Rotary Root Canal Instrumentation Research Articles

Adoption of rotary instrumentation among general practitioners in Qassim region, Saudi Arabia: A cross-sectional survey

Abstract Introduction: In contemporary dentistry, nickel–titanium (NiTi) rotary instrumentation is the standard of care. General dental practitioners (GDPs) should acquire and adopt rotary root canal instrumentation in their practices. Therefore, this study aimed to investigate the application of rotary root canal instrumentation among GDPs in the Qassim region of Saudi Arabia. Materials and Methods: This cross-sectional survey was conducted in the Qassim region of Saudi Arabia. An online survey was sent to GDPs registered in the Qassim region through the Saudi Dental Society contact list. It consisted of 15 questions about gender, demographics, sector, and the extent of rotary root canal instrumentation adoption in their daily practices. The Chi-square test was used to compare the frequency responses between the groups. Fisher’s exact test was used when the expected outcome was <5. Results: Of the 153 GDPs contacted, 81 completed the online survey. Of the 81 participants, 71.6% performed root canal treatment in their daily practice, whereas only 51.9% reported using NiTi rotary instrumentation. NiTi rotary instrumentation was adopted significantly more frequently by GDPs who graduated from non-Saudi schools, worked in the private sector, and had more than 10 years of experience. The lack of required equipment was the most commonly reported reason for not adopting NiTi rotary instrumentation. Most participants were interested in receiving training in NiTi rotary instrumentation. Conclusion: Almost half of the GDPs in the Qassim region did not use rotary files in their practices. Lack of undergraduate training and unavailability of equipment were the most commonly reported factors for not adopting rotary instrumentation. There was a significant interest in receiving additional training on NiTi rotary instrumentation.

Implementing rotary root canal instrumentation in the clinical training of undergraduate students from Saudi Dental Schools: A cross-sectional survey

Implementing rotary root canal instrumentation in the clinical training of undergraduate students from Saudi Dental Schools: A cross-sectional survey

Teaching rotary root canal instrumentation using a Peyton teaching approach.

The aim of the study was two evaluate the effectiveness of a Peyton teaching approach for rotary root canal instrumentation, in comparison to the traditional "see one-do one" method. Forty undergraduate students were randomly divided into two groups (n=20). Students of the first group (G1) were taught how to use rotary instrumentation using a modified Peyton method, whilst the second group (G2) watched a teaching video (30 min) on the same subject. Both groups instrumented a plastic block and subsequently both mesial canals of an extracted lower molar. The quality of the root canal instrumentation was analysed by 2 blinded observers on video recordings and x-rays. Interobserver correlation was 0.917 (p < .0005; Pearson) for the assessment of the video recordings; students of G1 received significantly more total points (83.55 ± 6.82 points) compared to G2 (69.76 ± 13.82) (p=.001; t-test), the gender had no significant effect on the overall results (p=.444; two-way ANOVA). Significant differences were detected for the categories "initial scouting," "coronal enlargement," "glide path preparation," "preparation using X2 file," "preparation using X3 file" (p < .05; t-test) as well as for the subcategories "sequence of rinse, recapitulation, rinse" (p=.001; t-test) and "recapitulation" (p < .002; t-test). No differences between groups were observed for the radiographic evaluation with respect to working length and canal straightening. Teaching rotary instrumentation by using the Peyton approach resulted in improved performance of undergraduate students assessed with a checklist-based process analysis. Enhanced implementation of rotary instrumentation could result in better long-term results of students' root canal treatment.

Effect of Rotational Modes on Torque/Force Generation and Canal Centering Ability during Rotary Root Canal Instrumentation with Differently Heat-Treated Nickel-Titanium Instruments.

This study aimed to evaluate how various rotational modes influence the torque/force production and shaping ability of ProTaper Universal (PTU; non-heat-treated) and ProTaper Gold (PTG; heat-treated) nickel–titanium instruments. J-shaped resin canals were instrumented with PTU or PTG using an automated instrumentation device operated with reciprocating rotation [150° clockwise and 30° counterclockwise (R150/30) or 240° clockwise and 120° counterclockwise (R240/120)], optimum torque reverse motion (OTR), or continuous rotation (CR) (n = 10 each). Maximum force and torque were recorded, and canal centering ratios were calculated. Statistical analysis was performed with two-way ANOVA and a Bonferroni test (α = 0.05). The results were considered with reference to previous studies on the microstructure of the instruments. The upward force generated by R240/120 and OTR was smaller than that generated by R150/30 and CR in PTG (p < 0.05). The clockwise torque produced by OTR was lower than that produced by R150/30 in PTU and R240/120 and CR in PTG (p < 0.05). R240/120 and OTR induced less canal deviation compared to CR in PTU at 0 mm from the apex (p < 0.05). In conclusion, R240/120 and OTR reduced the screw-in force in PTG and improved the canal centering ability in PTU, which may be associated with the heat treatment-induced microstructural difference of the two instruments.

Introduction of nickel titanium rotary instruments to undergraduate students

Many studies address the quality of root canal treatments, but few refer to endodontics using rotatory techniques performed by novice operators. This study evaluated the performance of undergraduates in their first contact with rotary root canal instrumentation concerning the findings of the final periapical radiograph, and the post endodontic treatment pain. A longitudinal observational study was performed on periapical radiographs of 491 teeth from 450 patients submitted to root canal treatment by undergraduate students from 2015 to 2018. The analysis of the length of root canal filling followed the criteria: (i) acceptable, if periapical radiograph presents root filling ending 0 - 1 mm short of radiographic apex; (ii) over, if periapical radiograph presents root filling ending beyond the radiographic apex; and (iii) under, if periapical radiograph presents root filling ending &gt; 1 mm short of radiographic apex. Evaluation of postendodontic treatment pain was categorized into either absence or presence of pain. Adequate length root canal filling was observed in 65.9% of the cases (324 teeth). Periapical lesions presence and dimensions did not interfere to the obturation quality. Statistical relation was found between the pulp condition and postendodontic treatment pain. The presence of pain was observed in 4.7% of the vital teeth and 0.3% of non-vital teeth. The presence of periapical lesion did not influence postoperative pain. Adequate length root canal filling was observed in most cases and NitTi rotary instrumentation had applicability in undergraduate programs, even with novice operators. Besides that, pulp condition had an effect on postendodontic pain.

Root canal cleaning and shaping

Root canal treatment is a frequently performed dental procedure and is carried out on teeth in which irreversible pulpitis has led to necrosis of the dental pulp. The speciality of endodontics encompasses numerous elements, but the use of a variety of instruments to shape root canal systems probably challenges the clinical time of practitioners more than any other. Removal of the necrotic tissue remnants and cleaning and shaping of the root canal are important phases of root canal treatment. Treatment options include the use of hand and rotary instruments and methods using ultrasonic or sonic equipment. Rotary root canal instruments manufactured from nickel-titanium alloy have proved to be a valuable adjunct for root canal therapy. But in certain cases such as in the presence of curved root canals hand filing becomes necessary. This article aims to explore various methods and instruments used in cleaning and shaping of Root canal system.

Influence of rotational speed on torque/force generation and shaping ability during root canal instrumentation of extracted teeth with continuous rotation and optimum torque reverse motion.

To evaluate how different rotational speeds affect the torque/force generation and shaping ability of rotary root canal instrumentation using JIZAI (MANI, Utsunomiya, Japan) nickel-titanium instruments in continuous rotation and optimum torque reverse (OTR) motion. Mesial root canals of extracted mandibular molars were instrumented up to size 25, 0.04 taper using JIZAI instruments, and anatomically matched canals were selected based on geometric features of the canal [canal volume (mm3 ), surface area (mm2 ), length, 15°-20° curvature and radius of curvature (4-8mm)] after micro-computed tomographic scanning. An automated root canal instrumentation and torque/force analysing device was programmed to permit a simulated pecking motion (2s downward and 1s upward at 50mmmin-1 ). The selected canals were prepared with size 25, 0.06 taper JIZAI instruments using continuous rotation or OTR motion and further subdivided according to the rotational speed (300 or 500rpm, n=10 each). Real-time clockwise/counterclockwise torque and downward/upward force were recorded using a custom-made torque/force analysing device. Then, the registered pre- and post-operative micro-computed tomographic datasets were examined to evaluate the canal volume changes and centring ratios at 1, 3, 5 and 7mm from the apical foramen. Data were analysed using two-way analysis of variance or the Kruskal-Wallis test and Mann-Whitney U test with Bonferroni correction (α=5%). Maximum upward force and clockwise torque were significantly smaller in 500rpm groups than in 300rpm groups (P<.05); however, no significant difference was found between continuous rotation and OTR motion (P>.05). OTR motion developed higher maximum counterclockwise torque than continuous rotation (P<.05). Maximum downward force, canal volume changes and centring ratios were not significantly different among all groups (P>.05). There was no file fracture in any of the groups. Under laboratory conditions using JIZAI instruments, a rotational speed of 500rpm generated significantly lower maximum screw-in forces and torque values than rotational speed of 300rpm. Continuous rotation and OTR motion performed similarly in shaping the canals.

Analysis of Torque and Force Induced by Rotary Nickel-Titanium Instruments during Root Canal Preparation: A Systematic Review

The aim of this review was to provide a detailed literature analysis of torque and force generation during nickel-titanium rotary root canal instrumentation. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search was performed using in PubMed and in journals for articles published in English from 1987 to June 2020 on studies that investigated dynamic torque and force in vivo or in vitro. We assessed article titles and abstracts to remove duplicates, and the titles and abstracts of the remaining articles were screened for eligibility. Full texts were read to verify eligibility by considering predetermined inclusion and exclusion criteria. Fifty-two out of 4096 studies met the inclusion criteria, from which we identified 26 factors that influence torque or force generation. Factors associated with higher torque or force generation and supported by multiple studies with mostly consistent results included convex triangle cross-sectional design, regressive taper, short pitch length, large instrument size, small canal size, single-length preparation technique, long preparation time, deep insertion depth, low rate of insertion, continuous rotation (torque), reciprocating motion (force), lower rotational speed and conventional alloy. However, several factors are interrelated, which obscured the independent effect of each factor, and there was insufficient scientific evidence supporting the influence of some factors.

Shaping Ability and Debris Extrusion of New Rotary Nickel-Titanium Root Canal Instruments.

The aim was to evaluate the canal straightening and the amount of apically extruded debris associated with five rotary nickel-titanium when preparing curved root canals. A total of 100 root canals in extracted human teeth (angles of curvatures 20°–30°; radii 5.9–13.5 mm) were divided into five groups (n = 20/group). The groups were balanced with respect to the angle and the radius of canal curvature. The root canals were prepared using conventional austenite 55-NiTi alloy instruments F360, F6 SkyTaper (both Komet, Lemgo, Germany), and the heat-treated NiTi Jizai, Silk-Complex and Silk-Standard instruments (all Mani, Tochigi, Japan) to an apical size 25. The amount of extruded debris was assessed with a micro balance. Statistical analysis was performed using Kruskal–Wallis test with Bonferroni correction at a significance level of p < 0.05. During canal preparation, neither instrument fractures nor procedural preparation errors were noticed. Regarding canal straightening, the use of Jizai instruments resulted in the significantly lowest straightening (p < 0.05), while no significant differences were obtained between all other groups (p > 0.05). Regarding the amount of apically extruded debris, no significant differences between all groups were obtained (p > 0.05). Within the limitations of this study, all instruments performed well, and especially the Jizai instruments showed an excellent shaping ability.

Clinical differences of hand and rotary instrumentations during biomechanical preparation in primary teeth-A systematic review and meta-analysis.

The hand and rotary instruments are used for cleaning and shaping of root canals during biomechanical preparation in primary teeth. To determine clinical differences of hand versus rotary root canal instrumentation in primary teeth. Comprehensive searches were made in four electronic databases [MEDLINE (via PubMed), EMBASE, Google Scholar, and The Cochrane Central Register of Controlled Trials] till March 2020, and prospective studies that met the inclusion criteria were included. The primary outcome was instrumentation time, whereas the secondary outcomes were quality of obturation, obturation time, and clinical and radiographic success. From 604 screened studies, eleven studies qualified for meta-analysis. The random-effect model and generic inverse variance approach were used for meta-analysis. There was significant decrease in instrumentation time [MD-5.00minutes (95% CI: 3.05-6.94), P<.00001, moderate evidence quality] and obturation time [MD-0.43minutes (95% CI: 0.15-0.71), P=.003, low evidence quality] with rotary instrumentation. Optimal quality of obturation was achieved in significantly more number of teeth [risk ratio (RR)=0.71(95% CI: 0.53-0.95),P=.02, moderate to high evidence quality] with rotary instrumentation. Similar clinical and radiographic success was observed in hand and rotary instrumentation techniques. Significant reduction in instrumentation time of five minutes was observed using rotary instrumentation with moderate quality evidence.

A Letter Regarding Recently Published Systematic Review Comparing the Effectiveness of Manual and Rotary Root Canal Instrumentation in Primary Teeth.

How to cite this article: Rahul M, Tewari N, Gowthaman K. A Letter Regarding Recently Published Systematic Review Comparing the Effectiveness of Manual and Rotary Root Canal Instrumentation in Primary Teeth. Int J Clin Pediatr Dent 2020;13(3):310.

Performance Evaluation on Rotary Preparation of Root Canal by Beginner Operators.

This study aims to analyze the performance of rotary root canal preparation, conducted by beginner operators (students). After acquiring the necessary skills involved in applying endodontic preparation techniques on extracted teeth, all students from a cohort learned to use ProTaper Universal files (Dentsply Maillefer). The preclinical training had several stages. Experience 1: instrumentation on extracted single-root teeth; Experience 2: instrumentation on EndoTraining blocks (Dentsply Maillefer); Experience 3: instrumentation on EndoTraining blocks (Dia Dent Group International); Experience 4: Instrumentation on extracted multiradicular teeth. Preparation was done according to the manufacturer’s instructions, the initial file is Sx, followed by S1, S2, F1, F2 and the last file is F3. A batch of 50 teeth (E1, E2, E3, E4) was randomly selected to evaluate the onset of the rotary preparation of young operators. Two independent evaluators analyzed the array radiologically by stereomicroscope evaluation (E1, E4) and photo-analysis of the resulting Endo Training blocks (E2, E3). The success rate was 80% for E1, 72% for E2, 64% for E3 and 76% for E4 (p<0.05). The following were considered a failure: ledge formation and apical transportation in 10.66%, over instrumentation in 6.66%, zipping in 3.33%, and instrument fracture in 4% of cases.Endodontic instrumentation techniques require training to acquire the necessary skills. Rotary root canal instrumentation techniques used almost exclusively in modern endodontics require adequate preclinical training.

Efficacy of Two Nickel-Titanium Rotary Root Canal Instruments compared with Different Instruments in Endodontic Treatment: A Systematic Review

The success of endodontic treatment depends on root canal preparation which is extremely important during the root canal treatment. The root canal instrumentation phase by using nickel-titanium instruments will help in the effectiveness of other procedures, such as facilitating irrigation and aspiration and three-dimensional obturation of canals. The objective of this review reviews all the data in regards to the efficiency of two nickel-titanium rotary instruments which are pro-taper next files and pro-taper universal files compared with different instruments in endodontics and which conducts are most used and appropriate for optimal root canal instrumentation. For such, we carried out a systematic review of the literature, using all the databases included in PubMed and Google Scholar. The search retrieved 401 articles, of which, after applying the exclusion/inclusion and quality criteria, 12 articles were selected for an in-depth analysis. Among the main results, we highlight two nickel-titanium rotary instruments that were used to aid the cleaning and shaping in root canal treatment, in addition to presenting several aspects such as different types of instrument systems, the efficiency of instruments during cleaning and shaping, and updating studies of their effect in the root canal treatment and re-treatment. This review concluded the rotary instrumentations especially pro-taper next files and pro-taper universal files illustrated great cleaning efficiency during root canal treatment and root canal re-treatment compared with hand stainless steel files and different instruments.

Volumetric analysis of hand and rotary root canal instrumentation using different obturation techniques: An in vitro spiral computed tomography study

Aim: The aim of this study is to volumetrically analyze the root canal volume after instrumentation with hand and rotary files and to evaluate and compare the volume percentage of root canals obturated (POV) with gutta-percha (GP), with various techniques using spiral computed tomography (SCT). Materials and Methods: Sixty sound, noncarious, single-rooted extracted human teeth were sectioned at the cementoenamel junction. The specimens were divided into five groups based on the type of canal instrumentation and obturation technique used. Specimens were prepared with Hand Files and ProTaper Next and HyFlex CM rotary Files. The volume of root canal space was measured using SCT, and root canals were obturated (cold lateral condensation, cold flowable “GuttaFlow 2,” and single cone). A second SCT scan was performed to determine the POV of GP at coronal, middle, and apical third. The data were subjected to statistical analysis using one-way ANOVA and Tukey's post hoc multiple comparison tests. Results: There was a highly significant difference in percentage of obturated volume between the groups at coronal, middle, and apical third, and also, there was a highly significant difference in the total percentage of obturated volume of canal between the groups. Conclusion: No obturation technique produced void-free root canal fillings and the greatest POV was obtained with lateral condensation followed by single cone and least with cold flowable obturation technique. Lateral condensation and single-cone technique showed 100% POV in the apical third region and GuttaFlow 2 had the maximum voids.

Evaluation of Apical Extent of Root Canal Instrumented Manually Using FlxoFile and Rotary Using ProTaper by the Aid of Dental Operating Microscope (An In Vitro Study)

Purpose: This study was designed to evaluate the influence of different apical limits of working lengths, electronic and radiographic methods of working length determination, maual and rotary root canal instrumentation on the apical extent of root canal filling material. Materials and Methods: Forty five roots of maxillary central incisors with mature apices were selected and divided into two groups: Group I ( 30 roots), and Group II (15 roots) according to the method of working length determination (electronic or radiographic respectively). Each main group was divided into three equal groups according to the apical limit of working Each group at main group (I) were subdivided into two equal subgroups: 1 and 2 (5 each) according to instrumentation system; rotary proTaper system or Flex-o-file while all roots at group (II) were cleaned & shaped with Flex-o-file. Each canal was obturated. The roots were longitudinally splitting .Under a surgical microscope, the integrity of apical constriction was observed and photographed. The distance between the apical terminus of the root canal filling and the apical foramen were measured and photographed by stereomicroscope. Results: ANOVA test revealed significant difference on the distance between the apical terminus of the root canal filling and the apical foramen were preserved at the three apical limits when working length and rotary canal preparation were carried by Tri Auto ZX headpiece, and when root canal were prepared by Flex-O-file after radiographic working length determination. Under different variables of this study, the integrity of apical constriction showed no significant difference. Conclusion: Electronic working length determination method is more accurate than radiographic method. Tri Auto ZX apex locating headpiece is a reliable method for electronic working length determination, and rotary root canal preparation.

First Experience of Rotary Nickel Titanium Root Canal Instrumentation Performed by Undergraduate Students and General Dentists

First Experience of Rotary Nickel Titanium Root Canal Instrumentation Performed by Undergraduate Students and General Dentists

Dynamic Torque and Vertical Force Analysis during Nickel-titanium Rotary Root Canal Preparation with Different Modes of Reciprocal Rotation

IntroductionThe purpose of the present study was to compare 2 modes of reciprocal movement (torque-sensitive and time-dependent reciprocal rotation) with continuous rotation in terms of torque and apical force generation during nickel-titanium rotary root canal instrumentation. MethodsA custom-made automated root canal instrumentation and torque/force analyzing device was used to prepare simulated canals in resin blocks and monitor the torque and apical force generated in the blocks during preparation. Experimental groups (n = 7, each) consisted of (1) torque-sensitive reciprocal rotation with torque-sensitive vertical movement (group TqR), (2) time-dependent reciprocal rotation with time-dependent vertical movement (group TmR), and (3) continuous rotation with time-dependent vertical movement (group CR). The canals were instrumented with TF Adaptive SM1 and SM2 rotary files (SybronEndo, Orange, CA), and the torque and apical force were measured during instrumentation with SM2. The mean and maximum torque and apical force values were statistically analyzed using 1-way analysis of variance and the Tukey test (α = 0.05). ResultsThe recordings showed intermittent increases of upward apical force and clockwise torque, indicating the generation and release of screw-in forces. The maximum upward apical force values in group TmR were significantly smaller than those in group CR (P < .05). The maximum torque values in clockwise and counterclockwise directions in groups TqR and TmR were significantly smaller than those in group CR (P < .05). ConclusionsUnder the present experimental conditions using TF Adaptive instruments, both torque-sensitive and time-dependent reciprocal rotation generated significantly lower maximum torque and may have advantages in reducing stress generation caused by screw-in forces when compared with continuous rotation.

Assessment of Torque and Vertical Force Generated by Torque-sensitive and Time-dependent Reciprocal Movements of Nickel-titanium Rotary Root Canal Instruments

Assessment of Torque and Vertical Force Generated by Torque-sensitive and Time-dependent Reciprocal Movements of Nickel-titanium Rotary Root Canal Instruments

'Volumetric analysis of hand and rotary root canal instrumentation and filling in primary teeth using Spiral Computed Tomography' - an invitro study.

To compare and evaluate the volumetric analysis of pre- and post-root canal instrumentation in primary teeth using hand and rotary files and also to analyse the volume of root canal filling. A total of 20 primary teeth were divided into two groups randomly and subjected to spiral computed tomography (SCT) analysis before and after instrumentation. For manual technique (Group 1), teeth were prepared using K files and rotary (Group 2) preparation was performed with Mtwo files. Volumetric enlargement was calculated using Osirix software. Root canals were then filled with rotary lentulospiral using zinc oxide-eugenol cement (ZOE). The filled volume in each canal was measured using SCT and the percentage of obturated volume was calculated. The data were statistically analysed using paired t-tests. There was a statistically significant difference in the volume of root canal enlarged in both the groups. Rotary files showed significant increase in the volume compared to K files. Mtwo instrumented root canals showed good obturated volume compared to manual technique, although voids were common in both the groups. Rotary root canal instrumentation may be indicated for utilization in primary teeth, for enhancing root canal preparation and good quality of root canal filling.

Effect of EDTA Preparations on Rotary Root Canal Instrumentation

IntroductionThe aim of this study was to evaluate whether rotary instrumentation using saline, EDTA 17% solution, or RC-Prep (Premier Dental, Philadelphia, PA) resulted in differences in root canal transportation. The secondary objective was to assess if instrumentation using these agents caused changes in the working length and canal volume. MethodsModerately curved mesiobuccal roots of 24 maxillary molars were standardized in length and randomized into 1 control and 2 experimental groups. The canals were instrumented with 0.04 taper rotary files to size #30. All groups were irrigated with saline. Group 1 was also irrigated using EDTA 17% solution (Pulpdent Corp, Watertown, MA), and in group 2, RC-Prep was used. X-ray micro–computed tomographic scans and working length measurements were made before and after instrumentation. Three-dimensional models were created from the pre- and postinstrumentation scan data and compared for volume changes. Centroid points were calculated in cross-sectional slices of the canals, and transportation was determined by measuring the distance between the pre- and postinstrumentation points. The data were analyzed with 1-way analysis of variance (α = 0.05) and the Tukey post hoc test. ResultsLess transportation was observed in group 2 than in group 1 (P = .001) and the control group (P = .014). Transportation in group 1 and the control group was not significantly different. Canal volume in group 1 was increased relative to group 2 (P = .004) and the control group (P = .022). No significant differences in the working length were observed. ConclusionsThe use of chelating agents during root canal instrumentation did not significantly increase apical transportation.