Effects of preparation techniques on root canal shaping assessed by micro-computed tomography

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Efficacy of Two Different Nickel-Titanium Rotary Systems in Retreatment Procedure With or Without Laser-Activated Irrigation: An In Vitro Study

Objective: The aim of this study was to compare the efficacy of HyFlex EDM (Coltene/Whaledent, Altstätten, Switzerland) and ProTaper Universal Retreatment Nickel-Titanium (NiTi) Systems [The ProTaper Universal Retreatment (PTR), Dentsply Maillefer, Ballaigues, Switzerland] in the removal of the root canal filling materials with or without laser activated irrigation. Materials and methods: The root canals of 60 human mandibular premolars were instrumented with K files up to size 35 at a working length; the step-back procedure was performed in 1 mm increments up to size 50. Next, the teeth were obturated using the lateral compaction technique with gutta-percha and resin-based sealer, and they were randomly divided into two groups (n = 30) according to the retreatment systems: PTR and HyFlex EDM NiTi rotary files. Then, each group was divided into two subgroups (n = 15), laser [photon-induced photo-acoustic streaming (PIPS); Fotona, Ljubljana, Slovenia] activated irrigation and conventional needle irrigation group. Following these procedures, the specimens were evaluated using micro-computed tomography. Results: There was no significant difference between the instrumentation systems regarding the cleaning efficacy (χ² = 0.754; p = 0.86). Additionally, PIPS method did not have a significant effect on the removal of the filling material compared to conventional needle irrigation. Conclusions: Both instrumentation systems were effective in removing the filling material, but neither was able to remove the filling material completely. PIPS method did not show a significant additional effect regarding the removal of filling material.

Shaping ability of protaper next compared with waveone in late-model three-dimensional printed teeth

Background

Comparison of the shaping ability of advanced nickel-titanium (Ni-Ti) instruments is of great interest to the field of endodontics. However, the models used to study canal preparation still lack uniformity, relevance to reality and complexity. The aim of this study was thus to compare the shaping abilities of the ProTaper Next (PN) and WaveOne (WO) Ni-Ti instruments in three-dimensional (3D)-printed teeth, which may overcome the present defects of most real teeth and model teeth including 3D S-shaped canals.

Methods

Six teeth and their corresponding 3D-printed replicas were prepared using the same kind of Ni-Ti instrument. The pre- and post-preparation volumes, surface areas and transportation of the canals were measured to compare the teeth with their replicas. Twenty 3D-printed teeth with S-shaped canals were used to support the preparation study. The S-shaped canals were then scanned to measure their volumes and surface areas. Next, the two kinds of instruments were used to prepare the 3D-printed canals (n = 10 per group). The volume and surface area of the canals, the transportation along the two curvatures and the percentage of unprepared surface area were measured. Micro-CT and VGstudio2.2 (VG2.2) software were used to perform scans and collect data throughout the research. The paired-samples T test and Kruskal-Wallis H test were used for statistical analysis.

Results

There was no significant difference between the real canals and the printed ones post-preparation (P > .05). The printed S-shaped root canals had a unified shape, with a small standard deviation and range. The WO group had higher mean values for the volume and superficial area measurements compared with the PN group (P < .05). No differences in the untouched areas were found between the two systems (P > .05). PN caused less transportation at the apical curve than WO did (P < .05).

Conclusions

In conclusion, 3D-printed teeth are suitable for the study of Ni-Ti rotary instruments. Furthermore, the PN rotary system caused less transportation at the apical curve than the WO system did in complicated root canal procedures.

In Vitro Comparison of Raypex 6 and Endopilot Using a Novel, Computer-Aided Measurement System, for Determining the Working Length

Introduction

Experimental evaluation of endometric devices usually relies on visual, subjective detection of the apical constriction to determine the accuracy of measurements. The aim of the present study was to analyze the accuracy of measurements of Raypex 6 and EndoPilot using a novel, objective image-analysis system.

Methods

Onehundred and twenty teeth were randomized and allocated to three groups: After coronal flaring, either Raypex 6 or EndoPilot were used to determine the endodontic working length during instrumentation using manual files (RPM and EPM group respectively). In addition, EndoPilot was used for continuous, automatic measurement during rotating instrumentation (EPA group). If the working length had been reached according to endometric results, the files were fixed in place. Tooth and file were then embedded and prepared for analysis. Subsequently, the distance between the tip of the file and the apical constriction (D_AC) or the apical foramen (D_AF) was calculated using trigonometric analysis and the position of the file relative to AC and AF was analyzed.

Results

Both inter- and intra-examiner-reliability of the trigonometric analysis were nearly perfect (ICC = 0.999, p<0.001). D_AC was not significantly different between groups (p>0.05, t-test). D_AF was significantly decreased when EPA had been used compared to EPM (p<0.05, Exact-test). EPA resulted in files being positioned beyond AF significantly more often than the other two methods (p<0.01).

Conclusions

All methods allowed reliable detection of AC. However, EPA significantly increased the risk of overpreparation. Objective, digital assessment based on image analysis was suitable to compare the accuracy of different endometric devices.

Computed tomography evaluation of rotary systems on the root canal transportation and centering ability

The endodontic preparation of curved and narrow root canals is challenging, with a tendency for the prepared canal to deviate away from its natural axis. The aim of this study was to evaluate, by cone-beam computed tomography, the transportation and centering ability of curved mesiobuccal canals in maxillary molars after biomechanical preparation with different nickel-titanium (NiTi) rotary systems. Forty teeth with angles of curvature ranging from 20° to 40° and radii between 5.0 mm and 10.0 mm were selected and assigned into four groups (n = 10), according to the biomechanical preparative system used: Hero 642 (HR), Liberator (LB), ProTaper (PT), and Twisted File (TF). The specimens were inserted into an acrylic device and scanned with computed tomography prior to, and following, instrumentation at 3, 6 and 9 mm from the root apex. The canal degree of transportation and centering ability were calculated and analyzed using one-way ANOVA and Tukey's tests (α = 0.05). The results demonstrated no significant difference (p > 0.05) in shaping ability among the rotary systems. The mean canal transportation was: -0.049 ± 0.083 mm (HR); -0.004 ± 0.044 mm (LB); -0.003 ± 0.064 mm (PT); -0.021 ± 0.064 mm (TF). The mean canal centering ability was: -0.093 ± 0.147 mm (HR); -0.001 ± 0.100 mm (LB); -0.002 ± 0.134 mm (PT); -0.033 ± 0.133 mm (TF). Also, there was no significant difference among the root segments (p > 0.05). It was concluded that the Hero 642, Liberator, ProTaper, and Twisted File rotary systems could be safely used in curved canal instrumentation, resulting in satisfactory preservation of the original canal shape.