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Introduction: The purpose of this study was to assess canal preparation outcomes in vitro by novice clinicians after standardized teaching sessions., Methods: All students received a training session. In experiment 1, twenty canals of mandibular molars were prepared with GT and ProTaper rotaries by 10 students. Standardized radiographs were exposed before and after canal preparation, and canal curvature was measured; canals were assessed for patency and preparation time. In experiment 2, mandibular molars (20 canals) were submitted to microcomputed tomography before and after canal preparation with ProTaper and GT rotaries by 2 dental students. Canals were metrically assessed for changes (volume, surface, cross-sectional shape, transportation) during canal preparation by using software., Results: In experiment 1, canal curvature decreased by 7.6 degrees and 7.8 degrees for GT and ProTaper preparations; there were no broken instruments, and 2 canals lost patency. The time for GT preparation was longer than for ProTaper (29.7 +/- 6.8 vs 19.4 +/- 8.1 minutes, P <.05). In experiment 2, canal volumes and surface areas increased (P < .001), and prepared canals were rounder in cross-section and more tapered. Mean canal transportation ranged between 0.14 +/- 0.05 mm and 0.23 +/- 0.09 mm for apical and coronal canal thirds. There were no significant differences between the instruments or the operators regarding center of mass shifts; qualitative and quantitative data for canal transportation were similar to earlier studies with experienced operators., Conclusions: Both rotary instruments performed adequately with inexperienced operators who received a brief structured training session.

Introduction: Usage of U.S. endodontists regarding rotary root canal instruments is not well-documented. Therefore, the aim of this study was to retrieve data from a representative sample of endodontists regarding contemporary usage of rotary instruments., Methods: A questionnaire addressing (1) nickel-titanium (NiTi) rotary instrument usage and (2) expectations for future instrument design was constructed. An online survey was e-mailed to 954 endodontists in California (n = 358), Iowa (n = 25), Massachusetts (n = 120), Minnesota (n = 49), New York (n = 217), Texas (n = 144), and Wisconsin (n = 41). Data were collected from respondents by using a web-based interface during a 4-month period. Valid responses were received from 359 endodontists, representing a 38% response rate. Chi-square tests and correlation coefficients were used to analyze the data; the level of significance was set at .05., Results: Usages varied by region, graduation date, and type of practice. Recent graduates were more likely to use NiTi rotary instruments for every treatment (P = .007), multiple NiTi systems (P = .002), torque control motors (P = .03), and Gates Glidden instruments (P = .001) than were older endodontists. More than 50% of respondents used NiTi rotary instruments in several patients before discarding, and 57% reported cleaning the instruments with a combination of ultrasonics and sterilization. Crown-down was the most frequently used preparation strategy. There were few differences regarding geographic regions. More than 70% of respondents expected similar but improved files during the next 10 years., Conclusions: Differences exist among U.S. endodontists regarding current NiTi instrument use, and expectations for future development might be correlated with level of exposure and training.

Introduction: M-Wire (Sportswire LLC, Langley, OK) is reportedly created by altering alloy temperatures during the manufacturing process of GT series X instruments (Dentsply Tulsa Dental Specialties, Tulsa, OK). Currently, there are few published studies looking at torsional profiles of these instruments. The purpose of this study was to investigate the torsional profiles of new and used 20/0.06 GT series X (GTX) and GT (GT) instruments (Dentsply Tulsa Dental Specialties)., Methods: Thirty instruments were allocated to one of eight groups and were used 2, 6, or 10 times in simulated canals or remained as unused controls. Testing of torque (TF) and angle at fracture (AF) were conducted in accordance with American National Standards Institute/American Dental Association (ANSI/ADA) specification No. 28. Data analyses were performed by using one- and two- way analysis of variance with honesty significance difference post hoc comparison with alpha = 0.05., Results: Overall, there were significant differences in TF and AF among the experimental groups (p < 0.001). GTX instruments showed a significant initial increase in TF with two and six uses (p < 0.001) in contrast to the GT, which showed a linear reduction in TF with increased use (p < 0.004). Both GTX and GT instruments showed no statistical difference in AF of new instruments but did show a significant decrease in AF in all groups except the GT two-use group (p < 0.02)., Conclusion: The GTX instruments had a higher resistance to torsional failure after use as compared with the GT.

Introduction: Previous micro-computed tomography analyses of root canal preparation provided data that were usually averaged over canal length. The aim of this study was to compare preparation effects on apical root canal geometry., Methods: Sixty extracted maxillary molars (180 canals) used in prior studies were reevaluated for analyses of the apical 4 mm. Teeth were scanned by using micro-computed tomography before and after canal shaping with FlexMaster, GT-Rotary, Lightspeed, ProFile, ProTaper, instruments or nickel-titanium K-files for hand instrumentation. Apical preparation was to a size #40 in mesiobuccal and distobuccal and #45 in palatal canals except for GT (#20) and ProTaper (#25 in mesiobuccal and distobuccal and #30 in palatal canals, respectively). Data for canal volume changes, the structure model index (quantifying canal cross sections), and untreated surface area were contrasted by using analysis of variance and Scheffé tests., Results: Mean mesiobuccal, distobuccal, and palatal canal volumes increased after preparation (P < .05), but differences were noted for preparation techniques. GT rendered the smallest (0.20 +/- 0.14 mm(3)); K-files and ProFile showed the largest volume increases (0.51 +/- 0.20 mm(3) and 0.45 +/- 021 mm(3), P < .05). All canals were slightly rounder in the apical 4 mm after preparation indicated by nonsignificant increases in structure model index. Untreated areas ranged from 4%-100% and were larger in mesiobuccal and palatal canals than in distobuccal ones. Preparation with GT left significantly larger untreated areas in all canal types (P < .05); among root canal types, distobuccal canals had the least amounts of untreated surface areas., Conclusions: Apical canal geometry was affected differently by 6 preparation techniques; preparations with GT instruments to an apical size #20 left more canal surface untouched, which might affect the ability to disinfect root canals in maxillary molars.

This study evaluated temperature changes during passive ultrasonic irrigation. Root canals of three extracted maxillary canines were enlarged to size #45. Thermocouples were mounted 3, 6, and 9 mm from the apical foramen. Teeth were placed in a water bath at 37 degrees C. Distilled water (20 degrees C) was continuously delivered through an ultrasonic unit (group 1) or deposited into the root canal before ultrasonic activation (group 2); for activation, noncutting nickel-titanium (NiTi) inserts or stainless steel K-files #15, #25, and #35 were used. Before and during ultrasonic activation, temperatures were continuously measured for 210 seconds. Statistical analysis was performed using analysis of variance and Scheffé post hoc tests. Temperatures initially decreased by up to 7.4 degrees C; these drops were significantly smaller in group 1 than in group 2 (p < 0.001) in the middle and apical root canal third. The decreases were followed by temperature rises for all inserts in group 2. However, in group 1, temperatures just reached baseline values in middle and apical thirds; in the coronal root canal third, lower temperatures were measured. In group 2, mean temperature rises were 7.7 degrees , 7.5 degrees , and 4.2 degrees C in coronal, middle, and apical root canal thirds. Here, K-file type inserts size #35 generated highest and inserts size #15 the lowest temperatures rises; NiTi inserts were more effective than size #15 K-files and less effective than #35 K-files. Continuous flow negated the potential of ultrasonic activation to heat irrigation solutions. Noncutting NiTi instruments and large K-files were more effective than small K-files in warming deposited irrigants.

The purpose of this study was to customize an application framework by using the MeVisLab image processing and visualization platform for three-dimensional reconstruction and assessment of tooth and root canal morphology. One maxillary first molar was scanned before and after preparation with ProTaper by using micro-computed tomography. With a customized application framework based on MeVisLab, internal and external anatomy was reconstructed. Furthermore, the dimensions of root canal and radicular dentin were quantified, and effects of canal preparation were assessed. Finally, a virtual preparation with risk analysis was performed to simulate the removal of a broken instrument. This application framework provided an economical platform and met current requirements of endodontic research. The broad-based use of high-quality free software and the resulting exchange of experience might help to improve the quality of endodontic research with micro-computed tomography.

Surface modifications of nickel-titanium instruments such as electropolishing may reduce fracture incidence but could potentially alter the instruments' mechanical properties. We studied the impact of two surface types, machined and electropolished, of ProTaper shaping files on torque and force during simulated root canal preparation. Pilot holes of 0.5-mm diameter were drilled perpendicularly through 3-mm thick human dentin discs and served as standardized simulated root canals (SSRCs). A total of 300 SSRCs were prepared with ProTaper Sx, S1, and S2 instruments using an automated testing platform. Maximum torque (in Ncm) and maximum force values (in N) were measured. In three experimental groups (Sx, S1, and S2) preparation of SSRCs was performed using electropolished versus machined instruments in the same dentin disc. For all three tested instruments, peak torque was higher for electropolished files; apically exerted forces were similar, except for Sx, in which machined instruments developed higher forces. We conclude that surface treatment by electropolishing alters the cutting ability of nickel-titanium rotary instruments.

The efficacy of amalgam, Fuji-Plus, Geristore, and mineral trioxide aggregate (MTA) as intraorifice barriers was compared in a simulated saliva leakage model. Fifty teeth were divided into 4 experimental (n = 10 each) and 2 control groups (n = 5 each). Two millimeters of the materials was placed as intraorifice barriers and brought into contact with human saliva in a coronal reservoir. Bacterial leakage into the apical reservoir was assessed daily for 3 months. Geristore barriers leaked significantly more often (5/10) than Fuji-Plus (0/10, P < .05) at 60 days. The first Fuji-Plus sample leaked after 70 days; after 90 days, 3 (Fuji-Plus), 4 (MTA, amalgam), and 6 (Geristore) samples leaked. There were no significant differences between the experimental groups at that time point. Three-dimensional gap volumes in the barrier-dentin interface and the porosity of the barrier materials were compared by using micro-computed tomography (microCT). A measurable gap was evident in only 1 specimen with an MTA barrier. MTA was significantly less porous than Fuji-Plus and Geristore (P < or = .05), whereas amalgam was too radiopaque to allow microCT measurements. In conclusion, Fuji-Plus might be an effective intraorifice barrier (up to 70 days in vitro), but all 4 materials showed leakage in some specimens at 90 days.

This study investigated the effect of immersion in sodium hypochlorite (NaOCl) on torque and fatigue resistance of two nickel-titanium files. Size 25 .04 ProFile and RaCe files were immersed in 5.25% NaOCl for 1 or 2 hours at temperatures of 21 degrees C and 60 degrees C. Torque and angle at failure were measured according to ISO 3630-1. Resistance to cyclic fatigue was determined by counting rotations to breakage in a 90 degrees curve with a 5-mm radius. Data were analyzed by 2-way analysis of variance. Torsional resistance of both rotaries was not significantly affected by immersion in NaOCl, except after 2 hours of immersion at 60 degrees C. Resistance to cyclic fatigue decreased significantly for ProFile and RaCe instruments after immersion in NaOCl. Spontaneous fractures occurred in 28 of 160 files during immersion in NaOCl. In conclusion, nickel-titanium rotaries have reduced resistance to cyclic fatigue after contact with heated NaOCl and may then be considered single-use instruments.

Decontamination of instruments is a prerequisite for their potential reuse but may affect surface integrity. Hence, the effect of prion removal protocols on 7 brands of nickel-titanium files was investigated. Baseline debris scores were determined under magnification after staining with van Gieson's solution. After shaping root canals in vitro, rotaries were mechanically and ultrasonically cleaned followed by immersion for 24 hours in 2 M sodium hydroxide (NaOH), 6 M CH(5)N(3), or 3% sodium hypochlorite (NaOCl); control files were stored dry. After sterilization, files were again stained and evaluated. Two of seven file brands demonstrated significantly higher baseline debris scores compared to final scores. Uniformly, debris could not be completely removed; there were no significant differences among groups. After immersion in NaOCl, 27.8% of instruments showed corrosion; however, no deterioration after immersion in the other solutions was found in the other groups. Regarding corrosion, no significant difference was found between brands. Based on these findings, single use of nickel-titanium rotaries appears beneficial.

In the current study, the impact of lubricant parameters on simulated root canal instrumentation was investigated. Using size 30 ProFile .06 instruments in milled artificial root canals in human dentin, the effects of sodium hypochlorite (1% NaOCl) and a chelator (18% etidronic acid) in aqueous irrigants on maximum torque, full torsional load, and maximum force values were gauged using a torque testing platform. Furthermore, the impact of the time a chelating lubricant was exposed to dentin as well as its galenic form (aqueous vs. gel-type) on the above outcome variables was evaluated. Aqueous lubricants significantly (p < 0.05, ANOVA, Newman-Keuls) reduced all outcome variables compared to dry conditions. The incorporation of a chelator further reduced these values (p < 0.05), whereas hypochlorite behaved similar to water. The chelator effect was immediate and did not increase with time. An aqueous lubricant was more beneficial than a gel-type counterpart.

The aim of the present study was to evaluate static fracture loads of ProTaper Nickel-Titanium instruments that had been subjected to various degrees of cyclic fatigue. Torque and angle at failure of new instruments and instruments that had been stressed to 30, 60, or 90% of their cyclic fatigue rotations in a simulated canal (90 degrees and 5 mm radius) were tested according to ISO 3630-1. With unused ProTaper instruments, resistance to cyclic fatigue decreased with diameter increase and ranged from 158 to 450 rotations. Torque at failure ranged from 0.5 to 2.1 Ncm and showed a strong linear relationship to instrument diameter (r = 0.9) while angle at failure was weakly related to diameter (r = 0.46). Cyclic prestressing significantly reduced torsional resistance in finishing files, while shaping files were largely unaffected. In conclusion, build-up of tension within NiTi rotary instruments depends on instrument diameter. Clinically, larger instruments that have been subjected to some cyclic fatigue should be used with great care or discarded.

The aim of this study was to compare torques and forces developed by two sequences of nickel-titanium rotary instruments, using only .04 taper instruments or a combination of .04 and .06 tapers, respectively. Curved canals in plastic blocks were shaped in a torque-testing device; torque, force, contact areas and numbers of working rotations were determined. Analysis of variance and Pearson correlation coefficients were used to compare the two sequences. Mean torque ranged from 0.2 +/- 0.03 to 3.19 +/- 0.28 Ncm and was higher for instrument sizes 25 to 45 in group A. Mean vertical forces ranged from 1.49 +/- 0.54 to 12.0 +/- 3.5 N; there were significant correlations between torque and force as well as between torque and contact areas. Numbers of rotations were lower in the combined .04 and .06 sequence. An instrumentation sequence encompassing various tapers seems to be safer regarding torsional and fatigue failure compared to a sequence that used one single taper. However, the former sequence requires the use of more instruments.

Objective: The goal of this study was to weigh the impact of patient-related, tooth-related, and treatment-related factors on therapy outcome in a series of consecutive patients., Study Design: Eighty-four patients were included. Of these, 66 (79%) were available for recall after > or = 30 months (mean = 46 months). Root canal treatments were performed using a standard protocol. At recall, teeth were scored by means of the periapical index (PAI), which was the dependent variable (dichotomized to sound/ unsound). Explanatory variables were patient age, integrity of the nonspecific immune system, smoking status, dichotomized PAI score before treatment, initial treatment versus retreatment, prior exposition of the root canal to saliva, stainless-steel hand versus NiTi rotary instrumentation, and quality of root filling. Unit of observation was the patient-individual. Data were analyzed using univariate tests and backward stepwise logistic regression analysis., Results: After 5 steps with elimination of the least significant independent variable, status of the immune system (P = .05), initial PAI (P = .04), and root filling quality (P = .01) were found to be the indispensable predictors for treatment outcome. Using these 3 explanatory variables, the logistic regression model had a predictive value of 87%, compared to 91% with all 8 variables. Success rate at recall (PAI < or = 2 without symptoms) was 88% (95% CI = 78, 94)., Conclusion: The integrity of a patient's nonspecific immune system, which has been neglected in earlier investigations, is a significant predictor for endodontic treatment outcome, and should receive more attention in future studies.

Nickel-titanium rotary instruments are important adjuncts in endodontic therapy. This review attempts to identify factors that influence shaping outcomes with these files, such as preoperative root-canal anatomy and instrument tip design. Other, less significant factors include operator experience, rotational speed, and specific instrument sequence. Implications of various working length definitions and desired apical widths are correlated with clinical results. Despite the existence of one ever-present risk factor, dental anatomy, shaping outcomes with nickel-titanium rotary instruments are mostly predictable. Current evidence indicates that wider apical preparations are feasible. Nickel-titanium rotary instruments require a preclinical training period to minimize separation risks and should be used to case-related working lengths and apical widths. However, and despite superior in vitro results, randomized, clinical trials are required to evaluate outcomes when using nickel-titanium instruments.

Purpose: To describe the treatment of a patient with a dismal oral situation after successful cure for drug addiction., Methods: After root canal treatment and surgical pretreatment, four maxillary glass-fiber reinforced composite fixed partial dentures, anchored by endo-crowns instead of post and core, were fabricated (Targis & Vectris). Additionally, full crowns on four dental implants and an inlay were produced of non-reinforced composite (Targis). All restorations were luted adhesively to abutments with a three component adhesive system (Syntac Classic), light-curing composite (Tetric) and an ultrasonic insertion technique., Results: An esthetic and functional acceptable result was achieved. Excessive removal of tooth structure by post preparation may weaken the root.

An increasing number of engine-driven rotary systems are marketed to shape root canals. Although these systems may improve the quality of canal preparations, the risk for instrument fracture is also increased. Unfortunately, the stresses generated in rotary instruments when shaping curved root canals have not been adequately studied. Consequently, the aim of an ongoing project was to develop a measurement platform that could more accurately detail physical parameters generated in a simulated clinical situation. Such a platform was constructed by fitting a torque-measuring device between the rotating endodontic instrument and the motor driving it. Apically directed force and instrument insertion depth were also recorded. Additional devices were constructed to assess cyclic fatigue and static fracture loads. The current pilot study evaluated GT rotary instruments during the shaping of curved canals in plastic blocks as well as "ISO 3630-1 torque to fracture" and number of rotations required for fatigue fracture. Results indicated that torques in excess of 40 Nmm were generated by rotary GT-Files, a significantly higher figure than static fracture loads (less than 13 Nmm for the size 20. 12 GT-File). Furthermore, the number of rotations needed to shape simulated canals with a 5 mm radius of curvature in plastic blocks was 10 times lower than the number of rotations needed to fracture instruments in a "cyclic fatigue test". Apical forces were always greater than 1 N, and in some specimens, scores of 8 N or more were recorded. Further studies are required using extracted natural teeth, with their wide anatomical variation, in order to reduce the incidence of fracture of rotary instruments. In this way, the clinical potential of engine-driven rotary instruments to safely prepare curved canals can be fully appreciated.