Dentinal Microcracks after Root Canal Instrumentation Using Instruments Manufactured with Different NiTi Alloys and the SAF System: A Systematic Review

Kashmira Sawant,Giuseppe Alessandro Scardina,Ajinkya M Pawar,Kulvinder Singh Banga,Anand Marya,Ricardo Machado,Mohmed Isaqali Karobari,Pietro Messina

doi:10.3390/app11114984

Abstract

Aim: The aim of this systematic analysis was to assess the prevalence of dentinal microcracks at various levels (3, 6, and 9 mm from the apex) after using instruments made with conventional, R-Phase, and M-Wire NiTi alloys and the SAF system. Materials and Methods: Electronic searches were conducted in the databases Embase, Cochrane Library, Scopus, PubMed, and Web of Science. To arrange search methods, “MeSH” terms and/or keywords typically associated with the subject were paired with the Boolean operators “AND” and “OR.” Additional searches were conducted on the websites of four separate endodontic journals. After reading the titles and excluding duplicates, 1000 of the 1343 documents originally found were eliminated. Upon reviewing the abstracts, 310 of the remaining 343 experiments were also eliminated. Based on qualifying requirements, only 13 of the remaining 33 articles were included in the qualitative review. Results: All systems triggered dentinal microcracks; however, when chemo-mechanical preparation was performed using Self-Adjusting File (SAF) and systems manufactured with R-phase technology—K3XF and Twisted File Adaptive (TFA)—less of these defects were found when compared to those manufactured with traditional NiTi—ProTaper Universal and Mtwo—and with M-Wire—ProTaper Next, Reciproc, and WaveOne. Conclusions: A lower prevalence of dentinal microcracks was observed after using SAF and endodontic systems manufactured with R-phase.

Highlights

Centered on the “PICOS” (PRISMA-P 2016) technique, studies that compared the occurrence of dentinal microcracks resultant from endodontic files made with different
P: extracted human teeth with complete rhizogenesis; I: biomechanical preparation; C: endodontic files made by different NiTi alloys; O: dentinal microcrack formation
Despite continuous developments in instruments to improve root canal system (RCS) cleaning [46], dentin microcracks continue to be a source of concern for clinicians and researchers [47,48] as they often contribute to the instrumented tooth fracturing and extraction [49,50,51]

Summary

Introduction

Endodontic treatment is primarily performed to maintain or reestablish the health of peri-radicular tissues in the vicinity of the involved teeth [1]. The pulp is removed, and the root canal is cleaned, shaped, and filled with a biocompatible material. Since the periapical tissues are not involved, the procedure is based on a “prophylactic target” to prevent the formation of a peri-radicular lesion [2]. The pulp cells in necrotic teeth are destroyed and permanently compromised, enabling microbial colonization of the root canal system (RCS) [3]. While a periapical lesion is not necessarily visible on radiographs, it can be present [4], and treatment is done to control the endodontic infection and avoid or preserve the integrity of the peri-radicular tissues [5]

Objectives

Methods

Results

Discussion

Conclusion