Proximity of maxillary molar apexes to the cortical bone surface and the maxillary sinus.

Objectives: This study aimed to analyze the proximity of maxillary molar roots to their overlying cortical bone surfaces and the maxillary sinus. Materials and Methods: Cone-beam computed tomographic images of 151 patients with completely erupted upper molars that had 3 separate roots were studied. The following distances were measured: from the root apex to the cortical plate and maxillary sinus floor, and from the apical 3-mm level of the root to the cortical plate. Differences between groups were analyzed with 1-way analysis of variance and the Scheffé post hoc test, the significance of differences between cone-beam computed tomography views with the paired t-test, and the significance of differences among age groups with linear regression analysis. The significance level was set at p < 0.05. Results: The mesiobuccal and distobuccal root apexes of maxillary second molars were more distant from the buccal cortical plate than the maxillary first molars (p < 0.05). The apical 3-mm level of the mesiobuccal root of the first molar was closer to the buccal cortical bone than the second molar (p < 0.05). In the maxillary first molars, the thickness of the buccal cortical bone decreased in all roots with age (p < 0.05). In all root apexes of both molars, the difference in the vertical level between the maxillary sinus floor and the root apex increased with age (p < 0.05). Conclusions: Awareness of the anatomical profile of maxillary molar apices in relation to the cortical bones and maxillary sinus will be beneficial for apical surgery.

Torsional Resistance of Heat-Treated Nickel-Titanium Instruments under Different Temperature Conditions.

This study compared the torsional resistance of heat-treated nickel-titanium (NiTi) instruments under different temperature conditions. Four thermomechanically treated single-use NiTi rotary instruments were selected for this study: OneShape (OS), OneCurve (OC), WaveOne Gold (WOG) and HyFlex EDM (HFE). Each instrument was further subdivided by temperature into 2 subgroups. Maximum torque and the distortion angle until fracture occurred were evaluated. Differential scanning calorimetry analysis was performed to measure the phase transformation temperature. Statistical analysis was performed using a two-way ANOVA and t-test (p < 0.05). Fractured fragments were observed using scanning electron microscopy (SEM). The two-way ANOVA showed no significant differences for different temperature conditions. At both room (RT) and body temperature (BT), OS was predominantly austenite while HFE was martensite. OC and WOG were predominantly martensite at RT and mixed phase at BT. At BT, more than half of WOG was martensite, while half of OC was austenite. SEM examination showed no topographical differences between instruments in different temperature groups. In relation to a limitation of this study, there was no difference in torsional resistance of NiTi rotary instruments between the BT and RT conditions. This implies that clinicians do not need to consider a decrease of torsional resistance of heat-treated NiTi instruments at BT.

A micro-computed tomographic evaluation of root canal filling with a single gutta-percha cone and calcium silicate sealer.

OBJECTIVES: The purpose of this study was to evaluate the void of root canal filling over time when a calcium silicate sealer was used in the single gutta-percha cone technique. MATERIALS AND METHODS: Twenty-four J-shaped simulated root canals and twenty-four palatal root canals from extracted human maxillary molars were instrumented with ProFile Ni-Ti rotary instruments up to size 35/0.06 or size 40/0.06, respectively. Half of the canals were filled with Endoseal MTA and the other half were with AH Plus Jet using the single gutta-percha cone technique. Immediately after and 4 weeks after the root canal filling, the samples were scanned using micro-computed tomography at a resolution of 12.8 µm. The scanned images were reconstructed using the NRecon software and the void percentages were calculated using the CTan software, and statistically analyzed by 1-way analysis of variance, paired t-test and Tukey post hoc test. RESULTS: After 4 weeks, there were no significant changes in the void percentages at all levels in both material groups (p > 0.05), except at the apical level of the AH Plus Jet group (p < 0.05) in the simulated root canal showing more void percentage compared to other groups. Immediately after filling the extracted human root canals, the Endoseal MTA group showed significantly less void percentage compared to the AH Plus Jet group (p < 0.05). CONCLUSIONS: Under the limitations of this study, the Endoseal MTA does not seem to reduce the voids over time.

Comparison of Screw-In Forces during Movement of Endodontic Files with Different Geometries, Alloys, and Kinetics.

This study compared the maximum screw-in forces of various instruments during their movements. Forty simulated canals in resin blocks were randomly divided into four groups (n = 10): ProTaper Universal F2, ProTaper Gold F2, WaveOne Primary, and WaveOne Gold Primary. To standardize a lumen size, all artificial canals were prepared with ProTaper Universal F1. The rotation speed was set at 350 rpm with an automated 4 mm pecking motion at a speed of 1 mm/s. The pecking depth was increased by 1 mm for each pecking motion until the file reached the working length. During instrumentation, screw-in forces were automatically recorded by customized software. Maximum screw-in forces were analyzed by one-way ANOVA and Tukey's post hoc comparison with the significance level at 0.05. WaveOne Gold files generated the lowest maximum screw-in forces, followed by ProTaper Gold, WaveOne, and ProTaper Universal (p < 0.05). Under the condition of this study, heat-treated nickel-titanium (NiTi) files with smaller cross-sectional area, fewer contact points, and reciprocating movements resulted in a lower screw-in effect.

Comparison of In Vitro Torque Generation during Instrumentation with Adaptive Versus Continuous Movement.

INTRODUCTION: The purpose of this in vitro study was to compare the torque generated by continuous and adaptive movements of 2 nickel-titanium rotary file systems. METHODS: Forty-five simulated resin blocks with an S-shaped canal were randomly divided into 3 groups (n = 15) according to the file system and kinematics: the K3XF rotary system (Kerr Endodontics, Orange, CA) with continuous rotary movement, the K3XF with adaptive movement, and the Twisted File (Kerr Endodontics) adaptive file with adaptive movement. After creating a glide path, the canal was instrumented to the same size (.04/#20 for K3XF or SM1 for the Twisted File with adaptive movement) before torque measurement. During the final instrumentation procedure with the .06/25 sized file (K3XF or SM2), the generated torque and the preparation time were recorded. The total torque experienced and the maximum torque value were calculated. The data were statistically analyzed using 1-way analysis of variance and the Tukey post hoc comparison test at a significance level of 95%. RESULTS: The K3XF file system used with adaptive motion group showed significantly lower total and maximum torque values compared with the K3XF with continuous rotary movement group. The Twisted File adaptive file with adaptive motion showed significantly lower torque generation and shorter preparation time than the K3XF groups with adaptive or continuous rotation (P < .05). CONCLUSIONS: Under the conditions of this study, adaptive movement for nickel-titanium files may reduce torque generation without increasing preparation time. Nickel-titanium files with a smaller cross-sectional area using adaptive movement may be helpful to reduce the potential risk of root dentin damage.

Root Canal Shaping Effect of Instruments with Offset Mass of Rotation in the Mandibular First Molar: A Micro-computed Tomographic Study.

INTRODUCTION: The aim of this study was to evaluate the root canal shaping effect of 2 nickel-titanium rotary instruments with offset mass of rotation compared with an instrument with a conventional centered mass of rotation. METHODS: Thirty-six extracted human mandibular first molars with 2 independent mesial canals and 1 oval distal canal were selected and divided equally into 3 groups for instrumentation with ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), Revo-S (RS; Micro-Mega, Besançon, France), and ProTaper Universal (PTU, Dentsply Maillefer) systems (n = 12). For apical preparation, PTN X2 (#25/0.06), RS SU (#25/0.06), and PTU F2 (#25/0.08) were used in the mesial canals and PTN X3 (#30/0.07), RS AS30 (#30/0.06), and PTU F3 (#30/0.09) were used in the distal canals. Specimens were scanned before and after instrumentation using a SkyScan 1272 scanner (Bruker micro-CT, Kontich, Belgium) at 10-µm isotropic resolution. Changes in the canal area, volume, structure model index (SMI), and untouched canal area were evaluated. Canal transportation and centering ratio were measured at 1, 3, 5, and 7 mm from the apical foramen. Data were statistically analyzed using 1-way analysis of variance with the Tukey post hoc test. RESULTS: The PTN and RS systems showed significantly less transportation and better centering ability compared with the PTU system at 1 mm from the apical foramen (P < .05). All instrumentation increased the canal area, volume, and SMI values without significant differences among the 3 groups (P > .05). CONCLUSIONS: Regardless of the differences in the cross-sectional design, alloy type, and taper variation, instruments with offset mass of rotation showed better root canal shaping ability compared with an instrument with a centered mass of rotation.

Effect of the Glide Path Establishment on the Torque Generation to the Files during Instrumentation: An In Vitro Measurement.

INTRODUCTION: The purpose of this study was to compare in vitro torque generation during instrumentation with or without glide path establishment. METHODS: Endo-training resin blocks with J-shaped canals were randomly divided into 2 groups according to glide path establishment (with or without) and subdivided into 2 subgroups with shaping instruments (WaveOne [Dentsply Maillefer, Ballaigues, Switzerland] or WaveOne Gold [Dentsply Maillefer]) (n = 15). For the glide path-established group, the glide path was prepared using ProGlider (Dentsply Maillefer). During the instrumentation with WaveOne or WaveOne Gold, in vitro torque was measured. The acquired data were analyzed with software. The maximum torque and total torque (the sum of the generated torque) were calculated. The data were statistically evaluated using 2-way analysis of variance and the Duncan post hoc comparison to examine any correlation of torque generation with glide path establishment and nickel-titanium instruments. The significance level was set at 95%. RESULTS: The generated total torque by WaveOne Gold was significantly reduced by glide path establishment (P < .05), whereas glide path establishment did not induce significant changes in the maximum torque for both file systems. WaveOne Gold with a glide path showed the lowest total torque generation among all groups (P < .05). WaveOne generated a higher maximum torque than WaveOne Gold regardless of the establishment of a glide path (P < .05). CONCLUSIONS: Under the limitations of this study, glide path establishment and the mechanical property of instruments have a significant influence on torque generation. It is recommended to create the glide path and use a flexible file to reduce torque generation and, consequently, the risk of file fracture and root dentin damage.

Anatomical profile of the mesial root of the Burmese mandibular first molar with Vertucci's type IV canal configuration.

This study evaluated the anatomical profile of the mesial root canals of the Burmese mandibular first molar with Vertucci's type IV canal configuration (VT4) using microcomputed tomography analysis. Seventy-five mesial roots of extracted mandibular first molars were scanned and evaluated. Fourteen middle mesial canals (MMCs) were observed in the specimens; each specimen had an average of 1.63 lateral canals and 3.77 apical foramina. The lateral canals arising from the mesiobuccal canal, mesiolingual canal, MMC, and isthmus terminated at an average distance of 0.92, 0.73, 2.11, and 1.89 mm, respectively, from the apex. The mean distance between the centers of the mesiobuccal and mesiolingual canals at 1.5 mm coronal to the furcation was 2.60 mm. A higher incidence of isthmus was observed in the apical 2-6-mm region compared with the apical 0-2-mm region (P < 0.05). The incidence of lateral canals in the isthmus was similar to that of the mesiobuccal and mesiolingual canals (P > 0.05). This study shows that the mesial root of the Burmese mandibular first molar with VT4 has complex anatomical profiles comprising MMCs and isthmus and their lateral canals.

Stress Generation during Pecking Motion of Rotary Nickel-titanium Instruments with Different Pecking Depth.

INTRODUCTION: The aim of this study was to evaluate the effect of different pecking depth on the stress generated by the screw-in forces of a rotating endodontic file in simulated canals. METHODS: Twenty simulated resin blocks with a J-shaped curvature were used. Twenty OneG files (MicroMega, Besançon, France) were assigned for a screw-in test depending on the pecking depth in 2 groups (n = 10). The files were operated at 300 rpm, and the up and down speed was controlled at 1 mm/s stroke velocity and a 10-millisecond dwell time using a customized device. The distances (pecking depth) for the pecking motion were 2 mm or 4 mm for each group; "6 mm forward and 4 mm backward" and "6 mm forward and 2 mm backward" movements were applied, respectively, for the 2 pecking groups. During the operation, the positive and negative apical loads were recorded at a rate of 50 Hz using customized software attached to the device. The maximum negative apical load (screw-in force [SF]) was recorded, and the total energy during pecking motion until the file reached the working length (cumulative screw-in forces [CSFs]) was computed. The data were analyzed using an independent t test at a significance level of 95%. RESULTS: No significant difference in SF was found between the 2 groups of pecking depths. However, the longer pecking depth (4-mm group) showed a significantly larger CSF compared with the shorter pecking depth group (P < .05). CONCLUSIONS: The shorter pecking depth may generate lower overall stresses for the root dentin as well as the instrument.

Effect from Rotational Speed on Torsional Resistance of the Nickel-titanium Instruments.

INTRODUCTION: The purpose of this study was to evaluate differences in torsional resistance using up-regulated speed of rotational spindle. METHODS: Three NiTi rotary instrument systems were selected in this study: K3XF (SybronEndo, Glendora, CA), BLX (B&L Biotech, Ansan, Korea), and OneShape (MicroMega, Besançon, France). The tip size and taper for all files were #25 and 0.06. Experimental groups (n = 10/group) were assigned to 2-, 60-, 350-, and 600-rpm groups by the rotational speed of spindle. Forty new files were used for each test. The file tip of 5-mm length was secured between brass plates. While keeping the file straight, it was rotated clockwise at a constant rotational speed until fracture occurred. The parameters of torsional resistance, torsional load (Ncm), and distortion angle (°) were measured using an AEndoS-k (DMJ System, Busan, Korea), and the toughness until fracture was computed from these data. The 1-way analysis of variance test was used to analyze the torsional resistance at a significance level of 95%. All fractured fragments were observed under a scanning electron microscope to evaluate the topographic features of the fractured surfaces. RESULTS: No significant difference in torsional resistance was found among groups when they were compared for ultimate strength at the maximum torque, fracture angle, and toughness. Scanning electron microscopic examination of the fractured cross-sectional surfaces revealed typical features of torsional fractures, concentric abrasion marks, and fibrous dimples from the torsional center. CONCLUSIONS: Under the conditions of the study, the torsional resistances of the rotary instruments were not affected by the rotational speed.

Screw-in forces during instrumentation by various file systems.

OBJECTIVES: The purpose of this study was to compare the maximum screw-in forces generated during the movement of various Nickel-Titanium (NiTi) file systems. MATERIALS AND METHODS: Forty simulated canals in resin blocks were randomly divided into 4 groups for the following instruments: Mtwo size 25/0.07 (MTW, VDW GmbH), Reciproc R25 (RPR, VDW GmbH), ProTaper Universal F2 (PTU, Dentsply Maillefer), and ProTaper Next X2 (PTN, Dentsply Maillefer, n = 10). All the artificial canals were prepared to obtain a standardized lumen by using ProTaper Universal F1. Screw-in forces were measured using a custom-made experimental device (AEndoS-k, DMJ system) during instrumentation with each NiTi file system using the designated movement. The rotation speed was set at 350 rpm with an automatic 4 mm pecking motion at a speed of 1 mm/sec. The pecking depth was increased by 1 mm for each pecking motion until the file reach the working length. Forces were recorded during file movement, and the maximum force was extracted from the data. Maximum screw-in forces were analyzed by one-way ANOVA and Tukey's post hoc comparison at a significance level of 95%. RESULTS: Reciproc and ProTaper Universal files generated the highest maximum screw-in forces among all the instruments while M-two and ProTaper Next showed the lowest (p < 0.05). CONCLUSIONS: Geometrical differences rather than shaping motion and alloys may affect the screw-in force during canal instrumentation. To reduce screw-in forces, the use of NiTi files with smaller cross-sectional area for higher flexibility is recommended.

Preference of undergraduate students after first experience on nickel-titanium endodontic instruments.

OBJECTIVES: This study aimed to compare two nickel-titanium systems (rotary vs. reciprocating) for their acceptance by undergraduate students who experienced nickel-titanium (NiTi) instruments for the first time. MATERIALS AND METHODS: Eighty-one sophomore dental students were first taught on manual root canal preparation with stainless-steel files. After that, they were instructed on the use of ProTaper Universal system (PTU, Dentsply Maillefer), then the WaveOne (WO, Dentsply Maillefer). They practiced with each system on 2 extracted molars, before using those files to shape the buccal or mesial canals of additional first molars. A questionnaire was completed after using each file system, seeking students' perception about 'Ease of use', 'Flexibility', 'Cutting-efficiency', 'Screwing-effect', 'Feeling-safety', and 'Instrumentation-time' of the NiTi files, relative to stainless-steel instrumentation, on a 5-point Likert-type scale. They were also requested to indicate their preference between the two systems. Data was compared between groups using t-test, and with Chi-square test for correlation of each perception value with the preferred choice (p = 0.05). RESULTS: Among the 81 students, 55 indicated their preferred file system as WO and 22 as PTU. All scores were greater than 4 (better) for both systems, compared with stainless-steel files, except for 'Screwing-effect' for PTU. The scores for WO in the categories of 'Flexibility', 'Screwing-effect', and 'Feeling-safety' were significantly higher scores than those of PTU. A significant association between the 'Screwing-effect' and students' preference for WO was observed. CONCLUSIONS: Novice operators preferred nickel-titanium instruments to stainless-steel, and majority of them opted for reciprocating file instead of continuous rotating system.

Proximity of the mandibular molar root apex from the buccal bone surface: a cone-beam computed tomographic study.

OBJECTIVES: The purpose of this study was to evaluate the proximity of the mandibular molar apex to the buccal bone surface in order to provide anatomic information for apical surgery. MATERIALS AND METHODS: Cone-beam computed tomography (CBCT) images of 127 mandibular first molars and 153 mandibular second molars were analyzed from 160 patients' records. The distance was measured from the buccal bone surface to the root apex and the apical 3.0 mm on the cross-sectional view of CBCT. RESULTS: The second molar apex and apical 3 mm were located significantly deeper relative to the buccal bone surface compared with the first molar (p < 0.01). For the mandibular second molars, the distance from the buccal bone surface to the root apex was significantly shorter in patients over 70 years of age (p < 0.05). Furthermore, this distance was significantly shorter when the first molar was missing compared to nonmissing cases (p < 0.05). For the mandibular first molars, the distance to the distal root apex of one distal-rooted tooth was significantly greater than the distance to the disto-buccal root apex (p < 0.01). In mandibular second molar, the distance to the apex of C-shaped roots was significantly greater than the distance to the mesial root apex of non-C-shaped roots (p < 0.01). CONCLUSIONS: For apical surgery in mandibular molars, the distance from the buccal bone surface to the apex and apical 3 mm is significantly affected by the location, patient age, an adjacent missing anterior tooth, and root configuration.

Involvement of TRPA1 in the cinnamaldehyde-induced pulpal blood flow change in the feline dental pulp.

OBJECTIVES: The purpose of this study was to investigate the involvement of TRPA1 in the cinnamaldehyde-induced pulpal blood flow (PBF) change in the feline dental pulp. MATERIALS AND METHODS: Mandibles of eight cats were immobilized and PBF was monitored with a laser Doppler flowmetry at the mandibular canine tooth. To evaluate the effect of cinnamaldehyde on PBF, cinnamaldehyde was injected into the pulp through the lingual artery at a constant rate for 60 seconds. As a control, a mixture of 70% ethanol and 30% dimethyl sulfoxide (DMSO, vehicle) was used. To evaluate the involvement of transient receptor potential ankyrin 1 (TRPA1) in PBF change, AP18, a specific TRPA1 antagonist, was applied into the pulp through the Class V dentinal cavity followed by cinnamaldehyde-administration 3 minutes later. The paired variables of experimental data were statistically analyzed using paired t-test. A p value of less than 0.05 was considered as statistically significant. RESULTS: Administration of cinnamaldehyde (0.5 mg/kg, intra-arterial [i.a.]) induced significant increases in PBF (p < 0.05). While administration of a TRPA1 antagonist, AP18 (2.5 - 3.0 mM, into the dentinal cavity [i.c.]) caused insignificant change of PBF (p > 0.05), administration of cinnamaldehyde (0.5 mg/kg, i.a.) following the application of AP18 (2.5 - 3.0 mM, i.c.) resulted in an attenuation of PBF increase from the control level (p < 0.05). As a result, a TRPA1 antagonist, AP18 effectively inhibited the vasodilative effect of cinnamaldehyde (p < 0.05). CONCLUSIONS: The result of the present study provided a functional evidence that TRPA1 is involved in the mechanism of cinnamaldehyde-induced vasodilation in the feline dental pulp.

Esthetic enhancement of a traumatized anterior tooth with a combination of forced eruption and tooth alignment: a case report.

Exposing sound structure of a subgingivally fractured tooth using orthodontic extrusion is considered to be a conservative way to re-establish biologic width without sacrificing esthetics or jeopardizing periodontal support of neighboring teeth. When a misaligned tooth is traumatically involved, a more comprehensive approach combining tooth extrusion and re-alignment may be necessary for a successful restorative outcome. This case report describes a successful esthetic management of a patient with complicated crown-root fracture on the maxillary right central incisor and pre-existing malocclusion in the maxillary anterior region. Forced eruption along with re-alignment of teeth by orthodontic movement seems to allow re-positioning of the fracture line to a favorable position and correction of crowding, providing a better esthetic result.

Debris extrusion by glide-path establishing endodontic instruments with different geometries.

BACKGROUND/PURPOSE: Glide-path preparation is an important step during initial endodontic procedure to reduce shaping-instrument fracture. The aim of this study was to evaluate the amount of apically extruded debris produced by glide-path preparation instruments with different geometric designs. MATERIALS AND METHODS: Forty teeth extracted for periodontal reasons were randomly divided into four groups (n = 10). The working length was standardized at 17 mm from the apical foramen by a flattening reference point. The glide-path was created using repetitive up-and-down movement three times with one of following four selected instruments: One G, ProGlider, a size 15 ScoutRace, and a size 15 stainless-steel K-file. To collect the apically extruded debris, the customized apparatus was used, and the collected debris was stored in an incubator. The weight of the debris was measured using an analytical balance with an accuracy of 0.00001 g. The data were analyzed by one-way analysis of variance and Duncan's multiple comparison test at a significance level of 95%. RESULTS: The ProGlider group produced significantly less debris extrusion relative to the other groups (P < 0.05). The One G and ScoutRace groups showed no significant difference, but debris production was lower than that observed for the stainless-steel group (P < 0.05). CONCLUSION: Creating the glide-path using nickel-titanium rotary files produced lower amounts of debris extrusion than using manual stainless-steel files. The progressive taper design of ProGlider, the center-off cross-section of One G, and the alternative-pitch design of ScoutRace may have increased the efficiencies of debris removal with minimal extrusion during glide-path preparation. Glide-path preparation using NiTi rotary files have better clinical efficiency than the manual stainless-steel file.

Effect of repetitive pecking at working length for glide path preparation using G-file.

OBJECTIVES: Glide path preparation is recommended to reduce torsional failure of nickel-titanium (NiTi) rotary instruments and to prevent root canal transportation. This study evaluated whether the repetitive insertions of G-files to the working length maintain the apical size as well as provide sufficient lumen as a glide path for subsequent instrumentation. MATERIALS AND METHODS: The G-file system (Micro-Mega) composed of G1 and G2 files for glide path preparation was used with the J-shaped, simulated resin canals. After inserting a G1 file twice, a G2 file was inserted to the working length 1, 4, 7, or 10 times for four each experimental group, respectively (n = 10). Then the canals were cleaned by copious irrigation, and lubricated with a separating gel medium. Canal replicas were made using silicone impression material, and the diameter of the replicas was measured at working length (D0) and 1 mm level (D1) under a scanning electron microscope. Data was analysed by one-way ANOVA and post-hoc tests (p = 0.05). RESULTS: The diameter at D0 level did not show any significant difference between the 1, 2, 4, and 10 times of repetitive pecking insertions of G2 files at working length. However, 10 times of pecking motion with G2 file resulted in significantly larger canal diameter at D1 (p < 0.05). CONCLUSIONS: Under the limitations of this study, the repetitive insertion of a G2 file up to 10 times at working length created an adequate lumen for subsequent apical shaping with other rotary files bigger than International Organization for Standardization (ISO) size 20, without apical transportation at D0 level.

Effect of alloy type on the life-time of torsion-preloaded nickel-titanium endodontic instruments.

This study was aimed to evaluate the effect of torsional preloads on the cyclic fatigue life of nickel-titanium (NiTi) instruments with different history of heat treatments by manufacturers. WaveOne (Primary) made of M-wire, K3XF (#30/0.06) of R-phase, and ProTaper (F2) of conventional NiTi alloy was used. Each file was preloaded at four conditions (nil, 25, 50, and 75% of their mean ultimate torsional strength) before fatigue testing. The torsional preloads 10-, 30-, or 50-times were applied by securing 5 mm of the file tip, rotating it until the preset torque was attained before returning to the origin. Then, the number of cycles to failure (NCF) was evaluated by rotational bending in a simulated canal. Data were analyzed using multiple linear regression analysis and two-way ANOVA. Fractured instruments were examined under scanning electron microscope (SEM). SEM showed that most WaveOne after 75% preloading, regardless of repetitions, showed some longitudinal cracks parallel to the long axis of the file, which were rare for K3XF. Regression analysis revealed that the brand of instrument was the most critical factor. At up to 75% preloading, ProTaper and K3XF did not show any significant decline in NCF. For 30-repetition groups of WaveOne, the 50 and 25% torsion preloaded groups showed a significantly higher NCF than the 0 and 75% groups. Within the limitations of this study, the alloy type of NiTi instrument have a significant effect on the phenomenon that a certain amount of torsional preload may improve the cyclic fatigue resistance of NiTi rotary instruments.

Buckling resistance, bending stiffness, and torsional resistance of various instruments for canal exploration and glide path preparation.

OBJECTIVES: This study compared the mechanical properties of various instruments for canal exploration and glide-path preparations. MATERIALS AND METHODS: The buckling resistance, bending stiffness, ultimate torsional strength, and fracture angle under torsional load were compared for C+ file (CP, Dentsply Maillefer), M access K-file (MA, Dentsply Maillefer), Mani K-file (MN, Mani), and NiTiFlex K-file (NT, Dentsply Maillefer). The files of ISO size #15 and a shaft length of 25 mm were selected. For measuring buckling resistance (n = 10), the files were loaded in the axial direction of the shaft, and the maximum load was measured during the files' deflection. The files (n = 10) were fixed at 3-mm from the tip and then bent 45° with respect to their long axis, while the bending force was recorded by a load cell. For measuring the torsional properties, the files (n = 10) were also fixed at 3-mm, and clockwise rotations (2-rpm) were applied to the files in a straight state. The torsional load and the distortion angle were recorded until the files succumbed to the torque. RESULTS: The CP was shown to require the highest load to buckle and bend the files, and the NT showed the least. While MA and MN showed similar buckling resistances, MN showed higher bending stiffness than MA. The NT had the lowest bending stiffness and ultimate torsional strength (p < 0.05). CONCLUSIONS: The tested instruments showed different mechanical properties depending on the evaluated parameters. CP and NT files were revealed to be the stiffest and the most flexible instruments, respectively.

Endodontic treatment of maxillary lateral incisors with anatomical variations.

Maxillary lateral incisors usually exhibit a single root with a single canal. However, maxillary lateral incisor teeth with unusual morphology of root canal system are frequently reported. These cases of variable root canal anatomy can be treated well by nonsurgical endodontic methods. A detailed description of root canal morphology is fundamental for successful endodontic treatment. Treatment using an operating microscope, radiographs from different angles, and cone-beam computerized tomography (CBCT) can produce more predictable endodontic outcomes.