Edgar Schäfer

Shaping ability and cleaning effectiveness of two single‐file systems in severely curved root canals of extracted teeth: Reciproc and WaveOne versus Mtwo and ProTaper

AIM To compare shaping ability and cleaning effectiveness of two reciprocating single-file systems with Mtwo and ProTaper rotary instruments during the preparation of curved root canals in extracted teeth. METHODOLOGY A total of 80 root canals with curvatures ranging between 25° and 39° were divided into four groups of 20 canals. Based on radiographs taken prior to instrumentation, the groups were balanced with respect to the angle and the radius of canal curvature. Canals were prepared to the following apical sizes: Mtwo: size 35 using the single-length technique; ProTaper: F3, instruments were used in a modified crown-down manner; Reciproc and WaveOne: size 25. Using pre- and post-instrumentation radiographs, straightening of the canal curvatures was determined with a computer image analysis program. Preparation time and instrument failures were also recorded. These data were analysed statistically using anova and Student-Newman-Keuls test. The amounts of debris and smear layer were quantified on the basis of a numerical evaluation scale and were analysed statistically using the Kruskal-Wallis test. RESULTS During preparation no file fractured. All instruments maintained the original canal curvature well with no significant differences between the different files (P = 0.382). Instrumentation with Reciproc was significantly faster than with all other instruments (P < 0.05), while WaveOne was significantly faster than Mtwo and ProTaper (P < 0.05). For debris removal, Mtwo and Reciproc instruments achieved significantly better results (P < 0.05) than the other instruments in the apical third of the canals. In the middle and coronal parts, no significant differences were obtained between Mtwo, Reciproc and WaveOne (P > 0.05), while ProTaper showed significantly more residual debris (P < 0.05). The results for remaining smear layer were similar and not significantly different for the different parts of the canals (P > 0.05). CONCLUSIONS Under the conditions of this study, all instruments maintained the original canal curvature well and were safe to use. The use of Mtwo and Reciproc instruments resulted in better canal cleanliness in the apical part compared with ProTaper and WaveOne.

Roentgenographic Investigation of Frequency and Degree of Canal Curvatures in Human Permanent Teeth

Canal curvatures of 700 permanent human teeth were determined by measuring the angle and the radius of the curvatures and the length of the curved part of the canal. For each type of tooth (except third molars) 50 were selected at random and were investigated. Size 08 silver points were inserted into the canals, and the teeth were radiographed from a facial and proximal view by using a standardized technique. All radiographs were analyzed by a computerized digital image processing system. Of the 1163 root canals examined, 980 (84%) were curved and 65% showed an angle < or = 27 degrees with radii < 40 mm. Thirteen percent displayed angles between 27 degrees and 35 degrees with radii not greater than 15 mm, and 9% of all canals that were investigated had curves > 35 degrees with the greatest radius of 13 mm. The greatest angle of all the teeth was 75 degrees with a radius of 2 mm. To define the canal curvature mathematically and unambiguously, the angle, the radius, and the length of the curve should be given.

Comparison of Hand Stainless Steel and Nickel Titanium Rotary Instrumentation: A Clinical Study

The aim of this study was to compare the effect of hand instruments and rotary nickel titanium Flex-Master files used by eight experienced dentists in private practice on the extent of straightening of curved root canals. In patients, 110 canals were prepared by FlexMaster instruments, and 84 canals were enlarged using hand instruments. After instrumentation, all canals were obturated. Preoperative and postoperative radiographs were taken of each tooth using customized bite blocks. Straightening of the canal curvatures was determined with a computer image analysis program. Preparation time and size of the master apical file were also recorded. The use of FlexMaster instruments resulted in significantly less straightening and a shorter preparation time (p < 0.0001) compared with hand instrumentation. Master apical file sizes were significantly greater for FlexMaster than for hand instruments (p < 0.01). This clinical study indicates that FlexMaster instruments prepared curved canals rapidly and with only minimal straightening.

Antimicrobial Efficacy of Chlorhexidine and Two Calcium Hydroxide Formulations Against Enterococcus faecalis

The purpose of this study was to investigate the efficacy of chlorhexidine (CHX) and calcium hydroxide (Ca(OH2) against Enterococcus faecalis in vitro. Extracted single-rooted human teeth were instrumented up to size 40. After removal of the smear layer, an inoculum of E. faecalis was inserted into the root canals. After incubation, the inoculum was removed and the root canals were filled with one of three different disinfectants: Ca(OH2 paste, CHX 2%, and a mixture of CHX and Ca(OH2 paste (n = 10 in each group). Control teeth were filled with water of standardized hardness (n = 10). The teeth were then incubated for 3 days. After incubation, each root canal was instrumented, and the removed dentin was examined microbiologically. CHX was significantly more effective against E. faecalis than was Ca(OH2 paste or a mixture of CHX with Ca(OH2 paste (p < 0.05). There was no increase in the efficiency of Ca(OH2 paste when CHX was added (p > 0.05). The results suggest that CHX is effective in the elimination of E. faecalis from dentinal tubules under the conditions of this study.

Bending properties of rotary nickel-titanium instruments

OBJECTIVE We sought to compare the bending properties of different rotary nickel-titanium instruments and to investigate the correlation between their bending moments and their cross-sectional surface areas. STUDY DESIGN Resistance to bending was determined according to International Standards Organization publication 3630-1. The sample size was 10 files for each type, taper, and size. The cross-sectional surface area of all instruments was determined by using scanning electron microscope photographs of the cross section. The images were scanned and the area was calculated by using special software. Data were analyzed by using analysis of variance and the Student t test and the Newman-Keuls test for all pairwise comparisons. The strength of the correlation between the bending moment and the cross-sectional area was determined by computing the Pearson product moment correlation. RESULTS Bending moments were significantly lower for ProFile and RaCe files than for all other files (P <.05). K3 files were significantly less flexible than all other instruments (P <.05). The correlation between stiffness and cross-sectional area was highly significant (r = 0.928; P <.0001). CONCLUSION Nickel-titanium files with tapers greater than.04 should not be used for apical enlargement of curved canals because these files are considerably stiffer than are those with.02 or.04 tapers.

Incidence of Dentinal Defects after Root Canal Preparation: Reciprocating versus Rotary Instrumentation

INTRODUCTION The purpose of this study was to evaluate the incidence of dentinal defects after root canal preparation with reciprocating instruments (Reciproc and WaveOne) and rotary instruments. METHODS One hundred human central mandibular incisors were randomly assigned to 5 groups (n = 20 teeth per group). The root canals were instrumented by using the reciprocating single-file systems Reciproc and WaveOne and the full-sequence rotary Mtwo and ProTaper instruments. One group was left unprepared as control. Roots were sectioned horizontally at 3, 6, and 9 mm from the apex and evaluated under a microscope by using 25-fold magnification. The presence of dentinal defects (complete/incomplete cracks and craze lines) was noted and analyzed by using the chi-square test. RESULTS No defects were observed in the controls. All canal preparation created dentinal defects. Overall, instrumentation with Reciproc was associated with more complete cracks than the full-sequence files (P = .021). Although both reciprocating files produced more incomplete cracks apically (3 mm) compared with the rotary files (P = .001), no statistically significant differences were obtained concerning the summarized values of all cross sections (P > .05). CONCLUSIONS Under the conditions of this study, root canal preparation with both rotary and reciprocating instruments resulted in dentinal defects. At the apical level of the canals, reciprocating files produced significantly more incomplete dentinal cracks than full-sequence rotary systems (P < .05).

A Comparative Scanning Electron Microscopic Investigation of the Efficacy of Manual and Automated Instrumentation of Root Canals

The cleaning effectiveness of automated and manual root canal instrumentation was investigated with the aid of a scanning electron microscope. Hand instrumentation was performed with K-Flexofiles used in a reaming working motion and according to the step-back technique and with Hedstrom files used in a filing motion. Automated preparation was performed with the KaVo-Endo Flash device featuring torque-limited rotation using K-Flexofiles, as well as with the mechanical ProFile system using rotary nickel-titanium instruments. Twelve teeth each with either straight or curved root canals were instrumented to size 40. After cracking the roots longitudinally (n = 120), the amount of debris and smear layer were quantified on the basis of a numerical evaluation scale (1 through 5). Comparison of manual instrumentation with the automated KaVo-Endo Flash resulted in an equivalent degree of canal cleaning. Complete cleanliness was not achieved by any of the techniques and devices investigated. Best instrumentation results, especially in curved canals, were obtained with rotary ProFile instruments.

Effect of Three Different Sealers on the Sealing Ability of Both Thermafil Obturators and Cold Laterally Compacted Gutta-Percha

The purpose of this study was to assess the seal obtained in straight and curved root canals filled with either laterally compacted gutta-percha or Thermafil obturators. Each technique was used in combination with three different sealers (RSA RoekoSeal, AH Plus, AH 26). Thermafil obturators were also used without sealer, resulting in a total of 14 test groups of 16 teeth each. Sixty teeth served as positive or negative controls. Included in the study were 142 extracted teeth with straight and 142 with curved root canals. All canals were enlarged up to size 40. After obturation, all roots were placed in India ink for 48 h and rendered transparent to measure the maximum linear dye penetration. Canals filled with Thermafil obturators had significantly more extrusion of filling material than canals filled by lateral compaction (p < 0.01). Thermafil without sealer showed significantly greater dye penetration compared with all other groups both in straight and in curved canals (p < 0.05). As long as a sealer was used, the seal obturated with Thermafil was equivalent in terms of dye penetration to lateral compaction. There were no statistical differences in the mean apical dye penetration among the three sealers. The differences between the dye penetration in straight and in curved canals were insignificant for all groups (p > 0.05). Under the conditions of this study, Thermafil obturators achieved seals comparable to lateral compaction, as long as a sealer was used.

Properties of endodontic hand instruments used in rotary motion Part 2. instrumentation of curved canals

The shaping abilities of nickel-titanium K-files, stainless steel reamers, K-files, and flexible stainless steel instruments with conventional cutting tips and with modified noncutting tips were investigated under standardized conditions using a computer-driven testing device simulating the clinical use of the instruments. Simulated root canals with a 42-degree curvature were sequentially enlarged from #15 to #35. Undesirable changes in the canal shape as a result of instrumentation occurred in all cases. None of the instruments were able to remove material on the whole length of the inner side of the curvature, whereas all instruments removed material on the whole length of the outer side of the curvature, resulting in slight to severe bulging. The extent of undesirable changes in the canal shape depended typically of the type of instrument used. Best instrumentation results were obtained with flexible instruments with noncutting tips.

Shaping Ability of Four Nickel-Titanium Rotary Instruments in Simulated S-Shaped Canals

INTRODUCTION The purpose of this study was to compare the shaping ability of ProTaper, Mtwo, BioRaCe, and BioRaCe + S-Apex instruments in simulated canals with an S-shaped curvature. METHODS Canal transportation and aberrations were assessed by comparing the preinstrumentation and postinstrumentation images under a stereomicroscope. Analysis of variance and post hoc Student-Newman-Keuls test were used for statistical analysis. RESULTS ProTaper instruments caused more pronounced canal transportation in the apical curvature (P < .01) than all other instruments. The use of ProTaper, Mtwo, and BioRaCe instruments resulted in more canal aberrations compared with BioRaCe + S-Apex (P < .05). CONCLUSIONS NiTi systems including less tapered and more flexible instruments like S-Apex seem to be favorable when preparing S-shaped canals.