Influence of sodium hypochlorite on fracture properties and corrosion of ProTaper Rotary instruments

Effect of phytic acid on chemical, structural, and mechanical characteristics of nickel-titanium endodontic files

This study investigated phytic acid (IP6) effect on chemical, structural, and mechanical characteristics of nickel-titanium (NiTi) files. The tested files were equally divided into groups according to the immersion protocol: sodium hypochlorite (NaOCl), ethylenediaminetetraacetic acid (EDTA), IP6, EDTA followed by NaOCl, and IP6 followed by NaOCl. These groups were then compared in terms of Ni, Ti, and chromium (Cr) ions release from the files. Microstructural changes using field emission scanning electron microscope (Fe-SEM) and energy dispersive X-ray spectroscopy (EDX) and surface roughness were analyzed. The mechanical characterization was conducted using cyclic fatigue resistance test. Fractured segments were scanned under SEM. Statistical analysis was performed using one-way ANOVA, Tukey test, Kruskal-Wallis test and Mann-Whitney U test. Results showed that NaOCl caused significant release of Cr, followed by IP6 and EDTA (P < 0.05). When files were pre-immersed in EDTA, NaOCl tended to induce less release of Ti and Cr. EDX evaluation revealed that the main surface elements were Ni, Ti, carbon, and oxygen. EDTA group contained the highest amount of carbon, while the control group showed the lowest. Surface roughness evaluation revealed no significant differences between groups despite the minor increases after immersion in certain groups. Black areas were observed in the NaOCl group which indicated corrosion. However, the cyclic fatigue test showed no significant differences between the groups.

Electrochemical Properties of Nickel-Titanium Rotary Endodontic Instruments

INTRODUCTION

Nickel-titanium rotary endodontic files have been commercially available for decades, but more recent innovations have introduced heat-treated and surface-treated files. This study investigated the corrosion properties of various nickel-titanium files in normal saline and sodium hypochlorite (NaOCl).

METHODS

Ten different file brands of size 40 with a 0.04 taper were subjected to electrochemical testing in 0.9% NaCl (saline) and 5.25% NaOCl at room temperature. The Open Circuit Potential (OCP) was observed for 1 hour followed by a cyclic polarization test from -300 to 700 mV and back to -300 mV (vs OCP). Nonparametric ANOVA and a pairwise comparison (P < .05) were used for statistical analysis of the OCP at 1 hour and the corrosion current (Icorr) obtained via the cyclic polarization test.

RESULTS

Significant differences (P < .05) were found between files with respect to OCP and Icorr in both solutions. Nine files exhibited significantly greater (P < .05) Icorrs in NaOCl than in saline. Conversely, pitting corrosion was observed in the saline solution but not NaOCl. Weak and/or moderate correlations existed between OCP and Icorr measures in the 2 solutions.

CONCLUSION

Significant differences in electrochemical properties were observed among the 10 brands of files. Overall, there was not a clear trend between conventional, heat-treated, or surface-treated files among OCP or Icorr in either solution.

Cutting efficiency and corrosion resistance of heat-treated endodontic files after various disinfection protocols

The aim of this study is to evaluate the effect of various disinfection protocols on the cutting efficiency and chemical composition of ProTaper, Twisted File, Twisted File Adaptive, and Hedström files. Four experimental groups (n = 10) were presoaked in either enzymatic solution or 1% sodium hypochlorite for 30 min, followed by either 5 or 15 min of ultrasonic cleaning and then autoclaved. Resin-simulated canals with a single curvature of 38-40° were prepared by each instrument system. Cutting efficiency of each instrument was analyzed by subtracting the final weight from the initial weight of the resin blocks. Chemical compositions were studied by field emission scanning electron microscopy and X-ray energy-dispersive spectrometry. The cutting efficiency of Hedström, ProTaper, and Twisted File instruments decreased compared to their control groups (p < 0.05) whereas it did not change for Twisted File Adaptive. More corrosion was detected with longer ultrasonication time. No difference was observed regarding the pre-soaking media. Disinfection protocols exerted a significant overall effect on the performance of Hedström, ProTaper, and Twisted File instruments. Corrosion, microcracks, and crevices were evident on all tested instruments after disinfection protocols applied. All disinfection protocols, regardless of the pre-soaking media used or the ultrasonic cleaning time applied, have some effect on the cutting efficiency and the surface characteristics of the files.

An in vitro comparative evaluation of cyclic fatigue resistance of two rotary and two reciprocating file systems

Context

Root canal instrumentation is one of the important procedures for successful endodontic therapy. Unexpected fracture of files occurs during root canal instrumentation without any visible signs of deformation compromising the success of root canal treatment.

Aims

The aim of the study was to evaluate and compare cyclic fatigue resistance (CFR) of rotary and reciprocating files in simulated canals with 45°, 60°, and 90° angle of curvature.

Settings and Design

The study design was an In vitro study.

Subjects and Methods

Sixty nickel-titanium files, 30 each of rotary and reciprocating files were selected and divided into four groups (n = 15) of Neoendo Flex, ProTaper Next, WaveOne Gold (WOG), and Reciproc Blue (RPB) files. Each group was further subdivided into three subgroups containing five samples each based on their use in simulated canals with 45°, 60°, and 90° angle of curvature. To simulate root canals with 45°, 60°, and 90° angle of curvature, three artificial canals were designed in a stainless steel metal block. Each file was autoclaved, immersed in 3% sodium hypochlorite (NaOCl), and coated with 17% ethylenediaminetetraacetic acid (EDTA). Each file was tested for CFR using a torque-controlled reduction handpiece by instrumenting in a simulated canal for 10 s until fracture. The cycle of autoclaving, exposure to NaOCl, EDTA, and testing of CFR for 10 s per canal as per groups and subgroups was repeated again and again until the respective file fracture. The time taken to file fracture was recorded using a digital chronometer. The time taken for each file fracture (in minutes) was multiplied by the number of rotations per minute to attain the number of cycles to failure (NCF).

Statistical Analysis Used

The obtained results were subjected to statistical analysis using one-way analysis of variance and independent t-test.

Results

One-way ANOVA test showed a statistically significant difference between the four groups, P < 0.001. Independent "t"-test between individual subgroups showed a statistically significant difference, as P < 0.05.

Conclusions

WOG and RPB reciprocating file systems showed superior CFR, more especially in canals with abrupt 90° angle of curvature compared to both rotary file systems tested. Among rotary file systems tested, Neoendo Flex showed greater CFR than ProTaper Next.

Effect of Sterilization and Irrigating Solutions on Nanostructure Alteration of Ni-Ti Rotary Instruments in Endodontics: An Atomic Force Microscopic Study

Aim

This study aimed to evaluate the effect of 5.25% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA) and sterilization on the nanostructural alteration of nickel titanium (Ni-Ti) rotary file systems in endodontics using the atomic force microscopy (AFM).

Materials and Methods

The study was performed on four commercially available rotary Ni-Ti files: group I-Vortex Blue (Dentsply), group II-ProTaper Next (Dentsply), group III-Mtwo (VDW), and group IV-iRaCe (FKG). Each group was divided into four subgroups (n = 4), that is, subgroup A-control (new rotary file), subgroup B-subjected for five cycles of autoclave, subgroup C-immersed in 5.25% NaOCl for 5 minutes, and subgroup D-immersed in 17% EDTA solutions for 5 minutes. All the specimens were evaluated with AFM using roughness average (RA) and root-mean-square (RMS) values for surface roughness.

Results

Among control groups, Vortex Blue showed the least RA and RMS values; the highest surface roughness was seen with Mtwo files. All the Ni-Ti rotary files showed a statistically significant (P <0.05) increase in surface hardness when subjected to autoclave and treatment with different irrigating solutions. In particular, 17% EDTA caused the highest surface deterioration in all the groups.

Conclusion

AFM analysis revealed increased surface roughness values recorded for all the rotary files when treated with irrigating solutions and autoclave cycles.

Influence of sodium hypochlorite on cyclic fatigue resistance of nickel-titanium instruments: A systematic review and meta-analysis of in vitro studies

OBJECTIVE

This systematic review/meta-analysis investigated the influence of NaOCl on cyclic fatigue resistance of endodontic NiTi instruments.

MATERIALS AND METHODS

A systematic search until July 2022 in PubMed/MEDLINE, Embase, Scopus, Web of Science, SciELO, Cochrane Library, and grey literature was conducted. According to the PECOS strategy, only in vitro studies evaluating the effects of NaOCl on the cyclic fatigue resistance of NiTi instruments were eligible. Cyclic fatigue resistance was the primary outcome. A modified Joanna Briggs Institute's Checklist was used for risk of bias assessment.

RESULTS

Of the 2,445 records screened, 37 studies were included. Most studies used simulated canals made of stainless-steel block with severe to moderate curvatures. NaOCl concentration varied from 1-6%, mainly at 37 °C. Regarding fatigue resistance, 23 studies using 1.2% to 6% NaOCl showed a reduction in the resistance compared to the control groups, especially when pre-heated. Four meta-analyses were performed according to the tested NiTi systems. The meta-analyses indicated that the PTU F2 files had higher reduction of fatigue resistance after exposure to 5.25% NaOCl; no differences between NaOCl and no immersion were observed for Reciproc R25, WaveOne 25.08, and WaveOne Gold Primary files. Included studies had low risk of bias.

CONCLUSION

NaOCl appears to reduce cyclic fatigue resistance of certain NiTi files, especially when they are pre-heated, particularly in conventional NiTi files compared to some heat-treated instruments. It is possible that the temperature of the solution may have a greater influence on resistance than NaOCl itself. Important to note that an overall tendency toward no significant influence was observed among various systems.

CLINICAL RELEVANCE

Precautions are necessary when a pre-heated high-concentration NaOCl is used to enhance its properties during root canal preparation, mainly using conventional wire.

Impact of endodontic irrigants on surface roughness of various nickel-titanium rotary endodontic instruments

BACKGROUND

The aim of the current study is to assess the surface roughness of several recent nickel-titanium (Ni-Ti) rotary endodontic instruments, namely: Protaper next (PTN); Hyflex CM (CM); Hyflex EDM (EDM); WaveOne gold (WOG); and trunatomy (TN), before and after application of 5.25% sodium hypochlorite (NaOCl) irrigant solution.

METHODS

In this in vitro study, five recently introduced rotary endodontic instruments of different metallurgical properties and designs were subjected to Atomic Force Microscopy (AFM) analysis, and then each file was rotated in 5.25% NaOCl for 15 min., with speed and torque according to manufacturer's instructions. The instruments were then subjected to AFM analysis again. The surface roughness average (Sa) parameter was calculated. Data were analyzed by Paired T test, One-way ANOVA and Tukey tests.

RESULTS

There was a statistically significant decrease in the surface roughness of all rotary endodontic instruments after immersion in irrigants (P ≤ 0.05).

CONCLUSION

The new TN and PTN instruments showed the least surface roughness. All tested Ni-Ti rotary endodontic instruments after irrigants exposure showed a varying increase in surface roughness.

Decontamination of lithium disilicate ceramics using various photosensitizers, herbal and chemical disinfectants, and the effect of surface conditioners on bond strength values

AIM

To assess and compare the antimicrobial efficacy of disinfectants on lithium disilicate ceramic (LDC) used in dental applications and shear bond strength (SBS) of LDC after using different conditioners hydrofluoric acid (HF), self-etching ceramic primers (SECP) and Neodymium-doped yttrium orthovanadate (Nd: YVO4).

MATERIALS AND METHODS

One hundred and twenty LDC discs were fabricated by auto-polymerizing acrylic resin using the lost wax technique. S. aureus, S. mutans, and C. albican were inoculated on thirty discs (n=30 each). Each group was further divided into three subgroups based on different disinfecting agents used (n=30) Group 1: Garlic extract, Group 2: Rose Bengal (RB) activated by PDT, and Group 3: Sodium hypochlorite (NaOCl). An assessment of the survival rate of microorganisms was performed. The remaining thirty samples were surface treated using three different LDC surface conditioners (n=10) Group 1: HF + Silane (S), group 2: SECP, and Group 3: Nd: YVO4 laser+S. SBS and failure mode analysis were performed using a universal testing machine and stereomicroscope at 40x magnification, The statistical analysis was conducted using one-way ANOVA and Post Hoc Tukey test.

RESULTS

Garlic extract, RB, and 2% NaOCl sample displayed comparable outcomes of antimicrobial potency against C. albicans, S aureus, and S. mutans (p>0.05). Furthermore, SBS analysis showed HF+S, SECP, and Nd: YVO4+S exhibited comparable outcomes of bond strength (p>0.05).

CONCLUSION

Garlic extract and Rose bengal activated by PDT can be contemplated as alternatives to the chemical agent NaOCl used for LDC disinfection. Similarly, SECP and Nd: YVO4 possess the potential to be used for the surface conditioning of LDC to improve the bond integrity with resin cement.

Good practices in the rearing and maintenance of zebrafish (Danio rerio) in Brazilian laboratories

Abstract Good Laboratory Practice (GLP) is a management quality control system that encompasses the organizational process and conditions under which non-clinical health and environmental studies are carried out. According to the World Health Organization, GLP must contain five topics: resources, characterization, rules, results, and quality control. This work aims to address a review according to WHO standards of implementing Good Laboratory Practices in zebrafish (Danio rerio) vivariums. Considering that the promotion of one health (animal, human, and environmental) associated with an education plan, protocols, and records are fundamental to guarantee the safety and integrity of employees, animals, and the environment as well as reliability in the results generated. In a way, Brazil still needs improvements related to the well-being of aquatic organisms (national laws, international agreements, corporate programs, and others), especially concerning its use in research and technological development. In this way, the implementation of GLPs provides valuable guidance for improving animal welfare and worker safety, facilitating the standardization of research.

Boas práticas na criação e manutenção de zebrafish (Danio rerio) em laboratório no Brasil

Resumo As Boas Práticas de Laboratório (BPL) são um sistema de controle de qualidade gerencial que abrange o processo organizacional e as condições sob as quais os estudos não clínicos de saúde e meio ambiente são desenvolvidos. Conforme a Organização Mundial da Saúde (OMS) as BPL devem conter cinco tópicos: recursos, caracterização, regras, resultados e controle de qualidade. O objetivo deste trabalho foi apresentar uma revisão conforme o padrão da OMS para a implementação das BPL em biotério de zebrafish. Considerando que a promoção da saúde única (animal, humana e ambiental) associada a um plano de educação, protocolos e registros são fundamentais para garantir a segurança e a integridade dos trabalhadores/pesquisadores, animais e meio ambiente assim como confiabilidade nos resultados gerados. De certa forma o Brasil ainda necessita de melhorias relacionadas ao bem-estar de organismos aquáticos (leis nacionais, acordos internacionais, programas corporativos e outros); especialmente em relação à utilização deste na pesquisa e desenvolvimento tecnológico. Desta forma, a implementação de BPL fornece uma orientação valiosa para a melhoria do bem-estar animal, e segurança do trabalhador vindo a facilitar a padronização da pesquisa.

Influence of contemporary ceramo-metallic crown decontamination on the surface roughness, color stability, and disinfection. An in vitro analysis

AIM

To assess the antimicrobial effects, surface roughness (Ra), and color change (ΔE) of Morinda Citrofolia, Sapindus Mukorossi, Indocyanine green photosensitizer, and 2% NaOCl on metal ceramic crown colonized with C. Albicans, S aureus, S. mutans, and E. coli.

MATERIAL AND METHODS

An aggregate of 40 (n = 10 each) Ni/Cr metal-ceramic crowns were fabricated and inoculated with the American Type Culture Collection (ATCC) of varied microbial colonies colonized by C. Albicans, S aureus, S. mutans, and E. coli. After inoculation, specimens were exposed to four different types of disinfection methods i.e. group 1: MC, group 2: SM, group 3:ICGP, and group 4 2% NaOCl respectively to evaluate antimicrobial efficacy, Ra, and color change. Later, the microbial assay was performed and expressed as CFU/ml (log 10). Ra was assessed using a surface analyzer and color change ΔE was evaluated using a spectrophotometer Statistical analysis was performed by using two-way ANOVA and Post HocTukey's test maintaining a significance level of p less than 0.05.

RESULTS

The highest antimicrobial efficacy for metallic-ceramic crown decontamination against all inspected microbial colonies was unveiled by group 1: MC, whereas the lowest disinfection efficacy was revealed by group 4 sterilized with 2% NaOCl (control). Metallic ceramic crown decontamination with MC and SM substantiated equivalent antimicrobial efficacy in plummeting CFU/mL (log10) of C.Albicans, S aureus, S.mutans, and E. coli (p>0.05). However, ICGP as a crown disinfectant validated antimicrobial efficacy significantly less compared to MC and SM (p<0.05). Ra was assessed post-disinfection with no changes observed (p>0.05) among all groups. Similarly, ΔE was significantly higher in crowns disinfected with ICGP (p<0.05) CONCLUSION: Metallic ceramic crown decontamination using herbal disinfectants Morinda Citrofolia and Sapindus Mukorossi exhibited favorable antimicrobial efficacies against microbial colonies of C. albicans, S aureus, S.mutans, and E. coli with no changes in surface roughness and color.

Influence of 17% EDTA and Sapindus mukorossi on the Surface Property of Protaper Gold Rotary Endodontic Instruments

The aim of the study was to evaluate the influence of 17% ethylenediaminetetraacetic acid (EDTA) and ethanolic extract of Sapindus mukorossi (S. mukorossi) in combination with canal shaping on surface properties of ProTaper Gold rotary endodontic file. Sixteen F1 ProTaper Gold rotary files underwent the standard protocol for root canal treatment using two irrigants (S. mukorossi and 17% EDTA) in single-rooted decoronated teeth. Eight unused files were used as a control. All files were examined under an atomic force microscope (AFM) to evaluate surface roughness (Ra) and root mean square (RMS). Data were analyzed using the t-test. RMS and Ra values of the control file were 1.37 and 0.607, respectively. The mean RMS (3.70 ± 1.41) and mean Ra (2.89 ± 1.41) in EDTA group were significantly higher than the control file (p < 0.05). The mean RMS in the S. mukorossi group (1.77 ± 0.66) did not show any significant difference with the control (p > 0.05). The Ra of S. mukorossi group (1.09 ± 0.05) was significantly higher than the control file (p < 0.05). Moreover, the mean RMS and Ra were found to be significantly higher in the EDTA group compared to the S. mukorossi group (p < 0.05). The mean Ra and RMS values of the ProTaper Gold files used to prepare canals using 17% EDTA and S. mukorossi irrigation were significantly higher than the control files. The EDTA-treated ProTaper Gold rotary files demonstrated higher surface Ra and RMS than the S. mukorossi files.

Influence of Sodium Hypochlorite and Chlorhexidine on the Dynamic Cyclic Fatigue Resistance of XP Endo Shaper Instruments

OBJECTIVE

 This study evaluated the dynamic cyclic fatigue resistance of the XP-Endo Shaper (XPS), associated with chlorhexidine digluconate (CHX) or sodium hypochlorite (NaOCl) in two different formulations: gel (G) or liquid (L).

MATERIALS AND METHODS

 Sixty XPS were used in an artificial stainless-steel canal, and the files were fully immersed in the irrigating solution throughout the experiment until the fracture. The files were divided into six groups (n = 10) based on the irrigation solution used: NaOCl(L), NaOCl(G), CHX(L), CHX(G), natrosol gel (NAT) (control), and lubricating oil (LO) (control). The artificial canal was manufactured 1.5 mm wide, 20 mm long, and, 3.5 mm deep with a straight cervical segment measuring 14.29 mm; an apical segment of 4.71 mm with 3 mm radius; and 90 degrees of curvature apical 1 mm long straight segment. Resistance to cyclic fatigue was determined by recording the number of cycles to fracture (NCF).

RESULTS

 The CHX(G), CHX(L), and OIL (LO) groups showed no significant difference between them and presented longer time to fracture (p > 0.05). NaOCl(L) shows the lowest NCF without significant differences between NaOCl(G) and NAT. The NCF of the NaOCl(G) was statistically similar to the CHX(L) and statistically lower than the CHX(G) and OIL groups. NAT did not present a statistical difference of the NaOCl(L), NaOCl(G), and presented a significantly lower NCF than the CHX(G) (p < 0.01).

CONCLUSION

 The use of CHX(G) resulted in increased cyclic fatigue resistance of the XPS instruments compared to NaOCl or LO.

Extrusion bond strength of glass fiber post to radicular dentin after final irrigation using MTAD, EDTA, Pineapple peel extract, and riboflavin

INTRODUCTION

The present study aims to determine the effect of different post-space final irrigants ethylenediaminetetraacetic acid (EDTA), a mixture of Doxycycline citric acid and detergent (MTAD), Riboflavin (RF) and Pineapple peel extract (PPE) on the bond integrity of GFPs bonded to radicular dentin.

MATERIALS AND METHODS

Crowns of forty human mandibular premolars teeth were sectioned up to cementoenamel junction CEJ. Root canal treatment was performed. Gates Glidden drills were used to retrieve gutta-percha from the canal. All the specimens were randomly divided into four groups based on the final irrigant used. Group 1 (NaOCl with EDTA), group 2 NaOCl+ MTAD, group 3 NaOCl+RF and group 4 NaOCl+PPE. Cementation of glass fiber posts (GFPs) was performed using self-etch dual-cure resin cement. Sectioning was performed using a slow-speed saw from the coronal, middle, and apical third under constant water irrigation. A universal testing machine was used to assess push-out bond strength (PBS) and failure mode was evaluated using a Stereomicroscope at 40x magnification. One-way analysis of variance (ANOVA) and Tukey multiple comparison tests were used for statistical analysis (p=0.05).

RESULTS

Group 4 (2.5% NaOCl+ PPE) displayed the highest PBS at all three root levels (Cervical: 11.22±0.74 MPa, Middle: 8.99±0.97MPa, and Apical: 6.00±0.88 MPa). However, Group 1 (2.5% NaOCl+17% EDTA) demonstrated the lowest EBS (Cervical: 9.25±0.17 MPa, Middle: 7.01±1.84 MPa, and Apical: 4.41±0.17 MPa). Inter-group comparison displayed that PBS to be comparable between group 1 and group 3 (2.5% NaOCl+ Riboflavin) (Cervical: 9.74±0.41 MPa, Middle: 7.44±1.18 MPa, and Apical: 4.21±0.05 MPa) (p > 0.05). Whereas, group 2 (1.3% NaOCl+ MTAD) (Cervical: 9.32±1.36 MPa, Middle: 7.17±1.75 MPa, and Apical: 4.85±0.19 MPa) and group 4 demonstrated comparable values of PBS (p >0.05).

CONCLUSION

Pineapple peel extract and a mixture of Doxycycline citric acid and a detergent when used as a final irrigant demonstrated better bond integrity of GFPs to radicular dentin at all three levels coronal, middle and apical.

What meaningful information are the instruments mechanical testing giving us? A comprehensive review

Instruments mechanical strength and flexibility are traditionally tested by running cyclic fatigue, torsional, bending, buckling and microhardness tests. Several cyclic fatigue test models have been used in endodontics, all capable of providing a curved trajectory for the instrument to rotate. The cyclic fatigue testing allowed to identify conditions that may affect the fatigue strength outcomes, such as canal radius and degree of curvature, handpiece static vs dynamic motions, test temperature, kinematics, instrument previously wear and sterilization cycles, or instrument's size and metal alloy features. Due to the international test specifications for both torsional and bending tests, the variations of their models are not as many as for cyclic fatigue. These tests have also identified conditions capable of affecting the outcomes, such as kinematics, instrument's preloading, cross-sectional diameters, or alloy heat treatments. Buckling and microhardness are less common, with the metal alloy being considered to have a major influence on the results. Instruments mechanical testing, having all these individual conditions as independent variables, allowed to understand them and moulded the way the technical procedures are performed clinically. Even though the artificiality and simplicity of these tests will hardly mimic real working situations, and independently of being capable of producing cornerstone knowledge, these tests are also associated with inconsistency, lack of reproducibility and low external validity. Several attempts have been made to increase the generalizability of the outcomes by adding test settings that intend to mimic the clinical condition. Although pertinent, these settings may also add variabilities inherent to their concepts and practical applications in the laboratory environment. Although the actual studies should be seen as laboratory mechanical tests that measure very specific parameters under very particular conditions and that by far do not mimic the clinical condition, the lower validity drawback seems to be possible to be minimized when achieving a comprehensive understanding of the instrument behaviour. A Finite Elements Method and/or a multimethod research approach may lead to superior data collection, analysis, and results' interpretation, which when associated with a reliable confounding factors control and proper study designs may be helpful tools and strategies in order to increase the reliability of the outcomes.

Efficacy of chemical and Photoactivated disinfectants against Candida Albicans and assessment of hardness, roughness, and mass loss of acrylic denture base resin

AIM

The present study aimed to assess the antimicrobial efficacy of hematoporphyrin derivative, sodium hypochlorite (NaOCl), glutaraldehyde (GaH), and a chlorhexidine (CHX) on mass loss (ML), microhardness, and surface roughness (Ra) of acrylic denture base colonized with C. Albicans.

MATERIAL AND METHODS

A total of 40 heat cure acrylic resin dentures were fabricated and inoculated by the American Type Culture Collection (ATCC) of C. Albicans in an in-vitro situation. Specimens were divided into four groups (n=10) based on the method of disinfection. Hematoporphyrin derivatives, 1% NaOCl, 2% GaH, and 4% CHX.The pre and post candida (CFU/ml) counts were recorded before and after immersion. ML, microhardness, and Ra of acrylic denture were also assessed. Statistical analysis was executed for CFU/mL (log10) for exposed C. Albicans by two-way ANOVA and Tukey's multiple tests (p>0.05). For normality of the data, Dunnet's Simultaneous test was performed.

RESULTS

In terms of candida strain analysis, pretreatment to posttreatment comparisons revealed a reduction in mean Candida count in all groups (p<0.05). The highest ML value after post candida disinfection of acrylic denture was observed in 2% GaH (1.587 ± 0.25) treated specimens. The least microhardness value was found in group 1 when treated with hematoporphyrin (0.97 ± 0.22 VHN) which was significantly different from other groups (p<0.05). Group 1 surface treated with hematoporphyrin derivate (1.84 ± 0.22 μm) showed the highest Ra values (p<0.05).

CONCLUSION

Acrylic denture base resin colonized with C. Albicans when treated with a chemical disinfectant of 4% chlorhexidine displayed the highest antimicrobial efficacy with reduced mass loss, less surface roughness, and maximum denture hardness.

Effects of sodium hypochlorite on corrosion of the rotary nickel-titanium endodontic instruments - SEM analysis

Introduction/Objective. of this study is to use SEM analysis to examine surfaces of new and same sets of Ni-Ti instruments after canal preparations, to check their susceptibility to corrosion. Methods. In this study, we used five different endodontic Ni-Ti instruments: K3, Mtwo, ProTaper Universal, HyFlex and BioRaCe. Instruments were analyzed before and after preparation of canals of different curvature, using SEM (150-2000X). Results. Corrosion of the working part was observed in 5.5% of new Ni-Ti instruments of the K3 system (apical and middle segment), in 5.5% of Mtwo instruments (apical third) and in 11.1% of ProTaper Universal systems (apical and middle third). Corrosion was not observed on the new instruments of the HyFlex and BioRaCe kits. After instrumentation, disinfection and sterilization, corrosion was observed in all sets of K3 and ProTaper Universal systems and in all HyFlex instruments of the first group. Corrosion was observed in the HyFlex system in the second group in 16.7% of instruments (apical and middle third) and in the third 83.3% in the apical and 66.7% in the middle segment. In the Mtwo set, corrosion was observed in 16.7% of instruments in the first (apical and middle third), in the second group in 33.3% of instruments in the apical part and 50% in the middle third, while in the third group, corrosion was observed in 16.7% of instruments in the middle third of instruments. Conclusion. Rotary Ni-Ti instruments K3 and ProTaper Universal are susceptible to corrosion in a very high percentage. Ni-Ti systems with post-heat treatment of the working part (HyFlex) are somewhat more resistant to corrosion, while in Ni-Ti systems with electropolished surface (BioRaCe), corrosion is not observed.

The Effects of Sterilization Procedures on the Cutting Efficiency of Endodontic Instruments: A Systematic Review and Network Meta-Analysis

Sterilization processes guarantee the sterility of dental instruments but can negatively affect instrument features by altering their physical and mechanical properties. The endodontic instrumentation can undergo a series of alterations, ranging from corrosion to variation in the cutting angle and then changes in the torsional properties and torsional fatigue resistance. This systematic literature review and meta-analysis aims to investigate alterations to the cutting efficiency of endodontic instruments that are induced by procedures for their disinfection and sterilization. Methodologies adopted for this investigation follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. The following were used as search terms on PubMed and Scopus: "endodontic sterilization", "endodontic autoclave", "cyclic fatigue", "torsional", "cutting efficiency", "sterilization", "surface characteristics", and "corrosion". At the end of the selection process, 36 articles were identified, and seven of them are included in this systematic review. The results of a meta-analysis conducted for the use of 10 autoclaving cycles shows a standardized mean difference (SMD) of 0.80 with a p-value equal to 0.04 with respect to effect on cutting efficiency. The network meta-analysis, through direct and indirect comparison between the different autoclave cycles (0, 1, 5, 10, and 15 cycles), revealed that treatment involving 15 autoclave cycles produced the most robust results in terms of having the greatest effects in terms of altered cutting efficiency with a probability of 57.7% and a SUCRA (surface under the cumulative ranking) of 80%. The alterations in the effects on cutting efficiency appear to be triggered after five cycles of sterilization by heat (autoclave). In conclusion, the meta-analysis of the data indicates that the autoclave sterilization protocol must not be repeated more than five times to preserve cutting efficiency. Within the limitations of this review, we can therefore establish that sterilization by autoclaving alone results in steel and NiTi instruments becoming less efficient in cutting after five cycles, as measured by a reduction in cutting efficiency.

Corrosion resistance assessment of nickel-titanium endodontic files with and without heat treatment

Objectives

The aim of this study was to evaluate the corrosion resistance of heat-treated (Reciproc and WaveOne) and non-heat-treated (ProTaper and Mtwo) superelastic nickel-titanium endodontic files when immersed in a 5.25% sodium hypochlorite solution.

Materials and Methods

Anodic polarization curves were obtained with potential sweeps that began at the open circuit potential or corrosion potential (E_corr). The pitting potential (E_pit) was identified on the anodic polarization curve as the potential at which a sudden increase in current was observed. The micromorphology of the 28 tested files was analyzed before and after the electrochemical assay using scanning electron microscope (SEM). The data were analyzed using 1-way analysis of variance with the post hoc Bonferroni test (for E_corr) and the Student t-test for independent samples (for E_pit).

Results

The mean E_corr values were 0.506 V for ProTaper, 0.348 V for Mtwo, 0.542 V for Reciproc, and 0.321 V for WaveOne files. Only WaveOne and Protaper files exhibited pitting corrosion, with E_pit values of 0.879 V and 0.904 V, respectively. On the SEM images of the ProTaper and WaveOne files, cavities suggestive of pitting corrosion were detected.

Conclusions

Signs of corrosion were observed in both heat-treated and non-heat-treated files. Of the evaluated files, WaveOne (a heat-treated file) and ProTaper (a non-heat-treated file) exhibited the lowest corrosion resistance.

Effect of immersion in sodium hypochlorite on the cyclic fatigue resistance of three rotary instruments

Context:

It is essential to know if the immersion in sodium hypochlorite (NaOCl) influences the cyclic fatigue resistance of nickel-titaniumm (NiTi) files.

Aim:

This study was aimed to evaluate the resistance to the cyclic fatigue of three NiTi systems, as well as the influence of 5.25% NaOCl on their resistance.

Methods:

Files from the Sequence Rotary File (MK life, Porto Alegre, Brazil), ProTaper Next (PTN) (Dentsply, Maillefer, Baillagues, Switzerland), and HyFlex EDM (Coltène Whaledent, Allstatten, Switzerland) systems were tested and separated into Group 1)-without immersion in NaOCl solution and Group 2 and Group 3-immersed in 5.25% NaOCl solution, for 1 min, and 5 min, respectively. All instruments were submitted to the cyclic fatigue test. Images of the instruments were observed by scanning electron microscopy, to evaluate the type of defect presented on the fractured surface. The test performed for the analysis of two independent factors was a two-way analysis of variance.

Results:

HyFlex EDM presented a greater number of cycles until fracture when compared to others (P < 0.001). The control group showed a greater number of cycles until fracture than the same instruments submitted to NaOCl (P < 0.001). Sequence instruments showed the lowest values of cycles until fracture (P < 0.001). There was no statistically significant difference between treatments (P = 0.998). PTN, showed intermediate values of fracture resistance when compared to the HyFlex EDM and sequence instruments (P < 0.001), but without intragroup differences (P = 0.437).

Conclusions:

Hyflex EDM instruments were the most resistant to cyclic fatigue.

Preventing nickel-titanium rotary instrument from breakage by continuous irrigation with different fluids during root canal preparation

To study the effect of continuous irrigation of rotating nickel-titanium instrument with several common clinical fluids on the diameter, breaking length and breaking position of nickel-titanium instrument, so as to provide some reference and theoretical basis for clinical operation and instrument improvement.A standardized curved root canal model was established, and ProTaper Universal (PTU) F1 instrument was selected for root canal preparation. The nickel-titanium F1 instrument was flushed with distilled water, 0.9% NaCl, 0.2% chlorhexidine, 1% sodium hypochlorite and 5% sodium hypochlorite, and the diameter, length and position of the instrument before and after breakage were recorded.Only 5% sodium hypochlorite influenced the diameter of 6 mm marker points under different irrigation conditions (P < .05). There was no statistical difference in the length of broken instruments among all the groups, and torsional deformation mainly occurred at the end of broken instruments. The broken positions of instruments in all the groups were located at the bending segment of the root canal. The breaking frequency of the 5% sodium hypochlorite group was the highest in the area 3-5.5 mm away from apical foramen, while the other 4 groups had the highest breaking frequency in the area 0 to 1.5 mm away from apical foramen.External irrigation with different fluids did not influence the breaking length of instruments. The closer to the apical foramen was, the higher the breaking frequency of instruments was. However, only 5% sodium hypochlorite can affect the diameter of rotary nickel-titanium instruments, and may lead to early breakage of the instrument, indicating that the use of disinfectants, except 5% sodium hypochlorite, cannot reduce breakage resistance of nickel-titanium instrument compared with distilled water flushing. Furthermore, 5% hypochlorite could not be recommended for irrigation in clinical practice.

Management of Instrument Sterilization Workflow in Endodontics: A Systematic Review and Meta-Analysis

Endodontic treatment consists of different working procedures, such as the isolation of the operating field, pulp chamber access, and cleaning and shaping phases with at last the need of a three-dimensional filling of the canals. Each step requires a series of single-use or sterilizable instruments. We have performed a systematic review of different sterilization and disinfection procedures aiming at drawing up a disinfection and sterilization procedure to be used on endodontic instruments. A search on PubMed and Scopus was carried out using the following keywords: “endodontic sterilization,” “endodontic autoclave,” “decontamination dental bur,” “sterilization dental burs,” and “gutta-percha points sterilization.” Eligible articles were included in the qualitative and quantitative analysis. Results of the meta-analysis showed that the most effective method in sterilization is autoclaving. The qualitative analysis showed that the use of single-use or first-use instruments requires presterilization or sterilization procedures, and for reusable tools, attention must be paid to the removal of debris deposited on the blades, not easy to remove manually.

Surface Alterations Induced on Endodontic Instruments by Sterilization Processes, Analyzed with Atomic Force Microscopy: A Systematic Review

Endodontic canal disinfection procedures that use sodium hypochlorite, and subsequently, heat sterilization procedures can alter the surface of endodontic instruments, described as corrosion and micropitting. These phenomena can be visualized on the surface of the instruments by SEM and atomic force microscopy analyses. The endodontic instruments used in probing, pre-enlargement, and shaping phases are made of steel alloy or nickel-titanium alloy (NiTi) and are subject to torsional, flexor, and cyclic fatigue; indeed, reuse of these instruments must be done with the knowledge that these instruments are subject to fracture following stress caused during their use. Fracture of the instrument within the canal is an eventuality that can lead to failure of the treatment, and therefore it is important to try to reduce situations that can contribute to the fracture. This review was performed based on the PRISMA protocol. Studies were identified through bibliographic research using electronic databases. A total of 1036 records were identified on the PubMed and Scopus databases. After screening the articles, restricted by year of publication (1979 to 2019), there were 946 records. With the application of the eligibility criteria (all the articles pertaining to the issue of sterilization in endodontics), there were 228 articles. There were 104 articles after eliminating overlaps. There were 50 articles that discussed the influence of sterilization procedures on the surface characteristics of endodontic instruments, and 26 articles that measured parameters on surface alteration. Applying the inclusion and exclusion criteria resulted in a total of eleven articles for quantitative analysis. Four articles were in reference to the primary outcome, eight articles to secondary outcome, and five articles to tertiary outcome. The meta-analysis showed a statistically significant surface alteration effect after five autoclaves and after immersion in the canal irrigants after 10 min.

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.

Effect of Temperature of Sodium Hypochlorite on Cyclic Fatigue Resistance of Heat-treated Reciprocating Files

INTRODUCTION

The aim of this study was to evaluate the effect of different temperatures of sodium hypochlorite (NaOCl) on the cyclic fatigue resistance of the heat-treated file systems.

METHODS

The cyclic fatigue resistance of Reciproc 25 (VDW Dental, Munich, Germany), Reciproc Blue R25 (VDW), WaveOne Primary (Dentsply Maillefer, Ballaigues, Switzerland), WaveOne Gold Primary (Dentsply Maillefer), and One Shape (25.06; Micro Mega, Besançon, France) was tested in the following conditions: control (no immersion), immersion in distilled water (DW) at 37°C ± 1°C, immersion in DW at 60°C ± 1°C, immersion in NaOCl at 37°C ± 1°C, and immersion in NaOCl at 60°C ± 1°C. The immersion period was 5 minutes for all conditions. A stainless steel artificial canal with a curvature of 60° and a 5-mm radius was used. The time to failure and fragment lengths were recorded for each instrument, and data were subjected to statistical analysis.

RESULTS

Reciproc Blue showed greater cyclic fatigue resistance in all conditions compared with the other systems (P < .05). Immersion in NaOCl at 60 °C negatively affected all instruments' cyclic fatigue resistance except Reciproc Blue. Immersion in DW at 60 °C increased the cyclic fatigue resistance of Reciproc Blue. Heat-treated files presented higher fatigue resistance than traditional files.

CONCLUSIONS

A high temperature of NaOCl affected the cyclic fatigue life of the file systems. Instruments produced with heat treatment presented a longer fatigue life.

Cyclic fatigue resistance of three rotary file systems in a dynamic model after immersion in sodium hypochlorite

To evaluate the effect of immersion in 3% sodium hypochlorite solution in the resistance to cyclic fatigue of three nickel-titanium (NiTi) rotary file systems, ProTaper Next (PTN), Hyflex CM (CM), and Hyflex EDM (EDM), in a mechanical model featuring axial movement. Ninety instruments of three different NiTi rotary file systems, PTN (size 25, 0.06 taper), CM (25, 0.06), and EDM (25/~, variable taper), were randomly divided according to a 3 × 3 factorial design and tested under dynamic immersion in a 3% NaOCl solution (1 or 5 min) or without immersion, making a total of 9 groups (n = 10). Files were tested in an artificial root canal with 45° angle and 5 mm radius apical curvature being submitted to back-and-forth movements until fracture. Statistical analysis was performed using two-way factorial ANOVA with Bonferroni post-hoc tests, at a significance level of 5%. Instruments were evaluated for reliability using a Weilbull approach. Regardless of the immersion treatment, PTN had on average 1200 ± 178 cycles to fracture, CM had 1949 ± 362, and EDM had 5573 ± 853, which was a significantly different (P < 0.01). The NaOCl immersion promoted a significant reduction in the mean number of cycles to fracture (P = 0.01), and was reflected in a significant reduction of the characteristic life of the instruments of the CM end EDM groups. Within this study conditions, EDM instruments performed better to cyclic fatigue followed by CM and then PTN. Immersion in NaOCl decreased the resistance to cyclic fatigue of all tested instruments, but affected more those manufactured from CM wire.

Effect of Sodium Hypochlorite and EDTA on Surface Roughness of HyFlex CM and HyFlex EDM Files

The aim of the present study was to compare the effect of exposure to sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) on the surface topography and roughness of HyFlex controlled memory (CM) and HyFlex electrical discharge machining (EDM) using atomic force microscopy (AFM). Twenty HyFlex EDM (25/.08) and 20 HyFlex CM (25/.06) files were divided into five groups (n = 4). One group served as a negative control group. The files in the other groups were exposed to 5.25% NaOCl and 17% EDTA solutions at 37°C for 5 and 10 min, respectively, and examined using AFM after each exposure. The data were analyzed using one-way ANOVA test. The lowest values were observed in the control group of HyFlex EDM files (p < .05). The highest values were observed in the HyFlex EDM and HyFlex CM files immersed in EDTA for 10 min (p < .05). In conclusion, the tested irrigants had a significant negative effect on the surface porosity of NiTi files. The immersion of NiTi files in irrigants during cleaning and sterilization procedures results in corrosion and surface deformation of the files, and this can lead to unexpected file fracture during clinical use. Thus, the investigation of effect of ethylenediaminetetraacetic acid (EDTA) and sodium hypochlorite (NaOCl) on surface topography of HyFlex files is important.

Lubrication during root canal treatment

Lubrication is involved in all root canal treatment phases, from dental dam placement to canal obturation. Most often associated with instrumentation, lubrication is required to facilitate the mechanical action of hand/rotary files and to help emulsify and suspend the debris produced. Aqueous irrigation solutions such as sodium hypochlorite and ethylenediaminetetraacetic acid (EDTA) should be regarded as lubricants, but paste-type substances are marketed specifically for this purpose. As more patients demand the retention of challenging teeth with narrow and curved root canals, the importance of lubrication in all aspects of root canal treatment must be acknowledged.

Shaping ability of Reciproc Blue reciprocating instruments with or without glide path in simulated S-shaped root canals

Background. The present study aimed to compare the shaping ability of Reciproc Blue instruments with or without the creation of a glide path in simulated S-shaped root canals. Methods. Root canals of thirty #15.02 clear resin S-shaped blocks were dyed using ink and photographed. Then the blocks were randomly divided into 2 groups: group A: Reciproc Blue with glide path created with ProGlider and group B: Reciproc Blue with no glide path preparation (n=15). The blocks were also photographed after preparation. The pre- and post-prepara-tion images were superimposed and evaluated at 9 different measurement points according to the 3 zones, as coronal straight, first curvature, and apical curvature zones. The data were evaluated with independent t-test or Kruskal-Wallis tests with 5% significance interval. Results. Group B removed greater amount of material from the inner aspect of simulated canal at the first curvature and apical curvature zones and from the outer aspect of the canal at apical curvature zone (P<0.05). Both groups exhibited trans-portation and the transportation width in group B was significantly greater in the levels of apical curvature zone (P<0.05). Conclusion. Glide path preparation using ProGlider rotary instrument improved the shaping ability of Reciproc Blue R25 instrument by leading to less transportation and maintaining centering ability.

An analysis of cyclic fatigue resistance of reciprocating instruments in different canal curvatures after immersion in sodium hypochlorite and autoclaving: An in vitro study

Aim

The aim of this study is to assess the effect of sodium hypochlorite and sterilization on the cyclic fatigue resistance of two reciprocating nickel-titanium files using a rotary and a reciprocating motor.

Materials and Methods

Totally, 160 Reciproc and Wave One files were tested. The eighty files of the same brand were assigned into four groups (n = 20). These four groups were further divided into two subgroups, 1a and 1b, 2a and 2b, 3a and 3b, 4a and 4b consisting of ten files in each group. 2.5% NaOCl for 5 min, 2.5% NaOCl for 5 min + 1 cycle of autoclave sterilization, 2.5% NaOCl for 5 min + 5 cycles of autoclave sterilization, no sterilization (control). Groups 1a, 2a, 3a, and 4a were subjected to 30° and Groups 1b, 2b, 3b, and 4b were subjected to 60° canal curvature.

Results

Intergroup comparison reveals that there is an increase in cyclic fatigue resistance from the first cycle to the fifth cycle of autoclave which is statistically significant.

Conclusion

Reciproc and Wave One showed reduced cyclic fatigue resistance on immersion in NaOCl for 5 min. Multiple autoclaving cycles significantly increased the cyclic fatigue resistance of Reciproc file system in both the curvatures. There was a decrease in cyclic fatigue resistance for Wave One after multiple autoclaving at 60° curvature which was statistically significant.

Sodium Hypochlorite Treatment and Nitinol Performance for Medical Devices

Processing of nitinol medical devices has evolved over the years as manufacturers have identified methods of reducing surface defects such as inclusions. One recent method proposes to soak nitinol medical devices in a 6% sodium hypochlorite (NaClO) solution as a means of identifying surface inclusions. Devices with surface inclusions could in theory then be removed from production because inclusions would interact with NaClO to form a visible black material on the nitinol surface. To understand the effects of an NaClO soak on performance, we compared as-received and NaClO-soaked nitinol wires with two different surface finishes (black oxide and electropolished). Pitting corrosion susceptibility was equivalent between the as-received and NaClO-soaked groups for both surface finishes. Nickel ion release increased in the NaClO-soaked group for black oxide nitinol, but was equivalent for electropolished nitinol. Fatigue testing revealed a lower fatigue life for NaClO-soaked black oxide nitinol at all alternating strains. With the exception of 0.83% alternating strain, NaClO-soaked and as-received electropolished nitinol had similar average fatigue life, but the NaClO-soaked group showed higher variability. NaClO-soaked electropolished nitinol had specimens with the lowest number of cycles to fracture for all alternating strains tested with the exception of the highest alternating strain 1.2%. The NaClO treatment identified only one specimen with surface inclusions and caused readily identifiable surface damage to the black oxide nitinol. Damage from the NaClO soak to electropolished nitinol surface also appears to have occurred and is likely the cause of the increased variability of the fatigue results. Overall, the NaClO soak appears to not lead to an improvement in nitinol performance and seems to be damaging to the nitinol surface in ways that may not be detectable with a simple visual inspection for black material on the nitinol surface.

Enhancement of NiTi superelastic endodontic instruments by TiO2 coating

Rotary nickel-titanium (NiTi) endodontic instruments were coated with a nanometric flexible TiO2 layer through dip-coating sol-gel. Control groups and coated samples of superelastic NiTi instruments model RaCe 25/0.06 (0.25mm tip-diameter, 6% conicity) were comparatively investigated with respect to the cutting efficiency, fatigue life, and corrosion resistance. Results showed an improvement in cutting efficiency for the coated samples and a high resistance to corrosion in NaClO. The coated instruments showed a better performance in fatigue life after corrosion.

Effect of Different Irrigating Solutions and Photo-Activated Therapy for In Vivo Root Canal Treatment

This study aimed to evaluate histologically the effect of irrigation with 400 ppm Sterilox, 2% and 5% sodium hypochlorite (NaOCl), with and without photo-activated therapy (PAD), in a single-visit root canal treatment of dog's teeth with apical periodontitis (AP). Ten dogs were randomly divided into two groups (n=5): with and without PAD, and the root canals into four subgroups, according to the irrigating solution: SX (400 ppm Sterilox), SH2 (2% NaOCl), SH5 (5% NaOCl) and SS (saline solution) as positive control. A total of 134 root canals were opened and left exposed to the oral environment for 14 days and then sealed for 60 days for AP induction. Then, root canals were treated according to each proposed disinfecting protocol and filled in the same session. After 120 days, the dogs were euthanized and the periapical inflammatory events were evaluated under light microscopy. Qualitative data were submitted to Kruskal-Wallis and Mann-Whitney tests (α=0.05). PAD did not produce significant differences in the scores for apical inflammation when used after chemo-mechanical preparation (p>0.05). The irrigating solutions SX, SH2 and SH5 without PAD were statistically different from SS (p<0.05) that presented the greatest scores for apical inflammation. PAD did not show any additional effect for the treatment of root canals with pulp necrosis and AP in a single visit and 400 ppm Sterilox may be considered an alternative to NaOCl in root canal treatment.

The impact of inducing germination of Bacillus anthracis and Bacillus thuringiensis spores on potential secondary decontamination strategies

AIMS

Decontamination and remediation of a site contaminated by the accidental or intentional release of fully virulent Bacillus anthracis spores are difficult, costly and potentially damaging to the environment. Development of novel decontamination strategies that have minimal environmental impacts remains a high priority. Although ungerminated spores are amongst the most resilient organisms known, once exposed to germinants, the germinating spores, in some cases, become susceptible to antimicrobial environments. We evaluated the concept that once germinated, B. anthracis spores would be less hazardous and significantly easier to remediate than ungerminated dormant spores.

METHODS AND RESULTS

Through in vitro germination and sensitivity assays, we demonstrated that upon germination, B. anthracis Ames spores and Bacillus thuringiensis Al Hakam spores (serving as a surrogate for B. anthracis) become susceptible to environmental stressors. The majority of these germinated B. anthracis and B. thuringiensis spores were nonviable after exposure to a defined minimal germination-inducing solution for prolonged periods of time. Additionally, we examined the impact of potential secondary disinfectant strategies including bleach, hydrogen peroxide, formaldehyde and artificial UV-A, UV-B and UV-C radiation, employed after a 60-min germination-induction step. Each secondary disinfectant employs a unique mechanism of killing; as a result, germination-induction strategies are better suited for some secondary disinfectants than others.

CONCLUSIONS

These results provide evidence that the deployment of an optimal combination strategy of germination-induction/secondary disinfection may be a promising aspect of wide-area decontamination following a B. anthracis contamination event.

SIGNIFICANCE AND IMPACT OF THE STUDY

By inducing spores to germinate, our data confirm that the resulting cells exhibit sensitivities that can be leveraged when paired with certain decontamination measures. This increased susceptibility could be exploited to devise more efficient and safe decontamination measures and may obviate the need for more stringent methods that are currently in place.

The effect of 5% sodium hypochlorite, 17% EDTA and triphala on two different rotary Ni-Ti instruments: An AFM and EDS analysis

Aim:

To use Atomic Force Microscope and Energy Dispersive X-ray Spectroscopy to evaluate the effect of 5% NaOCl, 17% EDTA and triphala on ProTaper and iRaCe rotary Ni-Ti instruments.

Methodology:

A total of eight Ni-Ti rotary files, four files each of ProTaper - S2 (Dentsply) and iRaCe - R3 (FKG DENTAIRE) were used. Three out of four files each from ProTaper and iRaCe were immersed in 5% NaOCl, 17% EDTA and Triphala separately for five minutes. The Roughness average (Ra), Root Mean Square (RMS) and Mean Height of Roughness Profile Elements (Rc) of the scanned profiles were then recorded using AFM and the elemental composition was evaluated with EDS. Data were analyzed by Student's t test, One Way ANOVA and Duncan's Multiple Range Test.

Results:

Topographic irregularities at the nanometric scale were observed for all files. Files immersed in EDTA and NaOCl showed highly significant surface roughness than untreated files.

Conclusion:

Short-term contact with 17% EDTA and 5% NaOCl can cause significant surface deterioration of ProTaper and iRaCe rotary NiTi files. AFM proves to be a suitable method for evaluating the instrument surface.

Experimental evaluation of cyclic fatigue resistance of four different nickel-titanium instruments after immersion in sodium hypochlorite and/or sterilization

NiTi instruments have a high risk of separation due to torsional or flexural fatigue (cyclic fatigue). Chemomechanical preparation, cleaning procedures, chemical disinfection and sterilization cause the corrosion of endodontic instruments that may weaken the fracture resistance of the instruments.

Cyclic fatigue resistance of two reciprocating nickel-titanium instruments after immersion in sodium hypochlorite

AIM

To assess resistance to cyclic fatigue of reciprocating nickel-titanium ( NiTi ) files (Reciproc and WaveOne) after immersion in NaOCl solution over several time periods.

METHODOLOGY

A total of 90 new Reciproc R25 and WaveOne Primary were tested. The 45 files of the same brand were randomly assigned to three groups (n = 15) and submitted to the following immersion protocol in 5% NaOCl at 37 °C for 16 mm: no immersion (control), 1 or 5 min dynamically. The dynamic immersion and the following cyclic fatigue tests were performed using the appropriate preset reciprocation modes ('RECIPROC ALL' or 'WAVEONE ALL') in a specially designed endodontic motor. Resistance to cyclic fatigue was determined by recording time to fracture (TtF) in a stainless steel artificial canal with a 60° angle of curvature and 5 mm radius of curvature. The artificial canal was manufactured reproducing the instrument's size and taper. Data were analysed by 2-way analyses of variance.

RESULTS

Resistance to cyclic fatigue of the same NiTi file was not significantly affected by immersion in NaOCl . Reciproc R25 was associated with a higher cyclic fatigue resistance in all groups compared to WaveOne Primary (P < 0.0001).

CONCLUSIONS

Reciprocating dynamic immersion in NaOCl for 1 or 5 min did not reduce the cyclic fatigue resistance of NiTi files significantly. However, the type of reciprocating instrument influenced cyclic fatigue resistance with Reciproc R25 being more resistant than WaveOne Primary.

Electrochemical corrosion assessment of RaCe and Mtwo rotary nickle-titanium instruments after clinical use and sterilization

Aim: The aim of the present study was to electrochemically evaluate corrosion resistance of RaCe and Mtwo files after repeated sterilization and preparation procedures. Study Design: A total of 450 rotary files were used. In the working groups, 72 files from each file type were distributed into 4 groups. RaCe and Mtwo files were used to prepare one root canal of the mesial root of extracted human mandibular first molars. The procedure was repeated to prepare 2 to 8 canals. The following irrigation solutions were used: group 1, RaCe files with 2.5% NaOCl; group 2, RaCe files with normal saline; group 3, Mtwo files with 2.5% NaOCl; and group 4, Mtwo files with normal saline in the manner described. In autoclave groups, 72 files from each file type were evenly distributed into 2 groups. Files were used for a cycle of sterilization without the use of files for root canal preparation. Nine new unused files from each file type were used as controls. Then the instruments were sent for corrosion assessment. Mann-Whitney U and Wilcoxon tests were used for independent and dependent groups, respectively. Results: Statistical analysis indicated that there were significant differences in corrosion resistance of files associated with working and autoclave groups between RaCe and Mtwo file types (p<0.001). Conclusions: Corrosion resistance of #25, #30, and #35 Mtwo files is significantly higher than that in RaCe files with similar sizes.

Key words:Corrosion, NiTi instruments, autoclave, RaCe, Mtwo.

Effect of environment on fatigue failure of controlled memory wire nickel-titanium rotary instruments

INTRODUCTION

This study examined the fatigue behavior of 2 types of nickel-titanium (NiTi) instruments made from a novel controlled memory NiTi wire (CM wire) under various environment conditions.

METHODS

Three conventional superelastic NiTi instruments of ProFile (Dentsply Maillefer, Ballaigues, Switzerland), Typhoon (Clinician's Choice Dental Products, New Milford, CT), and DS-SS0250425NEYY (Clinician's Choice Dental Products) and 2 new CM wire instruments of Typhoon CM and DS-SS0250425NEYY CM were subjected to rotational bending at the curvature of 35° in air, deionized water, 17% EDTA, or deionized water after immersion in 6% sodium hypochlorite for 25 minutes, and the number of revolutions of fracture (N(f)) was recorded. The fracture surface of all fragments was examined by a scanning electron microscope. The crack-initiation sites and the percentage of dimple area to the whole fracture cross-section were noted.

RESULTS

Two new CM Wire instruments yielded an improvement of >4 to 9 times in N(f) than conventional NiTi files with the same design under various environments (P < .05). The fatigue life of 3 conventional superelastic NiTi instruments was similar under various environments, whereas the N(f) of 2 new CM Wire instruments was significantly longer in liquid media than in air (P < .05). The vast majority of CM instruments showed multiple crack origins, whereas most instruments made from conventional NiTi wire had one crack origin. The values of the area fraction occupied by the dimple region were significantly smaller on CM NiTi instruments than in conventional NiTi instruments under various environments (P < .05).

CONCLUSIONS

Within the limitations of this study, the type of NiTi metal alloy (CM files vs conventional superelastic NiTi files) influences the cyclic fatigue resistance under various environments. The fatigue life of CM instruments is longer in liquid media than in air.