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Introduction: Rotary instrumentation has been included in the undergraduate endodontic curriculum to improve the quality of endodontic treatment. The aim of this study was to compare the technical quality of root canal fillings performed by preclinical dentistry students trained with hand instrumentation (THI) or not during their initial trial with rotary instruments. Materials and Methods: Twenty-four 3rd-year students were distributed into two groups: 12 students THI group and 12 students not trained with hand instrumentation (NTHI group). Both the groups received a 50-min theoretical lecture and a demonstration about the ProTaper Universal® system before being asked to complete endodontic treatments on one extracted maxillary central incisor, premolar, and molar using rotary instrumentation and obturation with the single-cone technique. The endodontic treatment technical quality was determined by periapical radiographs. Data were statistically analyzed, and P < 0.05 was considered statistically significant. Results: A total of 144 root canals were performed by preclinical students. Although the difference in the technical quality of the canals was nonsignificant among the groups (P > 0.05), the THI group had more adequately filled root canals (45.8%) than the NTHI group (29.2%). Only maxillary central incisors had underfilled canals, whereas teeth with multirooted canals were subjected to various procedural errors in both the groups (P > 0.05). Conclusions: Intensive hand instrumentation (HI) preclinical training did not significantly improve the technical quality of root canals performed by preclinical dentistry students during their initial trial with rotary instruments. The student’s familiarity with HI did not decrease the incidence of procedural errors when performing root canal treatment with rotary instruments.

Introduction: Rotary instrumentation has been included in the undergraduate endodontic curriculum to improve the quality of endodontic treatment. The aim of this study was to compare the technical quality of root canal fillings performed by preclinical dentistry students trained with hand instrumentation (THI) or not during their initial trial with rotary instruments. Materials and Methods: Twenty-four 3rd-year students were distributed into two groups: 12 students THI group and 12 students not trained with hand instrumentation (NTHI group). Both the groups received a 50-min theoretical lecture and a demonstration about the ProTaper Universal® system before being asked to complete endodontic treatments on one extracted maxillary central incisor, premolar, and molar using rotary instrumentation and obturation with the single-cone technique. The endodontic treatment technical quality was determined by periapical radiographs. Data were statistically analyzed, and P < 0.05 was considered statistically significant. Results: A total of 144 root canals were performed by preclinical students. Although the difference in the technical quality of the canals was nonsignificant among the groups (P > 0.05), the THI group had more adequately filled root canals (45.8%) than the NTHI group (29.2%). Only maxillary central incisors had underfilled canals, whereas teeth with multirooted canals were subjected to various procedural errors in both the groups (P > 0.05). Conclusions: Intensive hand instrumentation (HI) preclinical training did not significantly improve the technical quality of root canals performed by preclinical dentistry students during their initial trial with rotary instruments. The student’s familiarity with HI did not decrease the incidence of procedural errors when performing root canal treatment with rotary instruments. [ABSTRACT FROM AUTHOR]

Nonsurgical periodontal therapy aims to remove supragingival and subgingival biofilm to restore periodontal health. This systematic review aims to assess the clinical effectiveness of manual and/or ultrasonic instruments and to determine whether other therapies can improve periodontal clinical outcomes. Case-control, cross-sectional and cohort studies and clinical trials of patients undergoing nonsurgical periodontal therapy with ultrasonic and/or manual instruments (and any adjunctive therapies, such as glycine, erythritol, ozone, laser and glycine) from 2013 to 2023 were analyzed using Pub-med/MEDLINE, Scopus and Google Scholar. To assess the risk of bias in this review, blinding, randomization, allocation concealment, outcome data and outcome recording were assessed. No differences between treatments were found; all methods, including manual and ultrasound, were helpful in improving clinical parameters (primary outcome). Although the results were mixed, adjunctive therapies seemed to be helpful in the treatment of periodontal disease. The results of this systematic review are consistent with the previous scientific literature and have shown that both manual and ultrasonic instruments are effective in nonsurgical periodontal therapy. This review could not show how complementary therapies could further improve nonsurgical periodontal therapy. For future research, it would be good to standardize the sample with regard to the degree and stage of periodontal disease and to evaluate the risks and benefits of the instruments (manual and ultrasonic scalers). [ABSTRACT FROM AUTHOR]

AIM: The aim of the study is to evaluate and compare postoperative pain after single sitting pulpectomy using hand and rotary instrumentation in the primary molars of children. MATERIALS AND METHODS: Sixty children of age 4--8 years were selected using standard sample size formula for the single sitting pulpectomy after fulfilling inclusion and exclusion criteria and all participants were equally divided into two groups. Single sitting pulpectomy procedure was carried out in both groups. In the control group, K files and in the experimental group Pro AF baby gold pediatric rotary files were used, followed by obturation with zinc oxide-eugenol cement. Evaluation of postoperative pain was done using the modified visual analog scale at 24 h, 48 h, and 72 h. Furthermore, an evaluation of instrumentation time and quality of obturation was done. The patient is recalled after 7 days for the placement of stainless steel crown. RESULTS: The results showed no statistically significant difference in the postoperative pain after single sitting pulpectomy using hand and rotary instrumentation in the primary molars of children. There was no significant difference with the quality of obturation in both the study groups. However, a significant difference has been observed in the instrumentation time while using the rotary method of instrumentation as compared to hand instrumentation with independent t-test, t = 19.797 and P = 0.001. CONCLUSION: Among both the materials there was no significant difference found in postoperative pain and quality of obturation after single sitting pulpectomy in children. However, lesser instrumentation time was taken by rotary instrumentation as compared to conventional K file during single sitting pulpectomy in children. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study is to assess the efficacy of hand and ultrasonic scaling and to evaluate the surface roughness on the root surface of periodontally involved teeth using a scanning electron microscope. PATIENTS AND METHODS: A sample of 90 single-rooted teeth with a hopeless prognosis was selected for the study and divided into three separate groups. Group I consist of no treatment. In Group II, hand scaling was done using Gracey curettes, and in Group III, ultrasonic scaling was done. The teeth were then extracted and fixed in 10% formaldehyde solution for 24-48 hours and subjected to scanning electron microscopic (SEM) evaluation. RESULTS: The SEM analysis revealed that the remaining calculus index was found to be similar in the ultrasonic group and the hand scaling group, whereas the surface roughness was found to be the least in the ultrasonic group. CONCLUSIONS: Hand instrumentation has resulted in more surface roughness as compared to ultrasonic instruments. [ABSTRACT FROM AUTHOR]

Nonsurgical periodontal therapy aims to remove supragingival and subgingival biofilm to restore periodontal health. This systematic review aims to assess the clinical effectiveness of manual and/or ultrasonic instruments and to determine whether other therapies can improve periodontal clinical outcomes. Case-control, cross-sectional and cohort studies and clinical trials of patients undergoing nonsurgical periodontal therapy with ultrasonic and/or manual instruments (and any adjunctive therapies, such as glycine, erythritol, ozone, laser and glycine) from 2013 to 2023 were analyzed using Pub-med/MEDLINE, Scopus and Google Scholar. To assess the risk of bias in this review, blinding, randomization, allocation concealment, outcome data and outcome recording were assessed. No differences between treatments were found; all methods, including manual and ultrasound, were helpful in improving clinical parameters (primary outcome). Although the results were mixed, adjunctive therapies seemed to be helpful in the treatment of periodontal disease. The results of this systematic review are consistent with the previous scientific literature and have shown that both manual and ultrasonic instruments are effective in nonsurgical periodontal therapy. This review could not show how complementary therapies could further improve nonsurgical periodontal therapy. For future research, it would be good to standardize the sample with regard to the degree and stage of periodontal disease and to evaluate the risks and benefits of the instruments (manual and ultrasonic scalers).

Purpose The purpose of this follow-up proof-of-concept study was to determine the efficacy of a revised calculus disruption solution in facilitating the removal of both supragingival and subgingival calculus in-vivo, as measured by time, difficulty, and pressure required to remove supragingival and subgingival calculus. Methods Patients from a dental school in Minnesota were recruited to participate in a randomized, split-mouth, cross sectional proof-of-concept study comparing time, difficulty and pressure used with hand instrumentation alone compared to the use of a calculus disruption solution and hand instrumentation. Quadrants were randomized to either treatment or control group. Descriptive and inferential statistics were used to analyze the amount of time used. A paired Student's t-test was used to analyze the primary outcome (α = 0.05). Post-treatment questionnaires were completed by the investigator and participants to score the perceived difficulty and pressure required to remove calculus. Results Thirty participants completed the study. An average of 3.1 minutes less time was needed to remove supra and subgingival calculus in the treatment quadrants although this was not statistically significant (p=0.5757). The secondary outcomes, the investigator and participants' perceived difficulty and pressure used for calculus removal showed either no difference, or slight improvements in the treatment quadrants. Overall, the product was well tolerated by participants. Conclusion Quadrants treated with a calculus disruption solution, required slightly less time than control quadrants for calculus removal with hand instruments although the difference was not statistically significant. Reformulation to increase the viscosity of the solution may improve efficacy. Future studies should include a larger sample size, using multiple operators, and a double-blind study design. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to compare the remaining dentine thickness (RDT) following instrumentation with hand and rotary endodontic files during pulpectomy in primary molars. Research question was 'Is there any difference between the remaining dentine thickness following instrumentation with hand and rotary endodontic files during pulpectomy in primary molars?'. Methods: Electronic Databases like MEDLINE PubMed, Cochrane Library, EBSCOhost, Google scholar and grey literature were searched between January 1, 2006 and August 31, 2022 for in vitro and ex vivo studies that compared hand and rotary endodontic instrumentation to evaluate the RDT in primary molars. Articles published in English or which could be translated into English were searched. Two reviewers independently selected studies, extracted data, assessed risk of bias using the Revised, validated version of MINORS criteria. Results: Twelve studies were included in qualitative analysis. All included studies showed low risk of bias. Six studies showed more RDT with rotary instrumentation compared to manual instrumentation. Whereas, five studies showed variable results for RDT with manual and rotary instrumentation at different levels of root canals. One study showed no significant difference between manual and rotary instrumentation. In view of methodological heterogeneity of the findings, a meta-analysis was not conducted. Conclusion: High quality of evidence based on low risk of bias was found in all the included studies. Statistically, rotary instrumentation showed more RDT than manual instrumentation according to majority of studies. Despite the shortcomings of this systematic review, it is possible to infer that the use of rotary instrumentation provides more RDT and thus there is considerable conservation of tooth structure. [ABSTRACT FROM AUTHOR]

Purpose: To compare the technical quality of root canal treatment (RCT) depending on the incidence of procedural errors performed by undergraduate students using nickel‐titanium reciprocating and conventional hand instrumentation techniques, and to assess the impact of case difficulty and localization of the teeth (maxillary or mandibular molars). Methods: Dental records and periapical radiographs of molars that were treated with either hand or reciprocating WaveOne (WO) instruments were evaluated retrospectively. The technical quality of RCTs, the incidence of ledge formation, perforation, instrument fracture, overinstrumentation, underfilling, overfilling, inadequate root canal filling, and the effects of case difficulty and tooth localization were compared using the chi‐square test with a significance of 5% (α = 0.05). Results: While overinstrumentation was more frequent in the WO group (247 teeth), the incidence of inadequate root canal fillings was higher in the hand instrumentation group (245 teeth) (p < 0.01). No significant difference was observed in the incidence of other procedural errors (p > 0.05). The number of teeth with acceptable technical quality in preparation and obturation was 172 (69.6%) in the WO group, whereas it was 142 (58%) in the hand instrumentation group, presenting a significant difference between the instrumentation techniques (p < 0.01). Higher technical quality rates were observed with WO instrumentation in the high difficulty category and in maxillary teeth (p < 0.01). Conclusion: Higher technical quality in preparation and obturation can be achieved with WO reciprocating instruments and file‐matched greater tapered gutta‐percha cones. No significant difference was observed between the groups in the incidence of procedural errors except for overinstrumentation and insufficient root canal filling. WO instrumentation and obturation with file‐matched greater tapered gutta‐percha cones provided better technical quality in the high difficulty category and in maxillary teeth. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The present study was undertaken for evaluating various hand instrumentation techniques with different instruments in the formation of smear layer. Materials and Methods: One hundred and seventy-five extracted mandibular molars were collected and were cut at cementoenamel junction. Afterward, the distal roots were separated. Working length was determined, and roots were divided into five equal groups with 35 roots in each group as follows: Group A: K-type files with conventional step-back technique, Group B: Canal Master U instrument with clockwise–counterclockwise rotation, Group C: Flex-R® files with clockwise–counterclockwise rotation, Group D: FlexoFiles® with conventional step-back technique, and Group E: Nickel titanium files with conventional step-back technique. Biomechanical preparation was done according to their respective groups. The teeth in various groups were scanned under scanning electron microscope and scoring was done. All the results were analyzed by SPSS software version 17.0. Results: Scanning electron microscopic results indicated that apparently there seems to be a significant difference in the scoring of the smear layer between each group at all the three levels, but the difference was statistically nonsignificant. Microleakage was present in all the samples. Nonsignificant results were obtained while comparing the microleakage in between different the groups. However, microleakage was highest in Group D. Conclusion: The amount of smear layer is maximum at the apical third and lesser in the middle third followed by the coronal third in all the groups. All the samples showed microleakage to a varying extent.

Aims and Objectives: The present study was undertaken for evaluating various hand instrumentation techniques with different instruments in the formation of smear layer. Materials and Methods: One hundred and seventy-five extracted mandibular molars were collected and were cut at cementoenamel junction. Afterward, the distal roots were separated. Working length was determined, and roots were divided into five equal groups with 35 roots in each group as follows: Group A: K-type files with conventional step-back technique, Group B: Canal Master U instrument with clockwise-counterclockwise rotation, Group C: Flex-R® files with clockwise-counterclockwise rotation, Group D: FlexoFiles® with conventional step-back technique, and Group E: Nickel titanium files with conventional step-back technique. Biomechanical preparation was done according to their respective groups. The teeth in various groups were scanned under scanning electron microscope and scoring was done. All the results were analyzed by SPSS software version 17.0. Results: Scanning electron microscopic results indicated that apparently there seems to be a significant difference in the scoring of the smear layer between each group at all the three levels, but the difference was statistically nonsignificant. Microleakage was present in all the samples. Nonsignificant results were obtained while comparing the microleakage in between different the groups. However, microleakage was highest in Group D. Conclusion: The amount of smear layer is maximum at the apical third and lesser in the middle third followed by the coronal third in all the groups. All the samples showed microleakage to a varying extent. [ABSTRACT FROM AUTHOR]

Aim: An in vitro study was conducted to comparatively evaluate the two techniques – hand instrumentation and ultrasonic file irrigation for removal of various calcium hydroxide (Ca[OH]2)/chlorhexidine containing medicaments from the root canal by using Biological microscope and Digital Camera. Materials and Methods: Sixty-four human single-rooted teeth with straight canals were used. Root canal preparation was performed using Pro-taper Universal for Hand use (Dentsply Maillefer, Ballaigues Switzerland). Teeth were randomly divided into three Groups A, B, and C of 21 teeth each, the remaining tooth remained untouched and served as a negative control. Teeth of Group A were filled with Ca(OH)2 mixed with saline. Teeth of Group B were filled with Ca(OH)2 mixed with 0.2% chlorhexidine gel. Teeth of Group C were filled with Ca(OH)2 mixed with 0.12% chlorhexidine solution. Teeth were stored at 37°C and 100% relative humidity for 7 days. Then Ca(OH)2 was removed using two techniques: hand instrumentation and ultrasonic file irrigation in both groups. Teeth were sectioned longitudinally and observed under Biological microscope and Digital Camera. Results were statistically analyzed with the Mann–Whitney and Kruskal–Wallis test. Results: The results showed a significant difference between hand instrumentation and ultrasonic file irrigation in cervical and middle third, but no statistic difference in apical third. Conclusion: None of the techniques used in this study removed the inter-appointment root canal medicaments completely.

Purpose: The purpose of this study was to determine whether the adjunctive use of an experimental calculus disruption solution (EXP-955), combined with the exclusive use of hand instruments, decreases the amount of time required to remove supragingival dental calculus deposits. Methods: A single-site, randomized, split-mouth clinical trial was conducted to compare the time needed to remove supragingival dental calculus on deposits pretreated with an experimental calculus disruption solution vs. calculus deposits that were not pretreated. Quadrants were randomized to either the treatment or control group and the principal investigator (PI) was timed while using hand instruments to remove the calculus. At the end of each session, both the subjects and the PI completed a questionnaire assessing their perceptions regarding the various aspects of the appointment and the solution. Descriptive statistics were used to analyze the data. Recurring themes from the questionnaire were examined. Results: Twenty-five healthy subjects, each having two quadrants matched for number of teeth and level of calculus deposits, completed the study (n=25). A statistically significant difference was found in in the supragingival calculus removal times between the control, (M=12.5 minutes; SD=6.0), and the treatment, (M=9.7; SD=4.6), quadrants; Mean difference (95% CI) = 2.8 (1.8-3.7), p<0.0001. Thematic analysis of the questionnaire responses showed that the perceptions of the principal investigator and subjects were positive towards the use of the solution with less pain being a common participant comment. The experimental calculus disruption solution was well tolerated by all subjects. Conclusions: Results from this proof of concept study provide preliminary evidence that use of an experimental calculus disruption solution (EXP-955) reduced the time needed to remove supragingival calculus while using hand instrumentation. [ABSTRACT FROM AUTHOR]

Objective: The topography of the root surface plays an important role in plaque accumulation, cell adhesion, and periodontal healing. The aim of this study is to profilometrically evaluate the root surface changes following the instrumentation using different tools. Methods: Forty dentin blocks of buccal and lingual root surfaces were obtained from 20 single-rooted periodontally diseased hopeless teeth and randomly divided into 4 groups. Each group was subjected to different root instrumentation tools such as stainless steel (SS) Gracey curette (Group 1); titanium nitride (TIN) Gracey curette (Group 2); ultrasonic piezoelectric device with a special tip designed for root surfaces (H3) (Group 3); and Er:YAG laser (Er:YAG tip) chisel (Group 4). A calibrated clinician instrumented all surfaces in each group. The root surfaces were profilometrically evaluated before and after instrumentations. Results: There were no statistical differences between the initial roughness levels of the groups. TIN curettes revealed the most prominent effect on smoothing the surface, whereas the Er:YAG tip showed the highest roughness in comparison with the other root surface instrumentation tools. Conclusions: Considering the importance of root surface roughness after treatment for the success of periodontal therapy, the TIN curette was the most periodontally appealing tool followed by H3, SS curette, and Er:YAG tip. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to compare the step-down technique in simulated curved root canals using K hand files (VDW) and ProFiles 0.06/0.04 (Dentsply Maillefer). Method and Materials: A total of 72 canals were blindly prepared by instructed students: 1 block with K files and a second one with ProFiles 0.06/0.04 in connection with the EndoStepper (SET). Postoperative images of the canals were taken, and an independent dentist assessed preparations for amount and position of material removed during preparation. Efficacy of the instruments is described in terms of canal shape, instrument failure, canal blockages, and preparation time. Results: ProFile instrumentation provided well-centered and tapered preparations while maintaining the apical foramen; in contrast, the use of K files resulted in frequent alterations of the root canal. In the apical portion, both techniques showed unprepared areas. The coronal diameter in hand-instrumented canals was more irregular and wider than in those mechanically prepared. There was no separation of a ProFile instrument. Hand instrumentation was faster than mechanical, but the difference was not statistically significant. Conclusion: Under the conditions of the study, the ProFile rotary system was simple and safe to use and created better preparations than hand instrumentation. [ABSTRACT FROM AUTHOR]

Biofilm and calculus removal are very important components of periodontal therapy, and a variety of instruments may be used for debridement purposes. In recent years, the application range of sonic and ultra sonic scalers in such debridement procedures has been extended to the subgingival area as slim instrument tips allowing good access to the root surfaces have been developed. Treatment using oscillating scalers offers greater patient and operator comfort, and their treatment outcomes may be as successful as with hand instruments. However, a thorough knowledge of instrument function and profound clinical skills are necessary to allow safe, efficient application of these instruments. [ABSTRACT FROM AUTHOR]

Aim: An in vitro study was conducted to comparatively evaluate the two techniques - hand instrumentation and ultrasonic file irrigation for removal of various calcium hydroxide (Ca[OH]2)/chlorhexidine containing medicaments from the root canal by using Biological microscope and Digital Camera. Materials and Methods: Sixty-four human single-rooted teeth with straight canals were used. Root canal preparation was performed using Pro-taper Universal for Hand use (Dentsply Maillefer, Ballaigues Switzerland). Teeth were randomly divided into three Groups A, B, and C of 21 teeth each, the remaining tooth remained untouched and served as a negative control. Teeth of Group A were filled with Ca(OH)2 mixed with saline. Teeth of Group B were filled with Ca(OH)2 mixed with 0.2% chlorhexidine gel. Teeth of Group C were filled with Ca(OH)2 mixed with 0.12% chlorhexidine solution. Teeth were stored at 37°C and 100% relative humidity for 7 days. Then Ca(OH)2 was removed using two techniques: hand instrumentation and ultrasonic file irrigation in both groups. Teeth were sectioned longitudinally and observed under Biological microscope and Digital Camera. Results were statistically analyzed with the Mann-Whitney and Kruskal-Wallis test. Results: The results showed a significant difference between hand instrumentation and ultrasonic file irrigation in cervical and middle third, but no statistic difference in apical third. Conclusion: None of the techniques used in this study removed the inter-appointment root canal medicaments completely. [ABSTRACT FROM AUTHOR]

Introduction: Preparation of root canal system necessitates both enlargement and shaping of the complex root canal space together with disinfection of the easily accessible and hidden areas. The present article introduces a new manual root canal preparation technique and compares it with passive step-back and step-back regarding some items such as shaping efficacy, maintenance of working length and occurrence of procedural accidents. Methods and Materials: This canal preparation technique (Bolourchi Hybrid Technique-BHT) was compared with passive step-back and step-back root through preparation of 30 extracted human mandibular and maxillary molars. Three experienced endodontists evaluated the final radiographies for following items: 1) difficulty of the case 2) shaping efficacy 3) maintenance of working length 4) time of preparation. Two-way ANOVA was used to analyze the data. Multiple comparisons were done using the Tukey's HSD. Results: Regarding shaping efficacy and maintenance of working length, BHT group showed significantly higher scores and scores for step-back group were significantly the lowest. The difference between BHT group and passive step-back on these items was not significant. No significant differences were found between the techniques in other assessed criteria except for occurrence of procedural accidents which was significantly higher in step-back group. Conclusion: Considering the advantages of this novel technique as well as its comparability to the present routine techniques, it can be considered as an available root preparation technique for teaching in dental schools. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The purpose of this study was to evaluate the effects of three distinct periodontal treatment methods in comparison with hand instrumentation on residual cementum of periodontal diseased teeth. Cementum can influence the activities of periodontal cells and may play an important regulatory role in periodontal treatment. The ideal method for periodontal therapy involves removal of biofilm, calculus and endotoxin while preserving root cementum. Material and methods: Forty‐eight caries free, single‐rooted teeth in patients diagnosed with severe chronic periodontitis were treated using four different methods prior to extraction. The teeth were instrumented subgingivally at one approximal site either by hand curettes (HC), piezoelectric ultrasonic scalers (U), piezoelectric ultrasonic scalers following air polishing (U + AP) or air polishing (AP) alone. Following extraction of teeth, instrumented and non‐instrumented sites were analysed with a dissecting microscope and SEM for measurement of the amount of and surface characteristics of residual cementum. Results: The percentage of coronal cementum remaining following subgingival instrumentation was 84% for U, 80% for U + AP, 94% for AP and 65% for HC. Although subgingival instrumentation of apical portions of the cementum demonstrated 6% less retained cementum in comparison with coronal portions, the amount of retained cementum with AP was still significantly greater than with HC. SEM results found the smoothest root surfaces were produced by the HC followed by the AP, while root surfaces instrumented by U or U + AP presented grooves and scratches. Conclusions: This study demonstrated that AP was superior to U devices in preserving cementum, whereas HC were the most effective instruments in removing cementum. [ABSTRACT FROM AUTHOR]

Context: There is a possibility of dentinal crack formation in primary teeth after root canal preparation using rotary files., Aims: To evaluate and compare the effect of ProTaper-Gold and Kedo-S rotary files on crack formation after root canal preparation in primary molars., Settings and Design: A total of 120 freshly extracted mandibular primary molars (6-9 years) were randomly divided into three groups of 40 each: ProTaper-Gold, Kedo-S, and Hand H-files, respectively., Materials and Methods: The roots were covered with a snuggly fitting surgical glove and stabilized in the teeth slot of a silicone mold of mandibular mixed dentition. Dental casts were obtained in a mixture of plaster of paris and sawdust. A screw system was incorporated in the cast for stabilization of the cast into the phantom head. All the root canals were instrumented in a standard operating position till 1 mm short of the radiographic apex. All roots were then stained and sectioned perpendicular to the long axis at the furcation level and 2 mm below the furcation to obtain one section per tooth. Sections were examined under a stereomicroscope at 25× magnification for any crack formations and recorded. Data were analyzed using Wilcoxon signed-rank and Kruskal-Wallis tests ( p = 0.05)., Results: The total number of cracks in terms of percentage following the use of ProTaper Gold, Kedo-S, and H-files were 35, 10, and 0%, respectively, on the upper surface and 15, 5, and 0% on the lower surface. Within the group, there was a statistically significant difference in ProTaper-Gold ( p = 0.001)., Conclusion: The use of ProTaper-Gold resulted in a greater number of dentinal cracks compared to Kedo-S and H-files., How to Cite This Article: Patil MB, Mandroli PS, Jalannavar P, et al. Dentinal Microcracks after Root Canal Preparation in Primary Root: An In Vitro Evaluation of ProTaper Gold and Kedo-S Rotary File Systems. Int J Clin Pediatr Dent 2023;16(5):692-697., Competing Interests: Source of support: Nil Conflict of interest: None, (Copyright © 2023; The Author(s).)

Introduction: Cleaning and shaping of the root canal system with an efficient and safe technique are the major goals of root canal treatment. The aim of this study was to compare the conventional root canal preparation technique by hand instruments and Gates Glidden drills with ProTaper Universal Rotary system on the root susceptibility to vertical fracture. Methods: Thirty extracted human mandibular premolars were randomly assigned to two groups. In group I, apical preparation was performed with k-files up to #40 utilizing step back technique and coronal flaring was done with Gates Glidden drills. In group II, ProTaper Universal Rotary instruments were used up to the file F4. All teeth were obturated with lateral compaction technique using gutta-percha and AH26 sealer. A simulated periodontal ligament was fabricated, and the teeth were mounted. A stainless steel finger spreader #35 was mounted in an Instron testing machine and the necessary load to cause a root fracture was inserted and recorded. The obtained data were analyzed statistically using T-test. Results: The force required to fracture was significantly lower for the roots prepared by ProTaper instruments in comparison with the specimens prepared by hand instruments and Gates Glidden drills (P< 0.001). Conclusion: Canal preparation with ProTaper rotary instruments can make the roots more susceptible to vertical fracture than traditional instrumentation with k-files and Gates Glidden drills.

Background: Periodontally-diseased cementum surface contaminants inhibit growth and viability of fibroblasts and prevent the new connective tissue attachment. Thus, the removal of infected cementum has been advocated in periodontal therapy. These root surfaces decontaminated mechanically by hand instruments produce a smear layer. Acid conditioning of root surfaces after instrumentation has been used for removing endotoxins and smear layer. Citric acid and tetracycline hydrochloride have received great attention. Materials and Method: This in-vitro study included three groups -- one control (saline) and two experimental, where saturated solutions of citric acid and tetracycline hydrochloride were used as root conditioning agents on 45 single rooted extracted human teeth from 25 subjects with advanced periodontitis resulting in a sample size of 90. Each root surface was thoroughly planed with 100 strokes using a cut-sharp Gracey curette (11/12). 30 tooth sections were treated with saline. Cotton pellets soaked in citric acid and tetracycline hydrochloride solution were burnished on 30-30 tooth samples respectively. Samples were then mounted on SEM stub and sputter-coated with gold. All specimens were viewed using SEM by a single investigator. Mann Whitney 'U' test, Student's unpaired 't' test and Chi-square test were used to find the significance of results. Results and Conclusion: Citric acid was more efficient in removing smear layer, exposing more number of dentinal tubules and patent tubules than tetracycline hydrochloride. However, statistically no significant difference was found between the two agents as far as the diameter of exposed tubules was concerned. [ABSTRACT FROM AUTHOR]

The purpose of this research was to evaluate molar furcation entrances and the width of periodontal curette blades used in periodontal instrumentation. Materials and methods:  One hundred extracted molars (50 upper and 50 lower) were analysed. The furcation entrances were measured using orthodontic wires of different predetermined diameters: 0.4, 0.5, 0.6, 0.7, 0.8 and 0.9 mm. McCall 17–18, Gracey 5–6 and Gracey 5–6 mini-five curette blades were measured at their anterior (AT), middle (MT) and posterior (PT) thirds by a single trained investigator, through the use of a digital caliper. Results:  The results showed significant differences ( P < 0.0001) in relation to furcation entrances. The buccal upper molar furcations showed the narrowest dimensions. In relation to the blade diameter, significant differences among the instruments were found for their MT and PT ( P < 0.0001), but not for the AT ( P = 0.183). Significant differences were found among curette manufacturers. Nineteen per cent of evaluated furcations presented entrances <0.60 mm and 75% of the blades at their AT presented width >0.60 mm. Conclusions:  These findings demonstrated that some molar furcation entrances could not be adequately instrumented with the tested curettes. The use of other hand instruments, such as periodontal files, rotating instruments and ultrasonic devices should be taken into consideration during periodontal therapy. [ABSTRACT FROM AUTHOR]

Background: The role of vigorous root planing in the surgical treatment of gingival recession was recently questioned. The aim of the present randomized controlled split-mouth clinical study was to compare the effectiveness, in terms of root coverage, of hand and ultrasonic root instrumentation in combination with a coronally advanced flap for the treatment of isolated type recession defects. Methods: Eleven systemically and periodontally healthy subjects with bilateral recession defects (≥3 mm) of similar (≤1 mm) depth affecting contralateral teeth were enrolled in the study. Only Miller Class I gingival recession with no deep cervical abrasion or root caries/demineralization were included in the study. Control root exposures were treated with curets, whereas test roots were instrumented with ultrasonic piezoelectric devices. Randomization for test and control treatment was performed by a coin toss immediately prior to surgery. All recessions were treated with a coronally advanced flap surgical technique. The clinical reevaluation was made 6 months after surgery. Results: The two approaches resulted in a high percentage of root coverage (95.4% in the control group and 84.2% in the test group) and complete root coverage (03% in the control group and 55% in the test teeth), with no statistically significant difference between them. Clinical attachment level gains were clinically significant in both groups (3.36 ± 0.92 mm in the control group and 2.90 ± 0.70 mm in the test group), with no statistically significant difference between them. The increase in keratinized tissue height was statistically significant in both groups (0.55 ± 0.52 mm in the control group and 0.36 ± 0.67 mm in the test group), with no difference between them. Conclusions: The present study failed to demonstrate any superiority, in terms of root-coverage results, for hand instruments over ultrasonic treatment of the root surface in combination with coronally advanced flap mucogingival surgery. Further studies of longer-term duration and larger sample size could help to establish the superiority of one form of root instrumentation in conjunction with root-coverage surgery. [ABSTRACT FROM AUTHOR]

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

Objectives: The Vector® ultrasonic system provides root debridement supported by different abrasive irrigation fluids. The aim of this study was to investigate the clinical outcome of initial therapy with subgingival low-abrasive debridement. Material and Methods: Twenty patients, who had at least two teeth with pocket depths >5 mm in each quadrant, took part in this prospective randomized clinical study. Patients were treated in a split-mouth design as one test quadrant (1) subgingivally with Vector™ fluid polish (VU-H) and as three control quadrants, (2) with only supragingival polishing (PO-H), (3) with hand instruments (HI-H) performed by a hygienist and (4) with hand instruments (HI-D) performed by a dentist. At baseline, 3 and 6 months after treatment, pocket depths and attachment levels (ALs) were measured and bleeding on probing (BOP) was recorded. Results: At 6-month evaluation, all groups showed an improvement in clinical parameters. No statistically significant differences in any of the investigated parameters could be observed between the Vector group and the hand scaling groups, or when comparing the results of the two different operators. Conclusion: This study demonstrates that Vector™ treatment with polishing fluid was able to reduce pocket depths and the prevalence of BOP and improve clinical AL in a similar way as scaling with curettes. [ABSTRACT FROM AUTHOR]

Scaling and root planing are one of the most commonly used procedures for the treatment of periodontal diseases. Removal of calculus using conventional hand instruments is incomplete and rather time-consuming. In search for more efficient and less difficult instrumentation, investigators have proposed lasers as alternatives or adjuncts for scaling and root planing. The aim of the present study was to compare the effectiveness of subgingival scaling and root planing with erbium: yttrium, aluminium, garnet (Er:YAG) laser and hand instrumentation in vitro. The mesial and distal surfaces of 15 periodontal loosed extracted teeth were treated randomly either by hand instrumentation or by Er:YAG laser irradiation. After choosing the "very long pulse mode" (pulse duration of about 700 micros), the output energy of 160 mJ with 920-microm beam diameter (RO7 Perio tip, Fidelis, Fotona, Slovenia) and frequency of 12 Hz were selected, both according to the best results of past studies. In addition, air water spray was used during the procedures. The morphology of the root surface was evaluated by three observers with a scanning electron microscopy in magnifications of 50x and 400x. The result of this setting showed that the rate of remained roughness on treated root surfaces in two groups of hand instruments and Er:YAG laser had a meaningful difference: The surface roughness in Er:YAG laser group was more than in hand instruments group. The present study could demonstrate the in vitro capability of the Er:YAG laser for scaling and root planing in periodontitis, although the effectiveness of this setting did not reach that achieved by hand instrumentation. It could be concluded that lower frequency and long pulse duration maybe more suitable for the micro-morphology of root surface after treatment. This theory is going to be tested with the same laser instrument in the next study. [ABSTRACT FROM AUTHOR]

Sallum AW, Alves RV, Damis LFT, Bertolini PFR, Nociti Jr FH, Sallum EA. Open flap debridement with or without intentional cementum removal: a 4-month follow-up. J Clin Periodontol 2005; 32: 1007–1010. doi: 10.1111/j.1600-051X.2005.00815.x. © Blackwell Munksgaard, 2005. The aim of this study was to investigate the influence of cementum removal on periodontal repair. Forty subjects with chronic periodontitis and presenting, at least, two proximal sites in anterior teeth (upper or lower) with probing depth ⩾5 mm were selected. After oral hygiene instructions and ultrasonic supragingival instrumentation, the subjects were randomly assigned for one of the following groups: CIC, scaled with Gracey curettes; CIUS, scaled with ultrasonic device; CDC, calculus deattachment with Gracey curettes and brushing with saline solution; and CDUS, calculus deattachment with ultrasonic device and brushing with saline solution. Full-thickness flaps were reflected and the instrumentation was performed with a clinical microscope. Probing depth (PD), relative gingival margin level (RGML) and relative attachment level (RAL) were registered at five experimental periods: baseline and 30, 60, 90 and 120 days postoperative. All the approaches were able to markedly reduce the PD values from the baseline to the other evaluation periods ( p<0.0001). The increase in RGML values was statistically significant only for the CDUS group. There were no statistically significant differences between the baseline and postoperative values in all groups for the RAL changes. The changes in RAL were statistically significant only among the groups CDC and CDUS ( p<0.0001). The conventional scaling and root planing and the calculus deattachment were effective in reducing the probing depth values, regardless of the instrumentation method. [ABSTRACT FROM AUTHOR]

Braun A, Krause F, Frentzen M, Jepsen S: Removal of root substance with the Vector™-system compared with conventional debridement in vitro. J Clin Periodontol 2005; 32: 153–157. doi: 10.1111/j.1600-051X.2005.00651.x.© Blackwell Munksgaard, 2005.The aim of the present study was to assess the removal of root substance with the Vector™-system depending on different irrigation fluids and to compare the results with conventional methods for root debridement.Forty extracted human teeth were treated using four different methods: Vector™-system with polishing fluid and metal curette (VP), Vector™-system with abrasive fluid and metal curette (VA), conventional ultrasonic system (U) with insert tip“P” and hand instrument. Treatment of the calculus-free root surfaces was carried out for a total of 12 min. using an artificial periodontal pocket. At intervals of 120 s, the removal of dental hard tissues was assessed using a three-dimensional (3D) laser scanning device and the Match 3D software with an accuracy of 0.00001 mm3.No difference in the removal of root substance with the hand instrument (0.0055 mm3/s) and the Vector™-system using the abrasive fluid (0.0044 mm3/s) could be observed (p=0.51). Using these two systems, a larger amount of root substance (p<0.05) was removed compared with the other methods (U: 0.0023 mm3/s, VP: 0.0022 mm3/s), which did not differ from each other (p=0.76).The present study indicates that the Vector™-system in combination with polishing fluid or conventional ultrasonics might be used for root debridement without extensive root substance removal. [ABSTRACT FROM AUTHOR]

Braun A, Krause F, Frentzen M, Jepsen S. Efficiency of subgingival calculus removal with the Vector™-system compared to ultrasonic scaling and hand instrumentationin vitro.J Periodont Res 2004; doi: 10.1111/j.1600-0765.2004.00768.x© Blackwell Munksgaard 2004The recently introduced Vector™-system (Duerr Dental, Bietigheim-Bissingen, Germany) is recommended to be used in conjunction with different insert tips and irrigation fluids. The aim of the study was to assess subgingival calculus removal depending on the mode of operation and to compare the results to conventional methods for root debridement.Sixty extracted human teeth with calculus on the root surface were treated in an artificial periodontal pocket model using six methods: Vector™-system with metal probe insert (VPP) or metal curette insert (VPC), both used with polishing fluid, Vector™-system with metal probe insert (VAP) or metal curette insert (VAC), both used with abrasive fluid, EMS-ultrasonic system (U) and hand instrument (Gracey curette). Photographs of the root surface were taken at intervals of 10 s and calculus removal was assessed using a surface analysis software until the root surfaces were cleaned completely. Analysis of variances (ANOVA) of the ranks with subsequent comparison of mean ranks and calculation of homogeneous groups (Scheffé) were used for statistical analysis.Employing the hand instrument, highest efficiency could be observed (0.340 mm2/s). Calculus removal with the Vector™-system and metal probe insert (VPP: 0.036 mm2/s; VAP: 0.067 mm2/s) was less effective (p < 0.05) than using the system with metal curette inserts (VPC: 0.122 mm2/s; VAC: 0.209 mm2/s). Employing the abrasive fluid, removal of deposits with the metal curette insert was as efficient as with the conventional ultrasonic system (U: 0.199 mm2/s,p > 0.05).The presentin vitrostudy indicates that the efficiency of calculus removal with the Vector™-system is significantly dependent on the selection of inserts and irrigation fluids. [ABSTRACT FROM AUTHOR]

This in vitro study evaluated the efficacy and safety of six different nickel-titanium engine-driven instruments used with a torque-controlled engine device and nickel-titanium hand and stainless steel hand instruments in preparation of curved canals. A total of 80 curved (36°) simulated root canals were prepared. Images before and after were superimposed, and instrumentation areas were observed. Time of instrumentation, instrument failure, change in working length and weight loss were also recorded. Results show that stainless steel hand instruments cause significantly less transportation towards the inner wall of the canal than do nickel-titanium hand instruments. No instrument fracture occurred with hand instruments, but 30–60% breakage of instruments was recorded during instrumentation with the engine-driven devices. The working length was maintained by all types of instruments. Newly developed nickel-titanium rotary files were not able to prevent straightening of the severely curved canals when a torque-controlled engine-driven device was used. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the bacteriologic status of the root canal after sonic, Ultrasonic and hand instrumentation. Root canal infectional was induced in 50 single-rooted teeth in young dogs by removing tile pulp and filling the canals with dental plaque. After 7 days the root canals were instrumented under aseptic conditions with conventional hand instruments, a sonic vibratory device or an in ultrasonic device. Sterile saline or 2.5% sodium hypochlorite was used as irrigating solution. Following instrumentation a sterile paper point was sealed into die root canals. After 7 d the root canals were reopened tinder aseptic conditions and the paper points were incubated for the demonstration of bacteria, using pre-reduced thioglycolate culture medium and anaerobic chambers. The results obtained with the different instrumentation techniques and irrigating solutions were compared by means of the Chi-square test. The results indicated that the sonic and ultrasonic devices were not more effective in the elimination of bacteria from the root canal than conventional hand instrumentation. Irrigation with sodium hypochlorite appeared to be more effective than saline in producing bacteria-free root canals; however, this difference was not statistically significant. Thus, it appeared that more than one appointment and the supporting action of an anti-bacterial medicament between appointments would be necessary to achieve bacteria-free root canals in infected teeth in a predictable manner. [ABSTRACT FROM AUTHOR]

Background: Pulpal involvement, secondary to dental caries, is not uncommon and is a challenging task for pediatric dentists. Morphological differences in root canal of deciduous teeth increases the complexity of management. The aim of this study was to compare two rotary file systems and hand instrumentation for root canal preparation in regard to canal transportation, centering ability ratio, and dentin thickness using cone-beam computed tomography (CBCT)., Methods: A total of 72 canals from 24 freshly extracted mandibular deciduous second molars were divided into a set of 8 teeth, then prepared using 2 rotary files systems: the Kedo-S pediatric file system (Group A) and Pro AF Baby Gold file system (Group B) were compared to hand instrumentation (Group C). CBCT scans before and after root canal preparation were used to evaluate tested parameters. Instrumentation time for all three techniques was also measured using a chronometer., Results: Although rotary file systems have shown superior results in root canal preparation as compared to hand instrumentation, no significant differences were observed between all the groups for canal transportation and dentin thickness at all three levels of prepared canals. A comparison of centering ability ratio between all the groups was found to be statistically significant only at the cervical level. A significant difference was observed between hand instrumentation using K-files (117.3 s) and both rotary systems (Kedo-S (81 s) and Pro AF Baby Gold (81.5 s)) in terms of canal preparation time (P < 0.001)., Conclusions: Both tested rotary systems and hand instrumentation demonstrated comparable canal preparation results, with differences that were statistically non-significant in most tested parameters, without shaping errors. However, both the rotary systems were more efficient and faster than hand instrumentation., Competing Interests: None

Bechelli C, Zecchi Orlandini S, Colafranceschi M. Scanning electron microscope study on the efficacy of root canal wall debridement of hand versus Lightspeed™ instrumentation. International Endodontic Journal, 32, 484–493 1999. Aim The aim of this in vitro study was to compare the efficacy of root canal wall debridement following hand versus LightSpeedTM instrumentation. Methodology Twenty recently extracted single-rooted teeth were paired and randomly placed into two treatment groups of 10 teeth each. In group 1, a step-back instrumentation without initial coronal flaring with stainless steel Hedstroem files was used; group 2 was instrumented with Ni-Ti LightSpeedTM instru-ments. Both groups had the same irrigation regimen: 2.5% NaOCl and a 15% EDTA solution. The teeth were then decoronated and each root split longitudinally into two halves to be examined using the scanning electron microscope (SEM). The presence of superficial debris and smear layer was evaluated by a standardized grading system, and the resulting scores submitted to nonparametric statistics. Results Under the conditions of this study, the removal of superficial debris was generally excellent with both canal preparation techniques. Both techniques resulted in variable presence of residual smear layer, with a canal wall covered by smear layer as the predominant characteristic. Generally, the amount of smear layer was greater in the apical than in the middle third of the root, however, this difference was statistically significant (P 0.005) only in hand-instrumented teeth. The use of LightSpeedTM instruments was associated with significantly more (P 0.05) smear layer presence in the middle region of the root when compared with hand instrumentation. In addition, less smear layer was present in the apical region following LightSpeedTM instrumentation than stainless steel hand files, but this difference was not statistically significant.... [ABSTRACT FROM AUTHOR]