 0.5 mm of the mesiobuccal root. This was done to expose the canal and the instrument at the WL. The uppermost portions were observed using a 3D optical profilometer, and digital photographs were captured for each sample. RESULTS: The occurrence of coronal interferences and the choice of instruments for flaring had a notable impact on the estimation of the initial apical file (IAF) size. The file size frequency was augmented following flaring using various rotary instruments, namely ProTaper, HyFlex CM, and Endoflare. Group 1, which did not undergo preflaring, exhibited the highest disparity of 257.3 ± 54.4. The variation was substantially different (p<0.01) from all the groups that underwent flaring. The use of HyFlex CM (group 3) for preflaring resulted in the smallest average difference (124.4 ± 29.6) between the maximum diameter of the canal at the apex and the diameter of the initial file used. Endoflare (group 4) exhibited the second lowest mean disparity (178.7 ± 46) between the maximum width of the apical root canal and the diameter of the IAF, with the ProTaper group (211 ± 43.5) following closely behind. Nevertheless, there was no statistically significant discrepancy observed in the average differences between groups 2 and 4 (ProTaper and Endoflare groups, respectively). CONCLUSION: Coronal preflaring significantly contributes to minimizing the variation between the IAF and the diameter of the apical canal. Prior coronal expansion using rotary files enables a more precise identification of the IAF. The choice of equipment used for flaring affects the estimation of the IAF size.

Influence of Coronal Flaring on the Shaping Ability of Two Heat-Treated Nickel-Titanium Endodontic Files: A Micro-Computed Tomographic Study.

Nickel-titanium (NiTi) usage is associated in endodontics with some complications including canal transportation. Centering ability of a NiTi file is the ability to stay centered in the root canal system during instrumentation. Any undesirable deviation from the natural canal path is indicated as canal transportation. A possible strategy to improve the centering ability of NiTi instruments is the pre-enlargement of the coronal third of the root canal to minimize coronal interferences. This procedure is known as coronal flaring. The aim of this study was to perform a micro-computed tomographic (micro-CT) evaluation of the effect of coronal flaring on canal transportation and centering ability of two heat treated nickel-titanium rotary instruments, 2Shape (Micro Mega, Besançon, France) and HyFlex CM (Coltène Whaledent, Altstätten, Switzerland). Thirty extracted mandibular molars with two independent mesial canals were selected and randomly instrumented (n = 15 canals) with One Flare (Micro Mega, Besançon, France) before HyFlex CM, HyFlex CM (without coronal flaring), One Flare before 2Shape and 2Shape (without coronal flaring). One Flare (Micro Mega, Besançon, France) was introduced 4 mm below the canal entrance for canals prepared with coronal flaring. HyFlex CM and 2Shape were used accordingly to manufacturers' instructions. New files were used for each canal. During and after instrumentation, irrigation procedures were performed. Micro-CT images were obtained pre- and post-preparation to measure and record root canal transportation and centralization. They were reconstructed from root apex to canal orifices, generating approximately 1000 sections per specimen. The anatomical thirds were determined by dividing the number of cross-sectional slices by three. Root canal transportation and centralization were determined by Gambil method, and the mean values were analyzed by repeated measures analysis of variance followed by multiple comparisons of Bonferroni to compare the different instrumentations procedures and the root thirds (p < 0.05). As for root canal transportation, 2Shape reported significantly higher values compared to HyFlex CM in the cervical region independently from the coronal flaring. In the apical region, 2Shape caused significantly minor canal transportation when used with coronal flaring with compared with the absence of coronal flaring. Regarding the centralization, HyFlex CM showed higher values than 2Shape in the cervical, independently from coronal flaring. In the apical region, 2Shape with coronal flaring exhibited significant major centering ratio, compared with not. Within the limitations of this study, coronal flaring reduced canal transportation and improved centralization of the 2Shape files in the apical section while it had no significant influence on shaping ability of the HyFlex CM instruments. Coronal flaring could represent a valid strategy to improve the shaping ability of NiTi files knowing that its benefit could be influenced by the shaping file used.

A cone-beam computed tomographic analysis of total dentin removed, canal transportation, and canal-centering ability following instrumentation with three different file systems: An in vitro study.

Aims: The aim of this study was to evaluate the shaping ability following instrumentation with XP-endo Shaper (XPS), TruNatomy (TRN), and HyFlex CM (HCM) file system. Subjects and Methods: Fifty-four mesiobuccal canals of mandibular molars were selected and allocated into three groups randomly: XPS, TRN system, and HCM file system. Pre- and postinstrumentation scans were taken using a cone-beam computed tomography scanner to determine the amount of root dentin removed, mesiodistal and buccolingual transportation, and canal-centering ratio at 2, 5, and 8 mm from the root end. Statistical Analysis Used: Data were statistically analyzed using Kruskal-Wallis test and the significance level was set at P = 0.05. Results: TRN file system removed the least amount of root dentin. XPS showed statistically higher M-D canal transportation at 5 mm level from the apex. Conclusions: TRN file system showed better dentin preservation as compared to XPS and HCM. XPS showed the highest canal transportation at 5 mm. All three file systems performed similarly in terms of canal-centering ability.

Evaluation of apical root defects during canal instrumentation with two different nickel-titanium (NiTi) systems by optical coherence tomography (OCT) scan.

Background/purpose: Canal instrumentation with rotary nickel-titanium (NiTi) instruments might weaken the dentinal wall. This study aims to investigate the apical root defects during canal instrumentation with two NiTi rotary systems by using optical coherence tomography (OCT) scans. Materials and methods: Twenty mandibular incisors were selected and divided into two groups instrumented using HyFlex CM (HCM) and ProTaper Universal (PTU) systems. OCT scans were taken immediately after canal instrumentation with file #25, #30 and #40. Each cross-sectional reconstructed image of 1, 2 and 3 mm from the apex was examined, root cracks were scored, and dentin thickness was measured at 12 sites. The risk sites with dentin thickness less than 0.30 mm were recorded. Results: In HCM group, no cracks were observed after instrumentation with file #30/.06, while in PTU group, root cracks were found in 6 teeth with a total score of 9 after using F3 (#30/.09) (P < 0.05). After file #40, 8 teeth with cracks had a score of 14 in PTU group, while one tooth was observed crack with a score of 1 in HCM group (P < 0.05). The number of risk sites in PTU group was 49 (13.16%), which was significantly more than the 28 (7.78%) in HCM group (P < 0.05) when canals were instrumented with file #30. Conclusion: Within the limitations of this study, when the canals of mandibular incisors were instrumented with size #30 and #40 files, OCT scans showed less root defects in HCM group.

A comparative investigation between ProTaper Next, Hyflex CM, 2Shape, and TF-Adaptive file systems concerning cyclic fatigue resistance.

Background. This study aimed to compare the cyclic fatigue resistance of ProTaper Next, Hyflex CM, 2Shape, and TF-Adaptive nickel-titanium endodontic file systems with various alloy properties and production methods and investigate the fractured cross-sectional surface of files due to cyclic fatigue by scanning electron microscopy (SEM). Methods. A total of 120 instruments were used (n=30). For standardization, #25/.06 apical diameter and taper angle were selected for each file system. The experiment of files was subjected to a static cyclic fatigue model. The time for files' failure was recorded with a digital chronometer and multiplied by the rotation speed to calculate the number of cycles. Kolmogorov-Smirnov, one-way ANOVA, and post hoc Bonferroni analysis were used for statistical analysis. Statistical significance was set at P < 0.05. Results. The number of cycles for the failure of files was compared between the groups, and significant differences were found (P < 0.05). The number of cycles for instrument failure was recorded from the highest to the lowest as follows: Hyflex CM, TF-Adaptive, ProTaper Next, and 2Shape. Conclusion. The files were fractured at different average numbers of cycles in an artificial canal in all the groups. The Hyflex CM demonstrated better cyclic fatigue resistance than TF Adaptive, ProTaper Next, and 2Shape file systems. Factors such as production patterns, alloy properties, and the phase in which the files were produced might affect the lifespan of file systems.

Effects of repeated sterilization cycles on the surface alterations of ProTaper Next, TF Adaptive, HyFlex CM, and 2Shape instruments.

Background. This study aimed to evaluate the effects of repeated sterilization cycles on the surface alterations of various nickel-titanium instruments, including ProTaper Next (PTN), TF Adaptive (TFA), HyFlex CM (HCM), and 2Shape (2S). Methods. Twenty-four new NiTi files of four different alloys were selected. The instruments in each group were divided into two equal groups, as follows: control and sterilization. The first group was chosen as the control without applying any sterilization procedure, while in group 2, five cycles of sterilization procedures were applied. The surface topographies were evaluated using scanning electron microscope (SEM) and atomic force microscope (AFM). The root mean square (RMS) and maximum height (MH) values and three-dimensional images were recorded. The data were analyzed with the Shapiro-Wilk test, one-way ANOVA, and post hoc Tukey tests. The statistical significance level was set at P ≤ 0.05. Results. Before the experiment, HCM demonstrated the highest RMS value, and 2S showed the lowest. After the procedures, the RMS and MH values deteriorated on the surface of PTX, TFA, and 2S (P < 0.001). The HCM was not affected by sterilization processes (P > 0.05). Conclusion. The initial irregularity on the surface did not affect the rate of alteration. The HCM files demonstrated superior surface properties after several cycles of sterilization. The PTN, TFA, and 2S presented similar surface responses after five cycles of autoclave sterilization.

Cyclic Fatigue Resistance of Nickel-titanium Rotary Instruments according to the Angle of File Access and Radius of Root Canal.

INTRODUCTION: The aim of this study was to compare the influences from different access angles and curvature radii on cyclic fatigue resistance of nickel-titanium rotary files. METHODS: Two file systems (2Shape [TS; MicroMega, Besançon, France] and HyFlex CM [HCM; Coltène/Whaledent, Allstätten, Switzerland]) were used. A total of 192 instruments of TS #25/.04 (TS1), TS #25/.06 (TS2), HCM #25/.04, and HCM #25/.06 were evaluated at 3 insertion angles (0°, 10°, and 20°) and 2 radii (5 mm and 3 mm) in 16-mm stainless steel artificial canals with a 60° curvature. Cyclic fatigue resistance was determined by the number of cycles to failure (NCF) using a customized testing device. Data were analyzed statistically with the significance level established at 95%. RESULTS: In the 3-mm radius canal, the instruments showed lower cyclic fatigue resistance than in the 5-mm radius canal (P < .05). HCM #25/.06 and all .04 taper instruments had a significant NCF reduction at 20° and 10° in the 3-mm radius canal (P < .05), whereas TS2 showed no significant differences. In the 5-mm radius of curvature, although .06 taper instruments had no significant NCF reduction for each angle tested, .04 taper files exhibited significant NCF reduction when tested at 20° (P < .05). Comparing the same size instruments, HCM had higher NCF than TS (P < .05). Instruments with a .04 taper exhibited higher NCF than the .06 ones with the same heat treatment (P < .05). CONCLUSIONS: An inclined insertion into the canals decreased cyclic fatigue resistance of thermal-treated instruments with a .04 taper at all radii of curvature tested. The synergistic effect of a small radius of curvature and access angulation of heat-treated instruments decreases their fatigue resistance.

Comparative evaluation of apical bacterial extrusion following root canal instrumentation using different endodontic file systems: An in vitro study.

AIM: This study aims to evaluate the amount of apical extrusion of bacteria during root canal instrumentation using K3XF, Protaper Gold, Edge taper platinum, and Hyflex CM Rotary systems. MATERIALS AND METHODS: Sixty freshly extracted maxillary incisors teeth collected in saline. Access cavity prepared and canals were made free of bacterial and pulp. The teeth were mounted on the bacteria collecting apparatus. Root canals were contaminated with the Fusobacterium Nucleatum (ATCC25586) and dried at 37°C for 24 h. In Group 1 (Control group): No instrumentation was done and biomechanical preparation done in all other groups with Group 2: Hand K-files, Group 3: Protaper gold, Group 4: K3XF, Group 5: Edge taper platinum, and Group 6: Hyflex CM rotary file systems. Then, the extrude was collected, and it is incubated in Mueller-Hinton agar for 24 h and the number of colony forming units were counted and statistical comparison was done using Kruskal-Wallis test and Mann-Whitney U test. RESULTS: Hand K-files extruded more bacteria when compared to other four rotary systems, K3XF file system extruded least number of bacteria. CONCLUSION: All instrumentation techniques extruded intracanal bacteria apically. However, engine-driven nickel-titanium instruments extruded less bacteria than the manual technique. The K3XF rotary file system comparatively extruded less bacteria than other rotary file systems.

Cyclic fatigue resistance of three rotary file systems in a dynamic model after immersion in sodium hypochlorite.

To evaluate the effect of immersion in 3% sodium hypochlorite solution in the resistance to cyclic fatigue of three nickel-titanium (NiTi) rotary file systems, ProTaper Next (PTN), Hyflex CM (CM), and Hyflex EDM (EDM), in a mechanical model featuring axial movement. Ninety instruments of three different NiTi rotary file systems, PTN (size 25, 0.06 taper), CM (25, 0.06), and EDM (25/~, variable taper), were randomly divided according to a 3 × 3 factorial design and tested under dynamic immersion in a 3% NaOCl solution (1 or 5 min) or without immersion, making a total of 9 groups (n = 10). Files were tested in an artificial root canal with 45° angle and 5 mm radius apical curvature being submitted to back-and-forth movements until fracture. Statistical analysis was performed using two-way factorial ANOVA with Bonferroni post-hoc tests, at a significance level of 5%. Instruments were evaluated for reliability using a Weilbull approach. Regardless of the immersion treatment, PTN had on average 1200 ± 178 cycles to fracture, CM had 1949 ± 362, and EDM had 5573 ± 853, which was a significantly different (P < 0.01). The NaOCl immersion promoted a significant reduction in the mean number of cycles to fracture (P = 0.01), and was reflected in a significant reduction of the characteristic life of the instruments of the CM end EDM groups. Within this study conditions, EDM instruments performed better to cyclic fatigue followed by CM and then PTN. Immersion in NaOCl decreased the resistance to cyclic fatigue of all tested instruments, but affected more those manufactured from CM wire.

Comparison of cyclic fatigue resistance of XP-endo Shaper, HyFlex CM, FlexMaster and Race instruments.

Background. The aim of this study was to compare the cyclic fatigue resistance of XP-endo Shaper, HyFlex CM, FlexMaster and Race rotary instruments at body temperature (37±1°C). Methods. Twenty XP-endo Shaper (#30/.01), 20 HyFlex CM (#30/.04), 20 FlexMaster (#30/.04) and 20 Race (#30/.04) instruments were tested at body temperature (n=20). The instruments were evaluated in artificial canals with a 3-mm radius of curvature and 60° angle of curvature to the center of the 1.5-mm-wide canal. Each instrument was rotated until fracture occurred and the number of cycles to failure (NCF) recorded. Data were analyzed using one-way ANOVA and Tukey HSD tests (P<0.05). Results. The difference in the NCF of all the instruments was statistically significant (P<0.05). The order of the instruments from the highest to the lowest NCF was as follows: XP-endo Shaper (3064.0±248.1), HyFlex CM (1120.5±106.1), FlexMaster (569.8±48.4) and Race (445.5±53.5). Conclusion. Under the limitations of the present study, XP-endo Shaper instruments were more resistant to cyclic fatigue than the #30/.04 nickel-titanium rotary instruments immersed in water at simulated body temperature.

Effect of Sodium Hypochlorite and EDTA on Surface Roughness of HyFlex CM and HyFlex EDM Files.

The aim of the present study was to compare the effect of exposure to sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) on the surface topography and roughness of HyFlex controlled memory (CM) and HyFlex electrical discharge machining (EDM) using atomic force microscopy (AFM). Twenty HyFlex EDM (25/.08) and 20 HyFlex CM (25/.06) files were divided into five groups (n = 4). One group served as a negative control group. The files in the other groups were exposed to 5.25% NaOCl and 17% EDTA solutions at 37°C for 5 and 10 min, respectively, and examined using AFM after each exposure. The data were analyzed using one-way ANOVA test. The lowest values were observed in the control group of HyFlex EDM files (p < .05). The highest values were observed in the HyFlex EDM and HyFlex CM files immersed in EDTA for 10 min (p < .05). In conclusion, the tested irrigants had a significant negative effect on the surface porosity of NiTi files. The immersion of NiTi files in irrigants during cleaning and sterilization procedures results in corrosion and surface deformation of the files, and this can lead to unexpected file fracture during clinical use. Thus, the investigation of effect of ethylenediaminetetraacetic acid (EDTA) and sodium hypochlorite (NaOCl) on surface topography of HyFlex files is important.

Effect of multiple autoclave cycles on the surface roughness of HyFlex CM and HyFlex EDM files: an atomic force microscopy study.

AIM: To compare the effect of autoclave cycles on the surface topography and roughness of HyFlex CM and HyFlex EDM instruments using atomic force microscopy (AFM) analysis. METHODOLOGY: Eight new files of each brand were subdivided into four subgroups (n = 2/each subgroup). One group was allocated as the control group and not subjected to autoclave sterilization. The other three groups were subjected to different numbers (1, 5, and 10) of autoclave sterilization cycles. After the cycle instruments were subjected to AFM analysis. Roughness average (Ra) and the root mean square (RMS) values were chosen to investigate the surface features of endodontic files. The data was analyzed using one-way ANOVA and post hoc Tamhane tests at 5% significant level. RESULTS: The lowest Ra and RMS values were observed in the HyFlex EDM files that served as the control and in those subjected to a single cycle of autoclave sterilization (P < 0.05). The highest Ra and RMS values were observed in the HyFlex CM and HyFlex EDM files that were subjected to 10 cycles of autoclave sterilization (P < 0.05). The surface roughness values of the HyFlex CM group showed a significant increase after ten autoclave cycles, whereas those of the HyFlex EDM group exhibited a significant change after five autoclave cycles (P < 0.05). CONCLUSIONS: Although the initial surface roughness values of the HyFlex EDM files were lower than those of the HyFlex CM files, the surface roughness values of the EDM files showed a statistically significant increase after 5 cycles of autoclave sterilization. In contrast, the surface roughness values of the HyFlex CM files did not increase until 10 cycles of autoclave sterilization. CLINICAL RELEVANCE: Present study indicated that autoclave sterilization negatively affected the surface roughness of the tested NiTi files.

Effect of Torsional and Fatigue Preloading on HyFlex EDM Files.

INTRODUCTION: The purpose of this study was to evaluate the effect of a low amount of torsional preloading on the fatigue life and different degrees of cyclic fatigue on torsional failure of HyFlex EDM (EDM; Coltene-Whaledent, Allstetten, Switzerland) and HyFlex CM (CM; Coltene-Whaledent) instruments. METHODS: EDM and CM files were used. The fatigue resistance was examined in a 5-mm radius and 60° single curve, and the mean number of cycles to failure (Nf) was recorded. The torque and rotation angles at failure of the instruments were measured according to ISO 3630-1. New files were precycled to 0%, 50%, and 75% of the Nf, and torsional tests were then performed. Other new files were preloaded at 5%, 15%, 25%, and 50% of the mean rotation angles before the fatigue test. The fracture surfaces of the fragments were examined under a scanning electron microscope. RESULTS: The fatigue resistance of EDM instruments was higher than that of CM instruments (P < .05). The torque and angle of rotation at fracture of the files were similar. Torsional preloading lowered the Nf of EDM at 15% preloading (P < .05) and the Nf of CM at 50% preloading (P < .05). However, the Nf of EDM files even with 50% torsional preloading was significantly higher than unused CM files (P < .05). Fatigue prestressing even at 75% had no negative effect on the torque and rotation angle of the EDM files. Moderate precycling (50%) of EDM files increased their torsional resistance. The fractographic patterns corresponded to the pattern defined by the last stage test. CONCLUSIONS: A low amount (15%) of torsional preloading reduced the fatigue resistance of EDM files, whereas even extensive (75%) precyclic fatigue was not detrimental to their torsional resistance.

Comparison of Alterations in the Surface Topographies of HyFlex CM and HyFlex EDM Nickel-titanium Files after Root Canal Preparation: A Three-dimensional Optical Profilometry Study.

AIMS: The aims of the present study were to examine the surface topographies of intact HyFlex CM and HyFlex EDM nickel-titanium files and to compare alterations in the surface topographies of these files after root canal preparation of severely curved canals of molar teeth. METHODS: Eight HyFlex CM (25/.08) and 8 HyFlex EDM (25/.08) files were included in the present study. In total, 64 severely curved canals of molar teeth, with curvature angles ranging between 50° and 70°, were prepared with HyFlex CM and EDM (n = 32 in each group). Quantitative and qualitative analyses of the files' surface deformation were performed by using three-dimensional optical profilometry before and after root canal preparation. The data were analyzed with the Student t test at the 5% significant level by using SPSS 21.0 software. RESULTS: In the HyFlex EDM group, the qualitative evaluation revealed the presence of cracks and microcavities after use of the file for root canal preparation, whereas only minor surface deformation was observed in the HyFlex CM group. The average roughness, root mean square roughness, and peak to valley height values of the HyFlex EDM group were significantly higher than those of the HyFlex CM group before and after root canal preparation (P < .05). The surface roughness values were statistically significantly increased in the HyFlex CM group after root canal preparation (P < .05). In contrast, the increase in the HyFlex EDM group was not statistically significant (P > .5). CONCLUSIONS: Within the limitations of the present study, the HyFlex CM files showed significantly higher surface alterations compared with the HyFlex EDM files after the preparation of severely curved root canals.

Comparing the Centering Ability of Different Pathfinding Systems and Their Effect on Final Instrumentation by Hyflex CM.

INTRODUCTION: Recently, different rotary glide path systems have been introduced. The aim of this study was to compare the centering ability of different rotary pathfinding systems and their effect on the final preparation by Hyflex CM files. METHODS: Sixty endodontic training blocks with J-shaped canals were divided into 3 groups according to the pathfinding system used. Instrumentation was done with G-File + Hyflex CM (G-File group), PathFile + Hyflex CM (PathFile group), and Hyflex GPF + Hyflex CM (GPF group). Three images were taken: initial, after glide path preparation, and after final instrumentation. Pre-instrumentation and post-instrumentation images were superimposed, and centering ratio along the J-shaped canal was measured to evaluate the occurrence of deviation. Statistical analysis of the data was performed by using one-way analysis of variance, followed by Tukey test (α = 0.05). RESULTS: The ability of instruments to remain centered in canals at 0-mm level (apex) was significantly lower in PathFile group (P < .05). No significant difference was found at other levels. After final preparation by Hyflex CM no significant difference was found at any level. CONCLUSIONS: The centering abilities of Hyflex GPF and G-Files are better than that of PathFile at apex, but it has no significant effect on final preparation by Hyflex CM.

Micro-computed Tomographic Analysis of Apical Microcracks before and after Root Canal Preparation by Hand, Rotary, and Reciprocating Instruments at Different Working Lengths.

INTRODUCTION: This study aimed to compare apical microcrack formation after root canal shaping by hand, rotary, and reciprocating files at different working lengths using micro-computed tomographic analysis. METHODS: Sixty mandibular incisors were randomly divided into 6 experimental groups (n = 10) according to the systems and working lengths used for the root canal preparation: ProTaper Universal for Hand Use (Dentsply Maillefer, Ballaigues, Switzerland), HyFlex CM (Coltene-Whaledent, Allstetten, Switzerland), and Reciproc (VDW, Munich, Germany) files working at the apical foramen (AF) and 1 mm short of the AF (AF - 1 mm). The teeth were imaged with micro-computed tomographic scanning at an isotropic resolution of 14 µm before and after root canal preparation, and the cross-sectional images generated were assessed to detect microcracks in the apical portion of the roots. RESULTS: Overall, 17 (28.3%) specimens presented microcracks before instrumentation. Apical microcracks were present in 1 (ProTaper Universal for Hand Use), 3 (Hyflex CM), and 2 (Reciproc) specimens when the instrumentation terminated at the AF. When instrumentation was terminated at AF - 1 mm, apical microcracks were detected in 3 (ProTaper Universal for Hand Use) and 4 (Hyflex CM and Reciproc) specimens. All these microcracks detected after root canal preparation were already present before instrumentation, and no new apical microcrack was visualized. For all groups, the number of slices presenting microcracks after root canal preparation was the same as before canal preparation. CONCLUSIONS: Root canal shaping with ProTaper Universal for Hand Use, HyFlex CM, and Reciproc systems, regardless of the working length, did not produce apical microcracks.

In Vitro Comparison of Cyclic Fatigue Resistance of ProTaper Next, HyFlex CM, OneShape, and ProTaper Universal Instruments in a Canal with a Double Curvature.

INTRODUCTION: The aim of this study was to compare the resistance to cyclic fatigue of ProTaper Next X2 (PTN X2; size 25, 0.06 taper), Hyflex CM (HCM; size 25, 0.06 taper), OneShape (OS; size 25, 0.06 taper), and ProTaper Universal F2 (PTU F2; size 25, 0.08 taper) nickel-titanium files in an artificial root canal with a double (S-shaped) curvature. METHODS: A total of 160 new PTN X2, OS, HCM, and PTU F2 files were tested in an artificial stainless steel canal with a double curvature. Forty files from each system were rotated until fracture to calculate the number of cycles to failure. The length of each fractured fragment was recorded. Data were analyzed by using one-way analysis of variance and Tukey post hoc tests. RESULTS: The resistance to cyclic fatigue of the PTN X2 and HCM instruments was significantly greater than the OS and PTU F2 instruments in the apical curvature (P < .05). There was no statistical difference in the cyclic fatigue resistance of the PTN X2 and HCM instruments in the apical curvature (P > .05). In addition, there was no statistical difference between the OS and PTU F2 instruments in the apical curvature (P > .05). PTN X2, OS, HCM, and PTU F2 instruments showed similar cyclic fatigue resistance values in the coronal curvature (P > .05). CONCLUSIONS: This study showed that PTN X2 and HCM instruments exhibit greater resistance to cyclic fatigue than OS and PTU F2 instruments in the apical curvature of an artificial canal with a double curvature.

Mechanical reduction of the intracanal Enterococcus faecalis population by Hyflex CM, K3XF, ProTaper Next, and two manual instrument systems: an in vitro comparative study.

AIM: In the present study, the effectiveness of three rotary and two manual nickel titanium instrument systems on mechanical reduction of the intracanal Enterococcus faecalis population was evaluated. METHODS: Mandibular premolars with straight roots were selected. Teeth were decoronated and instrumented until 20 K file and irrigated with physiological saline. After sterilization by ethylene oxide gas, root canals were inoculated with Enterococcus faecalis. The specimens were randomly divided into five groups for canal instrumentation: Manual Nitiflex and Hero Shaper nickel titanium files, and rotary Hyflex CM, ProTaper Next, and K3XF nickel titanium files. Intracanal bacterial sampling was done before and after instrumentation. After serial dilution, samples were plated onto the Mitis Salivarius agar. The c.f.u. grown were counted, and log10 transformation was calculated. RESULTS: All instrumentation systems significantly reduced the intracanal bacterial population after root canal preparation. ProTaper Next was found to be significantly more effective than Hyflex CM and manual Nitiflex and Hero Shaper. However, ProTaper Next showed no significant difference with K3XF. CONCLUSION: Canal instrumentation by all the file systems significantly reduced the intracanal Enterococcus faecalis counts. ProTaper Next was found to be most effective in reducing the number of bacteria than other rotary or hand instruments.

Comparison of ProTaper Next and HyFlex instruments on apical debris extrusion in curved canals.

AIM: To evaluate the amount of apically extruded debris after root canal instrumentation with ProTaper Next and HyFlex instruments in curved root canals. METHODOLOGY: Forty extracted mandibular first molar teeth with curved mesial roots and of similar lengths were instrumented using ProTaper Next or HyFlex instruments. The extruded debris was collected into pre-weighed Eppendorf tubes. The tubes were stored in an incubator at 68 °C for 5 days. The tubes were weighed to obtain the final dry weight of the extruded debris. The weight of the extruded debris was determined by subtracting the initial weight from the final weight. Distribution of data was determined by Shapiro-Wilk test. Continuous variables were compared with the Independent Sample t-test or Mann-Whitney U-test. The significance level was set at P = 0.05. RESULTS: Both instruments were associated with apical debris extrusion. The HyFlex group had significantly less debris extrusion than the ProTaper Next group (P = 0.014). CONCLUSION: HyFlex CM was associated with significantly less apical extrusion than ProTaper Next.