Fatigue and nanomechanical properties of K3XF nickel-titanium instruments

A critical evaluation of physical and manufacturing properties of genuine and counterfeit rotary nickel-titanium endodontic instruments

BACKGROUND

Rotary nickel-titanium (NiTi) instruments are made to exacting standards and are costly to manufacture, and quality control is paramount. Consequently, unauthorized factories make counterfeit instruments that are less expensive and may therefore be attractive to dentists. Little information exists about the metallurgy and manufacturing quality of such instruments. There is the potential for counterfeit instruments to be at higher risk of fracture during treatment, thereby compromising clinical outcomes. The aim of this study was to evaluate physical and manufacturing properties of genuine and counterfeit ProTaper Next™ and Mtwo® rotary NiTi instruments.

METHODS

This study investigated the metallurgical properties, manufacturing quality, microhardness and number of cycles to failure of two commonly used rotary NiTi systems and compared them with counterfeit products purporting to be genuine articles.

RESULTS

Counterfeit instruments were found to be inferior in manufacturing standards and were less resistant to cyclic fatigue when compared to genuine instruments.

CONCLUSIONS

Counterfeit rotary NiTi instruments may be less efficient at preparing root canals and may be at higher risk of fracture during endodontic treatment. Dentists must be aware that, although less expensive, counterfeit instruments may be of dubious manufacturing quality and at higher risk of fracture if used in patients. © 2023 Australian Dental Association.

Effect of body temperature on the cyclic fatigue resistance of the nickel”titanium endodontic instruments: A systematic review and meta-analysis of in vitro studies

Aim:

The aim of this systematic review was to compare the effect of body temperature (I) on the cyclic fatigue resistance (O) of nickel–titanium (NiTi) endodontic instruments (P) to that of room temperature (C).

Methods:

The study was registered in the PROSPERO database (CRD42020204286). A systematic search in PubMed, Scopus, Web of Science, Google Scholar, and OpenGrey was conducted in English until December 31, 2021. In vitro studies comparing the cyclic fatigue resistance of NiTi instruments at the body (35°C ± 2°C) and room temperature (20°C–25°C) were included. Eligible studies were evaluated for risk of bias and meta-analyzed to estimate the effects.

Results:

Twenty-one studies out of 347 met the criteria for inclusion. The meta-analysis included six studies (n = 215) with comparative study parameters. The overall effect sizes (5.49; 95% confidence interval [CI]: 4.04–6.93) were significantly different (P < 0.001), indicating that the mean values at room temperature were significantly (P < 0.001) higher. The effect sizes for full rotary motion (standardized mean difference [SMD]: 4.80; 95% CI: 3.04–6.56) and reciprocating motion (SMD: 6.37; 95% CI: 3.63–9.11) were not significantly different (P = 0.346). Heterogeneity was high (I² = 94%). Sensitivity analysis revealed that the SMD values were not significantly different (P > 0.05) from the overall effect size, indicating that none of the studies had an effect on the overall effect size.

Conclusions:

Within the limitation of the study, the cyclic fatigue resistance of heat-treated NiTi endodontic files is significantly reduced at body temperature when compared to room temperature. Cyclic fatigue testing should be conducted at simulated body temperature.

Cyclic Fatigue Resistance of Blue Heat-Treated Instruments at Different Temperatures

The main aim is to evaluate the cyclic fatigue resistance of blue heat-treated instruments with different kinematics. Twenty-four endodontic instruments of the same brand were used for each of three experimental groups: VB (Vortex Blue 40/0.04), RB (RECIPROC Blue 40/0.06), and XB (X1 Blue 40/0.06). The instruments were randomly distributed and subjected to temperatures of 20°C and 37°C. The fatigue test was performed using a stainless steel device. Data were analysed using the Shapiro-Wilk test, Student's t-test, the F test, and Tukey's and Tamhane tests at significance level P=0.05. The instruments' cyclic fatigue resistance at both temperatures differed significantly for each instrument type (P < 0.001). The RB instruments displayed greater cyclic fatigue resistance at the tested temperatures compared with the VB and XB instruments (P < 0.001). Reciprocating kinematics positively influenced cyclic fatigue resistance. Blue heat-treated instruments showed decreased cyclic fatigue resistance as the temperature increased (P < 0.001).

The Effect of Taper and Apical Diameter on the Cyclic Fatigue Resistance of Rotary Endodontic Files Using an Experimental Electronic Device

The aim of this study was to analyze the effect of the taper and apical diameter of nickel–titanium (NiTi) endodontic rotary files on the dynamic cyclic fatigue resistance. A total of 50 unused conventional NiTi wire alloy endodontic rotary instruments were used in this study. All NiTi endodontic rotary files were submitted to a custom-made dynamic cyclic fatigue device until fracture occurred. The time to failure, the number of cycles to failure, the number of pecking movements, and the length of the fractured file tip were analyzed using the analysis of variance (ANOVA) test. In addition, the Weibull characteristic strength and Weibull modulus were also calculated. The paired t-test revealed statistically significant differences between the time to failure, number of cycles to failure, and number of cycles of in-and-out movement of both the apical diameter (p ˂ 0.001) and the taper (p ˂ 0.001) of NiTi endodontic rotary files; however, the results did not show statistically significant differences between the mean length of the fractured files regarding the apical diameter (p = 0.344) and taper study groups (p = 0.344). Increased apical diameter and taper of NiTi endodontic rotary files decreased their dynamic resistance to cyclic fatigue.

Effects of continuous irrigation at room temperature or +4ºC on the cyclic fatigue resistance of K3XF instruments

Background. The present study aimed to evaluate the impact of continuous irrigation with saline solution at room temperature or +4°C on the cyclic fatigue resistance of K3XF files.

Methods. Forty-eight new K3XF files (#30, .04 taper) were randomly assigned to three groups: control group (no irrigation), continuous irrigation with saline solution at room temperature, and continuous irrigation with saline solution at +4°C. The instruments were tested in an artificial, stainless steel root canal with a double curvature at body temperature (37±1°C). Time to fracture was converted to the number of cycles to fracture (NCF). The lengths of the fractured fragments were recorded. Kruskal–Wallis H test and one-way ANOVA were used to analyze data.

Results. K3XF files’ cyclic fatigue resistance was significantly higher in the continuous irrigation groups than in the control group. Continuous irrigation with saline solution at +4°C resulted in higher cyclic fatigue resistance than continuous irrigation with saline solution at room temperature. There were no significant differences between the groups in terms of the fractured fragments’ length.

Conclusion. Within this study’s limitations, continuous irrigation with saline solution increased the NCF of NiTi instruments; decreasing the saline solution’s temperature increased this effect.

Cyclic Fatigue Resistance of Nickel-titanium Rotary Instruments according to the Angle of File Access and Radius of Root Canal

INTRODUCTION

The aim of this study was to compare the influences from different access angles and curvature radii on cyclic fatigue resistance of nickel-titanium rotary files.

METHODS

Two file systems (2Shape [TS; MicroMega, Besançon, France] and HyFlex CM [HCM; Coltène/Whaledent, Allstätten, Switzerland]) were used. A total of 192 instruments of TS #25/.04 (TS1), TS #25/.06 (TS2), HCM #25/.04, and HCM #25/.06 were evaluated at 3 insertion angles (0°, 10°, and 20°) and 2 radii (5 mm and 3 mm) in 16-mm stainless steel artificial canals with a 60° curvature. Cyclic fatigue resistance was determined by the number of cycles to failure (NCF) using a customized testing device. Data were analyzed statistically with the significance level established at 95%.

RESULTS

In the 3-mm radius canal, the instruments showed lower cyclic fatigue resistance than in the 5-mm radius canal (P < .05). HCM #25/.06 and all .04 taper instruments had a significant NCF reduction at 20° and 10° in the 3-mm radius canal (P < .05), whereas TS2 showed no significant differences. In the 5-mm radius of curvature, although .06 taper instruments had no significant NCF reduction for each angle tested, .04 taper files exhibited significant NCF reduction when tested at 20° (P < .05). Comparing the same size instruments, HCM had higher NCF than TS (P < .05). Instruments with a .04 taper exhibited higher NCF than the .06 ones with the same heat treatment (P < .05).

CONCLUSIONS

An inclined insertion into the canals decreased cyclic fatigue resistance of thermal-treated instruments with a .04 taper at all radii of curvature tested. The synergistic effect of a small radius of curvature and access angulation of heat-treated instruments decreases their fatigue resistance.

Fatigue resistance of ProTaper gold exposed to high-concentration sodium hypochlorite in double curvature artificial canal

This study aimed to evaluate and compare the fatigue resistance of ProTaper Gold (PTG) and ProTaper Universal (PTU) in artificial single and double curvature canals in 5% sodium hypochlorite (NaOCl) at body temperature (37 °C). PTG and PTU files (size F1) were subjected to fatigue tests in two different artificial ceramic canals. The single curvature model had a 60° curvature angle with a 5 mm radius. The double curvature model had a 60° curvature angle with a 5 mm radius and a second 30° curvature with a 2 mm radius. A file segment was introduced into the artificial canal and immersed in water or 5% NaOCl at 37 °C. The total number of cycles to fracture (NCF) was recorded. Data were analyzed using t-test and linear regression analysis. The NCF of all files was significantly influenced by the type of NiTi metal alloy (P < .01), canal curvatures (P < .01), and the environmental conditions (P < .05). PTG had higher fatigue resistance than PTU files in both single and double curvature canals (P < .05). The NCF of PTU files in 5% NaOCl was shorter than that in water (P < .05). The mean length of broken PTG was significantly shorter than those of PTU files in both single and double curvature canals (P < .01). The fatigue performance of PTG is better than that of PTU in both single and double curvature. Environmental conditions may affect the fatigue behavior of PTU files with single curvature.

A critical appraisal of studies on cyclic fatigue resistance of engine-driven endodontic instruments

The endodontic literature contains a plethora of studies on static and dynamic cyclic fatigue resistance tests performed on a large array of rotary or reciprocating nickel-titanium endodontic instruments. It was the aim of this review to summarize the currently available evidence to point out the different outcomes from static versus dynamic tests and to assess whether cyclic fatigue tests provide useful data and information for clinical practice. An electronic literature research in the database PubMed was performed using appropriate search terms, and the titles and abstract were screened for relevance. Language was restricted to English. The review reveals marked differences between the results obtained in static and dynamic tests, and also, the results for the same instruments assessed either under static or dynamic experimental conditions are widely inconsistent. Between the lowest and the highest value for one and the same pathfinding instrument was a factor of about 123 when cyclic fatigue was assessed either under static or dynamic experimental conditions. Moreover, standard deviations of up to 30% have been reported. Environmental temperature has a 500% impact on the lifetime of instruments. In conclusion, fatigue resistance tests conducted under room temperature should be regarded as having little meaning and the scientific and clinical benefits of fatigue resistance tests are very limited. These data should be provided by the manufacturer of the instruments.

Nickel-titanium instruments in endodontics: a concise review of the state of the art

The introduction of automated instrumentation in endodontics represented a major advance in progress for this specialty, with improvements in the quality and predictability of root canal preparation and a significant reduction in procedural errors. In recent years, endodontic instruments have undergone a series of changes brought about by modifications in design, surface treatments, and thermal treatments. In addition, new movements have also been incorporated to offer greater safety and efficiency, optimizing the properties of the NiTi alloy, especially through eccentric rotary motion. An understanding of the mechanical properties of these new NiTi instruments and their effect on the clinical performance of root canal preparation is essential if dental practitioners are to select the instruments that provide optimal clinical outcomes, especially in curved or flattened canals. The objective of this literature review is to present and discuss the characteristics of the NiTi alloys used in the major instrumentation systems available in the market, as well as the influence of the metallurgical and mechanical properties of NiTi instruments and the movements that drive them, to enable more accurate and predictable planning of root canal preparation.

Rotary science and its impact on instrument separation: A focused review

Efficient endodontic treatment demands thorough debridement of the root canal system with minimal procedural errors. The inherent weakness of nickel-titanium alloys is their unexpected breakage. Modifications in the design, manufacturing, thermomechanical and surface treatment of alloys and advancements in movement kinetics have shown to improve the fatigue properties of the alloys, reducing the incidence of separation. This review enlightens the impact of these factors on fatigue properties of the alloy.

Fracture Resistance of K3 Nickel-Titanium Files Made from Different Thermal Treatments

The purpose of this study was to compare fracture resistances of K3 nickel-titanium files made from different thermal treatments. K3 (SybronEndo, Orange, CA), K3XF (SybronEndo), and experimentally heat treated K3 (K3H) were used. For the cyclic fatigue test, the samples were rotated with up-and-down motion in the artificial canal with the curvature of 60 degrees until the fracture occurred. The number of cycles to fracture (NCF) was measured. For the torsional fracture test, the samples were tightly bound and rotated until the fracture occurred. Elastic modulus (EM), ultimate torsional strength (UTS), and angle of rotation to fracture (ARF) were measured. The results were statistically analyzed by one-way ANOVA. The NCF of K3H was higher than those of K3 and K3XF (P < 0.05). The EM of K3XF and K3H was lower than that of K3 (P < 0.05). There was no significant difference in UTS. The ARF of K3XF was higher than that of K3 (P < 0.05). K3XF and K3H showed more flexibility than K3. The maximum torsional angle of K3XF was higher than that of K3, but there was no significant difference on the UTS in all three groups.