Nicola M. Grande

Fatigue Resistance of Engine-driven Rotary Nickel-Titanium Instruments Produced by New Manufacturing Methods

The aim of the present study was to investigate whether cyclic fatigue resistance is increased for nickel-titanium instruments manufactured by using new processes. This was evaluated by comparing instruments produced by using the twisted method (TF; SybronEndo, Orange, CA) and those using the M-wire alloy (GTX; Dentsply Tulsa-Dental Specialties, Tulsa, OK) with instruments produced by a traditional NiTi grinding process (K3, SybronEndo). Tests were performed with a specific cyclic fatigue device that evaluated cycles to failure of rotary instruments inside curved artificial canals. Results indicated that size 06-25 TF instruments showed a significant increase (p < 0.05) in the mean number of cycles to failure when compared with size 06-25 K3 files. Size 06-20 K3 instruments showed no significant increase (p > 0.05) in the mean number of cycles to failure when compared with size 06-20 GT series X instruments. The new manufacturing process produced nickel-titanium rotary files (TF) significantly more resistant to fatigue than instruments produced with the traditional NiTi grinding process. Instruments produced with M-wire (GTX) were not found to be more resistant to fatigue than instruments produced with the traditional NiTi grinding process.

Nonvital Tooth Bleaching: A Review of the Literature and Clinical Procedures

Tooth discoloration varies in etiology, appearance, localization, severity, and adhesion to tooth structure. It can be defined as being extrinsic or intrinsic on the basis of localization and etiology. In this review of the literature, various causes of tooth discoloration, different bleaching materials, and their applications to endodontically treated teeth have been described. In the walking bleach technique the root filling should be completed first, and a cervical seal must be established. The bleaching agent should be changed every 3-7 days. The thermocatalytic technique involves placement of a bleaching agent in the pulp chamber followed by heat application. At the end of each visit the bleaching agent is left in the tooth so that it can function as a walking bleach until the next visit. External bleaching of endodontically treated teeth with an in-office technique requires a high concentration gel. It might be a supplement to the walking bleach technique, if the results are not satisfactory after 3-4 visits. These treatments require a bonded temporary filling or a bonded resin composite to seal the access cavity. There is a deficiency of evidence-based science in the literature that addresses the prognosis of bleached nonvital teeth. Therefore, it is important to always be aware of the possible complications and risks that are associated with the different bleaching techniques.

Cyclic fatigue of Reciproc and WaveOne reciprocating instruments.

AIM To evaluate the cyclic fatigue resistance of Reciproc(®) and WaveOne(®) instruments in simulated root canals. METHODOLOGY Two groups of 15 NiTi endodontic instruments of identical tip size of 0.25 mm were tested, group A; Reciproc(®) R25 and group B: WaveOne(®) primary. Cyclic fatigue testing was performed in a stainless steel artificial canal manufactured by reproducing the instruments size and taper. A simulated root canal with a 60° angle of curvature and 5-mm radius of curvature was constructed for both the instruments tested. The centre of the curvature was 5 mm from the tip of the instrument and the curved segment of the canal was approximately 5 mm in length. The Reciproc(®) instruments were activated using the preset programme specific for the Reciproc(®) instruments, whilst the WaveOne(®) instruments were activated using the preset programme specific for the WaveOne(®) instruments. All instruments were rotated until fracture occurred and the time to fracture (TtF) and the length of the fractured tip were recorded and registered. Means and standard deviations of TtF and fragment length were calculated for each system and data were subjected to Students t-test (P < 0.05). RESULTS A statistically significant difference (P < 0.05) was noted between Reciproc(®) and WaveOne(®) instruments. Reciproc(®) R25 instruments were associated with a significant increase in the mean time to fracture when compared with primary WaveOne(®) instruments (130.8 ± 18.4 vs. 97.8 ± 15.9 s). There was no significant difference (P > 0.05) in the mean length of the fractured fragments between the instruments. CONCLUSIONS   Reciproc(®) instruments were associated with a significantly higher cyclic fatigue resistance than WaveOne(®) instruments.

The Effectiveness of Manual and Mechanical Instrumentation for the Retreatment of Three Different Root Canal Filling Materials

The aim of this study was to compare the effectiveness of the Mtwo R (Sweden & Martina, Padova, Italy), ProTaper retreatment files (Dentsply-Maillefer, Ballaigues, Switzerland), and a Hedström manual technique in the removal of three different filling materials (gutta-percha, Resilon [Resilon Research LLC, Madison, CT], and EndoRez [Ultradent Products Inc, South Jordan, UT]) during retreatment. Ninety single-rooted straight premolars were instrumented and randomly divided into 9 groups of 10 teeth each (n = 10) with regards to filling material and instrument used. For all roots, the following data were recorded: procedural errors, time of retreatment, apically extruded material, canal wall cleanliness through optical stereomicroscopy (OSM), and scanning electron microscopy (SEM). A linear regression analysis and three logistic regression analyses were performed to assess the level of significance set at p = 0.05. The results indicated that the overall regression models were statistically significant. The Mtwo R, ProTaper retreatment files, and Resilon filling material had a positive impact in reducing the time for retreatment. Both ProTaper retreatment files and Mtwo R showed a greater extrusion of debris. For both OSM and SEM logistic regression models, the root canal apical third had the greatest impact on the score values. EndoRez filling material resulted in cleaner root canal walls using OSM analysis, whereas Resilon filling material and both engine-driven NiTi rotary techniques resulted in less clean root canal walls according to SEM analysis. In conclusion, all instruments left remnants of filling material and debris on the root canal walls irrespective of the root filling material used. Both the engine-driven NiTi rotary systems proved to be safe and fast devices for the removal of endodontic filling material.

Root canal morphology of the mesiobuccal root of maxillary first molars: a micro-computed tomographic analysis

AIM To investigate ex vivo, the root canal morphology of the MB root of maxillary first molar teeth by means of micro-computed tomography. METHODOLOGY Thirty extracted intact human maxillary first molar teeth were selected for micro-tomographic analysis (SkyScan 1072, Aartselaar, Belgium) with a slice thickness of 38.0 mum. The following data regarding the MB root were analysed and recorded: number and type of root canals, prevalence of isthmuses, prevalence of intercanal connections, presence of accessory canals, presence of loops and number of apical foramina. RESULTS The MB2 canal was present in 80% of specimens and was independent in 42% of these cases. When present, the MB2 canal merged with the MB1 canal in 58% of cases. Communications between the two canals were found in all specimens, with isthmuses in 71% of the cases. These communications and isthmuses were respectively in 42% and 54% of the cases in the coronal third, in 59% and 79% of the cases in the middle third and in 24% and 50% of the cases in the apical third. A single apical foramen was found in 37% of specimens, two apical foramina were present in 23% of the cases, with three or more separate apical foramina occurring in 40% of the specimens. CONCLUSIONS The MB root canal anatomy was complex: a high incidence of MB2 root canals, isthmuses, accessory canals, apical delta and loops was found.

Bending Properties of a New Nickel-Titanium Alloy with a Lower Percent by Weight of Nickel

INTRODUCTION The aim of the present study was to evaluate the bending properties of Hyflex instruments, which exhibit a lower percent in weight of nickel (52 Ni %wt) and compare them with other commercially available nickel-titanium (NiTi) rotary instruments. METHODS Ten instruments with tip size 25, 0.06 taper of each of the following NiTi rotary instrumentation techniques were selected for the study: Hyflex, EndoSequence, ProFile, Hero, and Flexmasters. All instruments from each group were tested for stiffness by comparing their bending moment when they attained a 45-degree bend. Experimental procedures strictly followed testing methodology described in ISO 3630-1. All data were recorded and subjected to statistical evaluation by using analysis of variance test. Statistical significance was set at P < .05). RESULTS Statistical analysis of the data revealed that Hyflex files were found to be the most flexible instruments, with a significant difference (P < .05) in comparison with the other instruments. Among the other files, a significant difference has been reported for EndoSequence instruments compared with ProFile, Hero, and FlexMaster (P < .05), whereas no significant differences have been reported among those 3 files (P > .05). CONCLUSIONS Results of the present study have illustrated an increased flexibility of the new NiTi alloy over conventional NiTi alloy, and they highlight the potential of the new manufacturing process.

Cyclic fatigue of NiTi rotary instruments in a simulated apical abrupt curvature.

AIM To evaluate the cyclic fatigue resistance of five NiTi rotary systems in an abrupt apical curvature. METHODOLOGY Cyclic fatigue testing was performed in stainless-steel artificial canals with a 2-mm radius of curvature and an angle of curvature of 90 degrees constructed to the dimensions of the instruments tested. The middle of the simulated curvature was 2.5 mm from the tip of the instrument that was placed at full working length. All instruments were new and 25 mm in length. Ten ProTaper Universal F2 (Dentsply Maillefer, Ballaigues, Switzerland); FlexMaster (VDW, Munich, Germany) tip size 25, taper 0.06; Mtwo (Sweden & Martina, Padova, Italy) tip size 25, taper 0.06; ProFile tip size 25, taper 0.06 from Dentsply Maillefer (Ballaigues, Switzerland); and ProFile tip size 25, taper 0.06 from Dentsply Tulsa (Tulsa, OK, USA) were rotated passively at 300 rpm until fracture occurred, and the number of cycles to failure (NCF) recorded. Length of the fractured tip was measured. Data were analysed by one-way anova and Tukey HSD test to determine any statistical difference amongst groups. RESULTS Mtwo had the highest fatigue resistance compared to the other instruments (NCF 124 +/- 25) (P < 0.001); there was no statistical difference between ProFile from the two different brands, although ProFile from Maillefer had the higher fatigue life (NCF 75 +/- 10) compared to ProFile from Tulsa (NCF 66 +/- 10). No difference was registered between FlexMaster (NCF 53 +/- 5) and ProFile from Tulsa; ProTaper F2 had a significantly (P < 0.001) lower fatigue life compared to the other instruments tested (NCF 29 +/- 5). CONCLUSIONS Lifespan registered for the instruments tested in an apical abrupt curvature was Mtwo > ProFile from Maillefer > ProFile from Tulsa > FlexMaster > ProTaper.

Blue treatment enhances cyclic fatigue resistance of vortex nickel-titanium rotary files.

INTRODUCTION The aim of the present study was to evaluate the difference in cyclic fatigue resistance between Vortex Blue (Dentsply Tulsa Dental, Tulsa, OK) and Profile Vortex nickel-titanium (Dentsply Tulsa Dental) rotary instruments. METHODS Two groups of nickel-titanium endodontic instruments, ProFile Vortex and Vortex Blue, consisting of identical instruments in tip size and taper (15/.04, 20/.06, 25/.04, 25/.06, 30/.06, 35/.06, and 40/.04) were tested. Ten instruments from each system and size were tested for cyclic fatigue resistance, resulting in a total of 140 new instruments. All instruments were rotated in a simulated root canal with a 60° angle of curvature and a 5-mm radius of curvature of a specific cyclic fatigue testing device until fracture occurred. The number of cycles to failure and the length of the fractured tip were recorded for each instrument in each group. The mean values and standard deviation were calculated, and data were subjected to 1-way analysis of variance and a Bonferroni t test. Significance was set at the 95% confidence level. RESULTS When comparing the same size of the 2 different instruments, a statistically significant difference (P < .05) was noted between all sizes of Vortex Blue and Profile Vortex instruments except for tip size 15 and .04 taper (P = 1.000). No statistically significant difference (P > .05) was noted among all groups tested in terms of fragment length. CONCLUSIONS Vortex Blue showed a significant increase in cyclic fatigue resistance when compared with the same sizes of ProFile Vortex.

Fracture resistance of endodontically treated molars restored with extensive composite resin restorations

STATEMENT OF PROBLEM When cuspal coverage is required, there is no evidence that indirect composite resin restorations are superior to direct restorations in terms of biomechanical behavior. PURPOSE The purpose of this in vitro study was to compare the fracture resistance of cusp-replacing direct and indirect composite resin restorations in endodontically treated molars. MATERIAL AND METHODS Forty-five human mandibular molars were selected and divided into 3 groups (n=15): DIR specimens, restored with direct composite resin (Estelite Sigma) restorations; IND specimens, restored with indirect composite resin (Estelite Sigma) restorations, and control specimens, which remained intact. Endodontic treatment was performed using NiTi ProTaper rotary instruments, and teeth were filled using lateral condensation of gutta-percha and sealer. Extensive Class II MO cavities were prepared, and the 2 mesial cusps were reduced, allowing a 2-mm layer of composite resin. All teeth were prepared to the same dimensions, considering reasonable human variation. Specimens were loaded to failure and the fracture loads were recorded (N). The mode of fracture was determined using a stereomicroscope and classified as favorable or unfavorable failure. The data were subjected to a Kruskal-Wallis test, multiple-comparison Mann-Whitney test, and a chi-square test (alpha=.05). RESULTS Significant differences (P<.001) were observed between the control group and both DIR and IND groups. However, no significant difference was found between the DIR and IND groups. The chi-square test did not show a significant difference in the frequencies of favorable/unfavorable failure modes among the 3 groups (P=.981). CONCLUSIONS No significant difference was observed in the fracture resistance of endodontically treated molars restored to original contours with an extensive cusp-replacing direct or indirect composite resin restoration.

Cyclic fatigue of nickel-titanium rotary instruments in a double (S-shaped) simulated curvature.

INTRODUCTION The goal of the present study was to test the fatigue resistance of nickel-titanium rotary files in a double curvature (S-shaped) artificial root canal and to compare those results with single curvature artificial root canals. METHODS Two nickel-titanium endodontic instruments consisting of identical instrument sizes (constant .06 taper and 0.25 tip diameter) were tested, ProFile instruments and Vortex instruments. Both instruments were tested for fatigue inside an artificial canal with a double curvature and inside a curved artificial canal with a single curvature. Ten instruments for each group were tested to fracture in continuous rotary motion at 300 rpm. Number of cycles to failure (NCF) was calculated to the nearest whole number, and the length of the fractured fragment was measured in millimeters. Data were statistically analyzed with a level of significance set at 95% confidence level. RESULTS The NCF value was always statistically lower in the double curved artificial canal when compared with the single curve (P < .05) in both the apical and coronal curvatures. Statistically significant differences (P < .05) were noted between instruments of the same size of different brand only in the single curve; ProFile registered a mean of 633.5 ± 75.1 NCF, whereas Vortex registered a mean of 548 ± 48.9 NCF. CONCLUSIONS Regardless of the differences between the instruments used in the present study, the results suggest that the more complex is the root canal, the more adverse are the effects on the cyclic fatigue resistance of the instruments.