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Aim To evaluate retrospectively the incidence of K3 nickel titanium rotary instrument fracture in referred cases during root canal treatment and re-treatment. Methodology Clinical and radiographic reports of 12 867 endodontic cases treated at the King Abdulaziz medical city between January 2010 and November 2015 were reviewed to obtain information on intracanal fractured instruments with respect to the treatment performed, tooth type and the size and at what level the instrument fractured (coronal, middle or apical). The degree of canal curvature was classified into mild ( 25°). Logistic regression was used to test the incidence of instrument fracture in relation to the root canal treatment performed and tooth type. Chi-square tests were used to analyse the fracture incidence in the treated teeth in respect to fracture level and fractured file diameter. The level of significance was set at 0.05. Results Root canal treatment was performed on 8946 cases, whilst re-treatment was performed on 3921 cases. The fracture incidence was higher during re-treatment cases (2.96%) than in primary root canal treatment (0.74%) (P

Aim To determine the root surface strain (RSS) generated during root canal shaping and its effects on apical microcrack development. Methodology Twenty-five extracted human mandibular premolars were selected and decoronated. The teeth were instrumented with either the ProTaper (PT) or WaveOne (WO) (Dentsply Maillefer) NiTi rotary systems (n = 10 per group) or used as controls (n = 5). Instrumented root canals were enlarged to ProTaper F4 (size 40, 0.06 taper) or using WaveOne LARGE (size 40, 0.08 taper) instruments according to the manufacturer's instructions. An electrical strain gage (KFG02-120-C1-16, Kyowa Dengyo, Tokyo, Japan) was fixed on the proximal root surface and connected to a strain amplifier via a bridge box in order to measure RSS. During canal shaping, the strain output of the amplifier was recorded. The instantaneous RSS induced by each instrument and the maximum RSSs were determined. All teeth were then stained with contrast media and imaged with micro-computed tomography (micro-CT) at an isotropic resolution of 10 μm to detect microcracks. The mean maximum RSS values (microstrain) and mean number of microcracks recorded for both groups were tested for statistical significance using Mann–Whitney U-test. Presence/absence of microcracks in both groups was compared by chi-square tests. Results Increased baseline RSS from strain accumulation during canal shaping was observed, with similar maximum RSS (mean ± SD) for PT (416.6 ± 185.1 μstrain) and WO (398.2 ± 163.8 μstrain) (P = 0.94). The interevaluator reliability for microcrack detection using micro-CT had a kappa value of 0.998. Compared to the PT group, there was a trend for fewer samples with microcracks in the WO group (P = 0.051). On the micro-CT images, apical microcracks were detected in 20 PT and 11 WO samples (P = 0.10). The microcracks were observed in the buccolingual direction in all WO and 81% of PT samples. No vertical root fractures were found. The maximum RSS obtained during canal shaping was poorly correlated with the number of microcracks found (R2 = 0.093). Conclusions Based on these preliminary data, canal shaping appears to cause apical microcracks regardless of the type of rotary instrument motion. Contrast-enhanced micro-CT was able to identify microcracks in roots.

Jamleh A, Sadr A, Nomura N, Yahata Y, Ebihara A, Hanawa T, Tagami J, Suda H. Nano-indentation testing of new and fractured nickel-titanium endodontic instruments. International Endodontic Journal, 45, 462–468, 2012. Abstract Aim To investigate the effect of cyclic fatigue on nickel-titanium (NiTi) endodontic instruments using a nano-indentation test. Methodology Eight ProFile NiTi rotary instruments (size 30, taper 0.06; Dentsply Maillefer, Ballaigues, Switzerland) were tested using a cyclic fatigue set-up until fracture. The fractured instruments and eight new NiTi instruments of the same size and taper were used for a nano-indentation test on the internal surfaces of a NiTi instruments in the region just adjacent to their fractured edge (group I) and in the same region of the new group (group II), and the cutting part beside the shaft for both instruments [group III (fractured) and group IV (new)]. Data were statistically analyzed using one-way analysis of variance and Games–Howell post hoc test. The alpha-type error was set at 0.05. Results Significant differences in terms of hardness and elastic modulus for each group (P

To investigate the effect of cyclic fatigue on nickel-titanium (NiTi) endodontic instruments using a nano-indentation test.Eight ProFile NiTi rotary instruments (size 30, taper 0.06; Dentsply Maillefer, Ballaigues, Switzerland) were tested using a cyclic fatigue set-up until fracture. The fractured instruments and eight new NiTi instruments of the same size and taper were used for a nano-indentation test on the internal surfaces of a NiTi instruments in the region just adjacent to their fractured edge (group I) and in the same region of the new group (group II), and the cutting part beside the shaft for both instruments [group III (fractured) and group IV (new)]. Data were statistically analyzed using one-way analysis of variance and Games-Howell post hoc test. The alpha-type error was set at 0.05.Significant differences in terms of hardness and elastic modulus for each group (P0.05) were found, with group I having the lowest mean values followed by group III. Additionally, standard deviations increased remarkably after failure, as represented by groups I and III.The nano-indentation technique can be applied to determine the performance and the failure mechanism of NiTi instruments. The fatigue process revealed a significant decrease in the hardness and elastic modulus of the NiTi instrument. As indicated by the low hardness, the fatigue process did not result in work hardening but rather work softening.