Hard Tissue Research Articles

Influence of Porosities of 3D Printed Titanium Implants on the Tensile Properties in a Rat Tendon Repair Model.

There is a desire in orthopaedics to have soft tissue, particularly tendon, grow into metallic implants. With the introduction of three-dimensional (3D) printed porous metal implants, we hypothesized that tendons could directly attach to the implants. However, the effects of the porous metal structure on tissue growth and penetration into the pores are unknown. Using a rat model, we investigated the effect of pore size on tendon repair fixation using 3D printed titanium implants. There were three experimental groups of eight Sprague Dawley rats (n = 24) plus control (n = 3). Implants had defined pore sizes of 400µm (n = 8), 700µm (n = 8), and 1000µm (n = 8). A defect was created in the Achilles tendon and the implant positioned between cut ends and secured with suture. Specimens were harvested at twelve weeks. Half the specimens underwent mechanical testing to assess tensile load to failure. The remaining specimens were fixed and processed for hard tissue histological analysis. The average load to failure was 72.6N for controls (SD 10.04), 29.95N for 400µm (SD 17.95), 55.08N for 700µm (SD 13.47), and 63.08N for 1000µm (SD 1.87). The load to failure was generally better in the larger pore sizes. The 700µm and 1000µm specimens performed similarly, while the 400µm showed significant differences vs control (p = 0.039), vs 1000µm (p = 0.010), and approached significance vs 700µm (p = 0.066). There was increasing ingrowth as pore size increased. Histology showed fibrous tendon tissue within and around the implants, with collagen fibers organized in bundles. Tendon repair utilizing implants with 700µm and 1000µm pores exhibited similar load to failure as controls. Using a defined pore structure at the attachment points of tendons to implants may allow predictable tendon ingrowth onto/into an implant at the time of revision arthroplasty.

Advances in Zinc-Containing Bioactive Glasses: A Comprehensive Review.

Bioactive glasses (BGs) have attracted significant attention in the biomaterials field due to their ability to promote soft and hard tissue regeneration and their potential for various clinical applications. BGs offer enriched features through the integration of different therapeutic inorganic ions within their composition. These ions can trigger specific responses in the body conducive to a battery of applications. For example, zinc, a vital trace element, plays a role in numerous physiological processes within the human body. By incorporating zinc, BGs can inhibit bacterial growth, exert anti-inflammatory effects, and modify bioactivity, promoting better integration with surrounding tissues when used in scaffolds for tissue regeneration. This article reviews recent developments in zinc-containing BGs (ZBGs), focusing on their synthesis, physicochemical, and biological properties. ZBGs represent a significant advancement in applications extending beyond bone regeneration. Overall, their biological roles hold promise for various applications, such as bone tissue engineering, wound healing, and biomedical coatings. Ongoing research continues to explore the potential benefits of ZBGs and to optimize their properties for diverse clinical applications.

Implant-Supported Vertical Soft Tissue Augmentation for Severe Hard and Soft Tissue Deficiencies at Malpositioned Implants: A Case Report of a Mucogingival and Restorative Approach.

The management of severe mucogingival deformities surrounding malpositioned implants represents a complex issue with a high risk of aesthetic failure. The present case report describes a mucogingival and restorative approach for the treatment of severe localized peri-implant tissue deficiencies with interproximal bone loss combined with an interproximal gingival recession on the adjacent natural tooth. This consists of maintaining a non-restorable malpositioned implant, submerging it through one or multiple vertical soft tissue augmentations, according to the defect severity, and delivering a tooth supported bridge involving the adjacent natural teeth. The step-by-step surgical technique adopted for implant submergence and vertical soft tissue grafting, as well as the subsequent surgical and prosthetic interventions, are described, presenting results at 5 years from implant submergence and 3 years from prosthetic finalization.

Optimizing Hard and Soft Tissue Grafting Techniques and Timing in the Posterior Maxilla Aiming for Effectiveness and Reduction of Treatment Time. Case Report.

Optimizing Hard and Soft Tissue Grafting Techniques and Timing in the Posterior Maxilla Aiming for Effectiveness and Reduction of Treatment Time. Case Report.

Implant-Supported Vertical Soft Tissue Augmentation for Severe Hard and Soft Tissue Deficiencies at Malpositioned Implants: A Case Report of a Mucogingival and Restorative Approach.

Implant-Supported Vertical Soft Tissue Augmentation for Severe Hard and Soft Tissue Deficiencies at Malpositioned Implants: A Case Report of a Mucogingival and Restorative Approach.

Clinical and Radiographic Evaluation of Soft Tissue and Bone Status in Immediate Loaded Implants Placed Following Their Extraction in the Maxillary Anterior Region.

In the maxillary anterior region, teeth extraction leads to significant soft and hard tissue changes. Immediate implant placement following extraction aims to reduce bone loss and overall treatment time. However, it may result in adverse soft tissue changes impacting esthetics. This study evaluates the clinical and radiographic outcomes of immediately loaded implants in the maxillary anterior region, focusing on soft tissue preservation and bone status. This study, conducted from April 2022 to August 2024 at the Department of Oral and Maxillofacial Surgery, Ragas Dental College and Hospital, included 10 immediately loaded implants in seven patients. Following atraumatic extraction, implants were placed and loaded with functional provisional crowns fabricated using three-dimensional (3D) rapid prototyping models. Parameters such as crestal bone loss, buccal and palatal bone width, and interdental papilla thickness were evaluated preoperatively and postoperatively using radiographsand clinical assessments. The study found significant crestal bone loss at both mesial and distal sites over time, with the greatest loss observed at the three-month follow-up. Buccal and palatal bone width showed no significant differences preoperatively and postoperatively. Interdental papilla thickness and overall pink esthetic scores also showed no significant differences between preoperative and postoperative evaluations. Immediate implant placement in the maxillary anterior region, using 3D rapid prototyping for custom splint fabrication, demonstrated effective preservation of soft tissue profile and bone architecture. This approach provides functional and esthetic benefits, although careful monitoring of crestal bone loss is necessary.

Regulation of Osteogenic and Angiogenic Markers in Alkali Treated Titanium for Hard Tissue Engineering Applications.

Titanium (Ti) and Ti alloys are of great interest in bone and dental tissue engineering applications due to their biocompatibility, corrosion resistance, and close mechanical properties to natural bone. However, the formation of fibrous tissue prevents osteointegration and results in implant loosening. Thus, physical and chemical methods are used to improve the surface properties of Ti. This study aimed to understand the role of alkali treatment conditions, including alkali medium concentration, temperature, rotation speed, and post-heat treatment. Our results showed that alkali treatment using 5 and 10 molar sodium hydroxide solution allows the formation of web-like microstructure. However, a higher concentration of 15 molar resulted in cracks along the surface. Interaction between the human fetal osteoblast cells (hfOBs) and Ti samples showed that heat treatment is necessary for increased cellular proliferation, which was not significantly different at later time points compared to the polished Ti. Alkali heat treatment did not induce inflammatory reactions at later time points. It showed an increase in vascular endothelial growth factor, osteoprotegerin/nuclear factor kappa-В ligand ratio, and osteocalcin expression, which is evidence for accelerated osteoblast cell maturation and bone remodeling in surface-modified samples. Together, these data show that alkali treatment using 5 or 10 molar of NaOH followed by heat treatment may have therapeutic effect and assist with bone tissue integration with Ti implant.

Regulation of TGF-β1-induced fibroblast differentiation of human periodontal ligament stem cells through the mutually antagonistic action of ectonucleotide pyrophosphatase/phosphodiesterase 1 and 2.

Human periodontal ligament stem cells (hPDLSCs) differentiate into periodontal ligament (PDL) fibroblasts, osteoblasts, and cementoblasts. To identify inducers of PDL fibroblastic differentiation, monoclonal antibody series were developed a series of against membrane/extracellular matrix (ECM) molecules through decoy immunization. The anti-PDL13 antibody targets ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1), renowned for regulating skeletal and soft tissue mineralization. ENPP1 accumulates in the periodontal ligament region of tooth roots, and specifically localizes to the cell boundaries and elongated processes of the fibroblastic cells. As ENPP1 expression increases during fibroblastic differentiation, mineralization induced by tissue-nonspecific alkaline phosphatase (TNAP), a pyrophosphate-degrading enzyme, is completely inhibited. This is consistent with ENPP1 and TNAP acting in opposition, and TGF-β1-induced ENPP1 expression creates an essential environment for PDL fibroblast differentiation. Representative fibroblastic differentiation markers decrease with endogenous ENPP1 inhibition by siRNA and antibody blocking. ENPP2 generates lipid signaling molecules. In contrast to ENPP1, ENPP2 disappears in TGF-β1-induced PDL fibroblasts. Ectopic expression of ENPP2 hinders TGF-β1-induced PDL fibroblastic differentiation. Suppression of ENPP1 and ENPP2 leads to severe defects in undifferentiated and differentiated cells, demonstrating that these two factors play opposing roles in soft and hard tissue differentiation but can complement each other for cell survival. In conclusion, increased ENPP1 is crucial for TGF-β1-induced PDL differentiation, while ENPP2 and TNAP can inhibit ENPP1. ENPP1 and ENPP2 exhibit complementary functions in the cell survival.

Modified minimally invasive surgical technique with clindamycin-augmented or non-augmented platelet-rich fibrin in periodontal regeneration: A randomized clinical trial.

Injectable platelet-rich fibrin (I-PRF), a second-generation platelet concentrate, is widely used to enhance soft and hard tissue healing alone or in combination with biomaterials, relying on its harboring of various pivotal growth/differentiation factors. This randomized trial assessed the effect of clindamycin (CLN) augmented injectable platelet-rich fibrin (I-PRF) with modified minimally invasive surgical technique (M-MIST) versus I-PRF alone with M-MIST on the clinical and radiographic parameters in the management of periodontal intra-bony defects in patients with stage-III grade B periodontitis. This is a 9-month parallel-grouped, two arm, double-blinded, randomized controlled trial (RCT) that included 28 patients (n = 28) with stage-III grade B periodontitis, who were allocated randomly to test- (CLN/I-PRF + M-MIST, 50 μL of CLN per 1 mL of I-PRF; n = 14) or control-group (I-PRF + M-MIST; n = 14). Clinical attachment level (CAL; primary outcome), probing depth (PD), gingival margin level (GML), plaque index (PI), and gingival index (GI) were recorded at baseline, 3, 6, and 9 months, whereas radiographic parameters radiographic linear defect depth (RLDD), and radiographic defect area (RDA) were recorded at baseline, 6, and 9 months. The CLN release kinetics from the I-PRF were further characterized. Compared to baseline, both groups independently demonstrated significant improvements in CAL, PD, GML, GI, PI, RLDD and BDA at 3, 6 and 9 months (p < .05). A significant reduction in CAL measurements was noticeable in the CLN/I-PRF + M-MIST and I-PRF + M-MIST group independently over time (p < .05). CLN/I-PRF + M-MIST showed significantly lower CAL than PRF + M-MIST group at baseline, after three as well as 9 months (p < .05). Intergroup comparisons at 9 months demonstrated that CAL-gain was non-significant between groups (p > .05), GI significantly lower in CLN/I-PRF + M-MIST, whereas PD-reduction significantly higher I-PRF + M-MIST group (p < .05). CLN was steadily released for the I-PRF for up to 48 h, with a peak concentration at 24 h, which then gradually declined till the seventh day. I-PRF with M-MIST provided significant clinical and radiographic improvement up to 9 months postoperatively in stage-III grade B periodontitis. CLN, at the applied concentration and release duration, does not appear to further positively impact these observed I-PRF effects.

Evaluation of Postoperative Effects of Using Ozonated Water as an Irrigant on Soft and Hard Tissues Surrounding Dental Implants: A Randomized Controlled Clinical Trial.

Aim To evaluate the short-term and long-term postoperative effects of ozonated water when used as an irrigant in terms of postoperative pain, healing, and implant stability when compared to normal saline irrigation during implant surgery, both carried out using conventional drilling protocol. Methods A total of 34 implants were placed in 17 patients, two implants in each patient, one implant using normal saline as an irrigant and another one using ozonated water as an irrigant during the surgical procedure of implant site osteotomy. Postoperative pain was assessed after 48 hours of the surgical procedure using the visual analog scale (VAS). Soft tissue healing was assessed after eight days using the tissue healing index. Osseointegration was checked by measuring the primary stability at the moment of implant placement and comparing it to the secondary stability measured three months after the implant placement. These stability values (ISQ) were obtained using resonance frequency analysis (RFA). Results The VAS scores for the control group (Group A) after 48 hours were 71.76±5.57 and for the experimental group (Group B) after 48 hours were 47.64±5.33 so mean values in the experimentalgroup were significantly lower as compared to that in the control group (p<0.001). The mean healing index score for the control group (Group A) was 3.35±0.49 and the mean healing index score for the experimental group (Group B) was 4.64±0.49 so the mean values of tissue healing index in the experimental group were significantly higher as compared to that in the control group (p<0.001). The increase in stability value over the period of three months is 5.83 ISQ in the control group while the increase in stability value over the period of three months is 7.06 ISQ in the experimental group. The difference although not statistically significantshows a slight increase in stability in the experimental group as compared to that of the control group. Conclusion Ozone water irrigation at implant site osteotomy reduced postoperative pain and accelerated the tissue wound healing but the significant effect on osseointegration could not be determined.

ANTI-BACTERIAL EFFECTIVENESS OF CHITOSAN OF PAPUYU FISH (Anabas testudineus) AGAINST BACTERIA Streptococcus mutans

Background: Streptococcus mutans is one of the main bacteria that cause dental caries by demineralized hard tissues of the teeth. People can use natural ingredients to reduce the number of Streptococcus mutans microorganisms, that is chitosan papuyu fish scales (Anabas testudineus). Purpose: The purpose is to analyze the antibacterial effectiveness of chitosan from papuyu fish scales (Anabas testudineus) against Streptococcus mutans bacteria based on the values of the MIC (Minimum Inhibitory Concentration) and MBC (Minimum Bactericidal Concentration). Methods: This is an experimental study with posttest only with a control group design using 30 samples of chitosan papuyu fish scales (Anabas testudineus) grouped into 6 treatment groups and 5 samples repetitions. The treatment groups were chitosan papuyu fish scales (Anabas testudineus) with concentrations of 25%, 50%, 75%, and 100%, 0.2% chlorhexidine as a positive control, and aquades as a negative control. Calculation of absorbance using a UV-VIS Spectrophotometer Biobase BK-D560 for MIC and Streptococcus mutans bacterial colonies were visualized with a colony counter for MBC. Results: The results of the Kruskal Wallis test for MIC and MBC of papuyu fish chitosan concentrations of 25%, 50%, 75%, and 100% obtained significant results of p=0.00, which means p&lt;0, 05 and showed a significant difference between treatments. Conclusion: There are differences in the effectiveness of MIC and MBC chitosan of papuyu fish scales (Anabas testudineus) at concentrations of 25%, 50%, 75%, 100%, chlorhexidine gluconate 0.2% (positive control), and aquadest (negative control).

The Use of Autogenous Rib Graft in Craniofacial Reconstruction: Case Series Study

Background: Hard tissue defects in the maxillofacial region due to trauma or ablative surgery result in functional and cosmetic problems. The method of choice in the treatment of facial defects is autogenous bone grafts. Objectives: To evaluate the use of rib grafts in the reconstruction of craniofacial deformities. Methods: This prospective study was presented for the reconstruction of craniofacial deformity using a rib bone graft. These cases were collected from the Maxillofacial Surgery Unit from October 2011 to November 2020. The sample consisted of 16 patients (14 males and 2 females, with a mean age of 34 years). The patients were divided according to the site of the defect. In all cases, a single rib was harvested. The fifth rib was taken. Bone graft fixation by bone plate, direct screws, and transosseous wiring. The success of the bone grafting was assessed by clinical and radiological examination. Results: The overall success rate in this study was 87.5%, while we had bone graft resorption in two cases (12.5%) of mandibular reconstruction. Only one case experienced donor site complications, a pleural tear, which successfully underwent suturing and chest tube insertion. Conclusions: Free autogenous rib was successfully used to reconstruct defects in the maxillofacial regions. It gives the best result when minimum loading is needed. Stabilization of the graft by rigid internal fixation and good adaptation to the recipient site helped to minimize complications.

DESCRIPTION OF ORAL CAVITY MICROBIAL CULTURE IN DENTAL CARIES SUFFERERS

Background: Dental caries is one of the most common oral health problems worldwide, affecting 573 million children and 2.5 billion adults. Dental caries is a disease that attacks the hard tissues of the tooth, such as cementum, dentin, and enamel. This causes bacterial invasion, pulp death, and spread of infection to periapical tissues, which can cause pain. Purpose: The purpose of this study was to determine the microbial culture picture of the oral cavity of patients with dental caries. Methods: This research is descriptive and the samples in this study amounted to 7 samples of patients with dental caries at Dr. Sitanala Hospital, Tangerang City. The sampling technique in this study used purposive sampling technique. Results: The results of this study found 1 sample (14.3%) of Candida albicans fungus in fungal culture. In addition, 9 samples (64.3%) of Staphylococcus Sp. bacteria, 3 samples (21.4%) of Klebsiella Sp. bacteria, and 2 samples (14.3%) of Bacillus Sp. bacteria were found in the bacteria culture. Conclusion: It has been proven that the oral cavity of dental caries sufferers contains various kinds of microbes, such as the fungus Candida albicans, the bacteria Staphylococcus Sp., the bacteria Klebsiella Sp., and the bacteria Bacillus Sp..

Photoacoustic Signal Propagation Modes in Bone Tissue: a Simulation Study

Abstract Photoacoustic (PA) imaging has great potential in brain imaging. However, the strong acoustic attenuation and reverberation caused by the skull bone layers present challenges for PA brain imaging. In this work, we developed a three-dimensional (3D) photoacoustic numerical simulation platform using the finite difference time domain (FDTD) method to study PA signal generation and propagation in the human brain. This platform can simulate not only the propagation of longitudinal waves in soft tissues but also shear and longitudinal waves in hard tissues. Using this numerical simulation platform, we extensively simulated the propagation of PA waves in skull models with varying porosities, The results demonstrate that our 3D PA simulation platform accurately captures the propagation details of PA signals in the skull, including the refraction, reflection, and mode conversion of photoacoustic waves at tissue boundaries. Furthermore, an increase in skull porosity prolongs the duration of the photoacoustic signals and leads to high attenuation of PA signals for high frequency components. We expect that this study will contribute to the understanding of the impact on acoustic propagation of photoacoustic signals in cranial bone photoacoustic imaging.

Evaluation of soft tissue profile changes around the nose and upper lip following maxillary anterior alveolar osteotomy with Wassmund and Wunderer technique in Japanese

PurposeThe extent to which maxillary anterior alveolar osteotomy alters the facial profile remains unclear. The present study retrospectively analyzed and evaluated changes in maxillary anterior fragments and soft tissue from the nose to upper lip from pre- to postoperatively in patients who underwent the Wassmund and Wunderer (WW) technique. MethodsThirty-seven Japanese patients with maxillary prognathism underwent orthognathic surgery with the WW technique were retrospectively included in the present study. Changes in both hard- and soft-tissue landmarks and correlations between both tissues were evaluated using lateral cephalograms taken immediately before and ≥6 months after orthognathic surgery. ResultsThe maxillary anterior segment showed predominantly posterior movement, with only slight upward movement. Posterior shift and lingual inclination of the maxillary anterior teeth were prominent. As for soft tissues, the change in the nasal tip was small and posterior change was large in the subnasal and upper lip areas. Nasolabial angle, nasal height, and inclination of nasal tip increased, while upper lip protrusion, nasal tip angle, and philtrum length decreased. Correlations were found between posterior changes in hard tissues and posterior changes in soft tissues. Among these, posterior changes and lingual inclination of the maxillary anterior teeth strongly correlate with posterior changes of the upper lip. ConclusionPosterior shift of the maxillary anterior segment using the WW technique is useful because it can greatly improve the protrusion of the upper lip while minimizing nasal morphological changes, and the positioning of the maxillary anterior teeth may be an important key factor.

In situ metabolomic analysis of osteonecrosis of the femoral head (ONFH) using MALDI MSI.

Osteonecrosis of the femoral head (ONFH) is a common orthopedic disease characterized by disability and deformity. To better understand ONFH at molecular level and to explore the possibility of early diagnosis, instead of diagnosis based on macroscopic spatial characteristics, a matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI MSI) method was developed for ONFH disease for the first time. The most challenging step for ONFH MSI is to deal with human bone tissues which are much harder than the other biological samples studied by the reported MSI studies. In this work, the MSI sectioning method of hard bone tissues was established using tender acids and a series of test criteria. Small-molecule metabolites, such as lipids and amino acids, were detected in bone sections, realizing the in situ detection of spatial distribution of biometabolites.By comparing the distribution of metabolites from different regions of normal femoral head, ONFH bone tissue (ONBT), and adjacent ONFH bone tissue (ANBT), the whole process of femoral head from normal stage to necrosis was monitored and visualized at molecular level. Moreover, this developed MSI method was used for metabolomics study of ONFH. 72 differential metabolites were identified, suggesting that disturbances in energy metabolism and lipid metabolism affected the normal life activities of osteoblasts and osteoclasts. This study provides new perspectives for future pathological studies of ONFH.

The first report of the presence of collagen X in mammalian dentinal matrix

Collagen X is an extracellular matrix protein, usually found in the hypertrophic cartilage destined to be mineralized. It is intimately associated with the mineralization process of the mammalian hard tissues, and particularly, regulating the compartmentalization of matrix components. Despite the fact that the dentine of the tooth is highly mineralized, there are no previous reports to indicate the presence of collagen X in this connective tissue. Here we report, for the first time, its presence in mammalian dentine based on micromorphological and immunohistochemical data. We hypothesize that the collagen X in dentine may in the long term arrest the progression of the mineralization front towards the soft tissue components of the pulp that are not destined to be mineralized.

Application of Reciprocity Principle in Ultrasound Bone Tomography

Abstract Full-matrix synthetic aperture imaging (FMSA) is a well-established and widely used modality for ultrasound imaging Nevertheless, the accompanying relatively large amount of data acquisition, storage, and process results in heavy costs of computation and memory, which further hinders FMSA from real-time implementation. Moreover, the most existing FMSAs employed the hypothesis uniform sound velocity to reconstruct the soft tissues, which is not suitable for hard tissue imaging, irrespective of the high acoustic impedance contrast (i.e., the difference of sound velocity) between the bone and soft tissues. To overcome these limitations, a half-matrix ultrasound bone tomography method combining the reciprocity principle and sound velocity estimation was proposed for cortical cross-section imaging. The travel-time inversion was firstly utilized for sound velocity prediction, and then half-matrix synthetic aperture (HMSA) with ray-tracing was conducted to image the cortical cross-section. An ex-vivo bovine femur was used to validate the effectiveness of the method. Compared to the full-matrix capture method, the proposed method was demonstrated to be an accurate and cost-effective modality for cortical bone tomography.

Research progress and clinical application of veneer materials for implant-fixed restoration in edentulous jaws

Commonly used materials for fixed restorations in edentulous jaws include acrylic resins, polymerized ceramics, ceramics and zirconia, which have distinct physicochemical properties and clinical application features. The selection of these materials in clinical practice is related to the prosthodontic space, oral soft and hard tissue conditions, occlusal force, lifestyle habits, oral parafunctions, opposing dentition materials, and expectations of patients. Common mechanical complications associated with fixed restorations in edentulous jaws are cracking/chipping and abrasion of the facing materials, which can be avoided through occlusal adjustment, restoration design and processing, and the selection of appropriate restorative materials. This article reviews the characteristics, selection, and design considerations of commonly used materials for fixed restorations in edentulous jaws, as well as the causes and management of common clinical complications related to restorative materials, aiming to provide references for the selection of appropriate materials in fixed restorations for edentulous jaws in clinical practice.

Comparative evaluation of clinical efficacy and volumetric changes in pulpectomized primary molars using hand K-file, ProTaper rotary file, and Kedo-SG blue file: an in-vitro cone beam computed tomography analysis.

The accomplishment of a successful pulpectomy depends on multiple factors that involve targeted removal of the causative irritants and soft and hard tissue debris by mechanical and chemical means. Compare and evaluate the efficacy of canal preparation and volumetric filling using conventional files and two rotary file systems using cone beam computed tomography (CBCT). Thirty freshly extracted human primary second molars were randomly divided into three groups of 10 teeth each. After access opening and working length determination, pre-operative volume analysis was done using CBCT. The canals were then instrumented by either hand K-files, ProTaper rotary files or Kedo-SG Blue rotary files. Post-operative volume analysis was performed using CBCT. All the canals were obturated using Metapex and scanned again using CBCT. Mean values of the pre- and post-operative canal volumes were analyzed using one-way Analysis of Variance (ANOVA). Inter- and intra-group volumetric changes were analyzed statistically using a post hoc test. The mean difference in volume after canal preparation and obturation was the highest in the Kedo-SG Blue group, followed by the ProTaper group and the least in the hand K group (p = 0.001). Inter-group comparison showed statistically significant differences between the hand K group and ProTaper group (p = 0.001), the ProTaper group and Kedo-SG Blue group (p = 0.001), and the hand-K group and Kedo-SG Blue group (p = 0.02). The volume of preparation and obturation was the highest using Kedo-SG Blue, followed by the ProTaper file systems.