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Background/purpose: Recently introduced calcium silicate-based bioceramic (CSBC) sealers require moisture for setting, thus this study aimed to compare the setting times of epoxy resin-and CSBC sealers under different test conditions. Materials and methods: Four CSBC sealers (CeraSeal, EndoSeal TCS, One-Fil, and Well-Root ST) were compared to an epoxy resin-based sealer (AH Plus). Each sealer was placed in a stainless-steel and gypsum molds on a glass slide. Sealer samples (n = 10 per group) were stored in an incubator at 95% humidity and 37 °C. A Gilmore needle with a total weight of 100 g and a 2.0-mm diameter were carefully placed vertically against the sealer, and the setting time was recorded when the needle no longer formed an indentation on the sealer surface. Statistical analysis was performed using two-way analysis of variance and Tukey parametric tests. The level of significance was set at 95%. Results: The setting time of all sealers in gypsum molds was significantly shorter than that in stainless-steel molds (P

This study aimed to compare the fatigue resistance of files made from different heat treatment methods and surface treatment. Four prototype files were created through heat treatment and titanium coating surface treatment (AT, DT, ER, EN; named arbitrarily by the manufacturer) at different times and temperatures. Artificial canals with curvatures of 45- and 90-degree were used for the fatigue testing. The files were operated at the speed of 500 rpm at 37 °C, and the time until fracture incurred by a 4-mm dynamic pecking motion at a speed of 8 mm/s was measured, and the number of cycles to failure (NCF) was calculated by applying rotation speed and time. The length of the fractured fragment was measured. The fractured specimens were observed under the SEM to compare the characteristics of fatigue fracture patterns. Differential scanning calorimetry analysis was performed to estimate the phase transformation temperature. One-way ANOVA with Duncan’s post-hoc comparison, the Kruskal–Wallis test, and Mann–Whitney U were applied to compare the fatigue resistance among the prototypes at a significance level of 95%. Regardless of the canal angle, the EN showed the highest fatigue resistance (p < 0.05). AT had the lowest NCF at the 90-degree canal (p < 0.05). ER had a higher NCF than the DT at 45 degrees (p < 0.05), but there was no difference at 90 degrees. DSC analysis revealed that the ER and EN groups exhibited two austenite peaks above 40 °C. In conclusion, the file that underwent a specific temperature heat treatment with titanium coating surface treatment showed the highest fatigue resistance.

Knowledge and thorough understanding of the characteristics of endodontic nickel–titanium (NiTi) files is paramount for dentists performing root canal treatments to patients. Understanding the behavior of the NiTi files guides the clinicians in choosing the correct instruments for different clinical and anatomical situations. This review focuses on the metallurgical properties of endodontic NiTi files, with a special emphasis on recent developments and improvements in metallurgy and the effects of heat treatment and surface treatment. In this study, the impact that such developments have on the properties of endodontic NiTi files is discussed.

As the use of nickel-titanium (NiTi) file systems for root canal therapy has become popular; hence, knowledge and understanding of the characteristics of NiTi files is essential for dentists. Unintended sudden fracture can occur during root canal shaping, and it is important to understand the conditions that may cause instrument fractures. Torque is defined as the force required to rotate the NiTi file and can be considered of as a parameter for the stress generated. The endodontic engine maintains a constant rotational speed by adjusting torque regardless of the root canal conditions. The process of root canal shaping by rotary instruments is a series of actions that requires torque and generates stress to both the teeth and the NiTi instruments. The generated stress may induce the strain accumulation on NiTi instrument and the canal wall and lead to the development of microcrack in the instrument and dentinal wall. Therefore, understanding of torque and stress generated is important to prevent the fractures to the instrument and the teeth. This stress has been measured using various experimental approaches, including microcrack observation by using a microscope or computed tomography, attaching strain gauges to the teeth, and finite element analysis. This review focuses on the stress generated to the teeth and the instrument during instrumentation under various experimental conditions. The factors related to torque generation are also discussed.

Background/purpose: This study evaluated the torsional resistances of nickel-titanium rotary instruments by two methods: i) dynamic resistance: repetitive torsional loading (RTL) and ii) static resistance: single torsional loading (STL) based on the International Organization for Standardization. Materials and methods: In RTL method, a pre-set rotational loading (0.5 N cm) was applied after fixing the 3-mm tip of the file, and this clockwise loading to the pre-set torque and counter-clockwise unloading to original position was repeated at 50 rpm until the file fractured. The number of repetition cycles until fracture was counted. In STL method, the torsional strength was determined by continuous clockwise rotation (2 rpm) until fracture. Results from both methods were compared after testing the torsional resistances of four instrument systems (n = 15): Hyflex CM, HyFlex EDM, V-Taper2, and V-Taper2H. A scanning electron microscope (SEM) was used to examine the topographic features of the fractured surfaces and longitudinal aspects (n = 5) from both methods. Results: The RTL and STL methods had similar results: V-Taper2 had the highest resistance and the Hyflex CM had the lowest (P

This study compared the torsional resistance of heat-treated nickel-titanium (NiTi) instruments under different temperature conditions. Four thermomechanically treated single-use NiTi rotary instruments were selected for this study: OneShape (OS), OneCurve (OC), WaveOne Gold (WOG) and HyFlex EDM (HFE). Each instrument was further subdivided by temperature into 2 subgroups. Maximum torque and the distortion angle until fracture occurred were evaluated. Differential scanning calorimetry analysis was performed to measure the phase transformation temperature. Statistical analysis was performed using a two-way ANOVA and t-test (p < 0.05). Fractured fragments were observed using scanning electron microscopy (SEM). The two-way ANOVA showed no significant differences for different temperature conditions. At both room (RT) and body temperature (BT), OS was predominantly austenite while HFE was martensite. OC and WOG were predominantly martensite at RT and mixed phase at BT. At BT, more than half of WOG was martensite, while half of OC was austenite. SEM examination showed no topographical differences between instruments in different temperature groups. In relation to a limitation of this study, there was no difference in torsional resistance of NiTi rotary instruments between the BT and RT conditions. This implies that clinicians do not need to consider a decrease of torsional resistance of heat-treated NiTi instruments at BT.

Background/purpose: Geometric design dictates the mechanical performance of nickel–titanium rotary instruments. Using finite element (FE) analysis, this study evaluated the effects of an off-centered cross-sectional design on the stiffness and stress distribution of nickel–titanium rotary instruments. Materials and methods: We constructed three-dimensional FE models, using ProTaper-NEXT type design (PTN) as well as three other virtual instruments with varied cross-sectional aspect ratios but all with the same cross-sectional area. The cross-sectional aspect ratio of the PTN was 0.75, while others were assigned to have ratios of 1.0 (square), 1.5 (rectangle), and 2.215 (centered-rectangle). The PTN center of the cross-section was ‘k’, while others were designed to have 0.9992k, 0.7k, and 0 for the square, rectangle, and centered-rectangle models, respectively. To compare the stiffness of the four FE models, we numerically analyzed their mechanical response under bending and torque. Results: Under the bending condition, the square model was found to be the stiffest, followed by the PTN, rectangle, and then the centered-rectangle model. Under the torsion, the square model had the smallest distortion angle, while the rectangular model had the highest distortion angle. Conclusion: Under the limitation of this study, the PTN type off-centered cross-sectional design appeared the most optimal configuration among the tested designs for high bending stiffness with cutting efficiency while rotational stiffness remained similar with the other designs.

Objectives The aim of this study was to compare the mechanical properties of various nickel-titanium (NiTi) files with similar tapers and cross-sectional areas depending on whether they were surface-treated. Materials and Methods Three NiTi file systems with a similar convex triangular cross-section and the same ISO #25 tip size were selected for this study: G6 (G6), ProTaper Universal (PTU), and Dia-PT (DPT). To test torsional resistance, 5 mm of the straightened file's tip was fixed between polycarbonate blocks (n = 15/group) and continuous clockwise rotation until fracture was conducted using a customized device. To evaluate cyclic fatigue resistance, files were rotated in an artificial curved canal until fracture in a dynamic mode (n = 15/group). The torsional data were analyzed using 1-way analysis of variance and the Tukey post-hoc comparison test, while the cyclic fatigue data were analyzed using the Mann-Whitney U test at a significance level of 95%. Results PTU showed significantly greater toughness, followed by DPT and G6 (p < 0.05). G6 showed the lowest resistance in ultimate torsional strength, while it showed a higher fracture angle than the other files (p < 0.05). In the cyclic fatigue test, DPT showed a significantly higher number of cycles to failure than PTU or G6 (p < 0.05). Conclusions Within the limitations of this study, it can be concluded that the torsional resistance of NiTi files was affected by the cross-sectional area, while the cyclic fatigue resistance of NiTi files was influenced by the surface treatment.

Objectives The purpose of this study was to compare the maximum screw-in forces generated during the movement of various Nickel-Titanium (NiTi) file systems. Materials and Methods Forty simulated canals in resin blocks were randomly divided into 4 groups for the following instruments: Mtwo size 25/0.07 (MTW, VDW GmbH), Reciproc R25 (RPR, VDW GmbH), ProTaper Universal F2 (PTU, Dentsply Maillefer), and ProTaper Next X2 (PTN, Dentsply Maillefer, n = 10). All the artificial canals were prepared to obtain a standardized lumen by using ProTaper Universal F1. Screw-in forces were measured using a custom-made experimental device (AEndoS-k, DMJ system) during instrumentation with each NiTi file system using the designated movement. The rotation speed was set at 350 rpm with an automatic 4 mm pecking motion at a speed of 1 mm/sec. The pecking depth was increased by 1 mm for each pecking motion until the file reach the working length. Forces were recorded during file movement, and the maximum force was extracted from the data. Maximum screw-in forces were analyzed by one-way ANOVA and Tukey's post hoc comparison at a significance level of 95%. Results Reciproc and ProTaper Universal files generated the highest maximum screw-in forces among all the instruments while M-two and ProTaper Next showed the lowest (p < 0.05). Conclusions Geometrical differences rather than shaping motion and alloys may affect the screw-in force during canal instrumentation. To reduce screw-in forces, the use of NiTi files with smaller cross-sectional area for higher flexibility is recommended.

Nickel-titanium (NiTi) endodontic rotary instruments are used extensively in root canal procedures by both general dentists and specialists. However, their vulnerability to fracture is the major reason for clinicians’ concern regarding their use. The objective of this study was to investigate the potential effects of spring machining of the file shaft on the fatigue and torsional resistances of NiTi rotary instruments. Three types of NiTi rotary systems with (S) and without (NS) spring machining were used in this study (n = 15 each): a spring file (SPR; #25/.06, SPR-S, SPR-NS), a ProTaper Next X2 (PTN; #25/variable taper, PTN-S, PTN-NS), and a ProTaper Gold F2 (PTG; #25/variable taper, PTG-S, PTG-NS). Spring machining was adjusted on the 6 mm of each file system’s shaft via a laser cutting process. The number of rotation cycles until fracture (i.e., cyclic fatigue resistance), ultimate torsional strength, the distortion angle, and the toughness of each subgroup were estimated with specially designed devices. The results were analyzed using a paired t-test at a significance level of 95%. NiTi rotary instruments with spring machining exhibited a higher cyclic fatigue resistance than instruments without spring machining. The groups with spring machining exhibited a higher toughness and larger distortion angle than the groups without it (p < 0.05). In conclusion, spring machining on the shank of NiTi instruments may provide a stress-bearing area and attenuate the torsional and cyclic fatigue of NiTi rotary instruments.

Objectives This study aimed to compare two nickel-titanium systems (rotary vs. reciprocating) for their acceptance by undergraduate students who experienced nickel-titanium (NiTi) instruments for the first time. Materials and Methods Eighty-one sophomore dental students were first taught on manual root canal preparation with stainless-steel files. After that, they were instructed on the use of ProTaper Universal system (PTU, Dentsply Maillefer), then the WaveOne (WO, Dentsply Maillefer). They practiced with each system on 2 extracted molars, before using those files to shape the buccal or mesial canals of additional first molars. A questionnaire was completed after using each file system, seeking students' perception about 'Ease of use', 'Flexibility', 'Cutting-efficiency', 'Screwing-effect', 'Feeling-safety', and 'Instrumentation-time' of the NiTi files, relative to stainless-steel instrumentation, on a 5-point Likert-type scale. They were also requested to indicate their preference between the two systems. Data was compared between groups using t-test, and with Chi-square test for correlation of each perception value with the preferred choice (p = 0.05). Results Among the 81 students, 55 indicated their preferred file system as WO and 22 as PTU. All scores were greater than 4 (better) for both systems, compared with stainless-steel files, except for 'Screwing-effect' for PTU. The scores for WO in the categories of 'Flexibility', 'Screwing-effect', and 'Feeling-safety' were significantly higher scores than those of PTU. A significant association between the 'Screwing-effect' and students' preference for WO was observed. Conclusions Novice operators preferred nickel-titanium instruments to stainless-steel, and majority of them opted for reciprocating file instead of continuous rotating system.

Background/purpose: Glide-path preparation is an important step during initial endodontic procedure to reduce shaping-instrument fracture. The aim of this study was to evaluate the amount of apically extruded debris produced by glide-path preparation instruments with different geometric designs. Materials and methods: Forty teeth extracted for periodontal reasons were randomly divided into four groups (n = 10). The working length was standardized at 17 mm from the apical foramen by a flattening reference point. The glide-path was created using repetitive up-and-down movement three times with one of following four selected instruments: One G, ProGlider, a size 15 ScoutRace, and a size 15 stainless-steel K-file. To collect the apically extruded debris, the customized apparatus was used, and the collected debris was stored in an incubator. The weight of the debris was measured using an analytical balance with an accuracy of 0.00001 g. The data were analyzed by one-way analysis of variance and Duncan's multiple comparison test at a significance level of 95%. Results: The ProGlider group produced significantly less debris extrusion relative to the other groups (P

This study aimed to evaluate the effect of adaptive motion applied to conventional nickel-titanium (NiTi) rotary instruments on torsional stress generation during shaping procedure. One hundred and twenty mesio-buccal canals of molars were randomly assigned to two groups according to the kinetics; adaptive motion (AD) and continuous rotation (CR). Each group was divided into four subgroups (n = 15) according to the NiTi instrument systems: HyFlex EDM, One Curve, Twisted File Adaptive, and ProTaper Next. A glide path was established with PathFile #1, for each file group being used with either of the kinetic movements. During the instrumentation with the designated motion and file system, the generated torque was measured via the control unit and acquisition module. Based on the acquired data, the maximum and total torque were calculated. The data were statistically analyzed using Kruskal–Wallis and Mann–Whitney tests at a significance level of 95%. The maximum and total torque generated by all instruments were significantly reduced by the adaptive motion (p < 0.05). In the CR group, HyFlex EDM generated the highest maximum and total stress. In the AD group, HyFlex EDM showed the highest maximum torsional stress, and One Curve showed the highest total torsional stress (p < 0.05). The TF Adaptive instrument with adaptive movement produced the lowest maximum and total torsional stress (p < 0.05). Under the conditions of this study, the use of adaptive motion would be useful to reduce the torsional stress of instrument and root dentin. The reduction of torsional stress through adaptive motion may enhance the durability of instruments and reduce the potential risk of dentinal cracks.

Three bioceramic sealers (EndoSequence BC sealer, EndoSeal MTA, and MTA Fillapex) and three epoxy resin-based sealers (AH-Plus, AD Seal, and Radic-Sealer) were tested to evaluate the physicochemical properties: flow, final setting time, radiopacity, dimensional stability, and pH change. The one-way ANOVA and Tukey’s post hoc test were used to analyze the data (P=0.05). The MTA Fillapex sealer had a highest flow and the BC Sealer presented a flow significantly lower than the others (P

This study compared the maximum screw-in forces of various instruments during their movements. Forty simulated canals in resin blocks were randomly divided into four groups (n = 10): ProTaper Universal F2, ProTaper Gold F2, WaveOne Primary, and WaveOne Gold Primary. To standardize a lumen size, all artificial canals were prepared with ProTaper Universal F1. The rotation speed was set at 350 rpm with an automated 4 mm pecking motion at a speed of 1 mm/s. The pecking depth was increased by 1 mm for each pecking motion until the file reached the working length. During instrumentation, screw-in forces were automatically recorded by customized software. Maximum screw-in forces were analyzed by one-way ANOVA and Tukey’s post hoc comparison with the significance level at 0.05. WaveOne Gold files generated the lowest maximum screw-in forces, followed by ProTaper Gold, WaveOne, and ProTaper Universal (p < 0.05). Under the condition of this study, heat-treated nickel−titanium (NiTi) files with smaller cross-sectional area, fewer contact points, and reciprocating movements resulted in a lower screw-in effect.

This study compared the torque generation during canal shaping with a nickel-titanium endodontic instrument according to the extent of glide-path establishment. Seventy-five simulated S-shaped canal blocks were divided into five groups (n = 15) according to the number of repetitive insertions to the working length using a One G glide-path instrument: groups with 5, 10, 15, and 20 insertions as well as group Z without glide-path establishment. When the tip of the One G file reached the working length, the file was moved back and forth repetitively at the working length for the designated number of times for each group. The instrumentation procedure with HyFlex EDM had 15 pecking strokes. During instrumentation, the generated torque was transmitted to a customized data acquisition module and collected using customized software. Data were computed to determine the maximum torque and total stress. The maximum screw-in forces were statistically analyzed using one-way analysis of variance and Tukey’s post hoc comparison test with a significance level of 95%. While the maximum stress did not have significant differences among the five groups (p > 0.05), groups with more than 10 repetitive insertions generated lower total stress during instrumentation than did the group with 5 insertions and group Z (p < 0.05). Under the limitations of this study, repetitive insertions of glide-path establishment files at the working length reduced stress generation during the shaping using nickel-titanium instruments.

This study compares the safety limits and torsional resistances of WaveOne Gold (WOG) and WaveOne (WO) endodontic files while using the original motor. The safety limits for reciprocating angles were tested by measuring the torsional limit before plastic deformation (TLP) after repetitive torsional loading at gradually increasing load, and after single continuous rotation. Statistical analysis was performed by independent t-test at 95% confidence level. The tested specimens were observed under a scanning electron microscope (SEM). Regardless of the test mode, the distortion angle at the TLP was higher for WOG than WO (p < 0.05), and all were greater than the 150-degree rotation of the original motor. The mean values of the distortion angle and torque from the single continuous rotation loading were significantly lower than those with repetitive loading movements. Comparing the two systems under SEM, WO showed a catastrophic change in comparison with WOG. Evaluation of the lateral aspects showed longitudinal micro-cracks after 270-degree repetitive movements. After 150-degree repetitive movements, no distorted machining grooves were found in either group, but WO showed evidence of longitudinal micro-cracks. Under the conditions of this study, the torsional loading from the pre-set mode of the dedicated motor for WO was safe for WOG as well.

The purpose of this randomized controlled clinical trial was to assess the short-term clinical effectiveness of sealer-based root canal obturation using calcium-silicate-based sealer (CSBS) and epoxy-resin-based sealer (ERBS). A total of eighty patients (eighty teeth) were enrolled and seventy-two patients (seventy-two teeth) were randomly assigned into four different sealer groups: AH Plus (AH, Dentsply Sirona), ADseal (AD, Meta Biomed), CeraSeal (CS, Meta Biomed), or EndoSeal TCS (ES, Maruchi). At the first visit, root canal treatment was performed using ProTaper. Next, the NiTi file system and passive ultrasonic irritation was applied with 2.5% NaOCl. At the second visit, the teeth were obturated with a sealer-based obturation technique using the assigned sealer. The quality of filling obturation was evaluated with postoperative radiographs in terms of the presence of voids and sealer extrusion. The patients were recalled at 1-week, 1-month, and 3-month intervals, and pain levels were measured using visual analog scales (VAS), and clinical examination performed with percussion and palpation. Radiographs were also taken. The results were statistically compared by using the χ2 test or Fisher exact test. Among the 80 teeth included, 72 teeth received allocated intervention and 71 teeth were included in the analysis (98.6% recall). There was no significant difference among the sealers in void and sealer extrusion (p > 0.05). Postoperative pain was not indicated prominently regardless of the type of sealer. For a 3-month follow-up period, all cases were maintained successfully except for one case from AD. According to the findings, there was no significant difference between CSBS and ERBS in terms of postoperative pain or the healing process, and the variation in filling quality appears to be linked to the properties of each product.

Objectives This study compared the mechanical properties of various instruments for canal exploration and glide-path preparations. Materials and Methods The buckling resistance, bending stiffness, ultimate torsional strength, and fracture angle under torsional load were compared for C+ file (CP, Dentsply Maillefer), M access K-file (MA, Dentsply Maillefer), Mani K-file (MN, Mani), and NiTiFlex K-file (NT, Dentsply Maillefer). The files of ISO size #15 and a shaft length of 25 mm were selected. For measuring buckling resistance (n = 10), the files were loaded in the axial direction of the shaft, and the maximum load was measured during the files' deflection. The files (n = 10) were fixed at 3-mm from the tip and then bent 45° with respect to their long axis, while the bending force was recorded by a load cell. For measuring the torsional properties, the files (n = 10) were also fixed at 3-mm, and clockwise rotations (2-rpm) were applied to the files in a straight state. The torsional load and the distortion angle were recorded until the files succumbed to the torque. Results The CP was shown to require the highest load to buckle and bend the files, and the NT showed the least. While MA and MN showed similar buckling resistances, MN showed higher bending stiffness than MA. The NT had the lowest bending stiffness and ultimate torsional strength (p < 0.05). Conclusions The tested instruments showed different mechanical properties depending on the evaluated parameters. CP and NT files were revealed to be the stiffest and the most flexible instruments, respectively.

Objectives The purpose of this study was to compare the cutting efficiency of a newly developed microprojection tip and a diamond-coated tip under two different engine powers. Materials and Methods The apical 3-mm of each root was resected, and root-end preparation was performed with upward and downward pressure using one of the ultrasonic tips, KIS-1D (Obtura Spartan) or JT-5B (B&L Biotech Ltd.). The ultrasonic engine was set to power-1 or -4. Forty teeth were randomly divided into four groups: K1 (KIS-1D / Power-1), J1 (JT-5B / Power-1), K4 (KIS-1D / Power-4), and J4 (JT-5B / Power-4). The total time required for root-end preparation was recorded. All teeth were resected and the apical parts were evaluated for the number and length of cracks using a confocal scanning micrscope. The size of the root-end cavity and the width of the remaining dentin were recorded. The data were statistically analyzed using two-way analysis of variance and a Mann-Whitney test. Results There was no significant difference in the time required between the instrument groups, but the power-4 groups showed reduced preparation time for both instrument groups (p < 0.05). The K4 and J4 groups with a power-4 showed a significantly higher crack formation and a longer crack irrespective of the instruments. There was no significant difference in the remaining dentin thickness or any of the parameters after preparation. Conclusions Ultrasonic tips with microprojections would be an option to substitute for the conventional ultrasonic tips with a diamond coating with the same clinical efficiency.