RESUMO
Resumen Objetivo: Comparar la capacidad de centrado y el transporte apical de los sistemas Reciproc Blue y XP-endo Shaper en bloques de resina con fotografías pre y posoperatorias yuxtapuestas, mediante un programa de análisis de imágenes. Materiales y Métodos: Se dividieron al azar 20 tacos de resina en dos grupos (n=10) preparados con XP-endo Sha- per y Reciproc Blue respectivamente. Se tomaron fotografías digitales de los tacos, antes y después de la preparación con cada sistema en una misma posición. Luego las fotografías obtenidas fueron yuxtapuestas mediante el software Photo shop. Se midieron las desviaciones del centro del conducto con respecto a la pared interna y externa del mismo en diversos puntos de referencia preestablecidos. Estos datos fueron analizados estadísticamente con el test de ANOVA. Resultados: Ambos sistemas produjeron transporte y desviación respecto a la trayectoria original del conducto radicular, pero el análisis estadístico (ANOVA Factorial 2x8) no cuantificó diferencias significativas entre ambos sistemas (p=0,4044) Conclusiones: Bajo las condiciones de este trabajo, ambos sistemas producen transporte y desviación respecto a la trayectoria original del conducto radicular.
Abstract Aim: To compare the centering capacity and apical transport of the Reciproc Blue and X-Pendo Shaper system in resin blocks with juxtaposed pre and postoperative photographs, using the Photoshop software. Materials and methods: 20 resin plugs were randomly divided into two groups (n=10) that were prepared with XP-endo Shaper and Reciproc Blue respectively. Digital photographs of the blocks were taken, before and after preparation, with each system in the same position. Then the obtained photographs were juxtaposed using Photoshop software. The deviations of the center of the canal, with respect to its inter nal and external wall, were measured at various pre-established reference points. These data were statistically analysed with the ANOVA test. Results: Both systems produced transport and deviation from the original trajectory of the root canal, but the statistical analysis (2x8 Factorial ANOVA) did not quantify significant differences between both systems (p=0.4044) Conclusions: Under the conditions of this work, both systems produce transport and deviation with respect to the original trajectory of the root canal.
RESUMO
Evaluar la influencia del operador sobre el transporte apical y centrado de la instrumentación endodóntica utilizando WaveOne Gold en canales radiculares simulados de resina acrílica. Se asignaron 32 canales simulados de resina acrílica a dos grupos (n = 16). El grupo 1 conformado por estudiantes inexpertos y el grupo 2 por especialistas en el área de endodoncia. Estos canales se instrumentaron hasta un tamaño apical de 25/07 con lima Primary WaveOne Gold. Para evaluar el transporte apical y el centrado de la instrumentación se utilizaron imágenes fotográficas que fueron analizadas mediante los software de edición de imagen Photoshop e Image J. Además fue registrada la incidencia de fractura de instrumentos. Los datos fueron registrados mediante un formulario Google Forms y analizados mediante el software estadístico R. Se evaluó la normalidad de los dato s mediante el test Shapiro-Wilk y para establecer diferencias entre los grupos se realizó la prueba t. El nivel de significancia estadística fue establecido en p < 0,05. La mayor diferencia al evaluar el centrado se evidenció a nivel de los 6 mm y en cuanto al transporte apical la mayor discrepancia fue a nivel de 1 mm. Sin embargo, no se observaron diferencias significativas entre ambos grupos e n ninguno de los puntos evaluados. Se reportó una baja incidencia de fractura de instrumentos. La experiencia del operador no influye en la conformación del canal radicular simulado al evaluar centrado y transporte apical al utilizar limas WaveOne Gold.
To evaluate root canal transportation and centering ability as influenced by operator experience using WaveOne Gold files in simulated acrylic resin root canals. Thirty-two simulated acrylic resin canals were distributed to two groups (n = 16). Group 1 is made up of inexperienced students, and group 2 by specialists in the field of endodontics. These canals were shaped to an apical size of 07/25 with the Primary WaveOne Gold file. Photographic images were used to evaluate apical transport and centering of the instrumentation, which was analyzed using Photoshop and Image J image editing software. File separation was also recorded. The data were recorded using Google Forms and analyzed using the R statistical program. The normality of the data was evaluated using the Shapiro-Wilk test, and the t-test was performed to establish differences between the groups. The level of statistical significance was established as p <0.05. The normality of the data was evaluated using the Shapiro-Wilk test. Then statistical significance was analyzed using the T-test. The most remarkable difference when evaluating centering was evident at the 6 mm level. In terms of apical transport, the major discrepancy was at the 1 mm level. However, no significant differences were observed between both groups in any of the points evaluated. A low incidence of instrument fracture was reported. According to our results, the operator's experience does not influence shaping in simulated root canals in terms of centering ability and apical transportation when using WaveOne Gold files.
RESUMO
Objective: To assess the apical transportation in simulated root canals with different curvature angles prepared using manual instrumentation and rotary and reciprocating motions. Methods: Sixty simulated root canals were prepared using manual instrumentation (Flexofile K-file) (MT), continuous rotation (HyFlex CM) (HF), and reciprocating motion (WaveOne Gold) (WG). A trained operator prepared the canals, and the apical enlargement was standardized up to a #25 file in all systems tested. Two different curvature angles of the simulated root canals were tested: 70° and 50°. Overlapping photographs of the simulated root canals, before and after root canal preparation, were used to measure the apical transportation (mm), using the ImageJ software. Descriptive statistics (mean and standard deviation) were analyzed and the groups were compared with two-way ANOVA followed by Tukey's post-hoc, with α=5%. Results: There was a statistically significant interaction between the effects of group and angle in the apical transportation (F = 3.740; p = 0.031). Simple main effects analysis showed that HyFlex CM produced a significantly lower apical transportation when compared to WaveOne Gold (p = 0.02) and the manual technique (p < 0.01), regardless of the angle. However, there were no differences between WaveOne Gold and manual technique in canals with the 70° angle (p>0.05). The group with the highest mean apical transportation was the MT, with 0.0917 mm, followed by WG and HF, with 0.0633 and 0.0325, respectively. Conclusion: Simulated root canals prepared with rotary motion (HyFlex CM) showed the lowest apical transportation, followed by the reciprocating motion (WaveOne Gold). The manual technique showed the most unfavorable results, with the highest apical transportation.(AU)
Objetivo: avaliar o transporte apical em canais radiculares simulados com diferentes ângulos de curvatura preparados por meio de instrumentação manual e dos movimentos rotativo e reciprocante. Métodos: sessenta canais simulados foram preparados usando instrumentação manual (Flexofile K- -file) (MT), rotação contínua (HyFlex CM) (HF) e movimento reciprocante (WaveOne Gold) (WG). O preparo do canal radicular foi realizado por um operador treinado, e o alargamento apical foi padronizado até o instrumento #25 em todos os sistemas testados. Dois diferentes ângulos de curvatura dos canais simulados foram testados: 70° e 50°. Fotografias sobrepostas dos canais simulados, antes e após o preparo do canal radicular, foram utilizadas para medir o transporte apical (mm), utilizando o software ImageJ. Estatísticas descritivas (média e desvio padrão) foram analisadas e as comparações entre os grupos foram realizadas através de ANOVA de duas vias, seguido por post-hoc de Tukey, com α=5%. Resultados: houve interação estatisticamente significativa entre os efeitos do grupo e do ângulo no transporte apical (F = 3,740; p = 0,031). A análise simples dos efeitos principais mostrou que o sistema Hy- Flex CM produziu um transporte apical significativamente menor quando comparado ao sistema WaveOne Gold (p = 0,02) e à Técnica Manual (p <0,01), independentemente do ângulo. No entanto, não houve diferenças entre o WaveOne Gold e a Técnica Manual em canais com ângulo de 70 ° (p> 0,05). O grupo que apresentou maior transporte apical médio foi o MT, com 0,0917 mm, seguido pelo WG e pela HF, com 0,0633 e 0,0325, respectivamente. Conclusão: canais radiculares simulados preparados com movimento rotatório (HyFlex CM) mostraram o menor transporte apical, seguido de movimento reciprocante (WaveOne Gold). A técnica manual revelou os resultados mais desfavoráveis, com maior transporte apical.(AU)
Assuntos
Preparo de Canal Radicular/instrumentação , Ápice Dentário/anatomia & histologia , Instrumentos Odontológicos , Distribuição Aleatória , Reprodutibilidade dos Testes , Análise de Variância , Desenho de EquipamentoRESUMO
The aim of this study was to evaluate canal transportation; centering ability; dentin thickness; change in volume, and time spent on shaping ability of maxillary molars prepared with mechanized NiTi file systems composed of a conventional NiTi alloy (Mtwo), a CM-Wire (Prodesign R and Hyflex CM) NiTi alloy, R-phase (Twisted File Adaptive) and an M-Wire (Reciproc) NiTi alloy]. With the purpose of understanding the role of new treated NiTi alloys in larger apical preparations, this type of preparation was evaluated in the mesiobuccal (MB) and distobuccal canal (DB) of maxillary molars, as well as, in the second mesiobuccal (MB2) canals in extracted maxillary first molars by means of micro-computed tomographic (micro- CT) imaging. For the second mesiobuccal canal (MB2) evaluation, thirty maxillary molars with Vertucci type IV canal configuration were selected and randomly divided into 3 groups (n = 10): Reciproc [REC; VDW, Munich, Germany], Prodesign R [PDR; Easy, Belo Horizonte, Brazil] and Mtwo [MO; VDW, Munich, Germany]. To assess the mesiobuccal and distobuccal canals, a total of 45 extracted maxillary molars were selected according to the following criteria: MB canals exhibiting curvatures according to the Weine classification in the 20-30 degree range; and DB canals presenting curvatures in the 0-5 degree range. These teeth were randomly assigned to three groups, Reciproc (REC) [40.06]; Hyflex CM (HF) [40.06] [Coltene, Cuyahoga Falls, OH, USA] and Twisted file Adaptive (TFA) [35.04]. After root canal preparation, all the teeth were scanned to evaluate parameters previously cited. In particular, the percentage of negotiability of the MB2 canal was evaluated. All parameters were statistically compared using the Kruskal-Wallis and Dunn's Multiple comparison tests within groups with a significance level of 5%. For MB2 canals, no statistically significant difference was observed among the three groups with regard to the values of canal transportation, centering ability, remaining dentin thickness in the coronal third, number of specimens with thickness under 0.5 mm in the danger zone, and apical volume (P>0.05). However, the entire volume of the canal in Group MO differed statistically from that of Group PDR (P<0.05), but Group REC did not differ statistically from Groups MO and PDR (P>0.05). Group PDR demanded more time to reach WL than use of the MO and REC systems. For MB and DB canals, the trend of canal transportation was towards inner curvature in apical third, while in the coronal third it was towards the outer curve. There was no difference in apical transportation values in the first apical millimeters for both canals. In MB canal, at 3 and 4 mm, the Reciproc transportation value was significantly lower than that of Hyflex CM(P<0.05). In the DB canal, at 2 and 4 mm, Reciproc showed substantially higher values than Group TFA (P<0.05). There was no statistically significant difference between the two canals among the three systems for centering ability in the apical third and the remaining dentin thickness (RDT). For DB canal, there was no significant difference in shaping time, but in the MB canal, Group TFA was swifter than Reciproc and Hyflex CM. The initial changes in volume (apical/entire) after canal preparation was statistically significant within groups in MB and DB canals for percentage and volume of dentin removed. TFA had the lowest values for the apical and entire volumes of dentin removed in both canals compared with Reciproc and Hyflex CM (P<0.05). TFA had the lowest percentage of dentin removed from the entire MB canal, and from the apical and entire volume of DB canal. For negotiating and shaping the MB2 canal, the three file systems had similar performance. However, the REC system reached the full working length faster than PDR. The MO and REC systems removed more dentin in the inner furcation area when compared with PDR. For MB and BD canals, the heat treated NiTi alloy systems used for larger apical preparation evenly maintained the morphology of the MB and DB canals of maxillary molars. In shaping procedures, the larger apical preparation produced slight canal transportation without evidence of significant preparation errors. However, these variations may not be feasible of clinical significance. Use of TFA was swifter for preparing the MB canal and produced fewer changes in volume parameters. The TFA system was able to preserve the original canal anatomy with less canal transportation than the Reciproc and Hyflex CM systems.(AU)
O objetivo deste estudo foi avaliar o transporte do canal, a centralização do canal, a espessura dentinária, a alteração volumétrica e o tempo de trabalho de diferentes sistemas mecanizados de níquel-titânio compostos por ligas convencional (Mtwo) e tratados termicamente (CMWire (Prodesign R e Hyflex CM), M-Wire (Reciproc) e fase-R (Twisted file adaptive) em preparos de canais em molares superiores. O papel dos novos instrumentos de níquel titânio tratados termicamente em preparos apicais mais amplos de canais mésio-vestibulares e distovestibulares dos molares superiores foi avaliado, como também o preparo do canal mésiopalatino (CMP), por meio da microtomografia computadorizada (µ-CT). No estudo do canal mésio-palatino, 30 primeiros molares superiores com configuração tipo IV de Vertucci foram selecionados e divididos em 3 grupos (n = 10): Reciproc [REC; VDW, Munich, Germany], Prodesign R [PDR; Easy, Belo Horizonte, Brazil] and Mtwo [MO; VDW, Munich, Germany]. No estudo dos canais mésio-vestibulares e disto-vestibulares, o total de 45 molares superiores foram selecionados com angulação da raiz mésio vestibular de 20 a 30 graus e apresentando a raiz disto-vestibular com angulação de 0 a 5 graus, de acordo com a classificação de Weine. Os dentes foram aleatoriamente distribuídos em 3 grupos (n=15): Reciproc (40.06) [REC, VDW, Munich, Germany]; Hyflex CM (40.06) [HF, Coltene, Cuyahoga Falls, OH, USA]; e Twisted file Adaptive (35.04) [TFA, SybronEndo, Orange, CA]. Após o preparo dos canais mésio-palatino, mésio-vestibular, e disto-vestibular, todos os dentes foram escaneados para avaliação dos parâmetros previamente citados. Especificamente, na avaliação do canal mésiopalatino, foi avaliada a porcentagem de canais que alcançaram patência. Todos os parâmetros foram avaliados estatisticamente pelo teste de Kruskal-Wallis e pelo teste Dunn's de múltipla comparação entre grupos, com nível de significância de 5%. O canal mésio-palatino não apresentou diferença estatisticamente significante em relação ao transporte, centralização, remanescente de dentina no terço cervical, quanto ao número de espécime abaixo de 0,5 mm de espessura na zona de perigo e no volume apical (P>0.05). O volume total do canal no grupo MO diferenciou-se do volume total do grupo PDR (P<0.05), enquanto essa diferença não foi evidenciada entre os grupos REC comparado aos grupos MO e PDR (P>0.05). O grupo PDR demandou maior tempo para atingir o comprimento de trabalho comparado aos sistemas MO e REC. Na análise dos canais MV e DV dos molares superiores, o transporte coronal direcionou-se para o interior da curvatura do canal, enquanto no terço apical o transporte direcionou-se para o lado externo da curvatura. O transporte apical no primeiro milímetro de ambos os canais (MV e DV) foi equivalente entre os grupos (P>0.05). O canal MV apresentou nos níveis 3 e 4 mm transporte do grupo Reciproc significantemente menor do que no grupo Hyflex CM (P<0.05). Em relação ao transporte apical, no canal DV, nos milímetros 2 e 4 apicais do grupo Reciproc transportou significantemente mais comparado ao grupo TFA (P<0.05). Contudo, a centralização apical de ambos os canais e a quantidade de remanescente dentinário apical não se diferiram estatisticamente (P<0.05). O preparo do canal MV foi mais rápido com o sistema TFA comparado ao Reciproc e do Hyflex CM (P<0.05), enquanto no canal DV não foi evidenciado diferenças em relação ao tempo de preparo (P>0.05). A porcentagem e o volume de dentina removida em todo o canal e na região apical, após o preparo do canal apresentou diferenças significantes entre os grupos. O grupo TFA teve as menores porcentagens e valores de dentina removida no volume total do canal e no volume apical, em ambos os canais, comparado com os sistemas Reciproc e Hyflex CM (P<0.05). No canal MP, os três sistemas avaliados prepararam e patenciaram semelhantemente os canais MP. Contudo, o sistema Reciproc foi mais rápido para alcançar o comprimento de trabalho do que o sistema Prodesign R. Os grupos Mtwo e Reciproc removeram mais dentina na região voltada para o interior da furca quando comparado ao Prodesign R. Os sistemas compostos por ligas tratadas termicamente em preparos com maior ampliação apical mantiveram a morfologia dos canais MV e DV. Os sistemas promoveram discretos transportes, sem evidência de erros no preparo. Contudo, essas variações não são passíveis de significância clínica. O grupo do TFA foi mais rápido e promoveu menores alterações nos parâmetros volumétricos. O grupo do TFA foi capaz de preservar a anatomia original do canal com menor grau de transporte comparado ao Reciproc e Hyflex CM.(AU)
Assuntos
Humanos , Cavidade Pulpar/anatomia & histologia , Cavidade Pulpar/diagnóstico por imagem , Níquel/química , Preparo de Canal Radicular/instrumentação , Titânio/química , Instrumentos Odontológicos , Desenho de Equipamento , Dente Molar/diagnóstico por imagem , Valores de Referência , Reprodutibilidade dos Testes , Microtomografia por Raio-X/métodosRESUMO
La mantención de la anatomía original del canal radicular incide directamente en el éxito del tratamiento endodóntico. Para ello, los sistemas rotatorios de instrumentación requieren de canales radiculares permeables. Existen distintas limas y sistemas para la permeabilización o glide path como las limas tipo K manuales de acero inoxidable y los sistemas de NiTi rotatorios PathFile y ProGlider (Dentsply, Maillefer). Así, el objetivo de esta investigación fue comparar la capacidad de distintos sistemas de permeabilización para mantener la anatomía radicular sin producir transporte apical en canales mesiales de molares inferiores humanos extraídos. Se realizó un estudio cuantitativo experimental cuya muestra estuvo conformada por 36 canales mesiales de molares mandibulares humanos extraídos. Las muestras fueron divididas aleatoriamente en tres grupos conformados por 12 canales, cada uno de los cuales fueron sometidos a distintos sistemas de permeabilización (Lima K, PathFile y ProGlider). Las muestras fueron fotografiadas antes y después de la permeabilización utilizando un microscopio con magnificación 30X. Se cuantificó el desplazamiento del canal radicular en sentido mesio - distal y buco - lingual posterior a la permeabilización. Para el análisis de los datos se utilizó el paquete estadístico InfoStat/L y se aplicó la prueba de ANOVA / Tukey. Se observó que el sistema PathFile produce mayor transporte del canal radicular en su tercio apical en la dirección mesio-distal (p=0,77) y el sistema ProGlider en la dirección buco-lingual (p=0,57). Sin embargo, estas diferencias no fueron significativas. En conclusión, los sistemas de permeabilización analizados no presentaron diferencias en cuanto a su capacidad para mantener la anatomía sin producir transporte apical.
Preservation of the original root canal anatomy has a direct influence on the success of an endodontic treatment. In order to achieve this, rotary instrumentation systems require permeable root canals. Different files and systems are used for the establishment of a glide path such as manual stainless steel K files and NiTi rotatory systems like PathFile and ProGlider (Dentsply, Maillefer). Thus, the objective of this research was to compare the ability of different systems to create a glide path and maintain root canal anatomy without producing apical transportation in mesial root canals of extracted human lower molars. A quantitative experimental study was performed with a sample of 36 mesial root canals of extracted human mandibular molars. The samples were randomly divided into three groups consisting of 12 root canals each, which were subjected to different glide path systems (K-Files, PathFile and ProGlider). Samples were photographed before and after creating glide path using a microscope with 30X magnification. The displacement of the root canal in a mesio - distal and bucco - lingual direction was quantified after creating glide path. Data was analyzed using the statistical package InfoStat / L and the ANOVA / Tukey test was applied. The PathFile system produced greater transport of the root canal in its apical third in the mesio-distal direction (p = 0.77) and the ProGlider system in the bucco-lingual direction (p = 0.57). However, these differences were not significant. In conclusion, the glide path systems analyzed do not present any differences in their ability to maintain the anatomy without producing apical transportation.
