Validated finite element analyses of WaveOne Endodontic Instruments: a comparison between M-Wire and NiTi alloys

3D Surface Scanning-A Novel Protocol to Characterize Virtual Nickel-Titanium Endodontic Instruments

The nickel-titanium (NiTi) instruments' geometry plays an important role in their performance and behavior. The present assessment intends to validate and test the applicability of a 3D surface scanning method using a high-resolution laboratory-based optical scanner to create reliable virtual models of NiTi instruments. Sixteen instruments were scanned using a 12-megapixel optical 3D scanner, and methodological validation was performed by comparing quantitative and qualitative measurements of specific dimensions and identifying some geometric features of the 3D models with images obtained through scanning electron microscopy. Additionally, the reproducibility of the method was assessed by calculating 2D and 3D parameters of three different instruments twice. The quality of the 3D models created by two different optical scanners and a micro-CT device was compared. The 3D surface scanning method using the high-resolution laboratory-based optical scanner allowed for the creation of reliable and precise virtual models of different NiTi instruments with discrepancies varying from 0.0002 to 0.0182 mm. The reproducibility of measurements performed with this method was high, and the acquired virtual models were adequate for use in in silico experiments, as well as for commercial or educational purposes. The quality of the 3D model obtained using the high-resolution optical scanner was superior to that acquired by micro-CT technology. The ability to superimpose virtual models of scanned instruments and apply them in Finite Element Analysis and educational purposes was also demonstrated.

Influence of Cross-Section and Pitch on the Mechanical Response of NiTi Endodontic Files under Bending and Torsional Conditions—A Finite Element Analysis

In this article, the effects of cross-section and pitch on the mechanical response of NiTi endodontic files is studied by means of finite element analyses. The study was conducted over a set of eight endodontic rotary files, whose geometry was obtained from combinations of two cross-sections(square and triangular) and four pitches. Each file was subjected to bending and torsional analyses, simulating the testing conditions indicated in the ISO 3630 Standard, in order to assess their stiffness and mechanical strength. The results indicate that endodontic files with a square cross-section have double the stiffness of those with triangular cross-sections, both in terms of bending and torsion. For both loading modes, endodontic files with a triangular cross-section can undergo larger deformations before overload failure than those with a square cross-section: up to 20% more in bending and 40% in torsion. Moreover, under equivalent boundary conditions, endodontic files with triangular cross-sections present a higher fatigue life than those with square cross-sections: up to more than 300% higher for small pitches. The effect of pitch on the stiffness and strength of the file is smaller than that of the cross-section shape, but smaller pitches could be beneficial when using a triangularcross-section, as they increase the bending flexibility, fatigue life, and torsion stiffness. These results suggest a clinical recommendation for the use of files with a triangular-shaped cross-section and a small pitch in order to minimize ledging and maximize fatigue life. Finally, in this study, we reveal the sensitivity of the orientation of files with respect to the bending direction, which must be taken into account when designing, reporting, and interpreting test results under such loading conditions.

Present Status and Future Directions - Canal Shaping

This narrative review will focus on the evolution, present and future of engine‐driven root canal preparation. Root canal preparation changed drastically when Walia in 1988 introduced the use of nickel‐titanium (NiTi) alloys in Endodontics. In 2013, five generations of NiTi endodontic instruments had been established based on their metallurgical, mechanical properties and design features. Since then, manufacturers have been introducing further major changes in instrument design and characteristics that have not been translated in new recognized generations of instruments. In general, those changes have demonstrated enhanced instrument properties, but it is not clear yet if all those improvements are directly translated to an improvement in clinical success. This narrative review attempts to address the present status of engine‐driven instruments in terms of both evidence from laboratory‐based studies and clinical data, to identify potential further generations of instruments, and last to anticipate future directions for research and development.

Finite element analysis of rotary nickel-titanium endodontic instruments: A critical review of the methodology

Finite element analysis has been a valuable research tool for rotary nickel-titanium endodontic files over the last two decades. This review aims to summarise and critique the methodology as used in currently available endodontic literature for finite element analysis of rotary nickel-titanium instruments. An electronic literature research in PubMed and Scopus databases was performed using the appropriate search terms, and the titles and abstracts were screened for relevance. The review revealed an inconsistent approach to the finite element method, particularly with regards to the boundary conditions in which the instruments are tested. Moreover, there is a lack of experimental data to validate in silico findings. A standardised protocol to finite element analysis of rotary endodontic instruments could be considered for future studies.

Evaluation of Pressure Distribution against Root Canal Walls of NiTi Rotary Instruments by Finite Element Analysis

The aim of this study was to evaluate the contact pressure distribution of two different nickel-titanium (NiTi) endodontic rotary instruments against the root canal walls and to virtually predict their centering ability during shaping with finite element analysis (FEA). Resin blocks simulating root canals were used. One was shaped with ProGlider and ProTaper Next (PTN) X1-X2 and one with ScoutRace and BioRace (BR) 1, 2 and 3. Both resin blocks were virtually replicated with computer-aided design (CAD) software. The endodontic instruments ProTaper Next (PTN) X2 and BioRace BR3 were also replicated with CAD. The NiTi instruments and the shaped blocks geometries were discretized and exported for FEA. The instrument rotation in the root canals was simulated. The finite element simulation was performed by applying an insertion and extraction force of 2.5 N with a constant rotational speed (300 rpm). To highlight possible differences between pressure distributions against the root canal portions outside and inside the canal curvature, the parameter Var was originally defined. Var values were systematically lower for PTN X2, revealing a better centering ability. FEA proved effective for the virtual prediction of the centering ability of NiTi instruments during an early design phase without the use of prototypes.

Fracture and deformation of ProTaper Next instruments after clinical use

Background

The aim of this study was to evaluate the fracture and defects observed in ProTaper Next files discarded after a normal clinical use.

Material and Methods

571 ProTaper Next rotary instruments were collected after clinical use from the clinic of endodontics over 12 months. The length of the files was measured using a digital caliper to determine any fracture, later all the files were evaluated under a stereomicroscope to observe defects such as unwinding, curving or fracture. The data obtained were analyzed using a chi-square and z test.

Results

13.83% of the discarded files showed defects, the most frequent defect was fracture (7.53%). The highest rate of fracture was observed in the X1 (17.04) files (19.87%). The presence of deformations without fracture was also more frequent in the 17.04 file (11.8%).

Conclusions

Because of the relatively high incidence of deformation of smaller files, these instruments should be considered as a single use. It is important not to exceed the maximum uses recommended by the manufacturer to reduce the risk of cyclic fatigue, the main cause of fracture of the files (79.07%). It is also important to observe each file after use to discard small defects or fractures.

Key words:Clinical use, deformation, fracture, M-Wire, ProTaper Next.

Does adding an instrument after root preparation with Reciproc® R25 increase bacterial reduction?

Aim

The aim of this study was to compare the bacterial reduction achieved with reciprocating instruments such as Reciproc^® R25 (VDW GMBH, Munich, Germany) and Reciproc^® R25 combined with rotary file Mtwo 40.04 (VDW GMBH) during root canal preparation.

Materials and Methods

Fifty mesiobuccal root canals of maxillary molars were contaminated with Enterococcus faecalis broth culture and then an initial bacterial sample was collected from the root canal with paper cones and plated on brain-heart infusion agar. The root canals were divided into four groups as follows: Reciproc^® R25 (n = 20) and Reciproc^® R25 combined with Mtwo 40.04 instrument (n = 20). The negative controls consisted of five uncontaminated root canals and the positive control consisted of five contaminated roots that were not subjected to any decontamination procedure. Irrigation was performed using sodium chloride. After instrumentation, samples were collected with paper cones and the rate of bacterial reduction was calculated. Microbiological testing (colony-forming units [CFUs]) was performed to quantify the decontamination obtained by the proposed protocols. Statistical analysis was performed by paired t-test and analysis of variance test.

Results

Both techniques significantly reduced the number of bacteria in the root canal (P < 0.05), with no significant difference among them (P > 0.05).

Conclusion

The addition of the instrument Mtwo 40.04 after the root preparation with the instrument R25 does not improve its decontamination capability.

The effects of shape memory alloys’ tension–compression asymmetryon NiTi endodontic files’ fatigue life

Nowadays, NiTi rotary endodontic files are of great importance due to their flexibility which enables the device to cover all the portions of curved canal of tooth. Although this class of files are flexible, intracanal separation might happen during canal preparation due to bending or torsional loadings of the file. Since fabrication and characterization of such devices is challenging, time-consuming, and expensive, it is preferable to predict this failure before fabrication using numerical models. It is demonstrated that NiTi shape memory alloy shows asymmetric material response in tension and compression which can significantly affect the lifetime of the files fabricated from. In this article, the effects of this material asymmetry on the bending response of rotary files are assessed using finite element analysis. To do so, a constitutive model which takes material asymmetry into account is used in combination with the finite element model of a RaCe file. The results show that the material asymmetry can significantly affect the maximum von Mises equivalent stress as well as the force–displacement response of the tip of this file.

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.

Root canal volume change and transportation by Vortex Blue, ProTaper Next, and ProTaper Universal in curved root canals

Objectives

The aim of this study was to compare root canal volume change and canal transportation by Vortex Blue (VB; Dentsply Tulsa Dental Specialties), ProTaper Next (PTN; Dentsply Maillefer), and ProTaper Universal (PTU; Dentsply Maillefer) nickel-titanium rotary files in curved root canals.

Materials and Methods

Thirty canals with 20°-45° of curvature from extracted human molars were used. Root canal instrumentation was performed with VB, PTN, and PTU files up to #30.06, X3, and F3, respectively. Changes in root canal volume before and after the instrumentation, and the amount and direction of canal transportation at 1, 3, and 5 mm from the root apex were measured by using micro-computed tomography. Data of canal volume change were statistically analyzed using one-way analysis of variance and Tukey test, while data of amount and direction of transportation were analyzed using Kruskal-Wallis and Mann-Whitney U test.

Results

There were no significant differences among 3 groups in terms of canal volume change (p > 0.05). For the amount of transportation, PTN showed significantly less transportation than PTU at 3 mm level (p = 0.005). VB files showed no significant difference in canal transportation at all 3 levels with either PTN or PTU files. Also, VB files showed unique inward transportation tendency in the apical area.

Conclusions

Other than PTN produced less amount of transportation than PTU at 3 mm level, all 3 file systems showed similar level of canal volume change and transportation, and VB file system could prepare the curved canals without significant shaping errors.

Micro-computed Tomography versus the Cross-sectioning Method to Evaluate Dentin Defects Induced by Different Mechanized Instrumentation Techniques

INTRODUCTION

The objective of this study was to compare the methods of micro-computed tomography (micro-CT) and cross-sectioning followed by stereomicroscopy in assessing dentinal defects after instrumentation with different mechanized systems.

METHODS

Forty mesial roots of mandibular molars were scanned and divided into 4 groups (n = 10): Group R, Reciproc; Group PTN, ProTaper Next; Group WOG, WaveOne Gold; Group PDL, ProDesign Logic. After instrumentation, the roots were once again submitted to a micro-CT scan, and then sectioned at 3, 6, and 9 mm from the apex, and assessed for the presence of complete and incomplete dentinal defects under a stereomicroscope. The nonparametric Kruskal-Wallis, Friedman, and Wilcoxon tests were used in the statistical analysis. The study used a significance level of 5%.

RESULTS

The total number of defects observed by cross-sectioning followed by stereomicroscopy was significantly higher than that observed by micro-CT, in all of the experimental groups (P ≤ .05). All of the defects identified in the postoperative period were already present in the corresponding preoperative period. There was no significant difference among the instrumentation systems as to the median numbers of defects, for either cross-sectioning followed by stereomicroscopy or micro-CT, at all the root levels (P > .05). In the micro-CT analysis, no significant difference was found between the median numbers of pre- and postinstrumentation defects, regardless of the instrumentation system (P > .05).

CONCLUSION

None of the evaluated instrumentation systems led to the formation of new dentin defects. All of the defects identified in the stereomicroscopic analysis were already present before instrumentation, or were absent at both time points in the micro-CT analysis, indicating that the formation of new defects resulted from the sectioning procedure performed before stereomicroscopy and not from instrumentation.

Influence of Operator's Experience on the Shaping Ability of Protaper Universal and Waveone Systems: A Comparative Study on Simulated Root Canals

OBJECTIVE

To assess the influence of operator experience on: shaping and centering ability, mean preparation time and presence of canal aberrations of ProTaper Universal and WaveOne systems on simulated root canals.

MATERIALS AND METHODS

Sixty S-shaped canals in resin blocks were assigned to four groups (n=15 for each group). Group1 (Experienced operator, ProTaper), Group2 (Experienced operator, WaveOne), Group3 (Inexperienced operator, ProTaper), Group4 (Inexperienced operator, WaveOne). Photographic method was used to record pre- and post-instrumentations images. After superimposition, it has been evaluated presence of canal aberrations and differences in shaping and centering ability between groups.

RESULTS

WaveOne system produced a lower amount of canal aberrations both in the hand of expert than inexpert operators. However, a WaveOne instrument breakage occurred in the hands of an inexperienced operator. No differences have been found in the evaluation of shaping ability with both systematics. Operator's experience doesn't influence the shaping ability of ProTaper and WaveOne systems.

CONCLUSION

Experience factor could influence the centering ability in the use of both the systematics. However, WaveOne Primary reduce the mean preparation time and the presence of canal aberrations.

Preference of undergraduate students after first experience on nickel-titanium endodontic instruments

Objectives

This study aimed to compare two nickel-titanium systems (rotary vs. reciprocating) for their acceptance by undergraduate students who experienced nickel-titanium (NiTi) instruments for the first time.

Materials and Methods

Eighty-one sophomore dental students were first taught on manual root canal preparation with stainless-steel files. After that, they were instructed on the use of ProTaper Universal system (PTU, Dentsply Maillefer), then the WaveOne (WO, Dentsply Maillefer). They practiced with each system on 2 extracted molars, before using those files to shape the buccal or mesial canals of additional first molars. A questionnaire was completed after using each file system, seeking students' perception about 'Ease of use', 'Flexibility', 'Cutting-efficiency', 'Screwing-effect', 'Feeling-safety', and 'Instrumentation-time' of the NiTi files, relative to stainless-steel instrumentation, on a 5-point Likert-type scale. They were also requested to indicate their preference between the two systems. Data was compared between groups using t-test, and with Chi-square test for correlation of each perception value with the preferred choice (p = 0.05).

Results

Among the 81 students, 55 indicated their preferred file system as WO and 22 as PTU. All scores were greater than 4 (better) for both systems, compared with stainless-steel files, except for 'Screwing-effect' for PTU. The scores for WO in the categories of 'Flexibility', 'Screwing-effect', and 'Feeling-safety' were significantly higher scores than those of PTU. A significant association between the 'Screwing-effect' and students' preference for WO was observed.

Conclusions

Novice operators preferred nickel-titanium instruments to stainless-steel, and majority of them opted for reciprocating file instead of continuous rotating system.

Prevention and management of fractured instruments in endodontic treatment

Intracanal instrument fracture is an unpredictable and problematic occurrence that can prevent adequate cleaning and shaping procedures and influence the prognosis of endodontic treatment. The prevalence of instrument fracture is reported to range between 0.28% and 16.2%. This article presents an overview of the prevention and management of instruments fractured during endodontic therapy on the basis of literature retrieved from PubMed and selected journal searches. Instrument fracture occurs because of reduced metal fatigue and/or torsional resistance. The reasons include canal morphology and curvature, manufacturing processes and instrument design, instrument use times and technique, rotational speeds and operator experience. With the development of various equipment and techniques, most of the retained instrument separations can be removed safely. However, in canals without associated periapical disease not every fractured separation should be removed from difficult locations because of the increased risk for root perforation and fracture. In difficult cases, either retain or bypass the fragment in the root canal and ensure regular follow-up reviews. Fractured instruments retained in the presence of periapical disease reduce significantly the prognosis of endodontically treated teeth, indicating a greater need to attempt the removal or bypass of the file separations. Apical surgery might be required in some instances, emphasizing the importance of preventing instrument fracture.