An in vitro study to determine fracture resistance of tooth roots after different instrumentation techniques

Comparative Evaluation of Debris Extrusion, Remaining Dentin Thickness and Fracture Resistance of Endodontically Treated Teeth Using Rotary and Reciprocating Endodontic File Systems: An In Vitro Study

BACKGROUND

Preventing the apical extrusion of debris during instrumentation is of paramount importance to reduce the occurrence of flare-ups in endodontically treated teeth. Furthermore, an essential requirement for the longevity and strength of an endodontically treated tooth and its ability to resist fracture is the preservation of residual dentin thickness during instrumentation. The aim of this study was to compare the amount of debris extrusion, remaining dentin thickness at the coronal third, middle third, apical third, and the fracture resistance of the teeth using rotary (TruNatomy; Dentsply Sirona, Charlotte, NC) and reciprocating (WaveOne Gold; Dentsply Sirona) endodontic file systems.

METHODS

An in vitro study included 52 single-rooted, oval canal shaped teeth that underwent exploration and initial cleaning with a no. 15 K-file. The prepared canals were then randomly assigned to two groups: Group I, with instrumentation with the TruNatomy rotary file (n=26) and Group II, with instrumentation with the WaveOne Gold reciprocating file. Parameters like debris extrusion, remaining dentin thickness, and fracture resistance were evaluated in both the groups. Analysis was performed using a paired t-test for the assessment of difference between groups and one-way ANOVA test followed by the post-hoc Tukey test for difference between the coronal, middle and apical third for each study group.

RESULTS

The results revealed no significant difference (t=0.454, p=0.652) between the TruNatomy rotary file and WaveOne Gold reciprocating file in apical extrusion of debris after their use in root canal therapy. For the remaining dentin thickness, a significant difference was present between the TruNatomy rotary file and WaveOne Gold reciprocating rotary file at the coronal (t=5.766, p<0.0001) and middle (t=3.690, p=0.001) levels. The mean fracture resistance was significantly more (t=15.877, p<0.0001) with the TruNatomy rotary file compared to the WaveOne Gold reciprocating rotary file.

CONCLUSION

The TruNatomy rotary file system outperformed the WaveOne Gold reciprocating file system in terms of maintaining the remaining dentin thickness and providing improved fracture resistance. Nevertheless, debris extruded apically was comparable between the TruNatomy rotary file system and the WaveOne Gold reciprocating file system.

The "Butterfly Effect" and Its Correlation to the Direction of the Fracture Line in Root Dentin

INTRODUCTION

The butterfly effect is an optical phenomenon and is related to the presence of sclerotic dentin in the roots. The unique pattern of sclerotic dentin formation produces a characteristic butterfly shape in transverse sections of the roots. The objective of this study was to evaluate the direction of the fracture line in roots that exhibit the butterfly effect.

METHODS

Thirty single-rooted premolars with oval-shaped roots were decoronated and embedded in acrylic blocks and subjected to vertical force under a universal testing machine (HPBSD; Tec-Sol India, Chennai, India). Fractured roots were examined under a stereomicroscope (Model no. 080772; Lawrence and Mayo, Mumbai, India) at ×10 magnification to determine the location and direction of the fracture line. To evaluate the correlation between the direction of sclerotic dentin and the direction of the fracture line, teeth were sectioned and observed under a stereomicroscope at ×20 and ×40 magnification. The correlation was analyzed using the Fisher exact test (P < .05 for the coronal and apical thirds and P > .05 for the middle third).

RESULTS

Sclerotic dentin was observed more in the apical area and less in the coronal third of the root. The correlation between the direction of sclerotic dentin and the direction of the fracture line was statistically significant in the coronal and apical thirds of the root.

CONCLUSIONS

The vertical root fracture that runs buccolingually is correlated to the harder sclerotic dentin present in the mesiodistal direction.