The effect of rotation speed of XP-endo Shaper on apically extruded debris during endodontic procedures: an In Vitro study / El efecto de la velocidad de rotación de XP-endo Shaper sobre los desechos extruídos apicalmente durante los procedimientos de endodoncia: un estudio in vitro

Abstract The aim of this study was to evaluate the effect of using a higher rotation speed with the XP-endo Shaper (XPS) on apically extruded debris and operation time during endodontic treatment and retreatment procedures. Sixty mesial roots of mandibular first molar teeth were randomly assigned to four groups (Initial treatment groups: XPS used at 1000 or 3000rpm rotation speeds and Retreatment groups: XPS used at 1000 or 3000rpm rotation speeds). During the initial treatment and retreatment procedures preweighed eppendorf tubes were used to collect apically extruded debris, and the operation time was recorded in seconds. The extruded debris was quantified by subtracting the preinstrumentation from the postinstrumentation weight of the Eppendorf tubes. Data were analysed using two-way ANOVA at a significance level of 0.05. In all groups, the use of the XPS at 1000 or 3000rpm rotation speeds had no statistically significant effect on the amount of apically extruded debris (p>0.05). The use of the XPS at a 3000rpm rotation speed significantly decreased the instrumentation time (p<0.05). In summary, the use of the XPS at high rotation speeds in initial treatment and retreatment procedures did not have a significant effect on the amount of apically extruded debris but significantly decreased the operation time.

Resumen El objetivo de este estudio fue evaluar el efecto del uso de una mayor velocidad de rotación con XP-endo Shaper (XPS) sobre los desechos extruidos apicalmente y el tiempo de operación durante el tratamiento endodóntico y los procedimientos de retratamiento. Sesenta raíces mesiales de los primeros molares mandibulares se asignaron aleatoriamente a cuatro grupos (grupos de tratamiento inicial: XPS usado a velocidades de rotación de 1000 o 3000rpm y grupos de retratamiento: XPS usado a velocidades de rotación de 1000 o 3000rpm). Durante el tratamiento inicial y los procedimientos de retratamiento se utilizaron tubos Eppendorf pesados previamente para recoger los desechos extruidos apicalmente, y el tiempo de operación se registró en segundos. Los residuos extruidos se cuantificaron restando la preinstrumentación del peso postinstrumentación de los tubos Eppendorf. Los datos se analizaron mediante ANOVA bidireccional a un nivel de significación de 0,05. En todos los grupos, el uso del XPS a velocidades de rotación de 1000 o 3000rpm no tuvo un efecto estadísticamente significativo sobre la cantidad de detritos extruidos apicalmente (p>0.05). El uso del XPS a una velocidad de rotación de 3000rpm disminuyó significativamente el tiempo de instrumentación (p<0.05). En resumen, el uso del XPS a altas velocidades de rotación en los procedimientos de tratamiento inicial y retratamiento no tuvo un efecto significativo en la cantidad de detritos extruidos apicalmente, pero disminuyó significativamente el tiempo de operación.

Evaluation of the accuracy of different apex locators in determining the working length during root canal retreatment.

Background. This study aimed to assess the accuracy of three electronic apex locators (EALs) (Dentaport ZX [J Morita, Tokyo, Japan], Propex Pixi [Dentsply Maillefer, Ballaigues, Switzerland], and iPex II [NSK, Tokyo, Japan]) during root canal retreatment. Methods. The root canal lengths of 90 extracted single-rooted human teeth were determined under a dental operating microscope at ×10 magnification. The actual working length (AWL) was 0.5 mm less than the root length. Electronic measurements were performed with the three EALs. The root canals were instrumented and filled to the actual working length using the lateral compaction technique. After seven days, the teeth were retreated until the retreatment file was applied to the root canal at the working length determined by EALs, and then, the three EALs were used for determining the retreatment working length. Data were analyzed using chi-squared and Kruskal-Wallis tests. Results. In the retreatment, the accuracy of EALs was reported at %83.3 for Dentaport ZX, %83.4 forPropex Pixi, and %80 for iPex II within a tolerance of 0.5± mm of the AWL. Conclusion. Under the limitations of this study, Dentaport ZX, Propex Pixi, and iPex II can be a useful adjunct during retreatment. Clinicians should be aware that residual materials in the root canal during retreatment can affect the accuracy of EALs.

Micro-computed tomographic assessment of the shaping ability of the One Curve, One Shape, and ProTaper Next nickel-titanium rotary systems.

OBJECTIVES: This micro-computed tomographic (CT) study aimed to compare the shaping abilities of ProTaper Next (PTN), One Shape (OS), and One Curve (OC) files in 3-dimensionally (3D)-printed mandibular molars. MATERIALS AND METHODS: In order to ensure standardization, 3D-printed mandibular molars with a consistent mesiobuccal canal curvature (45°) were used in the present study (n = 18). Specimens were instrumented with the OC, OS, or PTN files. The teeth were scanned pre- and post-instrumentation using micro-CT to detect changes of the canal volume and surface area, as well as to quantify transportation of the canals after instrumentation. Two-way analysis of variance was used for statistical comparisons. RESULTS: No statistically significant differences were found between the OC and OS groups in the changes of the canal volume and surface area before and after instrumentation (p > 0.05). The OC files showed significantly less transportation than the OS or PTN systems for the apical section (p < 0.05). In a comparison of the systems, similar values were found at the coronal and middle levels, without any significant differences (p > 0.05). CONCLUSIONS: These 3 instrumentation systems showed similar shaping abilities, although the OC file achieved a lesser extent of transportation in the apical zone than the OS and PTN files. All 3 file systems were confirmed to be safe for use in mandibular mesial canals.

Effects of the endodontic access cavity on apical debris extrusion during root canal preparation using different single-file systems.

OBJECTIVES: This study was conducted to evaluate the effects of traditional and contracted endodontic cavity (TEC and CEC) preparation with the use of Reciproc Blue (RPC B) and One Curve (OC) single-file systems on the amount of apical debris extrusion in mandibular first molar root canals. MATERIALS AND METHODS: Eighty extracted mandibular first molar teeth were randomly assigned to 4 groups (n = 20) according to the endodontic access cavity shape and the single file system used for root canal preparation (reciprocating motion with the RCP B and rotary motion with the OC): TEC-RPC B, TEC-OC, CEC-RPC B, and CEC-OC. The apically extruded debris during preparation was collected in Eppendorf tubes. The amount of extruded debris was quantified by subtracting the weight of the empty tubes from the weight of the Eppendorf tubes containing the debris. Data were analyzed using 1-way analysis of variance with the Tukey post hoc test. The level of significance was set at p < 0.05. RESULTS: The CEC-RPC B group showed more apical debris extrusion than the TEC-OC and CEC-OC groups (p < 0.05). There were no statistically significant differences in the amount of apical debris extrusion among the TEC-OC, CEC-OC, and TEC-RPC B groups. CONCLUSIONS: RPC B caused more apical debris extrusion in the CEC groups than did the OC single-file system. Therefore, it is suggested that the RPC B file should be used carefully in teeth with a CEC.

The Effects of Different Endodontic Access Cavity Design and Using XP-endo Finisher on the Reduction of Enterococcus faecalis in the Root Canal System.

INTRODUCTION: The aim of this study was to evaluate the effect of using the XP-endo Finisher (XPF; FKG Dentaire, La Chaux de Fonds, Switzerland) in teeth that have a traditional access cavity (TEC) and a contracted access cavity (CEC) design on the amount of decrease in the number of Enterococcus faecalis bacteria within the root canal system. METHODS: Eighty mandibular first molar teeth were selected and randomly divided into 2 groups: TEC and CEC (n = 40/group). After access cavity preparation in the 2 groups, 80 mesiobuccal root canals were contaminated with Enterococcus faecalis for 4 weeks. After the first sampling (S1), in order to perform root canal instrumentation, the TEC and CEC groups were further divided into 4 subgroups (10 teeth/group): Reciproc (VDW GmbH, Munich, Germany) and ProTaper Next (Dentsply Maillefer, Ballaigues, Switzerland) with or without XPF. Bacterial sampling from the root canals was performed with sterile paper points before (S1) and after (S2) instrumentation to determine the bacterial load. The bacterial reduction was counted as colony-forming units/mL and analyzed statistically by 3-factor repeated measures analysis of variance. Multiple comparisons of the main factor effect were performed using the Bonferroni correction (α < .05), all at 5% significance. RESULTS: The number of E. faecalis bacteria in all the samples with different cavity designs were significantly reduced after instrumentation. The lowest value of bacterial decrease percentage was observed in the CEC-Reciproc-XPF (82.8%) group. CONCLUSIONS: The bacterial reduction counts of E. faecalis were a similar level in the TEC and CEC cavities, and the use of XPF did not show significant differences between groups.

Comparison of postoperative pain intensity following the use of three different instrumentation techniques: A randomized clinical trial.

Background. The aim of this study was to compare the postoperative pain intensity following the root canal preparation carried out with XP-endo Shaper (XPS; FKG Dentaire SA, La Chauxde-Fonds, Switzerland), iRace (iRC; FKG Dentaire SA) and Reciproc Blue (REC Blue; VDW, Munich, Germany) files. Methods. Mandibular molar teeth with asymtomatic necrotic pulps in 69 patients were randomly divided into three groups (n=23). The root canals were prepared using XPS, iRC or REC Blue instruments and obturated using the lateral condensation technique. The patients were asked to record their pain intensity at 24-, 48- and 72-hour and 1-week postoperative intervals on VAS. For intolerable pain after the procedure, ibuprofen (400 mg) was prescribed. Data were analyzed using chi-squared, Friedman, Kruskal-Wallis, and Mann-Whitney U tests. Results. The postoperative pain gradually decreased during the study period in all the groups (P<0.05). No statistically significant difference was found between iRC system and the two other systems at 12-, 24- 48-hour and 1-week intervals (P>0.05). When compared to XPS system, a higher level of postoperative pain was observed with REC Blue system at 24- and 48-hour intervals (P<0.05). Conclusion. The XPS group exhibited less postoperative pain than the REC Blue group at 24- and 48-hour intervals. iRC, XPS and REC Blue systems were found to be similar in terms of postoperative pain severity.

The effects of QMix and EndoActivator on postoperative pain in mandibular molars with nonvital pulps: a randomized clinical trial.

AIM: The purpose of this study was to compare the effects of different irrigation solutions when used EndoActivator on postoperative pain. METHODOLOGY: A total of 104 subjects with nonvital pulps were selected and randomly assigned to four experimental groups; (G) 1 (n = 26) 2.5% NaOCl + conventional endodontic syringe, (G) 2 (n = 26) 2.5% NaOCl + EndoActivator, (G) 3 (n = 26) 2.5% NaOCl + QMix + conventional endodontic syringe, (G) 4 (n = 26) 2.5% NaOCl + QMix + EndoActivator. All the patients were prescribed ibuprofen 400 mg to be taken every 8 h in case of pain. The patients were asked to rate the severity of the postoperative pain on a visual analog scale (VAS) for 8th, 24th, 48th, and 72nd hours after the visit. The data were analyzed using Kruskal-Wallis, Mann-Whitney U, and Chi-Square tests. RESULTS: G4 resulted in lesser postoperative pain levels on 8th, 24th, 48th, and 72nd hours than the G2, G3, and G1 did. There was no significant difference between G4 and G2 and between G3 and G1 in terms of the postoperative pain levels at any time interval (P > 0.05). CONCLUSION: It was determined that the postoperative values of the groups, in which EA was used, were statistically significantly lower than in the other groups. The combined use of QMix and EA provided the most significant decrease in the postoperative pain values. CLINICAL RELEVANCE: Successful management of postoperative pain is an important issue for the clinician. The combined use of Qmix and EA can be recommended to the clinicians.

Comparison of postoperative pain intensity after using reciprocating and continuous rotary glide path systems: a randomized clinical trial.

OBJECTIVES: The aim of this study was to compare postoperative pain intensity after root canal treatment with One G (OG) vs. R-Pilot (RP) files used for glide path preparation. MATERIALS AND METHODS: Ninety-three single-canaled mandibular premolar teeth with asymptomatic non-vital pulp were randomly assigned into 3 groups (n = 31): OG, RP, or without glide path (WGP). After creating the glide path, the root canals were prepared using sequential Mtwo rotary files to size 30/0.05. One endodontic specialist carried out single-visit endodontic treatment. The patients were asked to rate the severity of postoperative pain on a visual analogue scale at 24, 48, and 72 hours after the visit. They were also asked to record their intake of prescribed analgesics taken. The data were analyzed using the χ2, Friedman, Kruskal-Wallis, and Mann-Whitney U tests. RESULTS: In all 3 groups, postoperative pain decreased significantly at each time interval (p < 0.05). At 24 hours, the OG group had less postoperative pain than the WGP group (p < 0.05). However, no significant difference was found between the RP group and the others. No statistically significant difference was found among the WGP, OG, and RP groups in postoperative pain intensity at 48 or 72 hours or in analgesic tablet intake at the 3 assessed time intervals. CONCLUSIONS: The OG group had less postoperative pain than the WGP group in the first 24 hours. The OG and RP systems were similar regarding postoperative pain intensity and analgesic intake.

Comparison of the ability of Reciproc and Reciproc Blue instruments to reach the full working length with or without glide path preparation.

OBJECTIVES: The purpose of the present study was to compare the mean preparation times and frequency with which Reciproc and Reciproc Blue instruments reached the full working length in mandibular molars, with or without glide path preparation. MATERIALS AND METHODS: Previously untreated mesiobuccal and mesiolingual canals with completely formed apices were randomly divided into 6 groups (n = 50) depending on the usage of Reciproc (RC; VDW), Reciproc Blue (RC Blue; VDW), C-Pilot (CP; VDW), and R-Pilot (RP; VDW) files: RC, RC Blue, RC + C-Pilot (RC-CP), RC-Blue + C-Pilot (RC Blue-CP), RC+R-Pilot (RC-RP), and RC Blue + R-Pilot (RC Blue-RP). A glide path was prepared using the hand-operated C-Pilot or the machine-operated R-Pilot instruments, respectively. The χ2 test, analysis of variance, and the Tukey post hoc test were used for statistical comparisons. RESULTS: No statistically significant differences were observed in the distribution of the frequency of reaching the full working length in the RC (94%), RC Blue (88%), RC-CP (94%), RC Blue-CP (90%), RC-RP (96%), and RC Blue-RP (92%) groups (p > 0.05). CONCLUSIONS: Preparation of a glide path did not have a significant effect on reaching the full working length using these systems.

Evaluation of the sealing ability of different root canal sealers: a combined SEM and micro-CT study.

OBJECTIVE: The purpose of this study was to analyze the ability of multiple compounds to seal the dental tubules using scanning electron microscopy (SEM) and micro-computed tomogra-phy (micro-CT). MATERIAL AND METHODS: Twenty-four single-root human mandibular premolars were selected and instrumented with nickel-titanium rotary file and the final file size was #40/06. They were then randomly allocated into 2 groups, and all samples were filled with single cone gutta-percha (#40/06) and one of the tested sealers (AH Plus and EndoSequence BC sealers). All specimens were scanned using micro-CT and then three from each group were randomly selected for SEM analysis. RESULTS: According to SEM, both root canal sealers showed sufficient adaptation to dentin along the whole length of the root canal, though the coronal sections presented superior sealing than the apical sections. Micro porosity analyses revealed that the volume of closed pores and the surface of closed pores had the largest values in the coronal sections, followed by the middle and the apical sections for both sealants (p<0.05). However, no significant difference was observed for those two parameters between AH Plus and EndoSequence BC sealers in any of the three sections (p>0.05), whereas they were larger in the apical section when the AH Plus sealer was used. CONCLUSIONS: By using the single cone technique, neither EndoSequence or AH Plus pro-vides a porosity-free root canal filling. The EndoSequence BC sealer may have similar sealing abilities regarding the whole root canal as the AH Plus sealer. A better sealing effect could be obtained in the coronal and middle sections of a root canal than the apical part by using the tested sealers.

Evaluation of the sealing ability of different root canal sealers: a combined SEM and micro-CT study

Abstract Objective: The purpose of this study was to analyze the ability of multiple compounds to seal the dental tubules using scanning electron microscopy (SEM) and micro-computed tomogra-phy (micro-CT). Material and Methods: Twenty-four single-root human mandibular premolars were selected and instrumented with nickel-titanium rotary file and the final file size was #40/06. They were then randomly allocated into 2 groups, and all samples were filled with single cone gutta-percha (#40/06) and one of the tested sealers (AH Plus and EndoSequence BC sealers). All specimens were scanned using micro-CT and then three from each group were randomly selected for SEM analysis. Results: According to SEM, both root canal sealers showed sufficient adaptation to dentin along the whole length of the root canal, though the coronal sections presented superior sealing than the apical sections. Micro porosity analyses revealed that the volume of closed pores and the surface of closed pores had the largest values in the coronal sections, followed by the middle and the apical sections for both sealants (p<0.05). However, no significant difference was observed for those two parameters between AH Plus and EndoSequence BC sealers in any of the three sections (p>0.05), whereas they were larger in the apical section when the AH Plus sealer was used. Conclusions: By using the single cone technique, neither EndoSequence or AH Plus pro-vides a porosity-free root canal filling. The EndoSequence BC sealer may have similar sealing abilities regarding the whole root canal as the AH Plus sealer. A better sealing effect could be obtained in the coronal and middle sections of a root canal than the apical part by using the tested sealers.

Cone beam CT evaluation of mandibular molar root canal morphology in a Turkish Cypriot population.

OBJECTIVES: Microorganisms in untreated or overlooked root canals can cause endodontic failure or infection and inflammation. Therefore, clinicians should familiarize themselves with patient's root canal anatomy and morphology. The objective of this retrospective study was to analyze and characterize mandibular root canal morphology using cone beam computed tomography (CBCT) in a Turkish Cypriot population. MATERIALS AND METHODS: This cross-sectional study consisted of retrospective evaluation of CBCT scans from 272 adult patients (aged 16-80 years). The number of roots and canals and the canal configuration in each root were evaluated using Vertucci's classification. The incidence of additional roots and of C-shaped canals in the mandibular first and second molars was also noted. Pearson chi-square tests were performed to analyze canal configurations, laterality, and gender (p ≤ 0.05). RESULTS: For the female and male patients, 94.5 and 94.4 % of the mandibular first and 96.7 and 97.2 % of the mandibular second molars had two roots, respectively. In females, 4.4 % of mandibular first molars had three roots versus 2.7 % of mandibular first molars in male patients. Type IV was the most prevalent canal configuration regardless of the gender (female 61.3 % and male 64.2 %) in the mesial roots. No statistically significant differences according to gender or laterality were found in the incidence of additional canals for either maxillary first or second molars. CONCLUSIONS: Type IV was the most prevalent canal configuration of both the mandibular first and second molar teeth. There was a low prevalence of three-rooted mandibular molars in this particular population. CLINICAL RELEVANCE: The current study is the first of its kind to include a Turkish Cypriot population and, thus, provides baseline data for these patients regarding appropriate root canal treatments.

Evaluation of root canal sealer filling quality using a single-cone technique in oval shaped canals: An In vitro Micro-CT study.

The aim of this study was to evaluate and compare the presence of voids in oval root canals filled with different root canal sealers (EndoSequence BC Sealer, Smartpaste bio, ActiV GP) and to compare those with root canals filled with AH Plus sealer using micro-CT. In total, 40 freshly extracted human single-root maxillary premolars were used. Specimens instrumented with the EndoSequence NiTi rotary instrument were assigned randomly into four groups. In each group, root canals were filled with single-cone gutta-percha and one of the tested sealers. Each specimen was then scanned using micro-CT at a voxel resolution of 13.47 µm. Proportions of sections with voids in cross-sectional images and void volumes for each sealer were calculated in the apical, middle, and coronal thirds. Differences according to root canal sealers were evaluated statistically using the Kruskal-Wallis test and the Mann-Whitney U-test at a significance level of 5%. The analysis showed a decrease in void formation in the apical third, with a significant difference between the apical and coronal thirds among bioceramic sealers, ActiV GP, and AH Plus (p < 0.05) but no significant difference between the apical and middle thirds or between the middle and coronal thirds was found for the sealers tested (p > 0.05). All root canal sealers tested resulted in voids. The bioceramic sealers (EndoSequence BC Sealer, Smartpaste bio) produced similar voids which had the fewest in the apical third of root canals among the sealers tested which can be related due to root canal anatomy variations.

Cone-beam CT evaluation of root canal morphology of maxillary and mandibular premolars in a Turkish Cypriot population.

OBJECTIVES: Because of economic and political issues, Turkish Cypriots have been emigrating from Cyprus since the 1920s, especially to the United Kingdom, other European countries and Australia. Recently, according to the UK House of Commons, Home Affairs Committee, ~300,000 Cypriot Turks were living in the United Kingdom. However, this ethnic population residing in the United Kingdom has been insufficiently analysed. Although many Turkish Cypriots have been living abroad, little is known about the dental characteristics of this group. Premolar teeth, especially maxillary premolars, pose great challenges in endodontic treatment because of the number of roots and canals, and the variation in the configurations of the pulp cavity. Thus, it was considered valuable to determine the morphological characteristic of premolar teeth in a Turkish Cypriot population to aid clinicians in performing endodontic treatment in this ethnic population. MATERIALS AND METHODS: The sample for this cross-sectional study consisted of a retrospective evaluation of cone-beam CT scans of 263 adult patients (age range 16-80 years). The number of roots and their morphology, the number of canals per root and the canal configuration were examined. The root canal configurations were also classified according to the scheme of Vertucci in the maxillary and mandibular premolar teeth. Pearson's χ2-test was performed among canal configurations, sides and gender (P⩽0.05). RESULTS: In the present study, most root canal configurations were type IV (76.8%) and type I (49.4%) in the maxillary first and second premolars, respectively, whereas most root canal configurations were type I (93%) in both mandibular first and second premolars. In total, four (0.9%) teeth in the maxillary first premolars and two (0.4%) teeth in the maxillary second molar premolars had three roots. CONCLUSIONS: This is the first population-based study to focus solely on Turkish Cypriots' root canal anatomy. Our findings will be valuable for dental professionals who treat many Turkish Cypriot patients, in the United Kingdom, Australia and other countries.

Micro-CT assessment of the sealing ability of three root canal filling techniques.

This study used micro-CT to compare three obturation techniques with respect to void occurrence in canals filled with bioceramic sealer. Thirty extracted first mandibular premolars were prepared with a ProTaper Universal system and randomly allocated to three groups. Canals were obturated with gutta-percha and bioceramic root canal sealer, using either single-cone, lateral compaction, or Thermafil filling technique. Each tooth was then scanned with micro-CT. Voids in 2D cross-sectional images and void volumes in 3D images of all root thirds were assessed in relation to obturation technique. There was no significant difference between obturation techniques in the proportion of sections with voids (P > 0.05). However, the results of the obturation techniques significantly differed in relation to root region (P < 0.05). In conclusion, no root filling technique resulted in void-free specimens. Void volumes were highest for the single-cone technique and lowest for Thermafil, in all regions (P < 0.05).

Comparative evaluation of shaping ability of two nickel-titanium rotary systems using cone beam computed tomography.

BACKGROUND: We evaluated and compared the effects of different NiTi rotary systems--ProTaper Next and New One Shape--on the volume of dentin removed, canal transportation, and canal curvature in extracted human teeth using CBCT scanning with different voxel sizes. METHODS: Fifty extracted human maxillary first molars with mesiobuccal canal curvature (25-35°) were used. Specimens were instrumented with the ProTaper Next or New One Shape. Pre- and post-instrumentation scans were performed to compare transportation at the levels of 2, 5, and 8 mm and volumes with two different voxel sizes (0.125-and 0.100-mm(3)) using 3D CBCT images. This study evaluated and compare the volume of dentin removed, canal transportation, and canal curvature. Differences according to instrumentation and voxel sizes were assessed using the Mann-Whitney U-test and the Wilcoxon signed-rank test. RESULTS: Significant differences were found between apical and coronal levels for both systems (p < 0.05) in canal transportation. In comparing the systems, similar values were found at each level, without significant difference (p > 0.05) in terms of canal curvature and volume. Voxel sizes did not affect the measurements on canal volume, curvature or transportation; no significant difference was found between the 0.100- and 0.125-mm(3) voxel sizes (p > 0.05). CONCLUSIONS: Both instrumentation systems produced similar canal transportation and volume changes. The two voxel resolutions also showed similar results, however a 0.125-mm(3) voxel size can be recommend for a flat panel CBCT scanner with lower exposure dose.