Leakage along apical root fillings in curved root canals. Part I: effects of apical transportation on seal of root fillings

How Does Intentional Apical Foraminal Enlargement Affect the Foramen and Root Canal Morphology?

INTRODUCTION

This study assessed the effect of intentional foraminal enlargement on the foramen and the apical root canal morphology.

METHOD

Sixty mesial roots of mandibular molars were scanned by micro-computed tomography. Their apical foramina were photographed with a stereomicroscope before and after preparation. Three groups were formed (n = 20) according to the working length (WL). G-1: foramen - 1 mm; G0: foramen; and G+1: foramen + 1 mm. Each group originated 2 subgroups (n = 10): G-1: Buchanan's patency (size 10 K-type file) and foraminal debridement (sizes 20, 25 and 30 K-type files); G0 and G+1: rotary foraminal enlargement (ProDesign S size 25/.08) or reciprocating foraminal enlargement (R25). The area, perimeter, transportation, and noninstrumented walls of the foramen were evaluated. The root canal transportation and the centering index of preparation at 1, 3 and 5 mm from the foramen were also assessed. Data were compared statistically (α = 5%).

RESULTS

The instruments used at the foramen and 1 mm beyond promoted foraminal enlargement and transportation. Regarding NIW, there was no difference between mechanized foraminal enlargements performed at the foramen or 1 mm beyond, similar to the manual foraminal debridement group (P > .05). There was no difference in transportation and centralization at 1-, 3-, and 5-mm apical levels, regardless of the instrumentation systems.

CONCLUSION

Mechanical preparation at the foramen, or 1 mm beyond, resulted in foraminal enlargement, transportation and were not able to touch all root canal walls that delimit the foramen.

Shaping Efficiency of Rotary and Reciprocating Kinematics of Engine-driven Nickel-Titanium Instruments in Moderate and Severely curved Root Canals Using Microcomputed Tomography: A Systematic Review of Ex Vivo Studies

INTRODUCTION

This systematic review aimed to compare reciprocating with continuous rotary instrumentation kinematics, by means of microcomputed tomography evaluations, in extracted human permanent teeth with moderate and severe canal curvatures.

METHODS

The research protocol was registered in the International Prospective Register of Systematic Reviews and given the reference number CRD42023404035. An electronic search was undertaken in MEDLINE (PubMed), EBSCO, Scopus, Web of Science databases until December 2021. Manual screening of issues in endodontic journals and references of relevant articles were assessed individually. The risk of bias (RoB) of the included articles was evaluated with the QUIN tool (Quality Assessment Tool for In Vitro Studies).

RESULTS

Among 1640 retrieved articles, 49 were included in the qualitative synthesis. Fifteen articles had low RoB, 33 articles had medium RoB, and only 1 study was at high RoB. Continuous rotary systems had better centering ability in both moderate and severe canal curvatures and resulted in less apical transportation in severely curved root canals. None of the kinematic systems was capable of instrumenting the entire canal surface area. Reciprocating kinematics systems tended to provide higher increase in surface area of severely curved canals and produced fewer dentinal microcracks in moderately curved canals.

CONCLUSIONS

The evidence presented in this review suggests that continuous rotary system seems to be better than reciprocating system in solving the major issues encountered during root canal instrumentation of extracted teeth with moderate and severe curvatures.

CBCT Segmentation and Additive Manufacturing for the Management of Root Canals with Ledges: A Case Report and Technique

Cone-beam computed tomography (CBCT) assessment of a ledge could be useful to a clinician; however, using this information effectively during a treatment procedure can be challenging. Advanced additive manufacturing technologies combined with semi-automated segmentation of root canals can help simulate the ledge and help in management of these iatrogenic complications. A patient presented after unsuccessful root canal treatment with a ledge on the left mandibular first molar. A CBCT was taken, and the images imported into a segmentation software (Mimics, Materialise). The canal was isolated, and segmentation performed along with the other structures of the tooth. A 3-dimensional digital model of the internal structures of the canal were used to design a mock-up which was additively manufactured. This was used as a preclinical guide to simulate the procedure, precurve the file, and manage the canal. This novel technique using virtual modeling from CBCT data post ledge formation allowed for successful and quick management of a tooth with ledges.

Innovative ex vivo exploration: A comparative study of novel approaches of root canal filling material removal efficiency

Introduction

Retention of the natural tooth without any symptoms in the oral cavity is one of the prime desires of endodontic treatment. Root canal therapy usually leads to failure when treatment is not up to the mark of acceptable standards. To address these deficiencies, non-surgical endodontic retreatment is the most accepted option with the success rate ranging from 65% to 83%. Forty-five single-rooted mandibular premolars with undeviated canals (as per Schneider's criteria) were obtained and divided further into three groups with 15 specimens along with resin-based sealer solvent in each group: Group 1 - Retreatment rotary file system, Group 2 - Ultrasonics, and Group 3 - Diode laser. Specimens were then evaluated under a stereomicroscope at ×10 after cutting in two halves followed by evaluation of the remaining filling material using Hulsmann and Bluhm criteria.

Context

Nonsurgical retreatment.

Aims

The aim of the study was to evaluate and compare the efficacy of various retreatment techniques for the elimination of root canal filling material.

Settings and Design

The sample size was determined using the formula n = (Zα/2)2 s2/d2. The design of the study is in vitro experimental study.

Subjects and Methods

A sum of 45 single-rooted extracted human permanent mandibular premolars were included in this study. All teeth were biomechanically prepared and obturated followed by decoronating the samples. All specimens were randomly divided into 3 groups comprising 15 specimens along with solvent based on the technique for the filling material elimination from the root canal, i.e. Group I: retreatment rotary files, Group II: ultrasonics, and Group III: diode laser.

Statistical Analysis Used

The Tukey's post hoc tests and one-way analysis of variance were used for comparison of the study parameters among the groups.

Results

Results revealed that ultrasonics showed the least amount of remaining filling material within the root canal which had a significant difference from other groups, i.e. retreatment rotary files and diode laser.

Conclusions

Ultrasonics with a resin-based sealer solvent can be considered a preferred option for nonsurgical retreatment. However, none of the groups shows complete elimination of filling material inside the root canal system.

Shaping ability of Procodile and R6 Reziflow nickel-titanium reciprocating instruments in curved mesial root canals of mandibular molars: A MicroCT study

To compare the shaping ability of Procodile and R6 Reziflow instruments used in reciprocating motion in severely curved root canals, assessed with micro-computed tomography (μCT). Fourteen extracted human mandibular first molars were randomly assigned to two instrumentation techniques (n = 14 mesial root canals): Procodile or R6 Reziflow. For both groups, root canals were prepared to the working length up to a size 25, .06 taper. Molars were virtually divided into apical, middle and coronal thirds and μCT was used to scan all samples pre- and post-root canal. Canal transportation, centring ability, volume, surface area and unprepared area were evaluated. Geometrical parameter changes were compared with preoperative values (one-way analyses of variance and Tukey multiple comparison post-hoc test) between groups and Student t-test within groups (α = 0.05) Significantly less transportation was observed associated with the Procodile technique in the molar's coronal third compared to the R6 Reziflow technique (p < .05). No significant differences in root canal centring ability, volume, surface area and unprepared area were observed. Procodile showed a lower percentage increase of surface area compared to R6 Reziflow (p < .05). The Procodile and R6 Reziflow techniques applied to first molar root canal performed similarly except for the less transportation observed in the coronal third using Procodile. RESEARCH HIGHLIGHTS: MicroCT analysis of canal geometry before and after instrumentation revealed that Procodile and R6 Reziflow showed a similar shaping ability to shape curved root canals without substantially modifications of the original tooth anatomy.

Accumulated Hard Tissue Debris and Root Canal Shaping Profiles Following Instrumentation with Gentlefile, One Curve, and Reciproc Blue

INTRODUCTION

This laboratory study aimed to evaluate the accumulated hard tissue debris (AHTD) and shaping performance following root canal instrumentation with a novel stainless steel rotary system (Gentlefile; MedicNRG, Kibbutz Afikim, Israel) compared with two single-file nickel-titanium instruments of different kinematics through micro-computed tomography (micro-CT) analysis.

METHODS

Thirty isthmus-containing mesial roots of human mandibular molars with a curvature of 15°-35° were scanned with micro-CT at an isotropic resolution of 12 μm and randomly assigned to three groups (n = 10) according to the instruments used for canal preparation: Gentlefile (GF; #23/.04), One Curve (OC; #25/.06; Micro-Mega, Besancon, France), and Reciproc Blue R25 (RB; #25/.08; VDW, Munich, Germany). The AHTD, unprepared canal surface area, volume changes, surface area changes, and transportation were evaluated by comparing preoperative and postoperative micro-CT images. In addition, the time required for canal preparation was recorded. Data were statistically analyzed using the one-way analysis of variance (ANOVA) test or the Kruskal-Wallis test at a significance level of 5%.

RESULTS

No significant differences were observed in the percentage of AHTD or in the unprepared canal surface area between the three groups (P > .05). The RB group demonstrated a significantly greater percentage increase in volume and surface area than the GF group (P < .05). The GF and OC groups showed significantly less transportation at 3 mm from the apex than the RB group (P < .001). The OC group required significantly less time for instrumentation than the RB and GF groups (P < .05).

CONCLUSIONS

Instrumentation with GF (#23/.04), OC, and RB yielded similar levels of AHTD and unprepared surface area in isthmus-containing curved canals. GF achieved this with less dentin removal and apical transportation, at the expense of a longer preparation time.

Finding appropriate nickel-titanium instruments for lingual canals in mandibular first premolars with two canals: A micro-CT study

This study aimed to find appropriate nickel-titanium instruments for lingual canals in mandibular first premolars with two canals. Forty-two extracted mandibular first premolars with lingual canals (Vertucci type V) verified by micro-CT scanning were selected. The teeth were randomly divided into three groups, and their lingual canals were instrumented by M3, HyFlex CM and XP-endo Shaper, respectively. After instrumentation, the canal morphology was scanned again by micro-CT. The canal morphologies of pre- and post-instrumentation were reconstructed and aligned. Morphological changes of the lingual canals were evaluated. No instrument breakages occurred during the procedure of root canal instrumentation. HyFlex CM and XP-endo Shaper performed better than M3 files in preparation of lingual canals (Vertucci type V) of mandibular first premolars in terms of apical transportation and unprepared surface area.

Impact of cooling on shaping ability of thermally treated files in canal models with double curvature

Background

This study compared the ability of thermally treated files in shaping simulated canals with double curvature. Fifty-six canals were enlarged to a final size of 25 with ProTaper Next (PTN) or ZenFlex (ZF).

Materials

Half of the samples were shaped with cooled files (n = 14 each). The amount of removed resin was measured and canal deviation was determined at eight levels. Shaping time and maximum shaping torque values were also recorded. Data were statistically analyzed using analysis of variance and LSD, Kruskal-Wallis, and chi-square tests at a 0.05 significance level.

Results

Compared to PTN and cooled PTN, ZF and cooled ZF required lesser time to shape the canals. The maximum torques were found comparable between the groups. All the groups generated negligible deviations at every canal level evaluated and maintained the canal geometry. Although not significant, the cooled PTN and ZF files exhibited lesser canal deviations than their counterparts.

Conclusion

All groups demonstrated similar shaping ability whilst maintaining the original curvature of the canal in simulated canals with double curvature. However, ZF groups were able to shape the canals faster than PTN groups. There was a trend that cooled files made lesser canal deviations compared to their counterparts.

Comparative evaluation of canal transportation and canal centering ability in oval canals with newer nickel-titanium rotary single file systems - A cone-beam computed tomography study

Context

The purpose of this study was to evaluate and compare the centering ability and canal transportation of TruNatomy, OneCurve, and Jizai file systems to assess their performance in oval-shaped canals using cone-beam computed tomography imaging.

Materials and Methods

Forty-two fully formed single-rooted mandibular premolars were selected with a buccolingual canal size 2-2.5 times the mesiodistal size at 5 mm from the apex, with 0°-10° canal curvature with a 5-6 mm radius, at 5 mm from the apex. The teeth were divided into three groups (n = 14) and prepared with TruNatomy, OneCurve, and Jizai files based on the manufacturer's instructions. Cone-beam computed tomographic images were taken before and after instrumentation. The canal transportation and centering ability was calculated at 3, 6, and 9 mm from the apex in both mesiodistal and buccolingual directions.

Statistical Analysis

Intergroup comparison was done using Kolmogorov-Smirnov test. Intragroup comparison was done using Freidman test. A comparison of categorical variables was done using the Chi-square test.

Results

The results obtained did not present any statistically significant difference between the three groups, with TruNatomy and OneCurve showing relatively lesser canal transportation and better centering ratio when compared to the Jizai file system.

Conclusions

It can, therefore, be concluded that all three systems used in the study are capable of safely preparing root canals with minimal errors.

Analysis of Shaping Abilities of Rotary File Systems in Oval Canals with Moderate Root Curvature: A Randomized Controlled Ex Vivo Study

AIM

The purpose of this study was to evaluate and compare the canal transportation tendencies and centering ability of the TruNatomy shaper (TN) and XP-endo shaper (XPS) rotary systems in oval-shaped canals with moderate root curvature (15°-25°), using cone-beam computed tomography (CBCT) imaging.

MATERIALS AND METHODS

Sixty single-rooted permanent human teeth were chosen after considering the inclusion and exclusion criteria. The teeth were divided into two groups (n = 30). The test group was instrumented with TN files and the other with XPS according to manufacturer's instructions. CBCT images were taken before and after instrumentation to record the root canal distances from mesial, distal, buccal, and lingual borders of the root at 3, 5, and 7 mm distances from the root apex using a specific formula. Statistical analysis was done using the Statistical Package for the Social Sciences software program, version 20.0. The data were analyzed using the unpaired t test.

RESULTS

Both TN and XPS were safe for use in oval-shaped canals with moderate root curvature. However, the XPS showed higher buccolingual transportation as compared with TN at 3 mm from the apex and higher mesiodistal transportation at 3 and 5 mm levels from the apex as compared with TN.

CONCLUSION

Canal transportation has been detected in both systems; however, the values obtained were within the safe range (<0.3 mm). Overall, no significant difference was observed between TN and XPS (p > 0.05) in their canal transportation tendencies and centering ability.

CLINICAL SIGNIFICANCE

The study assesses the canal centering and transportation tendencies of the recently launched TN rotary system in extracted teeth with a combination of morphologies. The findings of the study are significant clinically as minimum transportation of the canal, minimal dentin removal, efficient disinfection, and three-dimensional obturation of the root canal are considered important factors in deciding the prognosis of endodontic therapy.

Investigation of the efficacy of different Ni-Ti systems on acrylic blocks for correcting ledge formation

BACKGROUND

The aim of this study was to compare the efficacy of K-type stainless steel hand instruments (Mani Inc. ), Fanta AF™ Ledge Correction (LC) (Fanta Dental), and Hyflex EDM (Coltene-Whaledent) for ledge correction, canal transport, centric ability, and shaping (preparation) time after an artificial ledge has been bypassed manually in highly curved canals using acrylic blocks.

METHODS

Forty-two resin blocks, each with a radius of 5 mm (Endo Trainer Block, VDW) and an apical inclination of 55°, were used. Under stereomicroscope magnification, standard artificial ledges were created on acrylic blocks, and attempts were then made to eliminate them using hand instruments, FantaAF™ LC, and Hyflex EDM. Before and after images were obtained using a stereomicroscope and compared using Photoshop.

RESULTS

Fanta AF™ LC and Hyflex EDM were found to be more effective for correcting ledges than hand instruments. The use of hand instruments resulted in the greatest transportation away from the canal curvature in the apical area. The canal shaping was completed in the shortest amount of time using Fanta AF™ LC, followed by HyFlex EDM and then the hand instruments.

CONCLUSION

In terms of centric ability, the order from best to worst is as follows: Fanta AF™ LC, Hyflex EDM, and hand instruments. After the ledge was manually bypassed with hand instruments in the root canals, Hyflex EDM and Fanta AF™ LC were found to be more effective than hand instruments in reshaping the previously unreachable region between the ledge and the foramen apical.

Effects of continuous chelation on the instrumentation of curved canals with a martensitic NiTi file system: an ex vivo micro-CT evaluation

This study aimed to evaluate the influence of continuous chelation on apical transportation and centrality in shaped curved canals prepared with a martensitic file system and evaluated by micro-CT. Twenty-four lower molar canals with a curvature of 25º-40º were scanned pre-operatively with micro-CT and divided into 2 groups according to two different irrigation regimens (n = 12). Group 1 was irrigated with NaOCl, group 2 with Dual Rinse. All canals were prepared with VDW.ROTATE system. The samples were scanned post-operatively and evaluated at 1, 3 and 5 mm from the apex to determine apical transportation and canal centrality using VG Studio software. Statistical analysis was performed with SPSS software using the non-parametric Mann-Whitney test. No statistically significant differences were found between the two groups for both apical transportation and canal centrality at any of the levels studied (p < 05). The use of continuous chelation during the instrumentation of the canals with martensitic alloy files does not produce greater transportation and does not generate changes in centralization compared to NaOCl-only irrigation. Combined chelation and disinfection while shaping with martensitic NiTi can simplify the irrigation regimen without inducing iatrogenic aberrations.

Comparison of five single-file systems in the preparation of severely curved root canals: an ex vivo study

BACKGROUND

The ex vivo study is to compare the root canal preparation outcomes achieved by five nickel-titanium single-file instrumentation systems (M3-L, Reciproc Blue, V-Taper 2H, WaveOne Gold, XP-endo Shaper) in severely curved molar root canals.

METHODS

A total of 60 root canals were selected from extracted human molar teeth with curvatures ranging from 25° to 50° and divided into five groups based on the instrumentation system employed (n = 12). Before and after root canal preparation, a Micro-CT scan was taken, and pre- and post-operative data were analyzed to evaluate the following parameters: volume increment of root canals (VI), untouched root canal areas (UTA), and canal transportation (CT). Apically extruded debris (AD) was collected during preparation. After that, all samples were separated into two parts and examined respectively by scanning electron microscope (SEM) to assess cleaning ability. Data were statistically analyzed with ANOVA (UTA, AD, VI) or Kruskal-Wallis test (CT, SEM-score), the level of significance was set at α = 0.05.

RESULTS

There were no significant differences between the five systems regarding the AD, VI, and UTA parameters (P > 0.05). In terms of CT, no significant difference was noted at the straight section of canal and apical levels, while XP-endo Shaper showed less canal transportation than M3-L at the level of curved vertex (P < 0.05), and the centering ability of V-Taper 2H was significantly better than WaveOne Gold at the initial point of bending (P < 0.05). Debris and smear layers were present on the canal walls of all specimens, the apical thirds of the canal presented higher SEM scores than the coronal thirds in all groups (P < 0.05). Reciproc Blue and XP-endo Shaper showed fewer smear scores than WaveOne Gold in the apical thirds (P < 0.01 and P < 0.05, respectively), and no statistical difference was found between other groups in the middle and coronal thirds.

CONCLUSION

The five single-file systems evaluated performed equally in apically debris extrusion, dentin removal, and untouched root canal areas, while XP-endo Shaper and V-Taper 2H resulted in less canal transportation compared to M3-L and WaveOne Gold. Regarding cleaning ability, Reciproc Blue and XP-endo Shaper were associated with less smear layer than WaveOne Gold in the apical thirds.

Evaluation of the Canal Transportation Following Glide Path Preparation with Different Rotary Systems: A Comparative Study

Objectives. Ideal root canal shaping might be more challenging particularly in cases with severely curved canals or complex anatomical variations. Glide path preparation is suggested as a critical step to achieve ideal canal preparation. The present study is aimed at evaluating transportation at different levels of the canal following glide path preparation by five different path finders. Materials and Methods. The study was conducted on 100 S-shaped canal simulator blocks. Glide path was prepared in five groups including (1) Scout RaCe (#10 and #15, 0.02), (2) One G (#14, 0.03), (3) PathFile (#13 and #16, 0.02), (4) GPS (#15, 0.03), and (5) K file (#15, 0.02) (Control group). The first four groups were NiTi rotary instruments, while the last group was a stainless steel hand file. The aforementioned files were used after canal negotiation by a #10 stainless steel hand file. Before- and after-preparation photos were taken and were superimposed in Adobe PhotoShop CC 2019. Transportation measurements were conducted in Digimizer. Absolute canal transportation was calculated at 10 cross-sections. Intergroup and intragroup data analysis were conducted using one-way and repeated measures ANOVA tests, respectively, in SPSS 26.0. The significance level was set to 0.05. Results. Although K file led to significantly more transportation in the apical and middle thirds ( $p<0.001$ ), rotary groups were not statistically different. In the coronal third, K files led to significantly more transportation compared to Scout RaCe and PathFile ( $p<0.05$ ). Conclusion. Within the limitations of the present study, regardless of the recruited rotary system, glide path preparation using NiTi rotary instruments leads to less canal transportation compared to stainless steel hand files.

A Comparative Study of Two Martensitic Alloy Systems in Endodontic Files Carried out by Unskilled Hands

The aim of this study was to compare the behavior of two heat-treated file systems on resin blocks in unskilled hands. For this purpose, an in vitro, randomized, cross-sectional study was conducted to compare ProTaper Gold (PTG) with BlueShaper (BS) files. A total of 81 resin blocks were used and analyzed photographically to assess the amount of material removed during instrumentation. PTG removed more material on the outside of the curve in the coronal and apical third, while BS removed more material on the inner part of the curve in the middle third. The procedural errors observed in the total sample were apical transportation (33.8%), blockages (4.9%), ledges (3.7%), and canal perforation. PTG produced more apical transportation, and there were no statistically significant differences between the groups in the formation of ledges, canal perforations, or blockages. No file fractures were recorded during the study. Within the limitations of this study, we can affirm that neither file excessively deformed the artificial canals, and the PTG file produced more apical transportation.

Antibacterial Effects of the Novel Blue Laser and Erbium Chromium Laser on Enterococcus Faecalis in Root Canal Dentin with Different Thicknesses

The aim of this study was to investigate the antibacterial effects of 445 nm blue diode lasers and erbium chromium lasers on the biofilm of Enterococcus faecalis in root canal dentin with different thicknesses. Dentin slices with thicknesses of 300, 500, and 1,000 microns were prepared; and after the biofilm formation, they were randomly divided into four groups: group A : Er, Cr:YSGG laser radiation; group B: 445 nm diode laser radiation; group C : laser radiation in three cycles; and control group D: 5 samples of each thickness were selected as a positive control group. Er, Cr:YSGG and diode lasers alone did not significantly reduce the number of bacteria in any of the thicknesses. Only in 1 mm thick sections, the group exposed with the both Er, Cr:YSGG laser and 445 nm diode laser (66%) significantly reduced the number of bacteria. There was a significant difference in a thickness of 0.3 mm compared to a thickness of 1 mm, indicating that these lasers had a better effect at a thickness of 0.3 mm than at 1 mm parts (P-value < 0.008). It seems that these lasers can be used as an adjunct to conventional chemical methods in cleaning infected canals.

The impact of TruNatomy and ProTaper Gold instruments on the preservation of the periradicular dentin and on the enlargement of the apical canal of mandibular molars

INTRODUCTION

This study aimed to evaluate the preservation of the periradicular dentin and the enlargement of the apical canal of mandibular molars with TruNatomy and ProTaper Gold instruments.

METHODS

Twenty mandibular molars were scanned in a micro-CT device, anatomically paired, and distributed into 2 groups (n=10). In the ProTaper Gold group, mesial and distal canals were prepared up to F2 (25/.08v) and F3 (30/.09v) instruments, while in the TruNatomy group, mesial and distal canals were enlarged until Prime (26/.04v) and Medium (36/.03v) instruments, respectively. After a new scan, surface area, volume, unprepared areas, transportation, percentage of dentin removal, and dentin thickness parameters were calculated. Data were compared between groups using Mann-Whitney, Student t-test, and the non-metric multidimensional scaling test with alpha set at 5%.

RESULTS

No difference was found between groups regarding unprepared canal areas and reduction of dentin thickness (P > 0.05). Transportation was lower than 0.1 mm in all groups and statistical differences were observed only at the apical third of the mesiobuccal canal with lower values in the TruNatomy group. ProTaper Gold removed more dentin than TruNatomy at the coronal level of mesial roots (1.8% and 1.0%, respectively) (P < 0.05).

CONCLUSIONS

TruNatomy and ProTaper Gold were efficient for performing canal preparation in mandibular molars. The tested systems were similar in terms of untouched canal walls and remaining dentin thickness, and slightly different in the apical transportation of mesial canals and percentage of dentin removal at the coronal third, but without clinically significant errors.

Shaping ability of 2Shape and NeoNiTi rotary instruments in preparation of curved canals using micro-computed tomography

Background

Various systems of nickel-titanium (NiTi) instrument have long been commercially available. However, the preparation of narrow and curved root canals has always been challenging. The purpose of this study was to compare the shaping ability of two NiTi systems (2Shape and NeoNiTi) in severely curved root canals with different morphological patterns using micro-computed tomography (Micro-CT).

Methods

A total of 22 human extracted permanent teeth of mandibular first molars, with the exact mesial angle of curvature of 25 and 35 degrees, according to Schneider’s technique, were distributed randomly into two groups (group I: 2Shape, group II: NeoNiTi) based on the rotary system used (n = 22). The groups were subdivided into two subgroups corresponding to the angle of canal curvature (25° and 35°) (n = 11). Canals were scanned using Micro-CT pre- and post-preparation to assess the volume of dentin removed; canal transportation; and canal centering ratio at 3, 6, and 9 mm from the apex. The Mann–Whitney U test was utilized to determine any significant differences between the two systems. The level of statistical significance was set at p < 0.05.

Results

There was no significant difference between the two groups in volume of dentin removed; canal transportation; and centering ability for 25° and 35° canal curvatures at 3, 6, and 9 mm from the apex (coronal, middle, and apical) thirds (p > 0.05). At the middle third, the NeoNiTi group demonstrated a statistically significant increase in volume of dentin removed for 35° canal curvatures compared to the 2Shape group.

Conclusion

Within the limitation of our in vitro study, 2Shape and NeoNiTi systems with severely curved canals were confirmed to be relatively safe in preparation and to respect original canal anatomy. Nevertheless, NeoNiTi instruments produced more centered preparation and minimal canal deviation compared to the 2Shape system.

Shaping ability of four single-file systems in the instrumentation of second mesiobuccal canals of three-dimensional printed maxillary first molars

Background

This study evaluated and compared the shaping ability of four advanced single-file nickel-titanium (NiTi) systems during the preparation of curved second mesiobuccal (MB2) canals in maxillary first molar replicas fabricated by three-dimensional (3D) printing via micro-computed tomography (Micro-CT) imaging.

Methods

A total of 60 3D-printed maxillary first molar replicas were constructed from one extracted tooth, with an angle of curvature ranging from 15° to 25°. The MB2 canals from these 60 replicas were divided into 4 groups of 15 replicas according to the canal instrumentation system used, namely, Waveone gold (WOG), Reciproc blue (RCB), XP-endo shaper (XPS) and M3-L. The specimens were scanned before and after preparation using Micro-CT. The pre- and post-instrumentation images of each specimen were superimposed, and the amount of resin removed, the change in surface area, the canal transportation, and centering ability were assessed using the Mimics software. Instrumentation time was also recorded. One-way analysis of variance and least significant difference (LSD) tests were used to statistically compare the groups. The significance level was set at 5%.

Results

Instrumentation time with M3-L was significantly longer than the other systems (P<0.05). The amount of resin removed and the change in surface area generated by the 4 systems were different at the apical, middle, and coronal thirds, and the total canal (P<0.05). Overall, WOG and XPS resulted in the less change than RCB and M3-L. There was no significant difference among the groups at the middle third regarding canal transportation and centering ability (P>0.05). However, a significant difference was found at the apical level (P<0.05), where RCB showed the poorest centering ability and the highest canal transportation (P<0.05). In addition, XPS resulted in the least canal transportation (P<0.05) at the coronal level, while there was no significant difference between the four groups in terms of centering ability.

Conclusions

The M3-L instrument required more time to prepare the curved MB2 canals compared with the other systems. Overall, WOG and XPS showed the least resin removal and surface area change. M3-L, XPS, and WOG instruments respected the original canal curvature better than RCB files.

Cone-beam computed tomographic analysis of apical transportation and centering ratio of ProTaper and XP-endo Shaper NiTi rotary systems in curved canals: an in vitro study

Background

Cleaning and shaping of the root canal system is an important step of endodontic treatment. Canal transportation is a common procedural error in preparation of curved canals. This study aimed to compare the canal transportation and centering ratio of two rotary files in curved canals using cone-beam computed tomography (CBCT).

Methods

Forty-four extracted human mandibular first molars with mature apices and 10° to 30° apical curvature were selected. The samples were randomly divided into two groups (n = 22) with similar curvature. The canals were prepared with ProTaper and XP-endo Shaper file systems according to the manufacturers’ instructions. The CBCT images were obtained using Cranex 3D CBCT scanner before and after root canal preparation, and canal transportation and centering ratio of the files at 3, 4 and 5 mm levels from the apex were calculated. Data were compared between the two groups using independent t-test at 0.05 level of significance.

Results

The ProTaper Universal caused greater canal transportation and had lower centering ratio than XP-endo Shaper in both mesiodistal and buccolingual directions at all levels from the apex. The difference between the two groups regarding canal transportation was significant at all levels from the apex in buccolingual direction (P < 0.05) except for 3 mm from the apex (P > 0.05). The difference between the two groups regarding centering ratio was not significant (P > 0.05) in mesiodistal direction at all levels except for 4 mm from the apex (P < 0.05).

Conclusion

The ProTaper Universal causes greater canal transportation in both buccolingual and mesiodistal directions than XP-endo Shaper.

Shaping ability of ProTaper Gold, One Curve, and Self-Adjusting File systems in severely curved canals: A cone-beam computed tomography study

Aim:

The aim of the study was to evaluate and compare canal transportation (CT), centering ability (CA), and volumetric changes in severely curved canals prepared using ProTaper Gold (PTG), One Curve (OC), and Self-Adjusting File (SAF) systems via cone-beam computed tomography (CBCT).

Materials and Methods:

Sixty mesiobuccal canals of maxillary molars were selected. Pre- and postinstrumentation CBCT scans were taken in the same position. CT and CA were calculated at 1 mm, 4 mm, and 7 mm from the apex; change in volume for whole canal was measured and analyzed statistically.

Results:

SAF showed the least mean CT at all the levels with no statistically significant differences at 1 mm and 4 mm when compared to other groups while statistically significant differences were observed at 7 mm with PTG and OC. Regarding CA, SAF better maintained canal centricity than PTG and OC at all the levels assessed, though the differences were not statistically significant except at 7 mm where statistically significant difference was observed between SAF and OC. SAF removed less volume of dentin followed by PTG and the highest removal was shown by OC.

Conclusion:

SAF showed promising behavior with the least CT, most centered preparation, and minimal dentin removal.

Shaping ability of a new heat-treated NiTi system in continuous rotation or reciprocation in artificial curved canals

The purpose is to evaluate canal transportation of a new heat-treated NiTi system, the Endostar E3 Azure operated in continuous rotation or reciprocation. 40 resin blocks were divided into two groups. The first was shaped in continuous rotation while the second in reciprocation. A preoperative and two postoperative images were taken, one after the use of the 20/06 and one after the 25/06. The images were superimposed to determine canal transportation. Time required for canal shaping was recorded. One-sample and student t tests, repeated-measure analyses of variance, univariate analyses and Bonferroni multiple comparisons tests were used for statistical analysis. The significance level was set at p < 0.05. There was no significant difference between continuous and reciprocating motion with the 20/06 and 25/06, respectively, at 1 mm (p = 0.761, p = 0.559), 2 mm (p = 0.584, p = 0.810) and 3 mm (p = 0.651, p = 0.070). The reciprocating motion showed significantly less canal transportation at 5 mm (p = 0.049, p < 0.001) and 7 mm (p < 0.001, p < 0.001) for the 20/06 and 25/0.6. Continuous rotation was more time-consuming than reciprocation (p < 0.001). The Endostar E3 Azure in reciprocation respected the original canal curvature better than in continuous rotation at all levels, and required less time to prepare artificial curved canals. Endodontists should know the shaping abilities of novel heat-treated NiTi files, regarding canal transportation and its relation with the instruments' motion and apical diameter enlargement.

Antimicrobial and physical properties of experimental endodontic sealers containing vegetable extracts

To assess the antimicrobial activity and the physical properties of resin-based experimental endodontic sealers with the incorporation of vegetable extracts obtained from Bixa orellana, Mentha piperita, and Tagetes minuta species. The extracts were obtained and characterized by gas chromatography-mass spectrometry (GC–MS), and minimum inhibitory concentration (MIC) against Streptococcus mutans, Enterococcus faecalis, and Candida albicans. The extracts were individually incorporated into a dual-cure experimental sealer at a mass concentration of 0.5%. A commercial reference RealSeal was used. The sealers were evaluated by measuring the setting time, degree of conversion, dimensional stability, radiopacity, flow, and film thickness of these materials, also and its antimicrobial effect was evaluated using the direct contact test. Data were statistically analyzed by analysis of variance and Tukey’s post-hoc test at α = 0.05 significance level. The physical properties were not influenced by the addition of the vegetable extracts (p > 0.05). For S. mutans, only T. minuta and B. orellana groups presented antibacterial activity after 24 h of contact (p < 0.05). All extracts evidenced an antibacterial effect against E. faecalis (p < 0.05). The experimental sealers hold promise as a novel vegetable sealer with great antimicrobial activity and also great physical–mechanical properties. Nonetheless, more studies are needed.

Comparison of canal transportation and centering ability of manual K-files and reciprocating files in glide path preparation: a micro-computed tomography study of constricted canals

Background

Optimum Glide Path (OGP) is a new reciprocating motion aiming to perform efficient glide path preparation in constricted canals. The aim of this study was to investigate and compare manual and OGP movement in terms of canal transportation and centering ability in glide path preparation of constricted canals.

Methods

Thirty constricted mesial root canals of mandibular molars, with initial apical size no larger than ISO#8, were selected and negotiated with #6–#8 K-files under the microscope. Canals were randomly divided into two experimental groups: Group 1 (MAN, n = 15): Glide path was established by using #10-#15 stainless steel K-files manually; Group 2 (OGP, n = 15): #10-#15 Mechanical Glide Path super-files were used with OGP motion (OGP 90°, 300 rpm). Each instrument was used to prepare only 2 canals (as in one mesial root). Canals were scanned before and after glide path preparation with micro-computed tomography (micro-CT) to evaluate root canal transportation and centering ratio at 1, 3 and 5 mm levels from the root apex. File distortions and separations were recorded. Paired t-test was used to statistically evaluate the data (P < .05).

Results

Group 2 showed a significantly lower transportation value than group 1 at 1-mm and 3-mm levels (P < .05), however the difference at 5-mm level was not significant. There was no significant difference regarding the centering ratio between the groups. Six #10 K-files were severely distorted in group 1, while no file separation or distortion was found in group 2.

Conclusions

OGP motion performed significantly less canal transportation (apical 3 mm) and file distortion during glide path establishment in constricted canals comparing to manual motion, while the centering ability between the two was similar.

Clinical relevance

OGP reciprocating motion provides a safer and efficient clinical approach compared to traditional manual motion in glide path establishment with small files in constricted canals.

A Critical Review of Methods for Quantitative Evaluation of Root Canal Transportation

INTRODUCTION

A comparison between root canal transportation studies is nearly impossible because of nonstandardized transportation evaluation methods. The aim of the present review was to search, compare, and critically discuss transportation evaluation methods.

METHODS

A search of PubMed, Web of Science, Scopus, ScienceDirect, and reference lists of articles was conducted up to March 2020 using appropriate key words to identify transportation evaluation methods. The methods in the included articles were extracted, compared, and categorized.

RESULTS

Seventy-four articles using original methods were selected. All studies share 3 main steps: image acquisition, image measurements, and calculation of parameters. Images were acquired by photography, radiography, and computed tomographic imaging. Two types of measurements were used: the amount of removed material and the canal center point distance. The parameters were calculated and reported as distance or ratio. Relationships between the different transportation parameters were found and confirmed with mathematical simulation.

CONCLUSIONS

Although methods were proposed as being novel, similarities between them were found, enabling the classification of the methods and identifying correlations. The canal center point distance is the most suitable for the description of canal transportation because it is comprehensible and it relates to the mathematical concept of translation. Removed material-based measurements are double the value of the canal center point distance. Ratio parameters are not suitable for reporting transportation.

Microcomputed tomographic evaluation of shaping ability of two thermo mechanically treated single-file systems in severely curved roots

Context:

Canal shaping abilities such as canal transportation, centering ability, and preparation time are important and have to be considered before using any Nickel–Titanium file system.

Aim:

This in vitro study aimed to evaluate and compare the amount of canal transportation, centering ability, and time required for the shaping of severely curved canals with WaveOne Gold (WOG) Primary Reciprocating file and One Curve (OC) Rotary file using the micro computed tomography (μCT).

Materials and Methods:

Thirty intact mesial roots of extracted human mandibular first molars having severe curvature (25°–35°) were selected. Samples were divided into two groups. Samples in Group I and II were shaped with WOG primary reciprocating files and OC rotary files, respectively, to the working length. Time required to prepare each canal was recorded. μCT pre- and post-instrumentation scans of all samples were taken. The cross-sectional images at 3, 6, and 9 mm from the radiographic apex were selected for analysis. Statistical analysis was performed using the Kruskal–Wallis and unpaired t-test.

Results:

At 3 mm, OC showed statistically lower canal transportation with mean value (0.17 ± 0.10) than WOG (0.55 ± 0.42). Furthermore, OC showed statistically significant better centering ability (0.59 ± 0.25) than WOG (0.39 ± 0.20) at 3 mm level. However, the differences between both instruments were not statistical significant at 6 and 9 mm level for canal transportation and centering ratio. WOG reciprocating file required less time for canal preparation than OC file.

Conclusions:

OC rotary file showed less canal transportation and better canal centring ability than WOG file, during the preparation of severely curved canals. However, WOG required less time for canal preparation.

Micro-computed Evaluation of Canal Transportation and Centering Ability of 5 Rotary and Reciprocating Systems with Different Metallurgical Properties and Surface Treatments in Curved Root Canals

INTRODUCTION

The aim of this study was to evaluate the transportation and centering ability of 5 different rotary and reciprocating file systems with different metallurgical properties and surface treatments in curved root canals.

METHODS

Fifty mesiobuccal round canals of upper molars with a curvature of 25°-40° were assigned to 5 experimental groups (n = 12) according to the instrumentation system used: ProTaper Next (Dentsply Sirona, York, PA), Reciproc Blue (RCB [VDW, Munich, Germany]), Reciproc (VDW), TruNatomy (TRN [Dentsply Sirona]), and XP-endo Shaper (FKG, La Chaux-de-Fonds, Switzerland). During instrumentation, 5 mL 2.5% sodium hypochlorite was used in each root canal. The final irrigation protocol included 15% EDTA followed by sodium hypochlorite irrigation. The micro-computed tomographic scanning of the samples was performed before and after instrumentation to analyze the transportation and centering ability at 3 canal levels. The results were analyzed with the 1-way analysis of variance test with the corresponding post hoc test.

RESULTS

Overall, RCB caused significantly more canal transportation compared with the other techniques (P < .05). There were no significant differences between the other techniques (P > .05). ProTaper Next had a significantly better ability to stay within the central axis of the root canal compared with the Reciproc and RCB techniques (P = .046 and P = .017, respectively). In the apical third, all techniques caused similar apical transportation and centering ability (P > .05). In the middle and cervical parts of the canal, the RCB caused significantly greater canal transportation than the other techniques (P < .05).

CONCLUSIONS

Under the limitations of this study, all tested techniques had similar transportation and centering abilities in the apical part of the canal. However, the overall results and those in the middle and coronal parts of the canal indicated that reciprocating instruments resulted in more canal transportation and less centered preparations.

Analysis of second mesiobuccal root canal instrumentation in maxillary first molars with three nickel-titanium rotary instruments: a micro-computed tomographic study

The aim of this study was to evaluate the shaping characteristics of Protaper Universal (PTU; Dentsply Tulsa Dental Specialties, Johnson City, TN), Hero Shaper (HS; MicroMega, Besacon, France) and Hyflex CM (HCM; Coltene-Whaledent, Allstetten, Switzerland) nickel-titanium systems with various apical sizes and tapers in second mesiobuccal (MB2) canal instrumentation using micro-computed tomographic imaging. A total of 27 maxillary first molars with independent patent MB2 canals were selected and randomly assigned to three groups according to the 3-dimensional morphologic aspects obtained from preoperative micro-computed tomographic scans. Canals were first negotiated with a size 8 K-file and finally prepared to F1, F2, and F3 with PTU and to sizes 20.04 taper, 25.04 taper, and 30.04 taper with HS and HCM. Postoperative scans were performed after each instrumentation with the same parameters used in the initial scan. The canal volume, canal transportation, untouched canal surface and wall thickness were measured and calculated using Mimics 10.01 software (Image Works, Materialise, Belgium). Statistical analysis was performed using one-way analysis of variance post hoc LSD tests. PTU removed more dentin than HS and HCM in all sections when instrumented to the same apical size (P < 0.05). HS and HCM presented a lower mean value of canal transportation than PTU in all measured sizes and sections. PTU presented a lower mean value of distal wall thickness than HS and HCM at the level of 1 and 2 mm below the furcation region in all measured sizes. In conclusion, for MB2 canal instrumentation, HS and HCM of 0.04 taper are safer than PTU.

Filling Ability and Flow of Root Canal Sealers: A Micro-Computed Tomographic Study

This study evaluated by micro-computed tomography (μCT) the filling ability in curved root canals, besides the flow of AH Plus (AHP) and Neo MTA Plus (NMTAP) sealers using different methodologies. Mandibular molars mesial roots with two root canals and degree of curvature between 20° and 40° were selected. The specimens were prepared with the ProDesign R system up to size 35.05 and were filled with the sealers by a continuous wave of condensation technique, Thermo Pack II (n=12). The teeth were scanned using μCT after root canal preparation and obturation. The volumetric percentage of filling material and voids were calculated. Flow was evaluated based on ISO 6876/2012 (n=10). Flow and filling were also evaluated in μCT using a glass plate with a central cavity and four grooves from the central cavity (n=6). Flow was linearly calculated into the grooves. The central cavity filling (CCF) and lateral cavity filling (LCF) were calculated in mm³. Data were submitted to non-paired t test with a significance threshold at 5%. The percentage of filling and voids between the root canals filled with AHP or NMTAP was similar (p>0.05). NMTAP presented the lowest flow in conventional test (p<0.05). Using μCT, sealers had similar CCF, LCF and linear flow (p>0.05). In conclusion, NMTAP and AHP had similar filling ability in curved mesial root canals of mandibular molars without presence of isthmus. Although AHP presented better flow than NMTAP using ISO methodology, there was no difference between these materials regarding volumetric filling when evaluated by μCT.

Working Length Transfer in the Endodontic Clinical Practice: A Comparative Study

The present paper evaluated the accuracy of two different methods for transferring working length (WL) between manual endodontic instruments and nickel–titanium (NiTi) shaping files. Thirty root canals of extracted permanent teeth were used. Root canals were divided according to canal length (CL) and canal curvature (CC). The reference cusp and the root end were flattened to provide reproducible and accurate measurements. During shaping, the WL measurements were obtained with manual k-files (KF) and transferred to WaveOne (W1) NiTi reciprocating files using the traditional method with the endodontic ruler (method I) and an alternative clinical procedure based on the comparison of the instruments side by side from tip to shank (method II). For each file and each tested method, two measures were taken by two examiners using Rhino (ver. 4.0, McNeel, Seattle, WA, USA) software for a total of 360 (30 × 3 × 2 × 2) measures. Analysis of variance was performed by taking the difference in length (Delta WL, DWL) between files used for the same canal. The difference between methods I and II for WL transfer was found to be statistically significant (df = 1; F = 71.52; p < 0.001). The DWL absolute values obtained with method II were found to be closer to 0 mm (i.e., same length as corresponding KF) than those obtained with method I. Both CL (df = 2; F = 1.27; p = 0.300) and CC (df = 1; F = 2.22; p = 0.149) did not significantly influence WL measurements. With respect to WL transfer, method II seemed to better preserve the correct WL transfer between instruments during the clinical endodontic procedures.

Effect of 2 Heat-treated Nickel-Titanium Files on Enlargement and Deformation of the Apical Foramen in Curved Canals: A Scanning Electronic Microscopic Study

INTRODUCTION

The aim of this study was to evaluate under scanning electronic microscopy the enlargement and deformation of the apical foramen of curved mesiobuccal roots with both reciprocating and rotary single-file systems made of a newly heat-treated alloy through the use of Reciproc Blue (REC Blue; VDW, Munich, Germany) and XP-endo Shaper (XPS; FKG Dentaire, La Chaux-de-Fonds, Switzerland).

METHODS

Forty mesiobuccal roots of mandibular and maxillary molars presenting a curvature ranging from 20°-40° were used in this study. The apical foramens were initially scanned with a scanning electronic microscope under 200× magnification. Roots were divided into 2 groups (n = 20): the REC Blue group instrumented with the REC Blue system and the XPS group instrumented with the XPS system. Both groups were instrumented at the foramen. The apical foramens were scanned after root canal preparation. The area, circularity, and ratio of the Feret diameters were calculated from each image. The Kolmogorov-Smirnov, Mann-Whitney, and Wilcoxon tests were used for statistical analysis (P ≤ .05).

RESULTS

The area of the foramen increased significantly after canal shaping with REC Blue and XPS. The variation of the area was significantly greater with XPS. However, there were no significant differences in circularity and the ratio of the Feret diameters with both instruments.

CONCLUSIONS

No transportation was found when using REC Blue and XPS. The newly heat-treated nickel-titanium alloy did not promote deformation of the apical foramen in curved canals.

Influence of endodontic cavity access on curved root canal preparation with ProDesign Logic rotary instruments

OBJECTIVE

This study evaluates whether endodontic cavity access into molars influences the chemomechanical preparation of curved root canals.

MATERIALS AND METHODS

Twenty mesiobuccal canals of maxillary molars were randomly divided into two experimental groups (n = 10), according to the type of endodontic access analyzed (conventional and minimally invasive). The preparations were made by a single operator, and the canals, after access, were prepared with Logic system (0.25, 0.04 taper) along the working length. Samples were scanned before and after canal preparation (SMX-90CT Plus (Shimadzu® microtomograph operated with 70 kV, 100 uA, FOV (XY) 13.3 mm, FOV (Z) 7.0 mm, and voxel size 0.013 mm/Pix)) to match canal volumes. Images were analyzed to evaluate surface areas, transport, and centralization at 3 mm from the canal entrance and 3 mm from the apex (OnDemand3D^TM Dental software). Student's t test with a significance level of 5% was used for the statistical analysis.

RESULTS

Regardless of the position of the analyzed canals, there was no difference in the prepared area regarding the transport and centralization of the endodontic instrument between the two types of cavity accesses performed.

CONCLUSIONS

The conventional and minimally invasive access did not influence the action of the 0.25 and 0.04 taper instrument during the curved root canal preparation.

CLINICAL RELEVANCE

The type of endodontic access did not influence the action of the rotary instrument during the curved root canal preparation.

Micro-computed tomographic assessment of the shaping ability of the One Curve, One Shape, and ProTaper Next nickel-titanium rotary systems

Objectives

This micro-computed tomographic (CT) study aimed to compare the shaping abilities of ProTaper Next (PTN), One Shape (OS), and One Curve (OC) files in 3-dimensionally (3D)-printed mandibular molars.

Materials and Methods

In order to ensure standardization, 3D-printed mandibular molars with a consistent mesiobuccal canal curvature (45°) were used in the present study (n = 18). Specimens were instrumented with the OC, OS, or PTN files. The teeth were scanned pre- and post-instrumentation using micro-CT to detect changes of the canal volume and surface area, as well as to quantify transportation of the canals after instrumentation. Two-way analysis of variance was used for statistical comparisons.

Results

No statistically significant differences were found between the OC and OS groups in the changes of the canal volume and surface area before and after instrumentation (p > 0.05). The OC files showed significantly less transportation than the OS or PTN systems for the apical section (p < 0.05). In a comparison of the systems, similar values were found at the coronal and middle levels, without any significant differences (p > 0.05).

Conclusions

These 3 instrumentation systems showed similar shaping abilities, although the OC file achieved a lesser extent of transportation in the apical zone than the OS and PTN files. All 3 file systems were confirmed to be safe for use in mandibular mesial canals.

Apical Transportation of Mesiobuccal Canals of Maxillary Molars Following Root Canal Preparation with Two Rotary Systems and Hand Files: A Cone-Beam Computed Tomographic Assessment

Objectives:

This study aimed to compare the transportation of the mesiobuccal canal of maxillary molars following root canal preparation with HyFlex CM (HCM) and Edge Taper Platinum (ETP) rotary systems and stainless steel (SS) hand files using cone-beam computed tomography (CBCT).

Materials and Methods:

This in-vitro study was performed on 48 maxillary molars in three groups of 16. The teeth were mounted in acrylic blocks, and root canals were prepared using HCM in group 1 (up to #30/0.06), ETP in group 2 (up to F3/0.06), and SS hand files in group 3 (up to #30). CBCT scans were taken before and after root canal preparation. The amount of canal transportation was measured at 0, 3, 6, and 9mm from the apex. Data were analyzed using Kruskal-Wallis and Mann-Whitney tests.

Results:

The difference in canal transportation at 0 and 6mm from the apex was significant between the HCM and ETP groups (P=0.031 and 0.023) but none of the systems showed any significant difference with hand files at 0-and 6-mm levels (P=0.10, 0.56, 0.22, and 0.50), respectively. At 3mm from the apex, no significant difference was noted among the groups (P=0.30). At the 9-mm level, the amount of canal transportation was not significantly different between HCM and ETP (P=0.83) but they showed significant differences with hand files (P<0.001).

Conclusion:

ETP and HCM caused less canal transportation at the curvature of the mesiobuccal canal of maxillary molars compared to hand files. ETP showed superior efficacy in root canal preparation compared to HCM.

Physico-chemical and antimicrobial properties and the shelf life of experimental endodontic sealers containing metal methacrylates

The objective of this study was to evaluate the physico-chemical and antimicrobial properties of a dual polymerization experimental endodontic sealer (E) and experimental sealers containing dibutyltin methacrylate (Sn²⁺) (ETs) or calcium methacrylate (Ca²⁺) (ECs). The pH and ion release levels of the sealers were measured. The dimensional stability was evaluated in accordance with ISO 6876. Biofilm growth inhibition was evaluated using confocal laser scanning microscopy (CLSM). Biofilm viability analysis was performed using the SYTO 9 technique. The shelf life was evaluated through the degree of conversion and film thickness tests after the sealers had been stored for different periods of time. For statistical analysis, ANOVA and Tukey's post hoc test were used, with a significance level of 5%. ETs revealed better anti-biofilm potential after 15 days than that of the controls. The degree of conversion was reduced after the shelf-life period. The addition of calcium and dibutyltin methacrylate improved the anti-biofilm properties of the experimental endodontic sealer without impairing their physico-chemical properties.

Cone-Beam Computed Tomographic Analysis of Shaping Ability of XP-endo Shaper and ProTaper Next in Large Root Canals

INTRODUCTION

The aim of this study was to evaluate and compare the shaping abilities of the XPS (XP-endo Shaper) and PTN (ProTaper Next) systems by using cone-beam computed tomography on apical, middle, and coronal thirds of the pre-created large canals with different apical sizes.

METHODS

Seventy-two teeth with single canal were divided into 3 groups, and then large root canals were created with apical diameter #30 (Group 1), #35 (Group 2), or #40 (Group 3) by using hand files. Each group was again divided into 2 experimental groups, and root canals were instrumented with either XPS or PTN. Canals were scanned before and after instrumentation by using cone-beam computed tomography scanner to evaluate mesiodistal transportation, buccolingual transportation, centering ratio, percent increased prepared area (PA) (mm²), and percent increased prepared outline (PO) (mm) at 2, 5, and 8 mm from the apex. Data were statistically analyzed, and the significance level was set at P < .05.

RESULTS

There were no statistically significant differences in PA, PO, and centering ratio values between instruments in size 30 and size 35. The mean increases in PA and PO (P < .021) were statistically higher with XPS in size 40. PTN had statistically higher buccolingual transportation in size 30 and size 35. XPS had lower mesiodistal transportation values in all 3 apical sizes.

CONCLUSIONS

PTN system is able to remove the dentin even in cases of increased apical diameter. However, XPS has less canal transportation and better centering ability compared with PTN.

Shaping Ability of 2Shape and WaveOne Gold Files Using Cone-Beam Computed Tomography

Aim and Objective:

The aim of this study is to evaluate the apical transportation, centering ability, and volume of removed dentin of WaveOne Gold (WOG) and 2Shape with the use of cone-beam computed tomography.

Materials and Methods:

Freshly extracted mandibular teeth with sample size of thirty were carefully chosen and instrumented using the 2Shape and WOG rotary files. Preoperative and postinstrumentation cone-beam computed tomographic scans were done to accomplish mesial and distal dentin walls’ measurements and volume of removed dentin calculations, apical transportation, and centering ratio. Statistical analysis was performed and confirmed by independent t-test. Statistical significance was set at 5%.

Results:

When shaping ability of 2Shape and WOG was evaluated, it was reported that there was no statistically significant differences noted among the groups in relation to the total volume of removed dentin, apical transportation, and centering ratio.

Conclusion:

It can be concluded that 2Shape and WOG preserved the original canal anatomy well and did not eliminate excess dentin during shaping and cleaning. Rotary nickel–titanium files which work on the principle of rotary movement attained an outcome analogous to that of the rotary files working on reciprocating motion in relation to alteration in angle.

Canal transportation and centering ratio after preparation in severely curved canals: analysis by micro-computed tomography and double-digital radiography

OBJECTIVES

This study compared canal transportation and centering ratio produced after instrumentation with a single heat-treated reciprocating system, WaveOne Gold (WOG; Dentsply Sirona, Tulsa, OK, USA) and a single heat-treated rotary instrument, XP-endo Shaper (XPS; FKG, La Chaux-de-Fonds, Switzerland), using micro-computed tomographic (micro-CT) imaging, and evaluated the ability of double-digital radiography (DDR) to detect canal transportation.

MATERIALS AND METHODS

Mesial root canals of mandibular molars with severe curvature (25-70°) were randomly assigned to either WOG or XPS groups for preparation. Centering ratio was measured by micro-CT imaging, while canal transportation was measured by micro-CT and DDR methods at 3, 5, and 7 mm from the apex. Data were statistically compared between groups using the t test (α = 5%).

RESULTS

The micro-CT method showed that XPS's shaping ability regarding the centering ability (P = 0.030) and canal transportation (P = 0.028) was significantly better than WOG only at the 7-mm level. The DDR technique detected no difference in canal transportation between groups at any level (P > 0.05); however, a significant difference between evaluation methods was detected at the 5-mm level in the WOG group (P = 0.023).

CONCLUSIONS

Micro-CT technique revealed a significantly better centering ability and less canal transportation with XPS compared to WOG. The DDR technique was not capable of detecting the significant difference between the tested groups.

CLINICAL RELEVANCE

Root canal curvatures may lead to procedural errors during endodontic treatment. Thus, differences on the shaping ability of single heat-treated reciprocating and rotary systems should be known.

A comparison of the characteristics of polyurethane-based sealers including various antimicrobial agents

A novel polyurethane sealer has been fabricated and demonstrates good physicochemical and antibacterial properties and cytocompatibility.

A microcomputed tomography evaluation of the shaping ability of three thermally-treated nickel-titanium rotary file systems in curved canals

OBJECTIVE

To evaluate the shaping ability of three thermally-treated rotary nickel-titanium (NiTi) systems including ProTaper Next (PTN), HyFlex™ CM (HFCM) and HyFlex™ EDM (HFEDM) during root canal preparation in simulated root canals.

METHODS

A total of 45 simulated root canals were divided into three groups ( n = 15) and prepared with PTN, HFCM or HFEDM files up to size 25. Microcomputed tomography (microCT) was used to scan the specimens before and after instrumentation. Volume and diameter changes, transportations and centring ratios at 11 levels of the simulated root canals were measured and compared.

RESULTS

HFEDM caused significantly greater volume increases than HFCM and PTN in the entire root canal and in the apical and middle thirds. HFCM removed the least amount of resin in the coronal third compared with HFEDM and PTN. Overall, HFCM caused significantly less transportation in the apical 2 mm and was better centred than PTN in the apical 3 mm.

CONCLUSION

Under the conditions of this study, all systems prepared curved canals without significant shaping errors and instrument fracture. PTN and HFCM cut less resin than HFEDM. HFCM stayed centred apically and cut the least material coronally.

Shaping ability of the profile 25/0.06 and protaper F2 in rotary motion, and reciproc in simulated canals

Background

Since the introduction of nickel–titanium (Ni–Ti) instruments to dentistry, a wide variety of Ni–Ti instruments have become commercially available. These Ni–Ti instruments are expensive, which limits their usage in developing countries and forces practitioners to use instruments repeatedly. Another problem is the possible prion cross-contamination associated with the multiple usage of endodontic instruments. In addition, the use of these instruments requires new skills and experience. In this article, the shaping capacities of two conventional rotary file systems, ProFile 25/0.06 and ProTaper F2, were reviewed and compared with the Reciproc single-file system.

Methods

A total of 45 simulated canals with 40° curvature, in clear resin blocks, were prepared using conventional rotary systems consisting of ProFile orifice shaping (OS) #3 and final flaring #25/.06, Reciproc R25, and ProTaper shaping file SX and finishing file F2. Pre-and post-instrumentation images were analyzed at ten different levels, using AutoCAD 2007 software. The measurement positions were defined in 1-mm intervals: positions 0–3 established the apical part, positions 4–6 constituted the middle part, and positions 7–10 established the coronal part of the canal. The amount of removed resin, the transportation, instrumentation time, change in working length (WL), instrumentation fractures, and the presence of ledge were evaluated. Data were analyzed using ANOVA, Kruskal–Wallis and independent t-test (p < 0.001).

Results

ProFile removed the least resin (p < 0.001) and caused less transportation than Reciproc and ProTaper, in total (p < 0.001). ProTaper caused more transportation ProFile and Reciproc in the apical part (p < 0.000). Reciproc caused more transportation than ProTaper and ProFile (p < 0.001), and the transportation tendency toward the inner aspect of the curvature in the middle part. Reciproc caused the less transportation than ProFile and ProTaper in the coronal part. The transportations tended to occur toward the outside of the curvature, except the middle part with Reciproc and at points 5 and 6 with ProTaper. There were no significant differences among the groups in terms of maintaining the original WL. Reciproc was significantly faster than the others group (p < 0.001). Only one instrument fracture (25/0.06 ProFile) was noted. All groups showed one ledge each.

Discussion

The results of the present study showed that both ProFile 25/06 and ProTaper F2, combined with a file used for coronal enlargement (OS3 and SX), have the potential to create satisfactory canal shape in the curved root canals. Further studies using real human teeth are needed to confirm our results.

Cone-beam Computed Tomographic Analysis of Canal Transportation and Centering Ability of Single-file Systems

INTRODUCTION

The purpose of this study was to compare canal transportation and the centering ability of Reciproc (VDW, Munich, Germany), WaveOne (Dentsply Maillefer, Ballaigues, Switzerland), and EdgeFile (EdgeEndo, Albuquerque, NM) rotary systems using cone-beam computed tomographic imaging.

METHODS

Ninety mesiobuccal mandibular first molar uncalcified canals with at least a 19-mm length, a canal curvature of 15°-30° (the Schneider method), and a mature apex were selected. Canals were randomly divided into 3 groups of 30 teeth, and canal preparation with the Reciproc, WaveOne, and EdgeFile systems was performed according to the manufacturers' instructions. Cone-beam computed tomographic images were taken before and after instrumentation in the same position. Apical transportation was calculated in the distances of 2, 3, and 4 mm from the apex. Kruskal-Wallis and Mann-Whitney U tests were used to statistically analyze the data.

RESULTS

The mean canal transportation was significantly lower with EdgeFile (P < .001) followed by the WaveOne rotary system. Moreover, the centering ability of the EdgeFile system was higher than that of the WaveOne and Reciproc systems.

CONCLUSIONS

The EdgeFile rotary system showed the lowest transportation in both the mesiodistal and buccolingual directions and the highest centering ability. The Reciproc system showed the highest transportation and the lowest centering ability.