An Initial Investigation of the Electrochemical Dissolution of Fragments of Nickel-Titanium Endodontic Files

Electrochemical dissolution and retrieval of broken NiTi endodontic files from root canal using chloride based isotonic fluids as electrolytes - An in vitro study

Objective

The electrochemical dissolution method of instrument retrieval emphasizes on the dissolution of the instrument rather than sacrificing dentine. Most of the studies conducted for electrochemical dissolution used fluoride-containing electrolytes and were performed inside a beaker. In this study, we used chloride-based fluids as electrolytes.

Materials and Methods

Fifty extracted mandibular first premolars were divided into five groups based on the electrolytes used. Canals were enlarged to ProTaper Universal F2, and files were intentionally broken inside the canal. These specimens were subjected to electrochemical characterization by applying the potential of 9V for 20 min. Optical images were taken to assess the change in surface topography. The results were analyzed statistically by one-way analysis of variance (analysis of variance [ANOVA]).

Results

The rate of dissolution based on the electrolyte used decreased in the following order, viz. Tyrode's solution>artificial saliva>normal saline>Ringer's lactate/physiological serum.

Conclusion

Apart from fluoride, chloride-based electrolytes could be an efficient alternative.

Electrochemical dissolution of nickel-titanium instrument fragments in root canals of extracted human maxillary molars using a small reservoir of electrolyte

AIM

To evaluate the viability of the electrochemical dissolution of fragments of fractured NiTi instruments in root canals of extracted human maxillary molars, using two electrodes and the solution restricted to a small reservoir coupled to the pulp chamber. The primary hypothesis was that this method enables the reduction of fragment volume and re-establishment of the root canal path with a size 08 K-file, both in simulated canals and in extracted human maxillary molars.

METHODOLOGY

Fragments of F1 ProTaper instruments were polarized in simulated root canals and in distobuccal root canals of extracted maxillary molars using a new method, with the solution restricted to a small acrylic microcell coupled to each resin block or pulp chamber. Two electrodes were used, where one was kept in contact with the intracanal fragment and another was positioned in the solution present in the acrylic microcell. After the tests, a size 08 K-file was used passively to verify the possibility of bypassing the fragment, which was also confirmed by radiographic analysis. Micro-CT analysis of the teeth was used before and after fragment dissolution to evaluate the volume, length and porosity of the fragments. The D'Agostino-Pearson normality test was used to verify the distribution of the data. A paired t-test (P < 0.05) was used to compare the volume, length and porosity of the fragments before and after the dissolution tests.

RESULTS

After dissolution, all fragments could be bypassed with a size 08 K-file in both simulated canals and in extracted teeth. The dissolution process did not result in significant reduction of neither the fragment length nor the fragment porosity. However, it resulted in a significant reduction of fragment volume (paired t-test, P < 0.05).

CONCLUSION

The electrochemical dissolution of fragments of NiTi files in root canals of extracted human maxillary molars using two electrodes, and the solution restricted to a small reservoir coupled to the pulp chamber resulted in a significant reduction of fragment volume. The re-establishment of the root canal path with the passive insertion of size 08 K-files was possible in all samples after the tests, both in simulated canals and in extracted teeth.

Evaluation of fluoride and sodium hypochlorite solutions during the electrochemical dissolution of conventional NiTi instruments and Gold thermomechanically treated NiTi instruments

AIM

To compare the dissolution time of two solutions, a fluoride solution and a sodium hypochlorite solution, both saturated with sodium chloride, during the electrochemical dissolution of instruments consisting of conventional nickel-titanium alloy and Gold thermomechanically treated nickel-titanium alloy.

METHODOLOGY

Two solutions, an NaF solution consisting of 12 g L^-1 NaF with 180 g L^-1 NaCl and an NaOCl solution consisting of 2.5% NaOCl with 180 g L^-1 NaCl, were evaluated in a polarization test of a sample of 48 ProTaper Universal F1 (PTU F1) and WaveOne Gold Small (WOGS) instruments. The electric potentials were 0.5 V and 5 V for the NaF and NaOCl solutions, respectively. The electrochemical cell consisted of three electrodes for the polarization test of the PTU F1 and WOGS instruments, which had 6 mm of the tip immersed in the test solutions. The electric current was recorded for 540 s. If complete dissolution of the immersed tip occurred in less than the expected time, the experiment was considered complete. The time variations (in seconds) of the instruments in the solutions were measured. Data were subjected to statistical analysis using the Mann-Whitney, Kruskal-Wallis and Dunn tests. The corrosion patterns of the instruments were evaluated by scanning electron microscopy (SEM).

RESULTS

The NaF and NaOCl solutions were associated with significantly different (P = 0.000) dissolution times of the instrument, with mean values of 12.96 s and 83.63 s, respectively. There was no significant difference (P = 0.649) in dissolution time between the PTU F1 and WOGS instruments.

CONCLUSIONS

NaF and NaOCl solutions were able to electrochemically dissolve PTU F1 and WOGS instruments. However, the NaF solution achieved dissolution in significantly less time.

Separated Instrument in Endodontics: Frequency, Treatment and Prognosis

Instrument separation during endodontic therapy is a frequent accident with rotary instruments being more likely to separate than manual ones. The treatment of cases with a separated instrument can be either conservative or surgical. A conservative approach involves the following treatment choices: a) bypass of the fragment, b) removal of the fragment, c) instrumentation and obturation coronally to the fragment. Concerning the removal of a separated instrument, a variety of techniques and systems have been developed. Ultrasonics, in combination with the operative microscope constitute the most effective and reliable tools for removing a separated endodontic instrument from a root canal. The likelihood of successful removal depends on: the level of separation (coronal, middle or apical third); location in relation to the root canal curvature; the type of separated instrument; its length; the degree of canal curvature and the tooth type. Several complications may occur during the management of a separated instrument: separation of the ultrasonic tip or file used for bypassing or removing the instrument; further separation of the fragment; perforation; ledge; extrusion of the file into periapical tissues; tooth weakening due to dentin removal, as well as excessive temperature rise in periodontal tissues. Prognosis for a tooth retaining a separated instrument depends on the presence of a periapical lesion, the microbial load of the root canal during the time of separation and the quality of the obturation.

Evaluation of the effects of the solution used for electrochemical dissolution of nickel-titanium endodontic files on dentine structure, microhardness and cell viability

AIM

To evaluate the effects of the [NaF 12 g L^-1  + NaCl 1 g L^-1 ] solution used in the electrochemical dissolution process of fractured endodontic files, as well as its NiTi-containing product, on dentine hardness, topography and human fibroblast viability.

METHODOLOGY

Sixty single-rooted human teeth were evaluated for dentine microhardness using the Vickers hardness test and the area and number of dentinal tubules by scanning electron microscopy. The samples were divided according to the dentine surface treatment: distilled water; 17% EDTA; [NaF 12 g L^-1  + NaCl 1 g L^-1 ]; and 17% EDTA + [NaF 12 g L^-1  + NaCl 1 g L^-1 ]. Thirty-six single-rooted human teeth were divided according to the irrigation protocol: Dulbecco's Modified Eagle's Medium + 10% foetal bovine serum; 5.25% NaOCl; [NaF 12 g L^-1  + NaCl 1 g L^-1 ]; and [NaF 12 g L^-1  + NaCl 1 g L^-1  + NiTi]. The extracts in contact with the apical foramen were used in the MTT assay to evaluate human fibroblast viability, with dilutions of 100%, 50%, 25% and 12.5%. Statistical tests used were paired t-tests, one-way anova, Tukey's test, Kruskal-Wallis test and Dunn's post-test.

RESULTS

The [NaF 12 g L^-1  + NaCl 1 g L^-1 ] solution did not modify dentine microhardness or the average dentinal tubule area. However, EDTA induced changes in dentine structure and microhardness (P < 0.05). The [NaF 12 g L^-1  + NaCl 1 g L^-1 ] solution, and its NiTi-containing product had lower cytotoxicity than NaOCl at dilutions of 25% and 50% (P < 0.01).

CONCLUSIONS

The [NaF 12 g L^-1  + NaCl 1 g L^-1 ] solution did not alter dentine microhardness or damage the dentine structure. It also demonstrated lower cytotoxicity than NaOCl.

Magnetic Resonance-Monitored Coaxial Electrochemical Ablation--Preliminary Evaluation of Technical Feasibility

PURPOSE

To evaluate the technical feasibility of a coaxial electrode configuration to rapidly create a mechanically defined electrochemical ablation zone monitored by magnetic resonance (MR) imaging in real time.

MATERIALS AND METHODS

A direct current generator supplied the nitinol cathode cage and central platinum anode for coaxial electrochemical ablation. Safety and efficacy were evaluated by measuring local pH, temperature, and current scatter in saline solutions. Ablation zone diameters of 3-6 cm (n = 72) were created on ex vivo bovine liver and verified by gross pathology. Feasibility of MR monitoring was evaluated using 8 swine livers to create ablations of 3 cm (n = 12), 4 cm (n = 4), and 5 cm (n = 4) verified by histology.

RESULTS

Local pH was 3.2 at the anode and 13.8 at the cathode. Current scatter was negligible. Ablation progress increased relative to local ion concentration, and MR signal changes corresponded to histologic findings. In the ex vivo model, the times to achieve complete ablation were 15 minutes, 20 minutes, 35 minutes, and 40 minutes for diameters of 3 cm, 4 cm, 5 cm, and 6 cm, respectively. Ablation times for the in situ model were 15 minutes, 35 minutes, and 50 minutes for 3 cm, 4 cm, and 5 cm, respectively.

CONCLUSIONS

The coaxial configuration mechanically defined the electrochemical ablation zone with times similar to comparably sized thermal ablations. MR compatibility allowed for real-time monitoring of ablation progress.

Electrochemical-induced dissolution of nickel-titanium endodontic instruments with different designs

AIM

To compare the active dissolution process of K3, ProTaper and Mtwo NiTi endodontic rotary instruments in chloride and fluoride containing solutions.

METHODS

Anodic polarization of K3 size 20, 0.06 taper, ProTaper size F1 and MTwo size 20, 0.06 taper instruments was performed, and anova (P < 0.05) was used to compare the weight loss, the time of dissolution and the electrical charge generated by the groups of instruments. Fragments of the instruments were polarized in simulated root canals to evaluate the dissolution process. After the tests, a size 10 K-file was used to verify whether the fragment could be bypassed. Radiographic analysis of the simulated canals was used before and after the tests to verify fragment dissolution.

RESULTS

A progressive consumption of the instruments was observed. K3 and ProTaper instruments had significantly greater weight loss than Mtwo instruments after 30 min of polarization. K3 instruments had the highest values of total electrical charge, and MTwo instruments the lowest (P < 0.05). After 60 min, the anodic polarization of instrument fragments in simulated root canals resulted in their partial dissolution.

CONCLUSION

The anodic polarization of K3, ProTaper and MTwo instruments resulted in their progressive consumption with increasing polarization time. Sixty minutes anodic polarization of the various NiTi instrument fragments in simulated root canals resulted in their partial dissolution.

Electrochemical-induced dissolution of stainless steel files

AIM

To investigate the effectiveness of the dissolution process when hand stainless steel files are polarized in solutions containing chloride and fluoride to promote their dissolution.

METHODOLOGY

Redox curves and anodic polarization curves were obtained to determine the conditions necessary for the dissolution of stainless steel endodontic files. Anodic polarization of sizes 20 and 30 files was performed, and a t-test (P < 0.05) was used to compare the weight loss, the time of dissolution and the electrical charge generated by both groups of files. Fragments were polarized in simulated root canals to evaluate the dissolution process. After the tests, a size 10 K-file was used to verify the possibility of bypassing the fragment. Radiographic analysis of the simulated canals was used before and after the tests to verify fragment dissolution.

RESULTS

A progressive consumption of the sizes 20 and 30 files was observed with total polarization times of 7.0 and 9.0 min, respectively. Files with the larger diameters exhibited greater weight loss, longer times of dissolution and generated a greater electrical charge during the active dissolution process (t-test, P < 0.05). After 60 min, the anodic polarization of file fragments in simulated root canals resulted in their partial dissolution.

CONCLUSION

A 60-min anodic polarization of stainless steel K-file fragments in simulated root canals resulted in their partial dissolution. The fragments could be bypassed after the test.

Comparison of the time required to create secondary fracture of separated file fragments by using ultrasonic vibration under various canal conditions

INTRODUCTION

Nickel-titanium files often separate because of mechanical fatigue. The purpose of this study was to determine safe preparation techniques for separated file removal by using ultrasonics.

METHODS

Fifty nickel-titanium file fragments were divided into 5 groups. An ultrasonic tip was activated on a file fragment positioned between dentin blocks simulating several canal conditions: Group 1 consisted of the fragment protruding from a pair of straight dentin blocks. For group 2, the fragment was also positioned between 2 straight dentin blocks except one block was positioned 1 mm more apically than the other block, simulating a troughed area that is often created during file removal attempts. For groups 3-5, the fragment was positioned similarly as group 2 but between blocks with 30°, 45°, and 60° curvatures, respectively. The time it took for secondary fracture to occur was recorded, and the data were statistically analyzed.

RESULTS

Fragments with dentin wall supporting on the opposite side of ultrasonic activation site resisted fracture significantly longer than those without it. Fragments in 30° and 45° curved blocks took significantly longer to fracture than the other groups (Fisher protected least significant difference, P < .05).

CONCLUSIONS

Secondary fracture of separated files appeared to be reduced when the ultrasonic tip was applied to the inner curvature of the canal.

Electrochemical induced dissolution of fragments of nickel-titanium endodontic files and their removal from simulated root canals

AIM

To improve the dissolution process of NiTi endodontic rotary files aiming at fragment removal and the recovery of the original path of the root canal during a clinically acceptable period of time.

METHODOLOGY

Anodic polarization curves and redox curves were obtained to determine the conditions necessary for the dissolution of endodontic files. Anodic polarization of K3 files was performed, and analysis of variance (P < 0.05) was used to compare different test times in relation to weight loss, length loss and electrical charge generated in each solution. The polarization of fragments in simulated root canals was undertaken to evaluate the dissolution process. After the tests, a size 10 K-file was used to verify the possibility to bypass the fragment. The total electrical charge of each test was obtained from the corresponding graph area. Radiographic analysis of the simulated canals was used before and after the tests to verify fragment dissolution.

RESULTS

The weight loss values, the length loss values and the total values of electrical charge in each period of time were significantly higher (P < 0.05) in the tests using the selected solution compared with the solution previously proposed. A progressive consumption of the K3 file tip was observed up to 30 min. The anodic polarization of file fragments in simulated root canals for 60 min resulted in their partial dissolution and enabled the recovery of the original canal pathway with size 10 K-files.

CONCLUSIONS

Increasing fluoride concentration resulted in greater active dissolution of NiTi files. The dissolution of fractured files in simulated root canals enabled the recovery of its original path during a clinically acceptable period of time.

Success of ultrasonic technique in removing fractured rotary nickel-titanium endodontic instruments from root canals and its effect on the required force for root fracture

INTRODUCTION

Fracture of rotary nickel-titanium files is a real concern among endodontists; it affects the long-term prognosis of treatment. Ultrasound is a favorable technique for removing broken files, although it may result in some complications. The aim of this study was to determine the success rate of ultrasonic technique in removing file fragments and to evaluate its influence on the force required to fracture a tooth root.

METHODS

An in vitro study was carried out on 70 extracted maxillary premolars. In the experimental group a #30/.04 taper Hero file was guided into the canal to break and lodge therein. The lodged file was removed by ultrasonic vibration and use of a dental operating microscope. The canals were instrumented with Hero files by using crown-down technique and then obturated. All the teeth were prepared for mechanical testing in Testometric machine to measure the required force for root fracture. The Fisher exact test and independent two-sample t test were used to analyze data.

RESULTS

Ultrasonic technique exhibited a success rate of 80% in removing broken files. Success rate in the roots with file fracture before the curve was 11.5 times more than that of file fracture cases beyond the curve. Other factors such as bypass possibility did not affect success rate. The average time required for removing file fragments was 36.3 ± 7.15 minutes, which did not significantly differ in different file locations within the canal. According to mechanical test results, ultrasonic application did not significantly affect the required force for root fracture. The force required to fracture a root did not significantly differ in various file locations. Vertical fracture in the buccolingual direction (split tooth) was the most incident fracture pattern. Procedural errors observed in this study predominantly included transportation, perforation, and craze line.

CONCLUSIONS

Ultrasonic technique was successful in removing 80% of fractured rotary files and did not significantly affect the required force for root fracture.

Electrochemical dissolution of nickel-titanium endodontic files induces periodontal ligament cell death

INTRODUCTION

Fractured endodontic files present a major problem. A novel method has been proposed to retrieve fractured nickel-titanium (NiTi) endodontic files by using electrochemical dissolution. However, the effect of file dissolution on adjacent soft tissues such as the periodontal ligament (PDL) has not been investigated. The aim of this study was to determine the effects of the dissolution products on PDL fibroblasts.

METHODS

Endodontic files were dissolved in sodium fluoride (NaF) by passing a 50-mA current through the NiTi files while immersed in the NaF solution. NaF/NiTi solutions were diluted with minimal essential medium-α media containing 10% serum. PDL cells were treated for up to 24 hours, and cell viability was quantified by using calcein AM to label live cells and ethidium homodimer to label dead cells. This was repeated by using artificial saliva (AS) as an alternative to NaF.

RESULTS

NaF solution reduced PDL cell survival, and the NaF/NiTi solution further reduced PDL cell survival. AS alone did not reduce cell survival, whereas AS/NiTi solution reduced PDL cell survival. Particles that resulted from the electrochemical dissolution of NiTi files were highly cytotoxic.

CONCLUSIONS

Electrochemically dissolving NiTi files in NaF results in solutions that are cytotoxic to PDL fibroblasts. AS may be a less toxic alternative for dissolving NiTi files.