Search Results (51)

This study aimed to examine how downward load applied during instrumentation affects the stress generation and shaping properties in thermally treated and non-treated NiTi rotary instruments. ProTaper Universal (PTU; non-thermally treated) and ProTaper Gold (PTG; thermally treated) were used to prepare J-shaped canals in resin blocks. Load-controlled automated instrumentation and torque/force sensing devices were employed with preset downward loads of 1, 2, or 3 N (n = 10 each). The torque/force, instrumentation time, and canal-centering ratio were measured and analyzed using two-way or one-way analysis of variance with Tukey’s test (α = 0.05). In the PTU-1N group, instrumentation was not completed because a ledge was formed in all canals. The PTU-3N group showed significantly greater upward force (screw-in force) and clockwise torque, along with a significantly smaller canal-centering ratio (less deviation) at the apical 0 mm level, than the PTU-2N group (p < 0.05). The downward load did not influence the instrumentation time (p > 0.05). In the PTG groups, these effects of downward load on the force generation and canal-centering ratio were not significant (p > 0.05). In the non-thermally treated PTU instruments, greater downward loads enhanced screw-in force while decreasing apical canal deviation; however, these effects were abolished in the thermally treated PTG instruments. This study highlights the importance of adapting the instrumentation technique with instrument characteristics: thermally treated flexible instruments facilitate smoother use, while stiffer, non-thermally treated ones may require precise control of downward loads. Full article

Recently, the single-cone hydraulic canal filling technique using bioceramic sealers was found to hinder retreatment due to the mechanical properties of the bioceramic sealers. This study assessed the effectiveness of four nickel–titanium rotary files in removing gutta-percha and bioceramic sealer from molar root canals in vitro. Eighty-eight root canals from extracted molars were instrumented with Vortex Blue rotary files and filled with gutta-percha and bioceramic sealer using a single-cone technique. After 30 days, the filled canals were randomly divided into four groups according to the file used for re-instrumentation: ProTaper Gold (PTG), Endo ReStart (ERS), XP-3D Shaper (XPD), and HyFlex Remover (HFR). This study assessed whether root canal filling material removal and patency were achieved within a 10-min time frame, recording the time required in seconds. The rate of regaining patency and the time required to achieve patency were compared among groups using a generalized linear model. Scanning electron microscopy was used to evaluate the mechanical changes to the files after use. The patency rate of XPD and HFR was significantly higher than PTG. ERS and XPD demonstrated shorter patency times than HFR and significantly shorter patency times than PTG. SEM images revealed a varied range of reverse windings across file groups. PTG and ERS exhibited microcracks and fractured tips, while XPD and HFR did not display these mechanical alterations. The four file systems in this study displayed varying levels of effectiveness in the retreatment of root canals filled with bioceramic sealers. Full article

The present research compared the design, metallurgical properties, and mechanical characteristics of the ProTaper Ultimate instruments with five multifile systems. A total of 469 new nickel–titanium rotary finishing instruments, all 25 mm in length but varying in size, taper, and metal alloy composition, from six different multifile systems (ProTaper Ultimate, ProTaper Next, ProFile, Mtwo, EndoSequence, and GT Series X), were inspected for irregularities and analyzed for their spiral density (spirals per millimetre), blade design, surface finishing, alloy composition, phase transformation temperatures, and mechanical performance (microhardness, torsional, and bending resistance tests). Group comparisons were performed using Kruskal–Wallis and one-way ANOVA with post hoc Tukey’s tests (α = 5%). ProFile instruments exhibited a greater number of spirals and a higher density of spirals per millimetre compared to the other systems. Microscopic analysis revealed distinct tip geometries and blade designs among tested instruments. All of them displayed parallel marks from the machining process, but the EndoSequence system had the smoothest surface finish. The alloys of all instruments consisted of an almost equiatomic ratio of nickel to titanium. At the testing temperature, the ProTaper Ultimate system exhibited a complete R-phase crystallographic arrangement, while the ProFile and Mtwo systems were fully austenitic. The ProTaper Ultimate F2, F3, and FX instruments demonstrated the highest maximum torque values (1.40, 1.45, and 3.55 N.cm, respectively) and the lowest maximum bending loads (202.7, 254.9, and 408.4 gf, respectively). EndoSequence instruments showed the highest angles of rotation, while the highest microhardness values were recorded for GT Series X (407.1 HVN) and ProTaper Next (425.0 HVN) instruments. The ProTaper Ultimate system showed a high spiral density per millimetre and a complete R-phase crystallographic arrangement at room temperature, which significantly contributed to its superior flexibility and torsional strength when compared to the other tested systems. Full article

Background/Objectives: Nickel–titanium (Ni-Ti) rotary instruments have significantly enhanced the efficiency and safety of root canal shaping. However, the variety of Ni-Ti systems, characterized by differences in alloy composition, taper design, and heat treatment, may influence their usability, particularly for novice operators. This study aimed to evaluate the perceptions of dental students using four Ni-Ti rotary systems (MTwo, SlimShaper Pro, ProTaper Gold, and HyFlex EDM) in a simulated environment. Methods: Forty dental students from two universities participated in the study and completed a standardized preoperative training session. Root canal shaping was performed on resin teeth models, and an 11-item questionnaire was used to assess various parameters, including flexibility, ease of use, and the ability to maintain working length. Results: The results indicated significant differences in student feedback. SlimShaper Pro and HyFlex EDM were preferred for their flexibility, reduced resistance, and ease of instrument transitions, likely due to their smaller tapers and martensitic alloys. MTwo was rated the least flexible and more challenging to use. Conclusions: These findings underline the importance of user-friendly Ni-Ti systems in pre-clinical training to reduce procedural difficulties and operator stress. Further research should validate these findings in clinical settings to improve the training of novice operators. Full article

The optimal amplitude of pecking motion during nickel–titanium rotary root canal instrumentation remains unclear. This study evaluated how different pecking amplitudes influence the force/torque generation, canal-centering ability, and cyclic fatigue resistance of the Reciproc Blue R25 instrument. Thirty J-shaped resin canals were instrumented with Reciproc Blue using automated instrumentation and a torque/force sensing device with an up-and-down speed of 50 mm/min and varying pecking amplitudes: Group S (1 s apically, 0.5 s coronally), Group M (2 s apically, 1 s coronally), and Group L (4 s apically, 2 s coronally) (n = 10 each). Force/torque were recorded, and canal-centering ratios were determined. In a dynamic cyclic fatigue test, the Reciproc Blue instruments were rotated in a curved metal canal with 1 mm or 3 mm back-and-forth motions (n = 10 each). Group L exhibited significantly greater maximum downward force and cumulative upward (screw-in) force than Group S (p < 0.05), but torque was not significantly different across groups. Groups M and L exhibited a significantly smaller canal-centering ratio than Group S (p < 0.05). Pecking at 3 mm led to a significantly longer time to fracture and shorter fragment lengths than 1 mm pecking (p < 0.05). In the Reciproc Blue instrumentation, higher pecking amplitude improved canal-centering ability and cyclic fatigue resistance while increasing upward and downward forces. Full article

The introduction of nickel–titanium rotary instruments revolutionized shaping procedures as they were able to produce a well-tapered preparation while reducing operator fatigue. The major drawback of rotary instruments was the high risk of fracture due to bending and torsional stress. Thus, the creation of a glide path has been advocated and recommended by most rotary instrument manufacturers. The aim of the present review is to summarize existing knowledge on glide path preparation and identify areas where further research is needed. The primary goal is to provide a comprehensive overview of the techniques and instruments used in glide path preparation, highlighting their advantages and limitations. The secondary goal is to explore the effect of glide path creation on the overall success of endodontic treatment, particularly in terms of reducing procedural errors and improving treatment outcomes. An online search on PubMed, ScienceDirect, UCLA, and Scopus databases was conducted, and 116 articles were identified. Eligible articles were divided into nine categories based on what they researched and compared. The categories included centering ability and/or root canal transportation, cyclic fatigue resistance, glide path and shaping time, tortional stress resistance, apical extrusion of debris and/or bacteria, defects in dentine walls, file separation, postoperative pain assessment, and scouting ability and performance. Establishing a glide path reduces root canal transportation, especially with rotary methods. Reciprocating and heat-treated files offer higher fatigue resistance and shorter preparation time. Instruments with shorter pitch lengths have greater torsional strength. Preparation and coronal preflaring reduce apical debris and bacteria. Glide paths do not affect dentine microcracks, file separation, or defects but reduce immediate postoperative pain and improve cutting ability. Randomized trials are needed to assess their impact on treatment outcomes. Full article

The resistance of nickel–titanium endodontic instruments against cyclic fatigue failure remains a significant concern in clinical settings. This study aimed to assess the cyclic fatigue strength of five nickel–titanium rotary systems, while correlating the results with the instruments’ geometric and metallurgical characteristics. A total of 250 new instruments (sizes S1/A1, S2/A2, F1/B1, F2/B2, F3/B3) from ProTaper Gold, ProTaper Universal, Premium Taper Gold, Go-Taper Flex, and U-Files systems underwent mechanical testing. Prior to experimental procedures, all instruments were meticulously inspected to identify irregularities that could affect the investigation. Using a stereomicroscope, design characteristics such as the number of spirals, length, spirals per millimeter, and average helical angle of the active blade were determined. The surface finishing characteristics of the instruments were examined using a scanning electron microscope. Differential scanning calorimetry was employed to establish the instruments’ phase transformation temperatures, while energy-dispersive X-ray spectroscopy was utilized to analyze the elemental composition of the alloy. The instruments were subjected to cyclic fatigue testing within a stainless steel non-tapered artificial canal featuring a 6 mm radius and 86 degrees of curvature. Appropriate statistical tests were applied to compare groups, considering a significance level of 0.05. The assessed design characteristics varied depending on the instrument type. The least irregular surface finishing was observed in U-Files and Premium Taper Gold files, while the most irregular surface was noted in Go-Taper Flex. All instruments exhibited near-equiatomic proportions of nickel and titanium elements, whereas ProTaper Universal and U-Files instruments demonstrated lower phase transformation temperatures compared to their counterparts. Larger-sized instruments, as well as ProTaper Universal and U-Files, tended to display lower cyclic fatigue strength results. Overall, the design, metallurgical, and cyclic fatigue outcomes varied among instruments and systems. Understanding these outcomes may assist clinicians in making more informed decisions regarding instrument selection. Full article

(1) Background: The failure of nickel–titanium (NiTi) rotary files is a complication related to endodontic instruments. The aim of this study was to compare the resistance to cyclic fatigue between rotary and reciprocating file systems. (2) Methods: Specific PICO: Population (P): artificial root canals; Interventions (I): instrumentation with NiTi rotary and reciprocating files; Comparison (C): rotary versus reciprocating files; Outcome (O): cyclic fatigue resistance. Studies were identified through bibliographic research using electronic databases (Medline, Embase, Scopus, SciELO, and WOS). The studies were combined using a random effects model by the inverse variance method. The effect size was the mean of the time to fracture (TTF) and number of cycles to fracture (NCF). Heterogeneity was assessed using the p value of the Q test for heterogeneity and the I2. (3) Results: TTF for rotary files was determined in 474.5 s and 839.1 for reciprocating without statistically significant differences. NCF for rotary systems was determined in 1444.2 and for reciprocating file systems in 4155.9 with statistically significant differences (p = 0.035), making reciprocating files more resistant. (4) Conclusions: Reciprocating files have better resistance to cyclic fatigue than rotary files. When tested in double curvature canals, reciprocating files also showed higher resistance. Full article

Sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) are commonly recommended for effectively removing organic and inorganic components in the smear layer. This layer is found on root canal walls after root canal instrumentation. However, high-concentration EDTA reduces the strength of dentin and the dissolution efficacy of organic substances in NaOCl solution. The objective of this study was to investigate the efficacy of applying nano and submicron diamonds in irrigation solutions with sonic and ultrasonic oscillation for removing the smear layer during endodontic treatment. Extracted single-rooted human teeth were instrumented with ProTaper^® Gold (Dentsply Sirona) nickel–titanium rotary instruments. Subsequently, each canal was irrigated with 3% NaOCl, 17% EDTA, distilled water, and 10–1000 nm-sized nano and submicron diamond irrigation solutions, respectively. Sonic and ultrasonic instruments were compared for oscillating the irrigation solutions. The teeth were processed for scanning electron microscopy to observe the efficiency of smear layer removal on the canal walls. Our results indicated that diamond sizes of 50 nm and above irrigation solutions showed significant effectiveness in removing the smear layer following the oscillation of sonic instruments for 10 s. Ultrasonic assisted 500 nm and 1000 nm diamond solutions significantly differed from the other diamond-sized solution in their ability to remove the smear layer. These results suggest that sonic and ultrasonic oscillation with specific sizes of nano and submicron diamond irrigation solution can be used as an alternative approach to removing the smear layer during endodontic treatment. The potential clinical application of root canal treatments can be expected. Full article

The present study aims to measure the number of cycles leading to fracture (NCF) of instruments in static and dynamic cyclic fatigue situations under body temperature in stainless steel double-curved canals. The framework was constructed to establish the movement of instruments occurring at a stable body temperature. A step motor, a holding system for an endodontic handpiece, created the movement in and out of the artificial canal of the file mounted on the handpiece. A total of 30 instruments of ProTaper Universal and ProTaper Next (Dentsply Sirona, Maillefer, Ballaigues, Switzerland) were divided into three groups of 10 per group. For group 1 (10 PTU F2), files were rotated in static cycles. For groups 2 (10 PTU F2) and 3 (10 PTN X2), files were rotated in dynamic cycles. Files were rotated using proprietary programs, and the times the files were rotated before fracture were recorded. Data were analyzed using survival probabilities and regression with life data. The ProTaper Next in the dynamic cycles had the largest NCF, and the ProTaper Universal in the static condition had the least. New modes of rotation, material, and design have affected the cyclic fatigue resistance of the instrument. Full article

Background: To evaluate the cyclic fatigue resistance of rotary endodontic nickel-titanium instruments using both experimental and finite element methods. Methodology: Four different proprietary rotary endodontic instruments (PTG, PTU, VB, and TRN) were subjected to cyclic fatigue tests through a custom-built fixture (n = 30 for each group) and tested until failure according to the manufacturer’s recommended settings, and the number of cycles to failure (NCF) was measured. Separated fragments were measured to determine the location of the fracture event. Finite element modeling replicated this experiment in silico via a two-step method, modeling the dynamic motion via an initial insertion step, then followed by rotation. Results: TRN showed the highest NCF (2027.94 ± 452.50) with the lowest values for strain (4.49% ± 0.23%) and fragment lengths (3.26 mm ± 0.47 mm), whereas PTU showed the lowest NCF (600.90 ± 80.86) and highest values for strain (6.29% ± 0.47%) and fragment lengths (5.36 mm ± 0.79 mm). All instruments showed an increase in von Mises and maximum principal stress during the insertion step but showed no changes to the maximum stress values during the rotational step. Conclusions: The finite element analysis approach used provided useful insights into the stress evolution and stress distribution of instruments during cyclic fatigue but lacked the ability with existing inputs to predict failure from cyclic fatigue. Full article

This study aimed to compare the intracanal lateral force and cutting efficiency associated with two engine-driven nickel-titanium (NiTi) systems during root canal shaping. Bovine single-rooted teeth models were assembled to a custom-made splitting force measuring platform while being endodontically treated with rotary (ProTaper Gold [PTG]) or reciprocal systems (WaveOne Gold [WOG]) by two clinicians. The cutting efficiency test was run for each group by a free-falling endomotor on dentin discs for 3 min. The resulting force, files, and stroke force peaks were recorded. Data were analyzed by the Shapiro-Wilk test and ANOVA. Statistical significance was set at alpha = 0.05. Intracanal lateral forces (p < 0.01), cutting efficiency (p < 0.01), and time efficiency (p < 0.01) were significantly different between the NiTi groups. The maximum lateral splitting force was detected using the PTG shaping full-length file (S1) and during the WOG final stroke. Thus, caution is advised when reciprocating single-file systems approach the apical third or when using a large taper and wide-diameter rotatory instruments. The WOG had significantly less maximum horizontal splitting force and significantly greater cutting efficiency but less time efficiency than the PTG system. Full article

Nickel-titanium (NiTi) usage is associated in endodontics with some complications including canal transportation. Centering ability of a NiTi file is the ability to stay centered in the root canal system during instrumentation. Any undesirable deviation from the natural canal path is indicated as canal transportation. A possible strategy to improve the centering ability of NiTi instruments is the pre-enlargement of the coronal third of the root canal to minimize coronal interferences. This procedure is known as coronal flaring. The aim of this study was to perform a micro-computed tomographic (micro-CT) evaluation of the effect of coronal flaring on canal transportation and centering ability of two heat treated nickel-titanium rotary instruments, 2Shape (Micro Mega, Besançon, France) and HyFlex CM (Coltène Whaledent, Altstätten, Switzerland). Thirty extracted mandibular molars with two independent mesial canals were selected and randomly instrumented (n = 15 canals) with One Flare (Micro Mega, Besançon, France) before HyFlex CM, HyFlex CM (without coronal flaring), One Flare before 2Shape and 2Shape (without coronal flaring). One Flare (Micro Mega, Besançon, France) was introduced 4 mm below the canal entrance for canals prepared with coronal flaring. HyFlex CM and 2Shape were used accordingly to manufacturers’ instructions. New files were used for each canal. During and after instrumentation, irrigation procedures were performed. Micro-CT images were obtained pre- and post-preparation to measure and record root canal transportation and centralization. They were reconstructed from root apex to canal orifices, generating approximately 1000 sections per specimen. The anatomical thirds were determined by dividing the number of cross-sectional slices by three. Root canal transportation and centralization were determined by Gambil method, and the mean values were analyzed by repeated measures analysis of variance followed by multiple comparisons of Bonferroni to compare the different instrumentations procedures and the root thirds (p < 0.05). As for root canal transportation, 2Shape reported significantly higher values compared to HyFlex CM in the cervical region independently from the coronal flaring. In the apical region, 2Shape caused significantly minor canal transportation when used with coronal flaring with compared with the absence of coronal flaring. Regarding the centralization, HyFlex CM showed higher values than 2Shape in the cervical, independently from coronal flaring. In the apical region, 2Shape with coronal flaring exhibited significant major centering ratio, compared with not. Within the limitations of this study, coronal flaring reduced canal transportation and improved centralization of the 2Shape files in the apical section while it had no significant influence on shaping ability of the HyFlex CM instruments. Coronal flaring could represent a valid strategy to improve the shaping ability of NiTi files knowing that its benefit could be influenced by the shaping file used. Full article

This study aimed to evaluate and compare the effects of ambient temperature and post-manufacture heat-treatment on the mechanical behavior of nickel-titanium (NiTi) wires. Four types of commercial NiTi variants (Stock NiTi, heat treated “Blue”, “Gold”, “Superflex”, all Dentsply Maillefer, Ballaigues, Switzerland) were stressed in a tensile testing machine in a temperature-controlled water bath at three different temperatures. Stress and strain values were extrapolated from the raw data, and 2-way ANOVA and Tukey’s test for multiple comparisons were performed to compare the differences of the mechanical constants. Differential scanning calorimetry (DSC) tests established the martensitic transformation starting (M_s), finishing (M_f) and austenitic (reverse-martensitic) starting (A_s) and finishing (A_f) points. Austenitic modulus of elasticity and transformation stress values increased with temperature for all NiTi groups. The martensitic modulus of elasticity, maximum transformation strain and ultimate tensile stress were not significantly affected by temperature changes. Stock NiTi and Gold wire samples presented with clearly delineated austenitic and martensitic transformations in the DSC experiments. Differences in manufacturing/heat treatment conditions and ambient temperature affect the mechanical behavior of nickel-titanium and may have clinical implications. Further improvements to the experimental setup could be considered to provide more accurate measurements of strain. Full article

Selection of an appropriate nickel–titanium (NiTi) rotary system is important for minimally invasive endodontic treatment, which aims to preserve as much root canal dentin as possible. This study aimed to evaluate selected mechanical properties and the root canal shaping ability of TruNatomy (TRN), a NiTi rotary system designed for minimally invasive endodontic shaping, in comparison with existing instruments: HyFlex EDM (HEDM), ProTaper Next (PTN), and WaveOne Gold (WOG). Load values measured with a cantilever bending test were ranked as TRN < HEDM < WOG < PTN (p < 0.05). A dynamic cyclic fatigue test revealed that the number of cycles to fracture was ranked as HEDM > WOG > TRN > PTN (p < 0.05). Torque and vertical force generated during instrumentation of J-shaped artificial resin canals were measured using an automated instrumentation device connected to a torque and vertical force measuring system; TRN exhibited smaller torque and vertical force values in most comparisons with the other instruments. The canal centering ratio for TRN was smaller than or comparable to that for the other instruments except for WOG at the apex level. Under the present experimental conditions, TRN showed higher flexibility and lower torque and vertical force values than the other instruments. Full article