Exploring morphometric transformations in temperature-sensitive NiTi instruments alongside real-time intracanal temperature dynamics.

AIM: This study was twofold: (i) it aimed to investigate the morphometric changes of three temperature-sensitive nickel-titanium (NiTi) instruments at different temperatures, and (ii) to conduct an in vivo real-time analysis of intracanal temperature changes. METHODS: Changes in the shape and length of XP-Endo Shaper, XP-Endo Finisher, and XP-Endo Finisher-R were evaluated in real time whilst heated in a temperature-controlled water bath from 22 to 45°C. Instruments were fixed to a laminated water-resistant 1 mm graph paper attached to a stone block. Instruments were imaged whilst subjected to increasing temperature using a digital camera attached to an operating microscope. From recorded videos, still frames were extracted at 10-s intervals and changes in the length and shape of each instrument were measured and changes were plotted against time. Moreover, the intracanal temperature of distal roots of lower molars was measured in vivo for patients attending the clinic for non-surgical root canal treatments. The temperature was measured using a K-type thermocouple probe inserted into the mid-root level after irrigating the canal with a solution set at room temperature (22°C) or heated to 45°C. The intraoral and intracanal temperatures were recorded using a video camera for 180 s at 5-s intervals to plot the change in the intraoral and intracanal temperature, after both irrigation solution temperatures, with time. RESULTS: The shape transformation of XP-Endo Shaper began at 31.5 ± 2.0°C and reached its optimal transformation at 35.1 ± 1.0°C. For the Finisher and Finisher-R, shape transformations began at 29.2 ± 1.9 and 26.9 ± 2.2°C reaching the optimal transformation at 33.9 ± 1.4 and 32.7 ± 1.7°C, respectively. The average decreases in lengths of XP-Endo Shaper, Finisher, and Finisher-R after full transformation were 0.43 ± 0.23, 1.07 ± 0.22, and 1.15 ± 0.22 mm, respectively. The intracanal temperature reached 32.9 ± 0.8 and 33.2 ± 1.0°C after 3 min of application of irrigation solutions set at 22 or 45°C, respectively. CONCLUSION: The tested instruments exhibited diverse changes in their shapes and lengths at varying temperatures. Despite the temperature of the irrigation solution, the intracanal temperature consistently remained lower than the intracanal temperature once equilibrium was reached. This highlights the importance of considering the temperature of irrigation solution during in vitro testing of endodontic instruments.

Comparison of the cyclic fatigue resistance of hyflex EDM, vortex blue, protaper gold, and onecurve nickel-Titanium instruments.

OBJECTIVE: This in vitro study aimed to compare the cyclic fatigue resistance of HyFlex EDM (HEDM), Vortex Blue (VB), ProTaper Gold (PG), and OneCurve (OC) nickel-titanium (NiTi) instruments. MATERIALS AND METHODS: About 12 HEDM (25/.~), 12 VB (25/.06), 12 PG (25/.08), and 12°C (25/.06) instruments were included in this study. All the instruments were tested with a 60° angle of curvature and a 3-mm radius of curvature. All the instruments were utilized until fracture occurred, and then the number of cycles to failure (NCF) was calculated. The data were analyzed statistically using Kruskal-Wallis H and Mann-Whitney U-tests. The statistical significance level was set at P < 0.05. RESULTS: HEDM instruments had the highest cyclic fatigue resistance among all the other instruments (P < 0.05). The OC instruments had a significantly higher fatigue resistance than the PG and VB instruments (P < 0.05); however, there was no significant difference between PG and VB instruments in the NCF (P > 0.05). CONCLUSION: Within the limitations of this in vitro study, it was found that the cyclic fatigue resistance was higher for the HEDM instruments than for the VB, PG, and OC instruments.

Comparative Analysis of Dentinal Crack Formation Following Root Canal Instrumentation with Hand K-Flex Files, ProTaper Next, and Self-adjusting Files.

AIM: To evaluate and compare in vitro the dentinal crack formation in root canal dentin after root canal instrumentation with hand K-Flex files, ProTaper Next, and self-adjusting engine-driven files. MATERIALS AND METHODS: Ninety-two human mandibular first molar teeth were randomly divided into four groups (n = 23) as per the instrumentation protocol: group I-unprepared teeth (control); group II-hand K-Flex files (Sybron Endo); group III-ProTaper Next X1 and X2 (Dentsply Maillefer); group IV-self-adjusting file (ReDent Nova, Israel). All the roots were sectioned perpendicular to the long axis of the tooth at 9 mm, 6 mm, and 3 mm from the apex and thereby obtaining sixty-nine samples, which were then subjected to a stereomicroscopic examination for detection of dentinal cracks. Statistical analyses were done using the Chi-square test with SPSS (version 19), and p value was set at p < 0.05. RESULTS: Statistically significant differences were seen between the instrumented groups. No dentinal cracks were found in the unprepared roots and those prepared with hand K-Flex files (0/23). Self-adjusting-file-instrumented group showed significantly less incidence of crack formation when compared to the ProTaper Next group with p = 0.001. CONCLUSION: Self-adjusting file is an efficient engine-driven NiTi instrument for root canal instrumentation with the least occurrence of crack formation in the root canal dentin compared to the ProTaper Next system. CLINICAL SIGNIFICANCE: The introduction of NiTi rotary file systems has metamorphosed the endodontic treatment by their better cutting efficiency and cleaning potentiality. Yet, evidenced-based clinical studies are to be conducted on the incidence of microfractures that can lead to vertical root fractures, which will be produced irrespective of the motion kinematics and design feature and thereby compromising the clinical maintenance of the endodontically treated teeth.

Defect propagation in NiTi rotary instruments: a noncontact optical profilometry analysis.

AIM: To evaluate the presence and propagation of defects and their effects on surfaces of nickel-titanium (NiTi) instruments using noncontact, three-dimensional optical profilometry, and to assess the accuracy of this method of investigation. METHODOLOGY: The flute surface areas of instruments from two commercial instrumentation systems, namely Reciproc R25 (n = 5) and WaveOne Primary (n = 5), were assessed and compared before and after performing two instrumentation cycles in simulated root canals in clear resin blocks. All the analyses were conducted on areas measuring 211 × 211 µm, located 3 mm from the tips of the instruments. A quantitative analysis was conducted before and after the first and second instrumentation cycles, using the Sa (average roughness over the measurement field), Sq (root mean square roughness) and Sz (average height over the measurement field) amplitude parameters. All the data were submitted to statistical analysis at a 5% level of significance. RESULTS: There was a significant increase (P = 0.007) in wear in both groups, especially between baseline and the second instrumentation cycle, with significantly higher wear values being observed on WaveOne instruments (Sz median values = 33.68 and 2.89 µm, respectively, for WO and RP groups). A significant increase in surface roughness (P = 0.016 and P = 0.008, respectively, for Sa and Sq) was observed in both groups from the first to the second instrumentation cycle, mostly in WaveOne specimens. Qualitative analysis revealed a greater number of defects on the flute topography of all the instruments after use. CONCLUSIONS: More defects were identified in WaveOne Primary instruments compared to Reciproc R25, irrespective of the evaluation stage. The investigation method provided an accurate, repeatable and reproducible assessment of NiTi instruments at different time-points.

Cutting efficiency of nickel-titanium rotary and reciprocating instruments after prolonged use.

The aim of the present study was to compare the cutting efficiency of Twisted File instruments used in continuous rotation or TF Adaptive motion and evaluate if prolonged use significantly affected their cutting ability. 20 new NiTi instruments were used in the present study (TF tip size 35, 0.06 taper; Sybron-Endo, Orange, CA, USA), divided into 2 subgroups of 10 instruments each, depending on which movement was selected on the endodontic motor. Group 1: TF instruments were activated using the program TF continuous rotation at 500 rpm and torque set at 2 N; Group 2: TF instruments were activated using the reciprocating TF Adaptive motion. Cutting efficiency was tested in a device developed to test the cutting ability of endodontic instruments. Each instrument cut 10 plastic blocks (10 uses) and the length of the surface cut in a plastic block after 1 min was measured in a computerized program with a precision of 0.1 mm. Maximum penetration depth was calculated after 1 use and after 10 uses, and mean and standard deviation (SD) of each group was calculated. Data were statistically analyzed with a one-way ANOVA test (P < 0.05). TF instruments used in continuous rotation (Group 1) cut a mean depth of 10.4 mm (SD = 0.6 mm) after the first use and 10.1 mm (SD 1.1 mm) after 10 uses, while TF instruments used with the Adaptive motion cut a mean depth of 9.9 mm (SD = 0.7 mm) after the first use and 9.6 mm (SD = 0.9 mm) after 10 uses. There was no statistically significant difference between the two groups investigated (P > 0.05) nor between instruments after 1 or 10 uses. In conclusion, the TFA motion showed a lateral cutting ability similar to continuous rotation and all tested instruments exhibited the same cutting ability after prolonged use.

Flexibility and torsional behaviour of rotary nickel-titanium PathFile, RaCe ISO 10, Scout RaCe and stainless steel K-File hand instruments.

AIM: To assess and compare the flexibility and torsional resistance of PathFile, RaCe ISO 10 and Scout RaCe instruments in relation to stainless steel K-File hand instruments. METHODOLOGY: Rotary PathFile (sizes 13, 16 and 19; .02 taper), Race ISO 10 (size 10; 0.02, 0.04 and 0.06 tapers), Scout RaCe (sizes 10, 15 and 20; 0.02 taper) and hand K-File (sizes 10, 15 and 20; 0.02 taper) instruments were evaluated. Alloy chemical composition, phases present and transformation temperatures were determined for the NiTi instruments. For all instruments, diameters at each millimetre from the tip as well as cross-sectional areas at 3 mm from the tip were measured based on ANSI/ADA Specification No. 101 using image analysis software. Resistance to bending and torsional resistance were determined according to specification ISO 3630-1. Vickers microhardness measurements were also taken in all instruments to assess their strength. Data were analysed using analysis of variance (α = 0.05). RESULTS: The alloys used in the manufacture of the three types of NiTi instruments had approximately the same chemical composition, but the PathFile instruments had a higher Af transformation temperature and contained a small amount of B19' martensite. All instruments had diameter values within the standard tolerance. The bending and torsional resistance values were significantly increased relative to the instrument diameter and cross-sectional area. CONCLUSIONS: PathFile instruments were the most flexible and the least torque resistant, whilst the stainless steel instruments were the least flexible although they were more torque resistant than the NiTi instruments.

Opto-magnetic imaging spectroscopy in analyzing rotary NiTi endodontic instruments.

Intra-canal fracture of rotary NiTi instruments occurs due to torsional stress, cyclic fatigue, or a combination of these two factors. Broken instruments are a serious obstacle to shaping, cleaning, and filling of the root canal and can adversely affect the outcome of endodontic therapy. The aim of this study was to examine the magnetic properties and ultrastructural changes of new, used, and fractured NiTi instruments using opto-magnetic imaging spectroscopy (OMIS). The study included three sets of different types of rotary instruments: MTwo (VDW, Munich, Germany), Pro Taper Universal (Dentsply Maillefer, Ballaigues, Switzerland), and BioRace (FKG DENTAIRE Swiss Dental Products, Le Crêt-du-Locle Switzerland). Root canal shaping was performed on root canals with different curvatures, and after intra-canal fracture, instruments of the same type (new, used, and fractured) were analyzed using OMIS at the Faculty of Mechanical Engineering, University of Belgrade. The obtained results showed a coincidence of peak localization for the used instruments that did not suffer a fracture, as well as for new, unused instruments of all examined groups. Additionally, there was a coincidence of peak intensities for new and fractured instruments in all groups. The specific treatment of electropolishing of the active surface of BioRace instruments caused a completely different electromagnetic response compared to conventional NiTi sets of tested instruments. New, unused BioRace instruments had the most pronounced positive (5.6078 n.a.u. x1000) and negative (-8.5218 n.a.u. x1000) intensity values. The analysis of NiTi instruments using opto-magnetic imaging spectroscopy indicated changes in the magnetic properties after their instrumentation.

Cyclic and torsional fatigue resistance of a new rotary file on a rotary and reciprocating motion.

This study evaluated the cyclic and torsional fatigue resistance of a new nickel-titanium (Flat File 25.04) instrument on the continuous and reciprocating motion. Sixty instruments of the ProDesign Logic2 25.03 and 25.05 (Easy Equipamentos Odontológicos, Belo Horizonte, Brazil), and MK Flat File 25.04 (n = 20) (MK Life, Porto Alegre, Brazil) were used. For the cyclic fatigue test, an artificial stainless steel simulated canal with an angle of 60° and a radius of curvature of 5 mm located 5 mm from its tip was used. The torque and rotation angle at the instruments' failure on the torsional fatigue test was based on the ISO 3630-1 protocol, in which the 3 mm tip of each instrument was fixed and connected to an electric motor and a load cell. The fractured surface of each fragment was examined by scanning electron microscopy. Data were analyzed using a 1-way analysis of variance and Tukey's test with a significance level of 5%. Flat File 25.04 had lower cyclic fatigue in both kinematics than the Logic instruments (p < .05). Reciprocating motion improved the cyclic fatigue of the tested instruments (p < .05). Flat File 25.04 had similar torque to Logic2 25.05 (p > .05), and both were superior to Logic2 25.03 (p < .05). The angular deflection values were different for the three tested instruments (p < .05), in the decreasing order: Logic2 25.03, 25.05, and Flat File 25.04. Flat File presented good resistance to cyclic and torsional fatigue resistance. Reciprocating motion improved the cyclic fatigue resistance of the instruments and can be considered when using programmable motors. RESEARCH HIGHLIGHTS: Scanning electron microscopy evaluation of different endodontic rotary file and fatigue resistance tests.

Stereomicroscopic Evaluation of Microcrack Formation in Dentin by ProTaper Next, Revo S, and WaveOne Gold File System.

BACKGROUND: During the biomechanical preparation of the root canal by rotary file systems, stress is generated within the canal, which leads to dentinal microcrack formation. Such defects are evaluated only under the microscope. AIM: The present study aimed to evaluate dentinal microcrack formation after instrumentation with ProTaper Next (M-wire), Revo S (conventional NiTi), and WaveOne Gold (Gold-wire) file systems under the stereomicroscope. MATERIALS AND METHODS: Forty single-rooted teeth free from any defect were selected and divided into four groups (Control, PTN, RS, and WOG). Experimental groups were instrumented with file system used in the study, and the control group were left unprepared. Samples were further decoronated and sectioned at 3 mm, 6 mm, and 9 mm from the apex perpendicular to the long axis and examined under a stereomicroscope at ×25 for different types of microcracks (no fracture, complete fracture, partial fracture, and other fracture). STATISTICAL ANALYSIS USED: Data analysis was done by the Chi-square test using the SPSS version 17.0 software. A two-sided (α = 2) P < 0.05 (P < 0.05) was considered statistically significant. RESULTS: The null hypothesis was rejected. There was a statistically significant difference between the groups. All file systems created microcracks in the root dentin. WOG group showed an incidence of 66.7% for no fracture, PTN group had 40% for other fracture, and RS group had 60% for complete fracture. CONCLUSION: Single file system WOG with gold wire technology proves to be the best choice for canal preparation among the tested groups in terms of least dentinal crack formation.

Combining apical torsional load and cyclic fatigue resistance of NiTi instruments: New approach to determine the effective lifespan of rotary instruments.

In the described proof-of-principle experiments, we introduced a novel testing device to investigate how different concurrent torsional loads influence the cyclic fatigue (CF) resistance of a nickel-titanium (NiTi) instrument. The device was designed to test CF resistance of NiTi files with a standardized load on the apical 5 mm; a movable cylinder controlled by a lever provided a uniform real-time load. Thirty-three NiTi instruments 25.04 (F360, Komet, Lemgo, Germany) were rotated until fracture at 30° curvature under three different torsional loads (n = 11 each); Group A: 2.5 Ncm; Group B: 5 Ncm; Group C: 10 Ncm. anova, multiple comparisons Tamhane tests, regression and Kaplan-Meyer analysis were performed to contrast means. Resistance to cyclic fatigue differed significantly among groups (P = 0.0001). Increased torsional loads led to a decrease in time to failure. An inverse correlation (r = -0.721, P = 0.001) was observed between time and torsional load, with higher torsional loads correlated to shorter times to fracture.

Comparison of the cyclic fatigue resistance of VDW.ROTATE, TruNatomy, 2Shape, and HyFlex CM nickel-titanium rotary files at body temperature.

OBJECTIVES: This study aims to compare the cyclic fatigue resistance of VDW.ROTATE, TruNatomy, 2Shape, and HyFlex CM nickel-titanium (NiTi) rotary files at body temperature. MATERIALS AND METHODS: In total, 80 VDW.ROTATE (25/0.04), TruNatomy (26/0.04), 2Shape (25/0.04), and HyFlex CM (25/0.04) NiTi rotary files (n = 20 in each group) were subjected to static cyclic fatigue testing at body temperature (37°C) in stainless-steel artificial canals prepared according to the size and taper of the instruments until fracture occurred. The number of cycles to fracture (NCF) was calculated, and the lengths of the fractured fragments were measured. The data were statistically analyzed using a 1-way analysis of variance and post hoc Tamhane tests at the 5% significance level (p < 0.05). RESULTS: There were significant differences in the cyclic fatigue resistance among the groups (p < 0.05), with the highest to lowest NCF values of the files as follows: VDW.ROTATE, HyFlex CM, 2Shape, and TruNatomy. There was no significant difference in the lengths of the fractured fragments among the groups. The scanning electron microscope images of the files revealed typical characteristics of fracture due to cyclic fatigue. CONCLUSIONS: The VDW.ROTATE files had the highest cyclic fatigue resistance, and the TruNatomy and 2Shape files had the lowest cyclic fatigue resistance in artificial canals at body temperature.

Influence of autoclave sterilization procedures on the cyclic fatigue resistance of heat-treated nickel-titanium instruments: a systematic review.

OBJECTIVES: This systematic review evaluated the influence of autoclave sterilization procedures on the cyclic fatigue resistance of heat-treated nickel-titanium (NiTi) instruments. MATERIALS AND METHODS: A systematic search without restrictions was conducted in the following electronic databases: PubMed, Scopus, Web of Science, ScienceDirect, Cochrane, and Open Grey. The hand search was also performed in the main endodontic journals. The eligible studies were submitted to the methodological assessment and data extraction. RESULTS: From 203 abstracts, a total of 10 articles matched the eligible criteria. After reading the full articles, 2 were excluded because of the absence of the heat-treated instruments in the experimental design and 3 due to the lack of a control group using heat-treated instruments without autoclave sterilization. From the 5 included studies, 1 presented a low risk of bias, 3 presented moderate and 1 high risk. It was observed heterogeneous findings in the included studies, with autoclave sterilization cycles increasing, decreasing or not affecting the cyclic fatigue life of heat-treated NiTi instruments. However, the retrieved studies evaluating the cyclic fatigue resistance of endodontic instruments presented different protocols and assessing outcomes, this variability makes the findings less comparable within and also between groups and preclude the establishment of an unbiased scientific evidence base. CONCLUSIONS: Considering the little scientific evidence and considerable risk of bias, it is still possible to conclude that autoclave sterilization procedures appear to influence the cyclic fatigue resistance of heat-treated NiTi instruments.

Secondary Root Canal Treatment with Reciproc Blue and K-File: Radiographic and ESEM-EDX Analysis of Dentin and Root Canal Filling Remnants.

Secondary root canal treatment requires the complete removal of filling materials with different chemical-physical properties. A newly developed single-use NiTi instrument (Reciproc Blue, RB) may be more effective in root canal retreatment. The aim of the present study was to evaluate morphology and composition of remnants after retreatment with RB compared to traditional K-File technique, in canals obturated with Thermafil/AH Plus. Twenty-four single-rooted human teeth were shaped with NiTi obturated with AH-Plus/Thermafil and retreated using RB NiTi instruments or manual K-Files. Radiographs were taken to evaluate endodontic space and radiopacity of residual filling-material before/after procedures. After retreatment, samples were longitudinally split and observed by environmental scanning electron microscopy connected to energy dispersive X-Ray spectroscopy (ESEM-EDX) to analyze the debris/remnant position, microchemistry, and dentinal surface morphology. Time for retreatments was recorded and compared using one-way ANOVA (p-value = 0.05). Radiopaque filling residuals were found in both groups. RB system resulted statistically faster than manual K-File in retreatment procedure (p < 0.001). Root canal space radiographic appearance obtained after retreatment with RB was wider than K-File (p < 0.05). ESEM-EDX revealed 4 different morphological dentin area. Area-1: debris-free with typical Ca, P, and N composition of dentin and detected in 70% of the surface. Area-2: presence of deproteinized smear layer free from N and debris in 15% of the surface. Area-3: a thick packed smear layer N-free and with fine debris consisting of trace elements from sealer in 10% of the surface. Area-4: packed with debris and trace elements. No difference was observed between both instruments regarding root canal space appearance and ESEM-EDX analysis. Both systems were able to remove filling material but created a dentine morphology composed of packed debris and filling materials embedded into the smear layer. Dentin surface composition resulted in collagen depleted by irrigation procedures. The reciprocating system required less time to complete retreatment.

Evaluation of Flexibility, Microstructure and Elemental Analysis of Some Contemporary Nickel-Titanium Rotary Instruments.

BACKGROUND: Contemporary nickel-titanium (NiTi) rotary endodontic instruments had a revolutionary impact on the success of root canal treatment. AIM: To evaluate the flexibility, microstructure and elemental analysis of four different recent NiTi rotary instruments, namely; Wave One Gold, TF adaptive, HyFlex EDM and Gr_Reciproc Blue compared to conventional Protaper Universal (F2). MATERIAL AND METHODS: The NiTi rotary files were subjected to cantilever bending test to evaluate their flexibility. The microstructural characteristics and elemental analysis were examined via scanning electron microscopy (SEM) and energy dispersive X-ray spectrometer (EDX). RESULTS: The TF adaptive, HyFlex EDM and Wave One Gold endodontic files showed significantly lower cantilever bending values (i.e., higher flexibility) than Protaper F2 and Gr_Reciproc Blue (p < 0.05). The SEM micrographs showed that the bulk of all examined files showed multiple striations due to the cutting process, on the other hand, their external surfaces were different: The Protaper Universal F2 showed multiple voids, while the TF Adaptive surface exhibited more uniform structure. The Hyflex EDM had a crater-like surface, whereas Wave one Gold showed machining grooves with minimum defects, while Reciproc Blue displayed machining grooves with random scratch lines. There was a significant difference in bulk and surface elemental analysis of the various examined files, yet composed mainly of the same elements. CONCLUSION: Chemical composition, heat treatment, manufacturing process and geometrical design of the NiTi rotary instrument have a great influence on their flexibility and microstructure.

Diameter and Taper Variability of Single-file Instrumentation Systems and Their Corresponding Gutta-percha Cones.

INTRODUCTION: Manufacturers offer single-file instrumentation systems with matching gutta-percha (GP) cones to simplify root canal preparation and obturation. The purpose of this study was to determine whether file diameters and tapers match with corresponding cone diameters and tapers (precision) as well as industry standards (accuracy). METHODS: Twenty files and corresponding GP cones from each size of F360 (#25, #35, #45, #55 with .04 taper) and Reciproc (#25, #40, #50 with variable tapers) instruments were examined by using optical microscopy (×32) to determine their diameter and taper. Precision was evaluated by using one-way analysis of variance (α = 0.05) with Scheffé post hoc tests and t tests with Bonferroni correction. Accuracy was calculated by subtracting the nominal values from the measured values of all files and GP cones, and mean diameter and taper differences were compared by using one-way analysis of variance (α = 0.05) and Scheffé post hoc test for pairwise comparison. RESULTS: For F360, the majority of file and cone diameters were within the tolerance levels, but most of the file diameters were significantly larger than GP cone diameters (P < .05), but the majority of all measured values were within the tolerance levels. For Reciproc, file and cone diameters at D1 and D3 mostly approached the nominal values. At the coronal end, file diameters #25 and #50 were significantly smaller than cone diameters (P < .05). For both instrumentation systems, almost all file and cone tapers matched with the preset tolerance ranges. For Reciproc, significant differences between file and GP cone demonstrated either smaller cone or smaller file diameters and tapers, depending on the size. Most of the measured values were within the acceptable range, but diameters at the coronal end exhibited the highest percent difference from the nominal values. CONCLUSIONS: Despite the call for standardization, variability in diameter and taper dimensions between single-file instrumentation systems and their corresponding GP cones can be expected.

The incidence of dentinal cracks during root canal preparations with reciprocating single-file and rotary-file systems: A meta-analysis.

As a dangerous factor in vertical root fracture, dentinal crack formation is often associated with root canal instruments. We conducted this meta-analysis to compare the influence of two types of nickel titanium (NiTi) instruments that have different movements (reciprocating single-file versus full-sequence rotary file systems) on dentinal cracks formation during root canal preparation. Searches were conducted in PubMed, ISI Web of Knowledge, Embase and Cochrane Library using a combination of keywords. Titles and abstracts of all articles were independently assessed by two reviewers in accordance with the predefined inclusion criteria. Relevant studies were acquired in full-text form. Data in these articles were independently extracted. A meta-analysis was conducted using Review Manager 5.3. The results showed that the WaveOne and Reciproc files with a reciprocating motion produced significantly fewer dentinal cracks than the conventional rotational ProTaper technique.

Effect of Different Instrumentation Techniques on Vertical Root Fracture Resistance of Endodontically Treated Teeth.

STATEMENT OF THE PROBLEM: Vertical root fractures are catastrophic events that often result in tooth extraction. Many contributing factor are associated with increasing incidence of vertical root fracture. Root canal preparation is one of the predisposing factors which can increase the root susceptibility to vertical fracture. PURPOSE: The aim of this study was to compare the effects of three different instrumentation techniques on vertical root fracture resistance of endodontically treated teeth. MATERIALS AND METHODS: In this study, 120 freshly extracted mandibular premolar teeth of similar dimensions were decoronated and randomly divided into control (n=30), nickel-titanium hand K-file (HF, n=30), BioRaCe rotary file (BR, n=30), and WaveOne reciprocating single-file (WO, n=30) groups. After cleaning and shaping the root canals, AH26 was used as canal sealer, and obturation was completed using the continuous wave technique. The root canals were embedded vertically in standardised autopolymerising acrylic resin blocks, and subjected to a vertical load to cause vertical root fracture. The forces required to induce fractures were measured using a universal testing machine. ANOVA and Tukey's post-hoc test were used to analyse the data. RESULTS: All experimental groups showed statistically significant reductions in fracture resistance as compared with the control group. There was a statistically significant difference between the HF and BR groups. The WO group did not differ significantly from the HF group or the BR group. CONCLUSION: All three instrumentation techniques caused weakening of the structure of the roots, and rendered them susceptible to fracture under lesser load than unprepared roots. The fracture resistance of roots prepared with the single-file reciprocating technique was similar to that of those prepared with NiTi hand and rotary instrumentation techniques.

Cyclic fatigue resistance of 3 different nickel-titanium reciprocating instruments in artificial canals.

INTRODUCTION: The purpose of this study was to evaluate the cyclic fatigue resistance of 3 different nickel-titanium reciprocating instruments. METHODS: A total of 45 nickel-titanium instruments were tested and divided into 3 experimental groups (n = 15): group 1, WaveOne Primary instruments; group 2, Reciproc R25 instruments; and group 3, Twisted File (TF) Adaptive M-L1 instruments. The instruments were then subjected to cyclic fatigue test on a static model consisting of a metal block with a simulated canal with 60° angle of curvature and a 5-mm radius of curvature. WaveOne Primary, Reciproc R25, and TF Adaptive instruments were activated by using their proprietary movements, WaveOne ALL, Reciproc ALL, and TF Adaptive, respectively. All instruments were activated until fracture occurred, and the time to fracture was recorded visually for each file with a 1/100-second chronometer. Mean number of cycles to failure and standard deviations were calculated for each group, and data were statistically analyzed (P < .05). Instruments were also observed through scanning electron microscopy to evaluate type of fracture. RESULTS: Cyclic fatigue resistance of Reciproc R25 and TF Adaptive M-L1 was significantly higher than that of WaveOne Primary (P = .009 and P = .002, respectively). The results showed no statistically significant difference between TF Adaptive M-L1 and Reciproc R25 (P = .686). Analysis of the fractured portion under scanning electron microscopy indicated that all instruments showed morphologic characteristics of ductile fracture that were due to accumulation of metal fatigue. CONCLUSIONS: No statistically significant differences were found between the instruments tested except for WaveOne Primary, which showed the lowest resistance to cyclic fatigue.

Constant Insertion Rate Methodology for Measuring Torque and Apical Force in 3 Nickel-Titanium Instruments with Different Cross-sectional Designs.

INTRODUCTION: The aim of this study was to evaluate the cutting characteristics of 3 nickel-titanium instruments with different cross-sectional designs using a recently developed methodology. METHODS: Insertion tests at a constant rate of 5.4 mm/min were performed on a bench test device by measuring the torque and apical force required for penetrating prefabricated acrylic blocks containing an artificial canal preflared with #10 and #15 K-files. Size 20/.06 Mtwo (VDW, Munich, Germany) and RaCe (FKG, La-Chaux De Fonds, Switzerland) instruments, together with ProTaper Universal (PTU) F1 instruments (Dentsply Maillefer, Ballaigues, Switzerland) (10 instruments of each type), were tested using an endodontic motor set at 300 rpm and 5 N·cm. The instruments were characterized with respect to the pitch length, rake angle, and cross-sectional area. Statistical analysis was performed with analysis of variance (α = 0.05). RESULTS: The torque was significantly lower for Mtwo compared with the other 2 groups (P < .05). It was also lower for RaCe in comparison with PTU F1 (P < .05). Regarding the apical force, the RaCe instruments had lower values when compared with the Mtwo and PTU F1 instruments (P < .05). There was no statistically significant difference between the PTU F1 and Mtwo instruments (P > .05). CONCLUSIONS: The methodology allowed the cutting properties of the instruments to be assessed in terms of their different geometric characteristics. The cross-sectional design, especially in Mtwo instruments with 2 sharp edges and great chip removal capability, was a differential factor for their higher cutting action.

Stereomicroscopic evaluation of dentinal defects induced by new rotary system: "ProTaper NEXT".

INTRODUCTION: The objective of this study was to evaluate dentinal defects formed by new rotary system - Protaper next™ (PTN). MATERIALS AND METHODS: Sixty single-rooted premolars were selected. All specimens were decoronated and divided into four groups, each group having 15 specimens. Group I specimens were prepared by Hand K-files (Mani), Group II with ProTaper Universal (PT; Dentsply Maillefer), Group III with Hero Shaper (HS; Micro-Mega, Besancon, France), and Group IV with PTN (Dentsply Maillefer). Roots of each specimen were sectioned at 3, 6, and 9mm from the apex and were then viewed under a stereomicroscope to evaluate presence or absence of dentinal defects. RESULTS: In roots prepared with hand files (HFs) showed lowest percentage of dentinal defects (6.7%); whereas in roots prepared with PT, HS, and PTN it was 40, 66.7, and 26.7%, respectively. There was significant difference between the HS group and the PTN group (P < 0.05). CONCLUSION: All rotary files induced defects in root dentin, whereas the hand instruments induced minimal defects.