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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 16  |  Issue : 4  |  Page : 176-182

Shaping ability of different root canal preparation systems


Department of Endodontics, Faculty of Dentistry, Tanta University, Tanta, Egypt

Date of Submission23-Jan-2019
Date of Acceptance14-May-2019
Date of Web Publication28-Feb-2020

Correspondence Address:
Dina A. Attia
Department of Endodontics, Faculty of Dentistry, Tanta University, Tanta
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tdj.tdj_6_19

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  Abstract 

Aim
To evaluate centering ability, amount of removed dentin of hand NiTi Flex K-files, ProTaper Universal system, OneShape, and WaveOne system in curved root canals.
Materials and methods
Forty extracted human premolars with a range of canal curvature (21–39°) were used. Samples were randomly divided into four groups (n = 10). Group 1: NiTi Flex (control group), group 2: ProTaper, group 3: OneShape, and group 4: WaveOne Primary. Centering ability of each instrument was evaluated using superimposed standardized preinstrumentation and postinstrumentation cone-beam computed tomography images recorded at three root canal levels (3, 6, and 9 mm from the apex). Amount of removed dentin was calculated by differences between preinstrumentation and postinstrumentation root canal volumes.
Results
WaveOne system showed the highest mean centering ratios at all tested canal levels in both directions. Apical thirds of all groups showed the highest centering ratios while the coronal showed the lowest. ProTaper system group recorded significantly highest amount of root dentin removal compared to other groups.
Conclusion
Reciprocating WaveOne files had more centering ability than other tested instruments. ProTaper Universal system removed significantly high amount of dentin in comparison to other systems.

Keywords: centering ability, OneShape, ProTaper Universal, WaveOne


How to cite this article:
Attia DA, Alhadainy HA, Darrag AM, Ghoneim WM. Shaping ability of different root canal preparation systems. Tanta Dent J 2019;16:176-82

How to cite this URL:
Attia DA, Alhadainy HA, Darrag AM, Ghoneim WM. Shaping ability of different root canal preparation systems. Tanta Dent J [serial online] 2019 [cited 2020 Mar 28];16:176-82. Available from: http://www.tmj.eg.net/text.asp?2019/16/4/176/279731


  Introduction Top


Successful root canal treatment depends on the chemo-mechanical continuously tapering preparation with homogeneous dentin removal without excessive wear of root structures[1],[2]. Maintaining the original canal anatomy by uniformly preparing all surfaces of the canal is one of the most important principles of shaping the root canal system to prevent procedural errors such as zipping, ledging, perforations, and apical transportation that can occur along with the loss of working length (WL)[3]. However, prevention of these undesirable consequences is a great challenge, especially in severely curved canals[1].

Centering ability is an essential feature of instruments to obtain uniform preparation, avoiding deviation of canal walls and apical stop[4]. It can be influenced by the instruments characteristics, such as alloy composition, cross-section, tapering, tip design, manufacturing method, type of movement, and rotation angle in addition to root canal anatomy [4–10].

ProTaper Universal (PTU) rotary file system is considered as a common multi-file NiTi rotary system which is made from a conventional superelastic NiTi wire[11],[12] with a convex triangular cross-sectional design and progressive taper that allows efficient movement and cutting ability to flare the canal more coronally.

The use of NiTi engine-driven single files in root canal preparation has increased with advantages of lower cost, saving time[13],[14], reduction of instrument fatigue and possible cross-contamination[12]. OneShape system (OS), composed of a 55-NiTi alloy, is a single instrument that features continuous rotation for performing a complete root canal preparation. The instrument has a #25 initial diameter and 0.06 mm taper and presents variable cross-sections across the length of its active portion[15].

A new type of instrumentation was suggested, based on alternated movement, known as reciprocation[16]. The reciprocation working motion is an evolution of the balanced force technique consists of a counterclockwise (cutting direction) with greater angle than the clockwise motion (release of the instrument) so, the file continuously move toward the apex promoting a safer use in curved canals[17]. Reciprocating mode of rotation has been introduced recently with the intent to extend the lifespan of NiTi instruments and its resistance to fatigue in comparison to continuous rotation[17],[18].

WaveOne (WO) NiTi file system is one of single reciprocating file systems which consist of three single use files: small for fine canals, primary for the majority of canals, and large for large canals. This file is made of heat-treated NiTi Memory-Wire (M-Wire), which is more flexible and fatigue resistant than conventionally martensitic NiTi files[19],[20].

Cone-beam computed tomography (CBCT) has been suggested for assessing the tomography of canal walls as it is a nondestructive technique which provides three-dimensional (3D) reproduction of the tooth and allows better preoperative and postoperative evaluation of morphological changes in the root canal trajectory[21] for better assessment of root curvatures and canal transportation[3].

Limited information exists on the effect of multi-file and single-file systems with different cutting motions on the canal geometry. Therefore, the current study was designed to evaluate centering ability, amount of removed dentin of four preparation systems (PTU, OS, and WO) which are different in their design, number of files, metallurgies and kinematics, in comparison to hand NiTi Flex K-file system in curved root canals.


  Materials and Methods Top


Approval of this research was obtained from Research Ethics Committee, Faculty of Dentistry, Tanta University. The purpose of the present study was explained to the patients and informed consents were obtained to use their extracted teeth on the research according to the guidelines on human research adopted by the Research Ethics Committee, Faculty of Dentistry, Tanta University.

Sample selection and preparation

Forty freshly extracted, fully developed human premolars with single root canals were collected. The teeth were extracted for orthodontic or periodontal reasons. Teeth were thoroughly cleaned, polished, rinsed under running water and stored in sterile saline solution at 4°C until use[22]. The teeth were selected with similar range of canal curvature (21–39°), which was measured according to Schneider's method[23] using a special software (SUNI Medical Imaging Inc., San Jose, California, USA).

All teeth were decoronated using water cooled low speed diamond disc (Dica, Dendia, USA) leaving 13 ± 1 mm long roots. Canals diameter were standardized by selecting roots fitting initial apical file #15 K-type (Dentsply Maillefer, Ballaigues, Switzerland). The WL of each canal was determined by measuring the length of K-type file size #10 at the apical foramen minus 1 mm[24].

Roots were coded and randomly divided into four equal experimental groups (n = 10) according to instrumentation system. All roots were aligned in four parallel rows and fixed with transparent self-cured acrylic resin (Acrostone Dental Factory, Egypt). Preinstrumentation CBCT scanning was done using CBCT machine (Scanora 3D Soredex, Helsinki, Finland) with voxel size 0.25 mm, a current intensity 16 mA, Kilovoltage 85 Kvp and a focal spot size 0.5 mm with target angle 5°. The scanning time was 10 s of pulsed exposure resulting in an effective exposure time 2.5 s to scan field of view of 7.5 cm height × 14.5 cm and width × 14.5 cm depth.

Root canal instrumentation

In group 1 (control group): 10 root canals were instrumented using NiTi Flex hand K-files (Dentsply Maillefer) up to (#35/0.02) master apical file in a crown down manner. While in group 2; root canals were prepared with PTU rotary system (Dentsply Maillefer) with a continuous rotation movement up to F2 (#25/0.08). Root canals in group 3 were prepared using OS single rotary files (#25/0.06) (MicroMega, Besancon, France) using an in-and-out passive movement while performing an upward circumferential filing movement and in Group IVWO Primary reciprocating files (#25/0.08) (Dentsply Maillefer) were used in a progressive up and down pecking motions until the file reached full WL without apical pressure.

For rotary and reciprocating groups, glide path was created with hand St-St k-files #20 till the full WL, each file was coated with Glyde file lubricant (Dentsply Maillefer) and used in slow downward movement without pressure. X-Smart Plus endodontic electro-motor (Dentsply Maillefer) was used and programed according to each file system. In multifiles groups (groups 1 and 2), each file sequence was used for preparing five canals then discarded[25]. In single-file groups (groups 3 and 4), single file was used for a single root canal preparation then discarded[26]. All root canals were irrigated with 10 ml of 2.5% sodium hypochlorite (NaOCl) (Clorox Co., 10th of Ramadan, Egypt) solution throughout instrumentation and flushed with 5 ml of 0.9% normal saline solution (NaCl) (EL Nasr Pharmaceutical Chemicals Co., Egypt) at the end of instrumentation and dried with absorbent paper points (Diadent Group International, Burnaby, B.C. Canada)[17].

After instrumentation, the specimens were scanned using the same standers as preinstrumentation scanning. Preinstrumentation image was fused to the postinstrumentation one automatically by a software (Ondemand 3D, Seoul, South Korea) allowing the best possible accuracy. From fused image, preinstrumentation and postinstrumentation images can be obtained to record the measurement of preinstrumentation and postinstrumentation on the same plane direction and cut to ensure standardization.

On axial view of the fused CBCT image, cut lines at 3 mm (mid-apical level), 6 mm (mid-middle level) and 9 mm (mid-coronal level) from the apical end of each root in each group were determined and the measurements were recorded on the preinstrumentation and postinstrumentation images at the same cut lines.

Evaluation of centering ability

Centering ability was calculated for each section using centering ratio[27].



Where D1 is the buccolingual measurement and D2 is the mesiodistal measurement.

X1 is the shortest distance from the buccal aspect of the root to the periphery of the un-instrumented canal. X'1 is the shortest distance from the buccal aspect of the root to the periphery of the prepared canal. X2 is the shortest distance from the lingual aspect of the root to the periphery of the un-instrumented canal. X'2 is the shortest distance from the lingual aspect of the root to the periphery of the prepared canal. Y1is the shortest distance from the mesial aspect of the root to the periphery of the un-instrumented canal. Y'1 is the shortest distance from the mesial aspect of the root to the periphery of the prepared canal. Y2 is the shortest distance from the distal aspect of the root to the periphery of the un-instrumented canal. Y'2 is the shortest distance from the distal aspect of the root to the periphery of the prepared canal as shown in [Figure 1].
Figure 1: Schematic presentation of the image used in the centering ability evaluation[27].

Click here to view


According to this formula, the ratio equal 1 indicates a perfect centering ability; the closer the result is to zero, the worse is the ability of the instrument to remain centered[28]. If these numbers were unequal, the numerator for this formula was the smallest of the two numbers X1–X'1 or X2–X'2 and the same for Y1–Y'1 or Y2–Y'2[29].

Evaluation of amount of removed dentin

Preinstrumented and postinstrumented volume of each canal was measured with 3D software (Ondemand 3D) from preinstrumentation and postinstrumentation images. Volume of dentin removed during instrumentation was determined for each canal by subtracting the preinstrumented canal volume from the instrumented one in cubic millimeters.

All data were collected, tabulated and statistically analyzed using Statistical Package for Social Sciences (SPSS version 24) (SPSS Inc. Chicago, Illinois, USA). Results of centering ratio and amount of removed dentin were expressed by descriptive statistics as mean, SD. One-way analysis of variance (ANOVA) and post-hoc test (Tukey test) was used to compare quantitative data within groups.


  Results Top


Centering ability

Mean ± SD of centering ratio of four tested groups at both directions D1 and D2 are expressed in [Table 1] and [Table 2]. One-way ANOVA revealed significant differences among four groups at the three levels in both directions. So, Tukey's test was performed at each tested root level for D1 and D2 and it revealed statistical significant differences between WO versus hand NiTi Flex files at the three tested levels, between WO versus PTU at apical and coronal levels, between OS versus hand NiTi Flex at apical and coronal levels and finally between PTU versus OS coronally.
Table 1: Mean± SD of centering ratio of four tested groups at buccolingual direction (D1) at the three tested root levels

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Table 2: Mean± SD of centering ratio of four tested groups at mesiodistal direction (D2) at the three tested root levels

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Results of amount of dentin removal

NiTi Flex hand K-files (group 1) recorded the least amount of removed dentin followed by OS single rotary file (group 3), WO primary reciprocating file and PTU system which showed the highest value [Figure 2]. Statistical analysis was performed using one-way ANOVA which revealed a highly statistical significant difference among four tested groups (P < 0.001).
Figure 2: Column chart of removed dentin in mm3 of the four tested groups.

Click here to view


Tukey's test was performed and it revealed statistical significant differences between group 1 versus groups 2 and 4 with P value of 0.001, 0.033, respectively, and between group 2 versus groups 3 and 4 with P value of 0.001, 0.010 respectively. However, there were no statistical significant differences between group 1 versus group 3 (P = 0.405) or between group 3 versus group 4 (P = 0.571).


  Discussion Top


Endodontic instruments should remain centered in the root canal throughout the preparation[30] otherwise, canal transportation may occurs and leads to inappropriate dentine removal, with a high risk of straightening the original canal curvature and forming ledges in the dentine wall[31],[32]. Therefore, centering ability of different instruments was tested in this study.

In the current study, different NiTi endodontic systems were tested for their features. PTU system was tested as it is widely used in many countries and constitutes a common NiTi rotary system. It is a multi-file system based on a sequence of files in different sizes and tapers, made from a conventional superelastic NiTi wire, and has a convex triangular cross-sectional design and progressive taper[2],[33]. In addition hand NiTi Flex file system was involved in the study because it is popular and considered as a standard method of preparing root canals[34] so, it was used as a control group.

Attention was directed to WO and OS NiTi files because they are sterile single-file systems having nonworking safety tip and variable cross-sections along the blade of the instrument. At the same time, they work with different mode of rotation; reciprocation WO and continuous rotation OS[34],[35].

CBCT image technology was used in this study as it provides a precise, reproducible, three-dimensional assessment of alterations in dentine thickness and root canal volume without destructive sectioning of the specimens [36–38]. It is also useful in detecting deviations, transportation[39] and centering ability of endodontic instruments[40] without examiner interference[41].

Primary WO file had better centering ability than other tested systems at all tested root canal levels which might be returned to its design of reverse helix with two distinct changing cross-sections along the working part, which could decrease core diameter with increased flexibility of the file[42],[43]. Additionally, WO files are manufactured from M-Wire NiTi alloy[44], which is more flexible and fatigue resistant variant of NiTi alloy[17],[20]. Additionally, reciprocating motion proved to be correlated to a more centered preparation compared with continuous rotating motion[14],[15]. This was supported by Berutti et al.[45].

Hand NiTi Flex files showed the least centering ability at apical and middle levels which may be due to the aggressive cutting tip of NiTi Flex hand files[46] and the absence of radial land[47]. These findings were in agreement with Glossen et al.[48] and Taşdemir et al.[49] who found that rotary NiTi instruments produced more centered preparation and less apical transportation than hand NiTi systems in curved root canals. In contrary, Nagaraja and Sreenivasa Murthy[6] found that, using hand NiTi K-files produced lesser canal transportation and more centering ability than other rotary systems, these different results may be due to using balanced force technique with hand NiTi files.

On the other hand, NiTi Flex files revealed better performance at coronal portion of the canal, with better centering ability than PTU system. This may be related to the fact that NiTi Flex system with its ISO taper (0.02) allows less aggressive cutting at the coronal portion and as a result minimizes canal transportation and increase centering ability[46]. These results were in agreement with Nagaraja and Murthy[50].

PTU system exhibited significantly inferior results compared to WO because it has sharp cutting edges, convex triangular cross-section, progressive taper sequence along the length of their cutting blades [51–53] especially the large increase in taper from 0.04 to 0.08 mm from S2 to F2[54] and some rigidity due to the considerable amount of metal in its structure. Several researches confirmed these results[2],[10],[20] while, McRay et al.[55] in a study based on μCT imaging reported no statistically significant difference in the canal centering ability of WO and PTU systems which could be attributed to the variation in root canal preparation where coronal pre-flaring with SX was not carried out.

Centering ability of OS system was significantly better than PTU and hand NiTi Flex files, which may be due to the unique asymmetrical cutting profile of OS files, which improves its snake-like movement into the canal and therefore may cause less transportation and preserves the original canal shape[52],[56],[57]. In addition to its safety tip of size 25 with continuous taper of 0.06 in comparison to 8% taper of F2 PTU file. These results were in agreement with Rolly et al.[58] and Ghobashy et al.[59].

It was found that, the apical level showed the highest centering ratio while the coronal level recorded the least one which may be attributed to the cross-sectional configuration of the premolars canals as the more round apical root canal section is associated with better adaptation of the file motion within the canal with more centered preparation[60],[61] and may be also related to highly tapered coronal cross-section of F2 and WO Primary files which is 0.08, OS files which is 0.06 with increased core diameter of the files [15, 29]. These results were supported by the studies of Jain et al.[62] and Rolly et al.[58].

It was found that, PTU system removed significantly the highest amount of dentin compared with the other three systems which could be attributed to the progressively tapered design of the PTU along with the sharp cutting edges of the convex triangular cross-sectional design[6]. These results are supported by the results of Franco et al.[63] that indicated the highest canal enlargement was produced by the continuous rotation compared to the reciprocating group. Every three sequential reciprocating cycles are equivalent to one complete rotational cycle[62].

Furthermore, WO Primary files design is characterized by fixed tapers of 8% from D1 to D3, whereas from D4 to D16, they have a unique progressively decreasing percentage tapered design which play essential role in preserving the remaining dentin in the coronal two thirds of the canal[64]. This was in agreement with Dioguardi et al.[65] and Kanagasingam et al.[66], Sharma et al.[12].

Regarding OS file system, it consists of only one instrument with a safety tip with continues taper of 0.06[67] compared to 0.08 taper of F2 file could be the cause of significant difference between the two systems[68]. These findings are in agreement with Capar et al.[69] and Harandi et al.[70].

It was found that, Hand NiTi Flex K-file removed the least amount of canal dentin which was significantly different than PTU and WO. This could be related to the difference in taper of the hand NiTi files which is ISO 0.02 which allow less aggressive cutting compared to the larger tapers of PTU and WO systems[46],[71],[72]. These results were confirmed with El Ayouti et al.[30]. However, the disagreement found by Yin et al.[73] who found hand NiTi files removed more dentin than PTU might be as a result of using Gates Glidden drill with hand NiTi Flex for coronal flaring.


  Conclusion Top


Under the conditions of the present study, it was concluded that:

  1. None of the tested instruments remained perfectly centralized within the root canals.
  2. Reciprocating WO files have more centering ability than other tested file systems.
  3. All tested root canal preparation systems remained more centralized apically than coronally.
  4. PTU system removed more dentin during root canal preparation than other tested systems.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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