Defects in GT rotary instruments after use: an SEM study

Nickel ion release and surface analyses on instrument fragments fractured beyond the apex: a laboratory investigation

BACKGROUND

To analyse the changes in surface and nickel ion release characteristics of fractured root canal shaping instruments in a simulated body fluid environment.

METHODS

A total of 54 new instruments were studied. The instrument groups consisted of five different NiTi alloys and a stainless-steel alloy. To standardize instrument fracture, a torsional type of failure was created on each instrument. The fractured specimens of each instrument group were randomly divided into three static immersion subgroups of 1 h, 7-day, and 30-day (n = 3). Simulated body fluid (SBF) was prepared to mimic human blood plasma by Kokubo&Takadama protocol for ex situ static immersions at 37ºC. The surfaces were examined via scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy. To determine the quantitative ion release, the retrieved SBFs were analyzed using inductively coupled plasma mass spectrometry. Two-way ANOVA and Tukey post hoc tests sought the statistical significance of the nickel ion values(p < 0.05).

RESULTS

In 1 h of immersion, the newly formed structures, exhibiting mostly oxygen signals, were widespread and evident on NiTi surfaces. In contrast, fewer structures were detected on the SS surface in that subgroup. In 7 days of immersion, a tendency for a decrease in the density of the new structures was revealed in NiTi groups. The oxygen signals on NiTi group surfaces significantly increased, contrary to their decrease in SS. Signals of sodium, chlorine, and calcium were detected, indicating salt precipitates in groups. In 30 days of immersion, salt precipitates continued to form. The Ni-ion release values in all instrument groups presented significant differences in comparison to the SBF control in all immersion periods(p < 0.001). No significant differences were observed in immersion time periods or instrument groups(p > 0.05).

CONCLUSIONS

Within the limitations of the presented study, it was concluded that the fractured SS and NiTi root canal instruments release Ni ions in contact with body fluid. However, the Ni ion release values determined during the observation periods are lower than the critical toxic or allergic thresholds defined for the human body. This was due to the ionic dissolution cycle reaching a stable state from 1-hour to 30-day exposure to the body fluid of fractured instruments.

Surface roughness and cyclic fatigue resistance of reciprocating and novel rotary instruments after use in curved root canals

This study evaluated surface wear and resistance to fracture of reciprocating and novel rotary instruments after use in curved canals. Twenty new instruments (n = 5/each group): Reciproc Blue, WaveOne Gold, XP-endo Shaper (XPS) and TruNatomy were used twice for the instrumentation of simulated curved canals in plastic blocks. The instrumentation was performed according to the manufacturer's instructions at body temperature. Surface roughness was evaluated, using a profilometer, before instrumentation and twice after the instrumentation. Instruments were, then, subjected to a cyclic fatigue test to evaluate the time to failure. Differences were assessed using ANOVA and post hoc tests (α = 0.05). The XPS instruments showed significantly higher values of roughness compared with TruNatomy at every stage, especially after the second use (p < 0.008). Reciprocating instruments showed superior cyclic fatigue resistance compared with novel rotary instruments (p < 0.05). TruNatomy showed minimal surface roughness, and XPS exhibited significantly higher surface roughness.

Effect of kinematics on the torque/force generation, surface characteristics, and shaping ability of a nickel titanium rotary glide path instrument: an ex-vivo study

AIM

To evaluate the effect of various rotational motions on the torque/force generation, surface wear, and shaping ability of the ProGlider glide path instrument (Dentsply Sirona).

METHODOLOGY

Mesiobuccal and mesiolingual canals of mandibular molars were selected based on the canal volume, length, angle of curvature (25°-40°), and radius of curvature (4-8 mm) after micro-computed tomographic scanning. The samples were randomly assigned to four groups (n = 13, each) according to movement kinematics [continuous rotation (CR; 300 rpm), optimum torque reverse motion (OTR; 180° forward and 90° reverse when torque > 0.4 N·cm), time-dependent reciprocal motion (TmR; 180° forward and 90° reverse), and optimum glide path motion (OGP; a combination of 90° forward, 90° reverse, 90° forward, and 120° reverse)]. Instrumentation was performed with an automated root canal instrument and torque/force analysing device. Maximum torque/force values, canal volume changes, and canal-centring ratios at 1, 3, 5, and 7 mm were evaluated. Surface defects (pits, grooves, microcracks, blunt cutting edges, and disruption of cutting edges) and spiral distortion on the ProGlider instrument were scored at the tip and 5 mm short of the tip before and after five consecutive uses with scanning electron microscopy. The Kruskal-Wallis test followed by Dunn's post-test with Bonferroni correction and Wilcoxon signed-rank test were used to analyse the data (α = 0.05).

RESULTS

OGP generated significantly less clockwise torque and greater upward force than other groups (P < 0.05). OGP resulted in significantly fewer surface defects than CR (P < 0.05). In OGP and CR, the tip exhibited more surface defects than 5 mm short of the tip (P < 0.05). CR resulted in greater volume changes than OGP and TmR (P < 0.05) and greater centring ratios (i.e., more deviation) than OGP at 1 mm and OTR at 3 mm (P < 0.05).

CONCLUSIONS

Under laboratory conditions using the ProGlider instrument, OGP generated significantly less clockwise torque and greater upward force than the other rotatory motions. OGP generated fewer superficial defects than CR, and the three modes of reciprocal rotation better maintained the apical curvature of root canals than CR with the ProGlider instrument.

Scanning electron microscopy analysis of conventional and controlled-memory nickel titanium files before and after multi-uses in root canals

The current study aimed to examine changes in the physical properties of conventional and CM nickel-titanium instruments after repeated clinical use, disinfection-sterilization processes, using scanning electron microscopy (SEM). Sixty extracted mandibular molar mesial roots were used in this ex vivo study. The 60 teeth underwent final apical shaping (#25/.06) by the Revo-S SU (Revo-S Group: #25/.06; Micromega; n = 10) and Hyflex CM (Hyflex CM group: #25/.06; Coltene-Whaledent; n = 10) groups. One instrument of each group was used to shape six different teeth (Revo-S SU in 3 MB and 3 ML canals, and Hyflex CM in 3 MB and 3 ML canals), sequentially. The physical changes evident on the surfaces of the files after sequential use and sterilization processes were analyzed by SEM after the first, third, and sixth use. The first SEM examination was performed immediately after removal from the packages. Following first SEM examination, the files were sterilized before the first use as would be customary in practice. Qualitative evaluations were made by two evaluators, according to the following criteria: tip deformation, cutting edge deformation, debris, and microfracture. Revo-S showed a significant difference in cutting edge deformation, tip deformation, and microcrack formation, as compared to Hyflex CM. There was no significant difference between the groups in debris with the increasing number of uses. In this study, Hyflex CM (CM nickel-titanium) files showed better performance in terms of deformation and microcrack formation as the number of uses increased than did Revo-S (conventional nickel-titanium) files.

Topographic changes in NiTi rotary instruments after the clinical use

Surface alterations of instruments were investigated after single and multiple uses in the root canals. XP-endo Shaper (n = 5) and WaveOne GOLD (n = 5) files were used until the separation of the instruments occurred. The apical 3-mm and separated fragments were analysed by SEM to determine the changes in the instruments and the cross-sections of the separated fragments. Each group was divided into five subgroups: control, first, second, third and fourth molar. The results were reported descriptively for each group. In the XP-endo Shaper group, microcracks started to appear after the second use, and pitting and galvanic corrosion occurred after the third use. During the fourth use, microcracks propagated, resulting in ductile fracture while it happened after the third use in the second group. The single use of XP-endo Shaper and WaveOne GOLD was safe without any major changes on their surfaces. Reciprocating motion was not necessarily superior to full rotation motion.

Cyclic fatigue resistance of novel Genius and Edgefile nickel-titanium reciprocating instruments

This study aimed to assess the cyclic fatigue resistance of Genius and EdgeFile X1 reciprocating instruments compared with WaveOne Gold Primary. Twenty Genius (Ultradent) 25.04, 20 Genius 30.04, 20 EdgeFile X1 (EdgeEndo) and 20 WaveOne Gold Primary (Dentsply Maillefer) instruments were included in this study and tested in a static cyclic fatigue testing device, which has an artificial stainless steel canal with a 60° angle of curvature and a 5-mm radius of curvature. All instruments were operated in reciprocation mode until fracture occurred. The number of cycles to failure (NCF) was calculated and time to fracture (TF) was recorded in seconds using a digital chronometer. The mean and standard deviations of NCF and TF were calculated for each reciprocating system and the data were subjected to Kruskal-Wallis one-way analysis of variance and to Dunn's test (p < .05) using SigmaPlot software (Systat software, CA, USA). The fractured surfaces of five instruments from each brand were randomly examined and microphotographed by a low-vacuum environmental scanning electron microscopy - SEM (Tabletop Microscope TM3030, Hitachi, Japan) to confirm the cyclic fatigue fracture. EdgeFile exhibited the highest cyclic fatigue resistance, followed by both Genius files (p < .05). Within the limitations of this in vitro study, EdgeFile X1 instruments had significantly higher cyclic fatigue resistance than did Genius and WaveOne Gold Primary instruments. The cyclic fatigue resistance of both Genius files was higher than that of WaveOne Gold Primary.

The Effect of surface topographical changes of two different surface treatments rotary instrument

Background

One of the major innovations in endodontics has been the introduction of nickel-titanium (NiTi) alloy. This study evaluated the surface topographical changes of two different surface treatments rotary instrument after instrumentation and sterilization.

Material and Methods

240 Extracted teeth were included in this study. 90 new AlphaKite and Revo-S NiTi rotary instruments were selected and divided into two groups (Group A 45 AlphaKite and group B 45 Revo-S). Each group were divided into three subgroups: (A1, B1) n=5 files were used as a control, (A2,B2) n=20 files were used to prepare three root canals using endodontic rotary motor then sterilized by autoclave for one cycle under 121°C at 15 psi for 30 minutes and (A3,B3) n=20 files were used to prepare nine root canals using the same rotary system then sterilized by autoclave for three cycles under 121°C at 15 psi for 30 minutes. Files were examined under scanning electron microscopy.

Results

On examining the AlphaKite, A1 revealed gross machining grooves on their surface with no pits, A2 showed disruption of cutting and A3 showed microcracks and deepening of the machining grooves. B1 showed a smoother surface with few machining grooves, B2 showed dulling and blunting of the cutting edges was predominant and B3 files showed plastic deformation in the form of unwinding of the flutes.

Conclusions

The defects were less distributed along the electropolished Revo-S files than the physical vapor deposition AlphaKite.

Key words:Endodontic instruments, electropolished, rotary, sterilization.

The effect of glide path on the surface quality of new and used rotary and reciprocating single files: OneShape versus WaveOne

The aim of this study was to evaluate the effect of glide path preparation on the surface topography changes of WaveOne and OneShape single files using atomic force microscopy analysis. Two commercially available brands of single file systems were analyzed, including 15 specimens/brand as following: Group I; WaveOne 0.08/25 (Dentsply Maillefer, Ballaigues, Switzerland) and Group II; OneShape 0.06/25 (Micro Mega, Besançon, France). In each group, 3 new files were subjected to AFM analysis as received from manufacturer, and 12 files were analyzed after preparation of root canals. A total of 20 human maxillary molar teeth were selected. In each group, 12 files were divided into 4 subgroups according to instruments that were used in one or three root canals with or without a previous glide path (n = 3). After preparation the surface analysis of single files was performed on 11 different points located along a 3-mm section starting at the tip of each file using AFM. Root mean square (RMS) values were recorded to investigate the surface features of endodontic files. The differences between RMS values were tested by one-way ANOVA. There was no statistically significant difference between the groups (p > 0.05). Creation of a glide path did not affect the surface topography of single file systems.

Evaluation of surface topography changes in three NiTi file systems using rotary and reciprocal motion: An atomic force microscopy study

AIM

To evaluate the surface topography changes in three nickel-titanium (NiTi) file systems using either rotary or reciprocal motion using atomic force microscopy (AFM), and to determine the effect of scanning area on the AFM results in this study.

METHODOLOGY

Five points on a F2 Protaper file, R25 Reciproc file, and a Primary file from WaveOne systems were scanned preoperatively in 1 × 1 and 5 × 5 µm(2) with an AFM device that can scan an intact (not sectioned) file. One standardized resin block was used for each instrument, according to the manufacturer's recommendations. Points were re-scanned postoperatively using the same AFM and settings. Root-mean-square (RMS) and roughness average (Ra) values were obtained. The preoperative and postoperative surface topographies were compared separately in terms of RMS and Ra values. The surface topography change scores were analyzed using Kruskal-Wallis and Mann-Whitney U tests using a 0.10 significance level.

RESULTS

There were no significant differences preoperatively among the NiTi file systems in 1 × 1 or 5 × 5 µm(2) areas. Postoperatively, the WaveOne Primary had more surface irregularities (significant for 5 × 5 µm(2) scan in Ra evaluation).

CONCLUSIONS

Three-dimensional AFM images of instrument surfaces showed topographic irregularities preoperatively and postoperatively. AFM results differ depending on the scanning area and file used.

Comparison of air-driven vs electric torque control motors on canal centering ability by ProTaper NiTi rotary instruments

AIM

Cleaning and shaping is one of the most important phases in root canal therapy. Various rotary NiTi systems minimize accidents and facilitate the shaping process. Todays NiTi files are used with air-driven and electric handpieces. This study compared the canal centering after instrumentation using the ProTaper system using Endo IT, electric torque-control motor, and NSK air-driven handpiece.

MATERIALS AND METHODS

This ex vivo randomized controlled trial study involved 26 mesial mandibular root canals with 10 to 35° curvature. The roots were randomly divided into 2 groups of 13 canals each. The roots were mounted in an endodontic cube with acrylic resin, sectioned horizontally at 2, 6 and 10 mm from the apex and then reassembled. The canals were instrumented according to the manufacturer's instructions using ProTaper rotary files and electric torque-control motors (group 1) or air-driven handpieces (group 2). Photographs of the cross-sections included shots before and after instrumentation, and image analysis was performed using Photoshop software. The centering ability and canal transportation was also evaluated. Repeated measurement and independent t-test provided statistical analysis of canal transportation.

RESULTS

The comparison of the rate of transportation toward internal or external walls between the two groups was not statistically significant (p = 0.62). Comparison of the rate of transportation of sections within one group was not significant (p = 0.28).

CONCLUSION

Use of rotary NiTi file with either electric torquecontrol motor or air-driven handpiece had no effect on canal centering.

CLINICAL SIGNIFICANCE

NiTi rotary instruments can be used with air-driven motors without any considerable changes in root canal anatomy, however it needs the clinician to be expert.

Comparative evaluation of surface changes in four Ni-Ti instruments with successive uses - An SEM study

AIM

To evaluate the surface alterations seen in four kinds of Nickel-Titanium (Ni-Ti) instruments using a scanning electron microscope (SEM) for five successive uses in preparing root canals of extracted human molars and also to determine whether the design of the instrument influenced the appearance of defects on the instrument surface.

MATERIALS AND METHODS

Four different types of instruments namely; ProFile, ProTaper Rotary, ProTaper Hand and K3 Endo were used in 300 mesio-buccal canals. The instruments were examined under the SEM, after every use, to assess the progress of changes on their surfaces for a maximum of five uses.

STATISTICAL ANALYSIS USED

Chi-square test.

RESULTS

The most prevalent defects observed were pitting, followed by metal strips. Signs of discontinuity, microfractures and disruption of cutting edge were also evident. Number of defects increased with successive uses.

CONCLUSIONS

ProTaper Hand showed significantly more microfractures and metal strips than other instruments from third use onwards. ProTaper Rotary and K3 Endo also showed significant changes.

Shaping ability of four nickel-titanium rotary instruments in simulated S-shaped canals

INTRODUCTION

The purpose of this study was to compare the shaping ability of ProTaper, Mtwo, BioRaCe, and BioRaCe + S-Apex instruments in simulated canals with an S-shaped curvature.

METHODS

Canal transportation and aberrations were assessed by comparing the preinstrumentation and postinstrumentation images under a stereomicroscope. Analysis of variance and post hoc Student-Newman-Keuls test were used for statistical analysis.

RESULTS

ProTaper instruments caused more pronounced canal transportation in the apical curvature (P < .01) than all other instruments. The use of ProTaper, Mtwo, and BioRaCe instruments resulted in more canal aberrations compared with BioRaCe + S-Apex (P < .05).

CONCLUSIONS

NiTi systems including less tapered and more flexible instruments like S-Apex seem to be favorable when preparing S-shaped canals.

Surface finishing of unused rotary endodontic instruments: a SEM study

During endodontic therapy, cleaning of root canals is performed using endodontic files and auxiliary chemical substances, and it is important that the endodontist be familiar with the instruments used in daily practice. This study evaluated, under scanning electron microscopy (SEM), the quality of the surface finishing of unused rotary endodontic instruments. Fifty sizes 20, 25 and 30 rotary files from different commercial brands (ProFile, Protaper, Race, Hero and K3 Endo) were removed directly from their packages and had their final 3 mm examined with a scanning electron microscope at x190 magnification with no previous preparation. The images were evaluated by 3 skillful, calibrated, blinded observers according to the following criteria: cutting edge, debris, grooves, microcavities, tip shape, tip position, scraping and transition angle. Data were recorded in worksheets designed for the study. Irregular edges were observed in 50-100% of the files. Except for ProFile, all commercial brands presented surface debris in 100% of samples. Only Race files showed no grooves or microcavities. K3 Endo files presented the best tip centralization. Excetp for ProTaper files, all commercial brands presented blunt-cutting edges in 100% of samples. All types of files presented surface scraping. K3 Endo files and Protaper had a high percentage of transition angle. Based on the evaluation criteria used in the present study, most samples presented a minimum of 2 alterations and a maximum of 7 alterations per instrument. Under the tested conditions, the quality of the surface finishing of the examined instruments was not as expected, given that no instrument was free of imperfections and most of them presented at least 2 and up to 7 types of surface defects. These results suggest that the manufacturing process and the packaging conditions of rotary endodontic instruments are far from ideal.

Influence of multiple clinical use on fatigue resistance of ProTaper rotary nickel-titanium instruments

AIM

To examine the influence of clinical use on the occurrence of deformation and fracture and on the fatigue resistance of ProTaper rotary instruments.

METHODOLOGY

Root canal treatments were performed on patients using the ProTaper rotary system. Ten sets of instruments were used by an experienced endodontist, each set in five molars. Another 10 sets of instruments were used by the same operator, each set in eight molars. In addition, 10 sets of instruments were used, each set in five molars, by undergraduate students with no clinical experience with the system. After clinical use, S1, S2, F1 and F2 instruments were analysed for damage by optical and scanning electron microscopy. The used sets, along with a control group of 12 sets of new instruments, were then tested in a bench device for fatigue resistance.

RESULTS

The use of the ProTaper rotary instruments by an experienced endodontist allowed for the cleaning and shaping of the root canal system of up to eight molars without fracture. During the students work, six instruments fractured. Fatigue resistance decreased upon clinical use for all instruments analysed.

CONCLUSIONS

Fatigue resistance of used instruments was reduced, but no significant change was observed amongst the instruments used for shaping the canals of five and eight molars. Operator experience affected the occurrence of fracture and plastic deformation during shaping.

Fracture resistance of electropolished rotary nickel-titanium endodontic instruments

The purpose of this study was to investigate the effect of electropolishing on cyclic flexural fatigue and torsional strength of rotary nickel-titanium endodontic instruments. Electropolished and nonelectropolished ISO size 30 (0.04 taper) EndoWave (J Morita Corporation, Osaka, Japan), ProFile (Dentsply Maillefer, Ballaigues, Switzerland), and RaCe (FKG, La-Chaux De Fonds, Switzerland) instruments from the same manufacturing batches were investigated. The number of rotations to fracture and torque at fracture were determined and compared among the instruments tested. Instruments were viewed under a scanning electron microscope (SEM) to assess the degree and quality of electropolishing. Overall, electropolished instruments performed significantly better than nonelectropolished instruments in cyclic fatigue testing and, to a lesser extent, in static torsional loading. When viewing electropolished instruments with the SEM, milling grooves, cracks, pits, and areas of metal rollover were observed, although they were more evident in the nonelectropolished instruments. Electropolishing may have beneficial effects in prolonging the fatigue life of rotary NiTi endodontic instruments. The benefits of electropolishing are likely to be caused by a reduction in surface irregularities that serve as points for stress concentration and crack initiation.

A dozen ways to prevent nickel-titanium rotary instrument fracture

BACKGROUND

and Overview. With the increased use of nickel-titanium (NiTi) rotary instruments for root canal preparation in endodontics, instrument fracture has become more prevalent. Extensive research has been conducted on the physical properties and mechanical characteristics of NiTi rotary instruments, as well as the factors that can contribute to instrument failure. NiTi rotary instruments are subjected to torque and are susceptible to cyclic fatigue, which are the main causes of instrument fracture. However, with an understanding of how these instruments function in preparing root canals and by applying ways to reduce torque-generated metal fatigue, clinicians can use the instruments safely in clinical practice.

RESULTS

The author presents 12 measures that clinicians can take to prevent NiTi rotary instrument fracture and discusses them in detail.

CLINICAL IMPLICATIONS

NiTi rotary instrument fracture complicates the progress, and compromises the prognosis of endodontic treatment. However, when clinicians take appropriate measures, rotary instrument fractures can be prevented.

Rotary NiTi Instrument Fracture and its Consequences

The fracture of endodontic instruments is a procedural problem creating a major obstacle to normally routine therapy. With the advent of rotary nickel-titanium (NiTi) instruments this issue seems to have assumed such prominence as to be a considerable hindrance to the adoption of this major technical advancement. Considerable research has been undertaken to understand the mechanisms of failure of NiTi alloy to minimize its occurrence. This has led to changes in instrument design, instrumentation protocols, and manufacturing methods. In addition, factors related to clinician experience, technique, and competence have been shown to be influential. From an assessment of the literature presented, we derive clinical recommendations concerning prevention and management of this complication.

Nickel-titanium rotary instrument fracture: a clinical practice assessment

AIM

To prospectively determine the incidence of nickel-titanium rotary instrument fracture in an endodontic clinical practice setting.

METHODOLOGY

Eleven second year endodontic residents, using four nickel-titanium rotary instrument systems (ProFile, ProTaper, GTRotary and K3Endo) according to the recommendations of the manufacturers, instrumented 3181 canals in 1403 teeth of 1235 patients, in a dental school post-graduate endodontic clinic, in 1 year. The incidence of instrument fracture was determined based on the number of instruments used. When fracture occurred, data were collected concerning the type, size, taper and prior use of the fractured instruments, the length and location of the fragment within the root canal and the curvature of the canal.

RESULTS

The overall incidence of instrument fracture was 0.39%. The incidence of fracture for ProFile, ProTaper, GTRotary and K3Endo files was 0.28%, 0.41%, 0.39% and 0.52%, respectively. There was no statistically significant difference between instrument systems. The percentage of teeth in which instruments fractured was 1.9% (0.28% for anterior teeth, 1.56% for pre-molars and 2.74% for molars). A total of 26 instruments fractured, of which 23 had tapers of 0.06 or greater. Most of the fragments were located in the apical third of the root canal, and both the median and mode amongst the fragment lengths were 2 mm.

CONCLUSIONS

The low incidence of nickel-titanium rotary instrument fracture supports the continued use of these instruments in root canal treatment.

Atomic Force Microscopy Study of Stainless-Steel and Nickel-Titanium Files

Atomic force microscopy (AFM) is a well established and documented tool for materials investigation. The aim of this study was to evaluate the topography of conventional stainless-steel files and both hand and rotary nickel-titanium (NiTi) files by using AFM. One endodontic file of each of the following was selected: stainless-steel K-file Dentsply, stainless-steel K-file Moyco, hand NiTi K-file Nitiflex, hand NiTi Greater Taper, rotary NiTi Greater Taper, and rotary NiTi Quantec. The analyses were performed on twenty different points located along a 3-mm section starting at the tip of each file. Root mean square (RMS) parameters for contact mode imaging microscopy variations were measured. The differences between RMS values were tested by ANOVA with Fisher's protected LSD test for multiple comparisons (p < 0.05). RMS of depth profile data was used to determine any statistically significant difference in vertical amplitude. According to results, all instruments showed topographic irregularities distributed on surface. Endodontic files manufactured by the same method and alloy demonstrated significant differences, whereas no significant differences were found for instruments produced by different alloys and methods (p < 0.05). The hand NiTi Greater Taper, rotary NiTi Greater Taper, and rotary NiTi Quantec showed greater values of vertical amplitude topography compared to K-Dentsply and Nitiflex files (p < 0.05). The AFM technique proved to be a valuable research tool in the investigation of endodontic files topography.

Defects in ProTaper S1 instruments after clinical use: longitudinal examination

AIM

To evaluate defects in ProTaper shaping instrument S1 after a defined schedule of clinical use.

METHODOLOGY

Among all ProTaper files discarded from an endodontic clinic at a stomatological school in China over a period of 17 months, 122 S1 instruments were collected. They were ultrasonically cleaned, autoclaved and then examined in the laboratory. Any instrument separation was noted; the average length involved was determined. The 0.5 mm region on either side of this length of discarded but intact instruments was examined circumferentially by scanning electron microscope. The region adjacent to the broken end of the fractured instruments was also examined in the same way.

RESULTS

One specimen was lost during processing. Of the remaining 121 instruments, 27 were separated with a mean fracture length of 3.67 mm from the tip. Of these, two files showed macroscopically torsional fracture and the others showed signs of flexural fatigue. Only one file that had not fractured showed visible unwinding defects. Examination of the 3.1-4.1 mm region of other unfractured instruments revealed the presence of microcracks, surface debris, pitting and/or wear of their cutting edges. Some debris particles seemed to have been trapped in crack-like structures.

CONCLUSIONS

Multiple use of ProTaper S1 pre-disposed the instrument to microcrack formation and wear of the cutting edges. There was a low prevalence of plastic deformation and most ProTaper S1 instruments failed without discernible sign of unwinding of the flutes. Further studies should address the mode of failure and the role of debris particles in the fracture mechanism.

SEM observations of nickel-titanium rotary endodontic instruments that fractured during clinical Use

Numerous discarded ProFile GT, ProFile, and ProTaper nickel-titanium rotary instruments obtained from two graduate endodontic clinics were examined by scanning electron microscopy. These instruments had an unknown history of clinical use and had fractured or experienced considerable permanent torsional deformation without complete separation. The failure processes generally exhibited substantial ductile character, evidenced by a dimpled rupture fracture surface. Crack propagation at grain boundaries and cleavage surfaces indicative of transgranular fracture were observed for some specimens. It appeared that oxide particles from the manufacturing process served as nucleating sites for the microvoids, leading to dimpled rupture. A previously unreported fracture mode also was observed, in which crack propagation, approximately parallel to the local flute orientation, connected pitted regions on the surface. Combining present and previous scanning electron microscopy observations of clinically failed instruments, suggestions are offered for improving their fracture resistance.

Proposed Role of Embedded Dentin Chips for the Clinical Failure of Nickel-Titanium Rotary Instruments

Discarded ProFile and ProTaper nickel-titanium rotary instruments, with unknown history of clinical use, were obtained from graduate endodontic clinics at Ohio State University and University of Texas Health Science Center at Houston Dental Branch. These discarded instruments and as-received instruments of both types were examined with a scanning electron microscope to investigate effects of clinical use and causes of failure. For used ProTaper instruments, dentinal debris was wedged mostly in narrow, radial, land-type regions and less on convex flute surfaces. For used ProFile instruments, dentinal debris was wedged mostly in the metal rollover and on concave flute surfaces. Used instruments of both types exhibited widened machining grooves, and elongated and stretched roll-over. Dentin chips were wedged in surface micro-cracks that appeared to propagate from original machining flaws and widen during in vivo root canal preparation. From our observational study, wedged dentinal deposits seem to play a pivotal role for clinical failure of these instruments.

Scanning electron microscope observations of new and used nickel-titanium rotary files

The appearances of the tip sections of ProFile 0.04 taper and Lightspeed 25-mm long, ISO size 25, nickel-titanium rotary instruments were compared with a scanning electron microscope in the as-received condition and after one, three, and six simulated clinical uses to prepare mesial canals of extracted mandibular molars. For the used ProFile instruments, there was some flattening of the characteristic material rollover and minor apparent wear at the edges of the flutes, but there was little change in the tip regions of the used Lightspeed instruments. Deposits on the surfaces of the instruments were attributed to the manufacturing processes and the in vitro preparation of root canals in the extracted teeth. The simulated clinical use did not cause substantial changes in the regions of these two brands of rotary instruments that are involved in the clinical preparation of root canals.