Dentinal Microcrack Formation by Different Rotary Endodontic File Systems: An In-vitro Study

Abstract

Introduction: During endodontic treatment, biomechanical preparation of the root canals constitutes one of the prime steps to enable bacterial eradication, irrigant percolation and three dimensional obturation of the canal space. Currently used rotary endodontic instruments generate stresses in the dentinal walls as microcracks and craze lines which can eventually precipitate vertical root fractures. This endangers the prognosis of an endodontically treated tooth or can even lead to tooth extractions. Aim: To compare dentinal micro-crack formation during biomechanical preparation by different Nickel-Titanium rotary endodontic instruments, Reciprocating single file system and Self-Adjusting File (SAF) using a stereomicroscope. Materials and Methods: The study was a randomised controlled trial conducted for a total duration of two months. A total of eighty extracted human mandibular molars with intact mesial roots were selected. Endodontic access was achieved. Hyflex CM file (Coltene), One Shape file (Micromega), Twisted File (TF; SybronEndo, Orange, CA), One endo file (Nano endo), ProTaper Next file (Dentsply Maillefer), Reciproc file (VDW) and SAFs were used to prepare the samples, leaving ten teeth unprepared which served as control. Sectioning of the prepared samples were carried out perpendicular to their long axes at 9, 6 and 3 mm. Under 40X magnification of a stereomicroscope, digital images of each section were recorded with the aid of a digital camera. Examination of each specimen was carried out by two operators to verify the presence of dentinal defects/microcracks. The statistical analysis was done by Chi-square test. Results: Except the control group, all the remaining groups recorded the presence of dentinal defects. The incidence of cracks was highest in One Endo (40%) followed by One Shape, Twisted (30%), Protaper Next (23.33%), Reciproc (10%), Hyflex (6.6%), SAF (3.3%) and control (0%). A significant difference was found for the cracks in coronal section between the file systems (p=0.0001). Conclusion: Usage of nickel titanium rotary instruments leads to the formation of microcracks or craze lines in root dentine. Instruments which have Matellurgical (M) wire or Controlled Memory (CM) wire in their metallurgy result in fewer formations of micro-cracks. When compared to multiple rotary files system, a reciprocating file led to the induction of lesser number of radicular cracks. SAF creates minimal cracks as compared to other file systems.