Pilot Evaluation of Sealer-Based Root Canal Obturation Using Epoxy-Resin-Based and Calcium-Silicate-Based Sealers: A Randomized Clinical Trial.

The purpose of this randomized controlled clinical trial was to assess the short-term clinical effectiveness of sealer-based root canal obturation using calcium-silicate-based sealer (CSBS) and epoxy-resin-based sealer (ERBS). A total of eighty patients (eighty teeth) were enrolled and seventy-two patients (seventy-two teeth) were randomly assigned into four different sealer groups: AH Plus (AH, Dentsply Sirona), ADseal (AD, Meta Biomed), CeraSeal (CS, Meta Biomed), or EndoSeal TCS (ES, Maruchi). At the first visit, root canal treatment was performed using ProTaper. Next, the NiTi file system and passive ultrasonic irritation was applied with 2.5% NaOCl. At the second visit, the teeth were obturated with a sealer-based obturation technique using the assigned sealer. The quality of filling obturation was evaluated with postoperative radiographs in terms of the presence of voids and sealer extrusion. The patients were recalled at 1-week, 1-month, and 3-month intervals, and pain levels were measured using visual analog scales (VAS), and clinical examination performed with percussion and palpation. Radiographs were also taken. The results were statistically compared by using the χ2 test or Fisher exact test. Among the 80 teeth included, 72 teeth received allocated intervention and 71 teeth were included in the analysis (98.6% recall). There was no significant difference among the sealers in void and sealer extrusion (p > 0.05). Postoperative pain was not indicated prominently regardless of the type of sealer. For a 3-month follow-up period, all cases were maintained successfully except for one case from AD. According to the findings, there was no significant difference between CSBS and ERBS in terms of postoperative pain or the healing process, and the variation in filling quality appears to be linked to the properties of each product.

Comparison of bacterial leakage resistance of various root canal filling materials and methods: Confocal laser-scanning microscope study.

This study evaluated the bacterial leakage resistance and root canal lining efficacy of various root canal filling materials and methods by using confocal laser-scanning microscope (CLSM). Sixty extracted human premolars with mature apex and single root canal were randomly divided into 2 control groups and 4 experimental groups. Group CW was filled with continuous wave technique using gutta-percha and AH Plus sealer. Group GC was coated with AH-Plus sealer and then obturated with soften GuttaCore. Group GF was obturated using GuttaFlow and gutta-percha. Group EM was filled with EndoSeal MTA and gutta-percha using ultrasonic vibration. The AH-Plus, GuttaFlow, and EndoSeal were labeled with Hoechst 33342 to facilitate fluorescence. The obturated root tip was incubated with Carboxyfluorescein diacetate succinimidyl ester (CFSE)-stained E. faecalis for 14 days. CLSM was performed to evaluate the sealer distribution and bacterial leakage for the apical 1-, 2-, 3-mm specimens. Statistically significant differences were determined by 1-way ANOVA with Tukey's post-hoc test and Pearson's correlation analysis. Group EM showed the better sealer distribution score than the other groups (p < 0.05). Group CW and group GC exhibited the less bacterial leakage than the group GF, while group EM showed the similar bacterial leakage score with the groups CW and GC. There was no significant correlation between the sealer distribution and bacterial leakage (p > 0.05). Under the conditions of this study, different root canal filling materials and methods showed different efficacy for canal distribution and bacterial leakage resistance.

Effect from surface treatment of nickel-titanium rotary files on the fracture resistance.

This study was aimed to compare the cyclic fatigue resistance and torsional resistance of rotary instruments with and without surface treatment. G6 A2 (Group A2) with and G6 A2 without surface treatment after machining (Group AN) were compared in this study. ProTaper F2 (Group F2) which has similar dimension and shape was also used for comparison. To evaluate the torsional resistance, ultimate torsional strength and distortion angle until fracture were recorded, and the toughness was calculated. The cyclic fatigue resistance was compared by evaluating the number of cycles to failure in a simulated canal. Statistical analysis was performed by one-way analysis of variance and Tukey post hoc test (p = 0.05). After torsional and cyclic fatigue tests, all fracture fragments were observed under a scanning electron microscope. Group A2 showed higher cyclic fatigue resistance than the groups AN and F2 (p < 0.05). Although group A2 demonstrated lower ultimate torsional strength than the others, there were no significant differences in toughness among the groups. While obvious machining grooves were seen in groups AN and F2, group A2 showed smooth surface resulting from the surface treatment. The specimens of fracture fragments showed typical features of cyclic failure such as micro-cracks, overloaded fast fracture zone, and torsional fracture such as unwinding helix, circular abrasion marks and dimples. Under the conditions of this study, the surface treated instruments may improve cyclic fatigue resistance while maintaining the torsional resistances and mechanical properties.

Geometric optimization for development of glide path preparation nickel-titanium rotary instrument.

INTRODUCTION: This study was done to develop a glide path preparation nickel-titanium rotary instrument by size optimization procedures and evaluate the properties of the prototype. METHODS: G-1 and G-2 files were tested for cyclic fatigue, torsional resistance, and screw-in force. The cyclic fatigue resistance was compared by measuring the number of cycles to failure by using a 90° curved metal canal (n = 10). The torsional resistance was evaluated at 3 levels (2, 4, and 6 mm from the file tip) by measuring the ultimate torsional load (n = 10 each level). The screw-in forces (n = 5) were measured during sequential pecking in a simulated resin block to the end of foramen by using the customized shaping device (AEndoS). Meanwhile, finite element models of G-1 and G-2 files were made by reverse engineering, and their bending stiffness and torsional properties were calculated. By analyzing the results from mechanical tests and finite element analysis, a universal G (uG) file was designed to have intermediary mechanical properties, and then the prototype was fabricated by the manufacturer. Cyclic fatigue and torsional resistance tests and screw-in force with the uG were compared with G-1 and G-2 files. RESULTS: The prototype of uG file showed higher cyclic fatigue resistance than the G-2 file and intermediary torsional strength and screw-in forces between the G-1 and G-2 files. CONCLUSIONS: The prototype production from a size optimization procedure produced appropriate mechanical properties for the purpose of development.

Buckling resistance, bending stiffness, and torsional resistance of various instruments for canal exploration and glide path preparation.

OBJECTIVES: This study compared the mechanical properties of various instruments for canal exploration and glide-path preparations. MATERIALS AND METHODS: The buckling resistance, bending stiffness, ultimate torsional strength, and fracture angle under torsional load were compared for C+ file (CP, Dentsply Maillefer), M access K-file (MA, Dentsply Maillefer), Mani K-file (MN, Mani), and NiTiFlex K-file (NT, Dentsply Maillefer). The files of ISO size #15 and a shaft length of 25 mm were selected. For measuring buckling resistance (n = 10), the files were loaded in the axial direction of the shaft, and the maximum load was measured during the files' deflection. The files (n = 10) were fixed at 3-mm from the tip and then bent 45° with respect to their long axis, while the bending force was recorded by a load cell. For measuring the torsional properties, the files (n = 10) were also fixed at 3-mm, and clockwise rotations (2-rpm) were applied to the files in a straight state. The torsional load and the distortion angle were recorded until the files succumbed to the torque. RESULTS: The CP was shown to require the highest load to buckle and bend the files, and the NT showed the least. While MA and MN showed similar buckling resistances, MN showed higher bending stiffness than MA. The NT had the lowest bending stiffness and ultimate torsional strength (p < 0.05). CONCLUSIONS: The tested instruments showed different mechanical properties depending on the evaluated parameters. CP and NT files were revealed to be the stiffest and the most flexible instruments, respectively.

Torsional and cyclic fatigue resistances of glide path preparation instruments: G-file and PathFile.

This study aimed to compare cyclic fatigue and torsional resistances of glide path creating instruments with different tapers and tip sizes. Two sizes (G1 and G2) from G-File system and three sizes (PathFile #1, #2, and #3) from PathFile system were used for torsional resistance and cyclic fatigue resistance tests (n = 10). The torsional resistance was evaluated at 2-, 3-, 4-, 5-, and 6-mm from the file tip by plotting the torsional load changes until fracture by rotational loading of 2 rpm. The cyclic fatigue resistance was compared by measuring the number of cycles to failure. Data were analyzed statistically using one-way ANOVA and Duncan's post-hoc comparison. The length of the fractured file fragment was also measured. All fractured fragments were observed under a scanning electron microscope (SEM). Although G-2 file showed a lower torsional strength than PathFile #3 at 2- and 3-mm levels (p < 0.05), they had similar ultimate strengths at 4-, 5-, and 6-mm levels (p > 0.05). The smaller files of each brand had a significantly higher cyclic fatigue resistance than the bigger ones (p < 0.05). PathFile #1 and #2 had higher fatigue resistances than G-files (p < 0.05). While G-1 had a similar fatigue resistance as PathFile #3, G-2 showed the lowest and PathFile #1 showed the highest resistances among the tested groups (p < 0.05). The SEM examination showed typical appearances of cyclic fatigue and torsional fractures, regardless of the tested levels. Clinicians may consider the instruments' sizes for each clinical case in order to get efficient glide path with minimal risk of fracture.

Cutting efficiency of apical preparation using ultrasonic tips with microprojections: confocal laser scanning microscopy study.

OBJECTIVES: The purpose of this study was to compare the cutting efficiency of a newly developed microprojection tip and a diamond-coated tip under two different engine powers. MATERIALS AND METHODS: The apical 3-mm of each root was resected, and root-end preparation was performed with upward and downward pressure using one of the ultrasonic tips, KIS-1D (Obtura Spartan) or JT-5B (B&L Biotech Ltd.). The ultrasonic engine was set to power-1 or -4. Forty teeth were randomly divided into four groups: K1 (KIS-1D / Power-1), J1 (JT-5B / Power-1), K4 (KIS-1D / Power-4), and J4 (JT-5B / Power-4). The total time required for root-end preparation was recorded. All teeth were resected and the apical parts were evaluated for the number and length of cracks using a confocal scanning micrscope. The size of the root-end cavity and the width of the remaining dentin were recorded. The data were statistically analyzed using two-way analysis of variance and a Mann-Whitney test. RESULTS: There was no significant difference in the time required between the instrument groups, but the power-4 groups showed reduced preparation time for both instrument groups (p < 0.05). The K4 and J4 groups with a power-4 showed a significantly higher crack formation and a longer crack irrespective of the instruments. There was no significant difference in the remaining dentin thickness or any of the parameters after preparation. CONCLUSIONS: Ultrasonic tips with microprojections would be an option to substitute for the conventional ultrasonic tips with a diamond coating with the same clinical efficiency.

Safety of the factory preset rotation angle of reciprocating instruments.

INTRODUCTION: This study aimed to investigate the torsional resistance of 2 reciprocating nickel-titanium instruments (Reciproc [VDW, Munich, Germany] and WaveOne [Dentsply Maillefer, Ballaigues, Switzerland]) operated at the maximum rotating angle in a proprietary motor. METHODS: With the file tip secured at various levels (3, 4, or 5 mm) of Reciproc R25 and WaveOne Primary, the distortion angles and torsional loads were monitored during counterclockwise movement at 2 rpm until fracture (n = 10 at each level) for a load-distortion graph. The rotation angles and loads at the beginning point of the plateau, the ultimate torsional strength, final fracture angle, and toughness were determined. The data were analyzed using 1-way analysis of variance and the Tukey post hoc test at α = .05. The lateral longitudinal aspect and the fracture cross-section of each specimen were examined by scanning electron microscopy after the test. RESULTS: The rotation angle at the beginning point of the plateau was significantly greater for a binding site farther away from the tip of the instrument for both systems (P < .05), and all were greater than 170° (preset in the dedicated motor from manufacturer). The ultimate strength and toughness also increased significantly at levels farther away from the instrument tip (P < .05). All specimens showed typical topographic features of torsional fracture, including the circular abrasion marks and fibrous dimples near the rotation center after the test. CONCLUSIONS: It was determined that the 2 brands of reciprocating files are safe when operated at the rotational angle in the proprietary motor.

Cyclic fatigue and torsional resistance of two new nickel-titanium instruments used in reciprocation motion: Reciproc versus WaveOne.

INTRODUCTION: The use of reciprocating movement was claimed to increase the resistance of nickel-titanium (NiTi) file to fatigue in comparison with continuous rotation. Recently 2 new brands of NiTi files have been marketed for use in a RM mode. The purpose of this study was to compare the cyclic fatigue resistance and torsional resistance of these 2 files, Reciproc and WaveOne. METHODS: Cyclic fatigue test with a simultaneous pecking motion was performed with the instrument (n = 10 each) operating in the recommended reciprocation motion until fracture for the Reciproc R25 and WaveOne Primary files. ProTaper F2 was tested in continuous rotation to serve as a control for comparison. The number of cycles to fracture (NCF) was determined by measuring the time to fracture. The length of the fragment was measured and the fracture surface was examined by using scanning electron microscopy. Torsional strength was measured by using a torsiometer after fixing the apical 5 mm of the instrument rigidly. Statistical analysis was performed by using one-way analysis of variance. RESULTS: The results showed that Reciproc had a higher NCF and WaveOne had a higher torsional resistance than the others. Both reciprocating files demonstrated significantly higher cyclic fatigue and torsional resistances than ProTaper (P < .05). The fractographic analysis showed typical features of cyclic fatigue and torsional failure for all instruments. CONCLUSIONS: The 2 brands of NiTi file for use with a reciprocation motion seem to have superior mechanical properties.