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Background: During mechanical preparation of the primary root canal, the original anatomy of the tooth should be preserved and the instrument should be perfectly balanced centrally into the canal space for reducing the probability of canal transportation. The aim of this research was to compare canal transportation and canal centring ability in primary root canals using ProTaper Next (Dentsply Mailfair,), AF baby (Fanta), and Kidzo Elephant (Endostar, Poldent Sp.) files. Materials and methods: Eighteen root canals were randomly divided into 3 experimental groups (n = 6 in each group). Instrumentation was performed using ProTaper Next, Fanta AF baby, and Kidzo Elephant files in groups 1, 2, and 3, respectively. During the instrumentation procedure, the irrigation of 2 mL of 1.5% sodium hypochlorite between each file was done, followed by 5 mL of 17% ethylenediaminetetraacetic acid as a final irrigating solution. Cone-beam computed tomography images were obtained before and after instrumentation. Each group was evaluated for transportation and centring ratios. Results: On comparing all the tested groups within each root canal level canal transportation, the results revealed a statistically nonsignificant difference in the buccolingual direction (P > 0.05). Meanwhile, in the mesiodistal direction, group 1 showed a statistically highly significant difference compared to groups 2 and 3 at the cervical level (P < .01). However, in both middle and apical root canal levels, there was a statistically nonsignificant difference amongst all groups (P > 0.05). Regarding the centring ability comparison of the 3 groups within each root canal level, there was a statistically nonsignificant difference amongst all groups (P > 0.05) in both buccolingual and mesiodistal directions. Conclusions: The ProTaper Next regular rotary file and the paediatric rotary files showed no difference in canal transportation and centring ability in the buccolingual direction, while in the mesiodistal direction at the cervical root canal level, the ProTaper Next showed high transportation liability.

Objectives: The aim of this in vitro study was to investigate the torsional fatigue resistance of different rotary files in straight and curved positions at a simulated intracanal temperature. Methods: Forty-eight size #25 files from ProTaper Universal (PTU), ProTaper Next (PTN) and ProTaper Gold (PTG) were tested for torsional resistance in both straight and curved (90 degrees) positions (n = 8 each). The experiment was conducted at a simulated intracanal temperature of 35 ± 1 °C. The torque gauge was reset before every use, and uniform torsional stress was applied by rotating the file clockwise at a speed of 40 rpm until fracture. Torque failure values were recorded, and fractured surfaces were tested using a scanning electron microscopy (SEM). Statistical analysis of the data was completed using one-way ANOVA and post-hoc test (LSD) in order to compare between the tested systems in each file position. Student’s t-test was also performed to compare between the two positions in each rotary system, and significance level was set at 5%. Results: In the straight position, torsional resistance of PTN was significantly lower than that of PTU and PTG (p 0.05). In the curved position, torsional resistance was found to be comparable among all systems (p > 0.05). Within each system, the curved position resulted in a significantly lower torsional resistance when compared to the straight position (p

Background: During mechanical preparation of the primary root canal, the original anatomy of the tooth should be preserved and the instrument should be perfectly balanced centrally into the canal space for reducing the probability of canal transportation. The aim of this research was to compare canal transportation and canal centring ability in primary root canals using ProTaper Next (Dentsply Mailfair,), AF baby (Fanta), and Kidzo Elephant (Endostar, Poldent Sp.) files., Materials and Methods: Eighteen root canals were randomly divided into 3 experimental groups (n = 6 in each group). Instrumentation was performed using ProTaper Next, Fanta AF baby, and Kidzo Elephant files in groups 1, 2, and 3, respectively. During the instrumentation procedure, the irrigation of 2 mL of 1.5% sodium hypochlorite between each file was done, followed by 5 mL of 17% ethylenediaminetetraacetic acid as a final irrigating solution. Cone-beam computed tomography images were obtained before and after instrumentation. Each group was evaluated for transportation and centring ratios., Results: On comparing all the tested groups within each root canal level canal transportation, the results revealed a statistically nonsignificant difference in the buccolingual direction (P > 0.05). Meanwhile, in the mesiodistal direction, group 1 showed a statistically highly significant difference compared to groups 2 and 3 at the cervical level (P < .01). However, in both middle and apical root canal levels, there was a statistically nonsignificant difference amongst all groups (P > 0.05). Regarding the centring ability comparison of the 3 groups within each root canal level, there was a statistically nonsignificant difference amongst all groups (P > 0.05) in both buccolingual and mesiodistal directions., Conclusions: The ProTaper Next regular rotary file and the paediatric rotary files showed no difference in canal transportation and centring ability in the buccolingual direction, while in the mesiodistal direction at the cervical root canal level, the ProTaper Next showed high transportation liability., Competing Interests: Conflict of interest None disclosed., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: This laboratory-based study aimed to investigate the quantitative amount of apically extruded debris from severely curved root canals and the preparation time for the novel rotary system TruNatomy (TN; Dentsply Sirona, Charlotte, NC) compared with Reciproc Blue (RCB; VDW Dental, Munich, Germany), HyFlex (HyFlex Controlled Memory [HCM; Coltene/Whaledent, Altstatten, Switzerland] and HyFlex EDM [HEDM, Coltene/Whaledent]), and ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland) rotary systems., Methods: One hundred mandibular molar human teeth with severe curvature of the mesiobuccal canal (25°-45°) were included in the present study. The specimens were randomly distributed into 5 balanced groups (n = 20): TN, RCB, HCM, PTN, and HEDM. The amount of extruded debris for each group during instrumentation at body temperature was collected in an Eppendorf tube. After desiccation, the mean debris weights for each group were calculated. The total preparation time for each group was also recorded. Data were statistically analyzed using the Kruskal-Wallis test at a significance level of P < .05., Results: The HCM and HEDM groups extruded a significantly higher amount of debris than the other tested groups (P < .001). TN extruded the least amount of debris, but it was not significantly different compared with the RCB and PTN groups (P > .05). In terms of preparation time, the TN group did not show any significant difference compared with the other groups., Conclusions: All instrumentation systems extruded debris. TN was among the groups that produced the lowest amount of apically extruded debris that is clinically acceptable. The amount of apically extruded debris using the TN system was equal to 2 popular systems and statistically significantly less than 2 other popular systems studied., (Copyright © 2021 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to evaluate the amount of root canal dentin removed and apical transportation occurrence after instrumentation of mesiobuccal canals of maxillary molars with ProTaper Next (PTN [Dentsply Maillefer, Ballaigues, Switzerland]), OneShape (OS [MicroMega, Besançon, France]), and EdgeFile (EF [Edge Endo, Albuquerque, NM]) rotary systems., Methods: Twenty-seven mesiobuccal canals of maxillary molars were used. Canals were randomly divided into 3 groups for canal preparation: PTN, EF X3, or OS (n = 9 for each group). Micro-computed tomographic imaging was used to measure apical transportation (mm) and the volume of dentin removed (mm 3 ). The amount of dentin removed was measured for the coronal portion and for the whole canal length. Superposition of pre- and postoperative cross-sectional apical slices were used to measure apical transportation at 1 mm from the apex; the differences were evaluated using the Kruskal-Wallis test and Wilcoxon analysis. The Spearman correlation coefficient was used to display the relationship between variables for each group. The significance level was set at P < .05., Results: The percentages of the amount of dentin removed on the coronal portion and the amount removed for the whole canal length were statistically similar between groups (P > .05). The average amount of apical transportation for the PTN, OS, and EF X3 were 0.197, 0.263, and 0.218 mm, respectively. Statistically, there were no significant differences between the 3 rotary instruments for apical transportation., Conclusions: The amount of dentin removed for the coronal third portion and the whole canal length was similar for the PTN, OS, and EF X3 rotary instruments. Although there were differences in the sizes of apical enlargement, no apical transportation was observed in any of the instrumentation systems., (Copyright © 2020 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to evaluate and compare the shaping abilities of the XPS (XP-endo Shaper) and PTN (ProTaper Next) systems by using cone-beam computed tomography on apical, middle, and coronal thirds of the pre-created large canals with different apical sizes., Methods: Seventy-two teeth with single canal were divided into 3 groups, and then large root canals were created with apical diameter #30 (Group 1), #35 (Group 2), or #40 (Group 3) by using hand files. Each group was again divided into 2 experimental groups, and root canals were instrumented with either XPS or PTN. Canals were scanned before and after instrumentation by using cone-beam computed tomography scanner to evaluate mesiodistal transportation, buccolingual transportation, centering ratio, percent increased prepared area (PA) (mm 2 ), and percent increased prepared outline (PO) (mm) at 2, 5, and 8 mm from the apex. Data were statistically analyzed, and the significance level was set at P < .05., Results: There were no statistically significant differences in PA, PO, and centering ratio values between instruments in size 30 and size 35. The mean increases in PA and PO (P < .021) were statistically higher with XPS in size 40. PTN had statistically higher buccolingual transportation in size 30 and size 35. XPS had lower mesiodistal transportation values in all 3 apical sizes., Conclusions: PTN system is able to remove the dentin even in cases of increased apical diameter. However, XPS has less canal transportation and better centering ability compared with PTN., (Copyright © 2019 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study was to evaluate and compare the centering ability and canal transportation of the ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland) and Self-adjusting File (SAF; ReDent-Nova, Ra'anana, Israel) systems in long oval root canals using cone-beam computed tomography imaging., Methods: Fifty-six fully formed single-rooted mandibular premolars were selected with a buccolingual canal size 2 to 2.5 times the mesiodistal size at 5 mm from the apex, ranging from a 0°-10° canal curvature with a 5- to 6-mm radius. The teeth were divided into 2 groups (n = 28) and prepared with PTN or SAF according to the manufacturers' instructions. Cone-beam computed tomographic images were taken in the same position before and after instrumentation using modeling wax. The centering ability and canal transportation were calculated at 3, 6, and 9 mm from the apex in both mesiodistal and buccolingual directions. The mean and standard deviation were calculated, and the Student t test was used for comparative analysis., Results: significant difference for canal transportation was observed mesiodistally at 9 mm from the apex (P < .05) where the PTN shaved more dentin in 1 direction. A significant difference for the centering ability was observed at 6 mm buccolingually from the apex (P < .05) where the PTN was less centered in the canal compared with the SAF., Conclusions: Both SAF and PTN were shown to be safe for being used in long oval canals. SAF resulted in less transportation at the coronal third in the mesiodistal direction and more centered at the middle third in the buccolingual direction compared with PTN., (Copyright © 2019 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to compare the shaping ability of 4 different nickel-titanium systems, considering their variation in alloy treatment, kinematics, and design, used to prepare canals with severe curvature using micro-computed tomographic analysis., Methods: Thirty-two mesial roots of mandibular molars with severe curvature were matched based on similar morphologic dimensions and assigned to 4 experimental groups (n = 8) according to the canal preparation: ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), Reciproc (RC; VDW GmbH, Munich, Germany), Reciproc Blue (RCB, VDW GmbH), and TRUShape (TRU; Dentsply Tulsa Dental Specialties, Tulsa, OK) systems. Changes in 2-dimensional (area and perimeter) and 3-dimensional (volume, surface area, and structure model index) morphologic parameters as well as canal transportation were compared among groups using the analysis of variance post hoc Tukey tests with the significance level set at 5%., Results: Preparation significantly increased all analyzed parameters. No statistically significant differences (P > .05) were observed between RC and RCB or between PTN and TRS in any of the analyzed parameters. In the cervical third, RC and RCB presented higher mean increases than PTN and TRU. In the apical third, there were no statistically significant differences (P > .05) among the systems., Conclusions: The instruments of greater taper may promote greater morphologic changes. However, regardless of the number of instruments (multiple or single), the type of movement (rotation or reciprocating), the type of heat treatment of alloys, and the particular characteristics of each instrument (taper and design), the evaluated systems did not result in different dimensional changes and canal transportation in the critical apical area., (Copyright © 2019 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to evaluate the root canal shaping effect of instruments manufactured from nickel titanium, M-Wire, and Gold wire with different glide path preparation techniques., Methods: One hundred thirty-five mesiobuccal canals of extracted human maxillary molars were randomly divided into 3 equal groups (N = 45) for glide path preparation with K-files (KF) (Dentsply Sirona, Ballaigues, Switzerland), One G (OG) files (Micro-Mega, Besançon, France), and ProGlider (PG) files (Dentsply Sirona). Specimens of each glide path group were further divided equally into 3 groups for instrumentation with ProTaper Next (PTN, Dentsply Sirona), One Shape (OS, Micro-Mega), and WaveOne Gold (WOG, Dentsply Sirona) systems (n = 15). Micro-computed tomographic imaging was used to scan teeth before instrumentation and after shaping to compare centering ratio and canal transportation values at the apical, midroot, and coronal levels and the overall changes in canal volume. Data sets were statistically analyzed (analysis of variance and Kruskal-Wallis H tests)., Results: The centering ratios for all groups were statistically similar at all levels. Apical canal transportation was significantly high for K/OS and K/PTN (P = .003). Midroot canal transportation was significantly high for K/PTN, K/OS, and OG/OS (P = .0003). Coronal canal transportation was significantly high for K/PTN and K/OS (P = .011). The highest change in canal volume was observed with all PTN groups and the lowest with PG/WOG (P = .06)., Conclusions: WOG manufactured from Gold wire combined with PG showed better root canal shaping ability and removed less dentin from the canal walls. The nickel-titanium (OS) and M-Wire (PTN) instruments used in combination with KF significantly transported more canals. PTN removed the most dentin from the canal walls regardless of the GPP technique., (Copyright © 2018 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to evaluate the root canal shaping effect of 2 nickel-titanium rotary instruments with offset mass of rotation compared with an instrument with a conventional centered mass of rotation., Methods: Thirty-six extracted human mandibular first molars with 2 independent mesial canals and 1 oval distal canal were selected and divided equally into 3 groups for instrumentation with ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), Revo-S (RS; Micro-Mega, Besançon, France), and ProTaper Universal (PTU, Dentsply Maillefer) systems (n = 12). For apical preparation, PTN X2 (#25/0.06), RS SU (#25/0.06), and PTU F2 (#25/0.08) were used in the mesial canals and PTN X3 (#30/0.07), RS AS30 (#30/0.06), and PTU F3 (#30/0.09) were used in the distal canals. Specimens were scanned before and after instrumentation using a SkyScan 1272 scanner (Bruker micro-CT, Kontich, Belgium) at 10-μm isotropic resolution. Changes in the canal area, volume, structure model index (SMI), and untouched canal area were evaluated. Canal transportation and centering ratio were measured at 1, 3, 5, and 7 mm from the apical foramen. Data were statistically analyzed using 1-way analysis of variance with the Tukey post hoc test., Results: The PTN and RS systems showed significantly less transportation and better centering ability compared with the PTU system at 1 mm from the apical foramen (P < .05). All instrumentation increased the canal area, volume, and SMI values without significant differences among the 3 groups (P > .05)., Conclusions: Regardless of the differences in the cross-sectional design, alloy type, and taper variation, instruments with offset mass of rotation showed better root canal shaping ability compared with an instrument with a centered mass of rotation., (Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study was to determine whether final-year undergraduate dental students achieved better shaping outcomes using the new ProTaper Next (PTN; Dentsply Sirona, Ballaigues, Switzerland) system to prepare root canals for the first time compared with the existing ProTaper Universal (PTU, Dentsply Sirona) system on which they had trained. A secondary aim was to explore the attitudes and preferences of the students toward both systems., Methods: Forty students prepared 1 simulated S-shaped canal using PTN and another with PTU. Images of the canals were saved before and after preparation, and the outcomes assessed included the formation of aberrations and the amount of resin removed at specific points along the canal length. Student opinions relating to PTN and PTU were collected via a questionnaire completed immediately after using the systems. For statistical analysis, the McNemar test was used to compare the incidence of aberrations, and a paired t test was used to analyze the width measurements. Responses to the questionnaire were analyzed using frequencies. Thus, the McNemar test was used for paired binary data and the marginal homogeneity test for categoric data when more than 2 categories were used. Finally, the overall preferences (either PTN or PTU) were analyzed using the sign/binomial test, which is a standard statistical test that allows us to determine if the proportion preferring one or the other is equal or not., Results: Canal ledges were formed in 30% of the canals prepared with PTU, whereas no ledges were formed with PTN (P < .001). A middle constriction, a form of canal aberration, was created by both systems although it occurred significantly (P = .006) more often with PTN. The "number of files" was judged by students to be significantly higher (P < .001) for PTU compared with PTN. Even though using PTN for the first time, students were more likely to recommend the system to other students for preparing S-shaped canals than PTU (P = .018) and preferred to use PTN in the future (P < .001)., Conclusions: The students who had previous experience with the use of PTU were able to produce comparable shaping outcomes when they used PTN for the first time. For the preparation of S-shaped canals, the students preferred PTN over PTU in terms of the number of files and would prefer to use it in the future., (Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to evaluate and compare, by means of micro-computed tomography imaging, the shaping ability of ProTaper Next (PTN) and the novel HyFlex EDM (HFEDM) instruments., Methods: Forty teeth were randomly divided into 2 groups and prepared with PTN or HFEDM. Root canal transportation and centering ratio were evaluated in mesiodistal and buccolingual directions at 5 levels (at the midpoint of the apical, middle, and coronal thirds and at the boundaries between them). Variations in volume, surface, and cross-sectional shape were measured for the apical, middle, and coronal thirds. The null hypotheses were that no differences existed between the 2 groups. The D'Agostino-Pearson test (α = .05) was conducted to assess the normality of the data sets. The distributions were compared by using the Mann-Whitney test (α = .05)., Results: Statistically significant differences (P < .005) were recorded only for buccolingual canal transportation and centering ratio at the section between the middle and coronal thirds, where HFEDM files were superior., Conclusions: HFEDM and PTN files were similarly effective, and both safely prepared the root canals, respecting their original anatomies. HFEDM files performed better in terms of buccolingual canal transportation and centering ratio at the section between the middle and coronal thirds., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to compare the amount of debris extruded from the apex during retreatment procedures with ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), Reciproc (RCP; VDW, Munich, Germany), and Twisted File Adaptive (TFA; SybronEndo, Orange, CA) files and the duration of these retreatment procedures., Methods: Ninety upper central incisor teeth were prepared and filled with gutta-percha and AH Plus sealer (Dentsply DeTrey, Konstanz, Germany) using the vertical compaction technique. The teeth were randomly divided into 3 groups of 30 for removal of the root filling material with PTN, RCP, and TFA files. The apically extruded debris was collected in preweighed Eppendorf tubes. The time for gutta-percha removal was recorded. Data were statistically analyzed using Kruskal-Wallis and 1-way analysis of variance tests., Results: The amount of debris extruded was RPC > TFA > PTN, respectively. Compared with the PTN group, the amount of debris extruded in the RPC group was statistically significantly higher (P < .001). There was no statistically significant difference among the RCP, TFA, and PTN groups regarding the time for retreatment (P > .05)., Conclusions: Within the limitations of this in vitro study, all groups were associated with debris extrusion from the apex. The RCP file system led to higher levels of apical extrusion in proportion to the PTN file system. In addition, there was no significant difference among groups in the duration of the retreatment procedures., (Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: To evaluate the vertical load induced with the Twisted File Adaptive (TFA; SybronEndo, Orange, CA) system during canal shaping of extracted teeth by comparing it with the Twisted File (TF, SybronEndo), ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), and ProTaper Universal (PTU, Dentsply Maillefer) systems., Methods: Fifty-two root canals were shaped using the TFA, TF, PTN, or PTU systems (n = 13 for each system). They were shaped gently according to the manufacturers' instructions. During canal shaping, vertical loads were recorded and shown in 2 directions, apically and coronally directed loads. The vertical peak loads of 3 instrumentation stages were used for comparison. The effects of rotary systems on the mean positive and negative peak loads were analyzed statistically using the Kruskal-Wallis and Mann-Whitney tests at a confidence level of 95%., Results: The overall pattern of the instantaneous loads appeared to increase with the use of successive instruments within the system. During canal shaping in all groups, the apically and coronally directed peak loads ranged from 0.84-7.55 N and 2.16-2.79 N, respectively. There were significant differences in both peak loads among the tested systems at each instrumentation stage. TFA had the lowest apically directed peak loads. In terms of coronally directed peak loads, the TFA and TF had a significantly lower amount of loads developed with their instruments than PTN and PTU., Conclusions: The choice of instrument system had an influence on the loads developed during canal shaping. TFA instruments were associated favorably with the lowest values of peak loads followed by TF, PTN, and PTU., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to compare the resistance to cyclic fatigue of ProTaper Next X2 (PTN X2; size 25, 0.06 taper), Hyflex CM (HCM; size 25, 0.06 taper), OneShape (OS; size 25, 0.06 taper), and ProTaper Universal F2 (PTU F2; size 25, 0.08 taper) nickel-titanium files in an artificial root canal with a double (S-shaped) curvature., Methods: A total of 160 new PTN X2, OS, HCM, and PTU F2 files were tested in an artificial stainless steel canal with a double curvature. Forty files from each system were rotated until fracture to calculate the number of cycles to failure. The length of each fractured fragment was recorded. Data were analyzed by using one-way analysis of variance and Tukey post hoc tests., Results: The resistance to cyclic fatigue of the PTN X2 and HCM instruments was significantly greater than the OS and PTU F2 instruments in the apical curvature (P < .05). There was no statistical difference in the cyclic fatigue resistance of the PTN X2 and HCM instruments in the apical curvature (P > .05). In addition, there was no statistical difference between the OS and PTU F2 instruments in the apical curvature (P > .05). PTN X2, OS, HCM, and PTU F2 instruments showed similar cyclic fatigue resistance values in the coronal curvature (P > .05)., Conclusions: This study showed that PTN X2 and HCM instruments exhibit greater resistance to cyclic fatigue than OS and PTU F2 instruments in the apical curvature of an artificial canal with a double curvature., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to compare the cleanliness of root canal walls after retreatment using ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), Twisted File Adaptive (TFA; Axis/SybronEndo, Orange, CA), Reciproc (PRC; VDW, Munich, Germany), and ProTaper Universal retreatment (PTR, Dentsply Maillefer) nickel-titanium systems and the time required for gutta-percha and sealer removal., Methods: Eighty human maxillary central incisors with single and straight root canals were instrumented up to #40.02 with manual K-files (Dentsply Maillefer) and obturated using the continuous wave of condensation technique. Removal of the gutta-percha and sealer was performed using 1 of the following nickel-titanium systems: PTN, TFA, RPC, or PTR. The teeth were sectioned, and digital images were captured. The photographs were analyzed using AutoCAD software (Autodesk, San Rafael, CA). Also, the total time required for gutta-percha removal was calculated by a chronometer., Results: The total retreatment time was significantly shorter in the PTR group compared with the other groups (P < .05). There was a significant difference between the groups according to the total residual gutta-percha and sealer (P < .05). The PTN and PTR groups left significantly less gutta-percha and sealer remnant than the TFA and RPC groups (P < .05)., Conclusions: Within the limitations of this study, the PTN and the PTR groups showed less residual gutta-percha and sealer than the TFA and RPC groups. The time required for gutta-percha and sealer removal was similar for all the groups, except for the PTR group., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: A great number of studies performed in the last 3 decades have shown the superior mechanical features of nickel-titanium files as compared with stainless steel files. A novel file system recently developed, Gentlefile, defies these findings and claims to have superior qualities despite the fact it is made from stainless steel., Methods: Three file systems were used in this experiment: ProTaper Next (X1, X2, and X3), RevoS (SC2, SC3, and AS30), and Gentlefile (GF1, GF2, and GF3). Time to fracture, rotations to fracture, and vertical forces applied to a simulated root canal, which was fabricated from a metal block with a Plexiglas cover, were measured., Results: The GF system required significantly longer time and more rotations to fracture compared with the ProTaper and RevoS systems (P < .001). The GF system applied significantly less vertical force to the canal in comparison with the ProTaper and RevoS systems (P < .01)., Conclusions: Under the limitations of this study the GF system showed better mechanical properties in comparison with the ProTaper and RevoS systems. Further investigation is needed to assess the clinical meaning of these findings., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Cleaning and shaping without making procedural errors have always been a challenge in endodontics, particularly when the root canals are curved. Several rotary instruments have been developed to minimize such errors. The purpose of this study was to compare the shaping ability of 2 rotary file systems, BioRace (BR; FKG, La Chaux-de-Fonds, Switzerland) and ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), during the preparation of curved root canals in extracted teeth using micro-computed tomographic imaging., Methods: A total of 20 first and second human mandibular molars with 2 separate mesial canals were scanned before and after root canal preparations using the SkyScan 1176 X-ray microtomograph (Bruker microCT, Kontich, Belgium) at a resolution of 17.42 μm. Canals were prepared using the BR and PTN systems. The percentage of dentin removed after preparation, root canal volume increase, untreated canal walls, structure model index, degree of canal transportation, and centering ability were also measured., Results: There were no significant differences between the 2 groups in the removed dentin after preparation and determination of the root canal volume, percentage of untreated canal walls, structure model index, degree of canal transportation, and centering ability (P > .05)., Conclusions: In conclusion, within the limitations of this ex vivo study, instrumentation of moderately curved mesial roots with 2 independent root canals and foramina using the BR and PTN rotary file systems were equally effective. Both instrumentation systems caused negligible procedural errors with minimal apical transportation., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The objective of the present study was to clinically compare the incidence of postoperative pain and the intake of analgesic medication (frequency and quantity) after endodontic treatment of posterior teeth using 2 reciprocating systems and a continuous rotary system., Methods: In a prospective randomized clinical study, 210 patients with vital teeth indicated for conventional endodontic treatment were treated by 5 specialists according to a pre-established protocol. The teeth were randomly assigned to 1 of 3 groups (n = 70) according to the instrumentation system used: ProTaper Next (Dentsply Tulsa Dental Specialties, Johnson City, TN), WaveOne (Dentsply Tulsa Dental Specialties), or Reciproc (VDW, Munich, Germany). Treatments were performed in a single visit. After the visit, the patients were given a prescription for ibuprofen 400 mg to be taken every 6 hours if they experienced pain. Participants were asked to rate the intensity of the postoperative pain on a visual analog scale according to 4 classes (no pain, mild pain, moderate pain, and severe pain) after 24 hours, 48 hours, 72 hours, and 7 days. Patients were also asked to record the number of prescribed analgesic medication tablets taken at these time points., Results: No statistically significant difference was found among the 3 groups in relation to postoperative pain or analgesic medication intake at the 4 time points assessed (P > .05, Kruskal-Wallis test)., Conclusions: The reciprocating systems and the continuous rotary system were found to be equivalent in regard to the incidence of postoperative pain and intake of analgesic medication at the time points assessed., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Root canal anatomy and canal preparation instruments affect the outcome of endodontic treatment. The purpose of this study was to determine the root surface strain (SS) generated and the extent of canal center transportation during canal shaping using 3 different nickel-titanium instruments., Methods: Simulated root canals in resin blocks (n = 10 per group) were prepared using adaptive rotary motion with twisted files (Twisted File Adaptive [TFA]; SybronEndo, Orange, CA), reciprocating rotary motion with WaveOne (WO; Dentsply Maillefer, Ballaigues, Switzerland) files, and continuous rotary motion with ProTaper Next files (PTN, Dentsply Maillefer). Electrical strain gauges at 3 sites recorded SS real time during canal shaping, and the blocks were scanned by micro-computed tomographic imaging to assess the canal center deviation at 3 sections after root canal instrumentation. The mean maximum SS and the canal center transportation for all groups and sites were derived and analyzed for a possible correlation between them., Results: An overall increase in root SS was observed after root canal instrumentation. A significant difference in the induced mean maximum SS between TFA, WO, and PTN at specific sites of curved root canals was observed. A statistically significant difference in the mean distance of canal center transportation was observed among the 3 shaping techniques at the apical section. Finally, the mean maximum SS values induced during canal shaping strongly correlated with canal center transportation in the apical section and the coronal section., Conclusions: The curved canals prepared using TFA exhibited lower SS and less canal center transportation at the apical section than the WO and PTN systems. SS generated during canal shaping correlated with canal center transportation in a site-specific manner., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this micro-computed tomography study was to describe the shaping properties of ProGlider/ProTaper Next (PG/PTN) and ScoutRace/BioRace (SR/BR) nickel-titanium rotary systems., Methods: Thirty maxillary first permanent molars were selected. Mesiobuccal canals were randomly assigned (n = 15) to PG/PTN or SR/BR groups. Irrigation was performed with 5% NaOCl and 10% EDTA. Specimens were scanned (voxel size, 9.1 μm) for matching volumes and surface areas and post-treatment analyses. Root canal centering ability, canal geometry enlargement, and thickness of dentinal wall at inner curvature were assessed at apical level and point of maximum curvature. Results were analyzed with 4 one-way analyses of variance., Results: Canal centering ability was superior in PG/PTN (P = .006 at apical level, P = .025 at point of maximum curvature). PG/PTN demonstrated a more conservative increase of canal areas (P = .027 at apical level, P = .038 at point of maximum curvature). Centrifugal increase in canal diameters did not significantly differ between groups (P = .65 at apical level, P = .61 at point of maximum curvature). Inner dentinal wall thickness was less reduced with PG/PTN compared with SR/BR, with no statistical differences (P = .23 at point of maximum curvature, P = .89 at apical level). PG/PTN shaping taper ranged between 6% and 7%., Conclusions: Neither system produced significant shaping errors in curved canals. PG/PTN system showed better preservation of canal anatomy. PTN offset section did not influence final preparation taper., (Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to compare the incidence of root cracks after root canal instrumentation with the TF Adaptive, WaveOne, ProTaper Next, and ProTaper Universal systems., Methods: Seventy-five extracted mandibular central incisors with mature apices and straight root canals (<5°) were selected and kept in distilled water. The root canals were instrumented by using the ProTaper Universal, ProTaper Next, WaveOne, and TF Adaptive systems. All the roots were horizontally sectioned 3, 6, and 9 mm from the apex with a low-speed saw under water cooling. The slices were then viewed through a stereomicroscope at ×25 magnification. The samples were photographed with a camera to determine the presence of dentinal cracks., Results: The control group had no cracks, and the difference between the control group and the experimental groups was statistically significant (P < .001). The ProTaper Next and TF Adaptive systems produced significantly less cracks than the ProTaper Universal and WaveOne systems in the apical section (3 mm) (P < .05)., Conclusions: Under the study conditions and within the limitations of this study, it can be concluded that the ProTaper Universal, ProTaper Next, WaveOne, and TF Adaptive instruments can result in dentinal cracks., (Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study was to evaluate and compare the volume of removed dentin, transportation, and centering ability of ProTaper Next (PTN) system with and without glide path preparation by using cone-beam computed tomography (CBCT) imaging., Methods: Sixty mesiobuccal canals of mandibular first molars with curvatures of 25°-35° were divided into 3 experimental groups (n = 20) according to the instrumentation technique as follows: group PG/PTN (glide path was created with ProGlider [PG]) and canals were shaped with PTN system), group PF/PTN (glide path was created with PathFile [PF]) and canals were shaped with PTN system), and group PTN (glide path was not performed and canals were shaped with PTN system only). Canals were scanned before and after instrumentation by using CBCT scanner to evaluate root canal transportation and centering ratio at 3, 5, and 7 mm from the apex and volumetric changes. Data were statistically analyzed, and the significance level was set at P < .05., Results: There was no significant difference among the tested groups regarding the volume of removed dentin and centering ratio (P > .05). At 3-mm and 5-mm levels, the PG/PTN group showed a significantly lower mean transportation value among the groups (P < .05). However, at 7-mm level, there was no significant difference in canal transportation among the groups (P > .05)., Conclusions: PG/PTN instrumentation method revealed better performance with fewer canal aberrations when compared with instrumentation performed with PF/PTN or PTN only., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study was to compare the torsional resistance, flexibility, and surface microhardness of ProTaper Next files (PTN) with Twisted Files (TF) and RaCe (RC)., Methods: A metal block with a cubical hole was used to evaluate the torsional resistance. Five millimeters of the tip of each file was securely held in place by filling the mold with a resin composite, and the files were driven clockwise at 300 rpm. The number of load applications before fracture was recorded for each file. A scanning electron microscope was used to characterize the topographic features of the fracture surfaces of the broken files. The files were tested for bending resistance by using cantilever-bending test. Vickers microhardness was measured on the cross section of instruments with 300-g load and 15-second dwell time. Torsional resistance data were analyzed by using the nonparametric Kruskal-Wallis and Mann-Whitney U tests. Bending resistance and microhardness data were analyzed by using analysis of variance and Tukey tests., Results: PTN showed the highest torsional resistance and microhardness, followed by RC (P < .05). The fracture cross sections of all brands showed dimpling near the center of fracture surface. The ranking in the bending resistance values was as follows: RC > PTN > TF., Conclusions: PTN improved its resistance to torsional stresses and wear compared with TF and RC. TF showed improved flexibility compared with other tested brands., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to describe the canal shaping properties of ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), ProTaper Universal (PTU; Dentsply Tulsa Dental Specialties, Johnson City, TN), and WaveOne (Dentsply Maillefer) nickel-titanium instruments in mandibular first molars by using micro-computed tomographic (micro-CT) scanning., Methods: A total of 36 maxillary first molars with 2 separate mesial canals and 1 distal canal were selected and scanned preoperatively and postoperatively by using micro-CT scanning with a voxel size of 30 μm. Canals were prepared with PTU, PTN, and WaveOne systems under hypochlorite irrigation. The volume of the untreated canal; the volume of dentin removed after preparation; the amount of the uninstrumented area; and the transportation to the coronal, middle, and apical thirds of canals were measured. The preparation time and instrument failure were also recorded., Results: Instrumentation of canals increased their volume and surface area. The distal canals had a significantly higher proportion of unprepared surfaces than mesial canals (P < .05). The PTN system produced less transportation than the WaveOne and PTU systems in the apical third of the mesial canals (P < .05). There was no significant difference on apical transportation in distal canals among the 3 instrument systems. Instrumentation with WaveOne was significantly faster than with the other 2 instruments (P < .05)., Conclusions: The PTN, PTU, and WaveOne instruments shaped root canals in mandibular first molars in vitro without significant shaping errors. The curved canals prepared using PTN had less apical transportation than the canals prepared using WaveOne and PTU., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study was to compare the in vitro amount of apically extruded debris with new endodontic rotary nickel-titanium instruments., Methods: Sixty mandibular premolars were instrumented up to size 25 using ProTaper Universal (Dentsply Maillefer, Ballaigues, Switzerland), ProTaper Next (Dentsply Maillefer), Twisted File Adaptive (SybronEndo, Orange, CA), and HyFlex (Coltene-Whaledent, Allstetten, Switzerland) rotary systems. The apically extruded debris was collected and dried in preweighed Eppendorf tubes. The amount of extruded debris was assessed with an electronic balance. The total time required to complete root canal shaping with the different instruments was also recorded. The significance level was set at P = .05., Results: The instrumentation time with the ProTaper Universal rotary system was significantly longer than with all the other instruments (P < .05). The Twisted File Adaptive and ProTaper Next systems extruded significantly less debris than the ProTaper Universal and HyFlex systems (P < .05)., Conclusions: The ProTaper Next and Twisted File Adaptive instrumentation systems were associated with less debris extrusion compared with the ProTaper Universal and HyFlex systems., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: New designs and alloys have been developed to increase cyclic fatigue (CF) resistance of rotary files. The aim of this study was to compare CF resistance of ProTaper Universal (PTU; Dentsply Tulsa Dental, Tulsa, OK) and ProTaper Next (PTN, Dentsply Tulsa Dental) instruments at different points of curvature., Methods: A total of 420 files (240 PTU, S1, F1, F2, and F3 and 180 PTN, X1, X2, and X3) were divided in 14 groups of 30 instruments each. Instruments in groups S1-5, F1-5, X1-5, F2-5, X2-5, F3-5, and X3-5 were tested at 5 mm from the tip. Groups S1-12, X1-12, and F1-12 were tested at 12 mm from the tip because S1, X1, and F1 instruments have the same diameter at that level. Groups F2-8, X2-8, F3-8, and X3-8 were tested at 8 mm (F2/X2 and F3/X3, respectively, had the same diameter at 8 mm). All files were rotated at 300 rpm until fracture. CF resistance was tested in stainless steel curved canals (60°, r = 3 mm). Time to fracture was recorded. The mean half-life and beta and eta were calculated for each group and were compared with Weibull analysis., Results: PTN instruments will last significantly longer than PTU files with a probability higher than 98% at all tested levels except for S1, which was the significantly the most resistant instrument to CF at 5 mm from the tip., Conclusions: PTU S1 was significantly the most resistant instrument at 5 mm from the tip. PTN files were significantly more resistant to CF than PTU instruments at all the other tested levels., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of the present study was to investigate the incidence of cracks in root dentin after root canal preparation with ProTaper Next (Dentsply Maillefer, Ballaigues, Switzerland), HyFlex (Coltene-Whaledent, Allstetten, Switzerland), and ProTaper Universal (Dentsply Maillefer) rotary instruments., Methods: One-hundred mandibular premolars were selected. Twenty-five teeth were left unprepared and served as a negative control; another 25 teeth were instrumented with the ProTaper Universal system up to size F4 as a positive control, and the remaining 50 teeth were shaped with the following experimental groups with an apical size 40 file: ProTaper Next X4 and HyFlex 40/0.4. After root canal preparation, all of the roots were sectioned perpendicular to the long axis at 2, 4, 6, and 8 mm from the apex, and the sections were then observed under a stereomicroscope. The absence/presence of cracks was recorded, and the data were analyzed with a chi-square test. The significance level was set at P = .05., Results: No cracks were observed in the negative control group. Vertical root fractures were not observed in any of the groups. The ProTaper Next and HyFlex instruments caused fewer cracks (28%) than the ProTaper Universal instrument (56%) (P < .05). However, there were no significant differences in crack formation between the ProTaper Next and HyFlex groups (P > .05)., Conclusions: Within the limitations of this in vitro study, all of the instrumentation systems used in this study created cracks in the root dentin. The ProTaper Next and HyFlex instruments tended to cause fewer dentinal cracks compared with the ProTaper Universal instrument., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study was to compare peak torque and force between ProTaper Universal (PTU) and ProTaper Next (PTN) instruments during the preparation of large and small root canals in extracted teeth., Methods: Twelve maxillary incisors and each independent canal of 6 mesial roots of mandibular molars were randomly assigned to be prepared with a new set of either PTU or PTN instruments after a glide path was achieved. A total of 12 new sets of each instrument system were used. The tests were run in a standardized fashion in a torque-testing platform. Peak torques (Ncm) and force (N) were registered; analysis of variance and Tukey post hoc tests were then applied., Results: Among instruments in the same sequence, no significant differences in peak torque and force were found among PTN instruments when shaping small or large root canals, but some PTU instruments showed statistically lower peak torque and force (P < .01) than others for both types of canals. Whereas PTU instruments showed significant differences in peak torque and force (P < .05) between large and small root canals, PTN instruments showed significantly lower force (P < .04) in large canals, but peak torque was not significantly different for upper central incisors or mesial mandibular root canals., Conclusions: Under the conditions of this study, instruments in ProTaper Next set showed greater regularity in peak torque for small and large canals than ProTaper Universal instruments., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: We compared the effects of 6 different rotary systems on transportation, canal curvature, centering ratio, surface area, and volumetric changes of curved mesial root canals of mandibular molar via cone-beam computed tomographic (CBCT) imaging., Methods: Mesiobuccal root canals of 120 mandibular first molars with an angle of curvature ranging from 20°-40° were divided into 6 groups of 20 canals. Based on CBCT images taken before instrumentation, the groups were balanced with respect to the angle and radius of canal curvature. Root canals were shaped with the following systems with an apical size of 25: OneShape (OS) (MicroMega, Besancon, France), ProTaper Universal (PU) F2 (Dentsply Maillefer, Ballaigues, Switzerland), ProTaper Next X2 (Dentsply Maillefer), Reciproc (R) R25 (VDW, Munich, Germany), Twisted File Adaptive (TFA) SM2 (SybronEndo, Orange, CA), and WaveOne primary (Dentsply Tulsa Dental Specialties, Tulsa, OK). After root canal preparation, changes were assessed with CBCT imaging. The significance level was set at P = .05., Results: The R system removed a significantly higher amount of dentin than the OS, PU, and TFA systems (P < .05). There was no significant difference among the 6 groups in transportation, canal curvature, changes of surface area, and centering ratio after instrumentation., Conclusions: The 6 different file systems straightened root canal curvature similarly and produced similar canal transportation in the preparation of mesial canals of mandibular molars. R instrumentation exhibited superior performance compared with the OS, TFA, and PU systems with respect to volumetric change., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study was to assess torque and force for simulated canal preparation with a new root canal instrument, ProTaper Next., Methods: Six sets of ProTaper Next Instruments (X1-X5) were used to prepare 36 artificial canals. Files were divided into 6 groups. Different settings of rotations per minute (250, 300, and 350 rpm) and numbers of in-and-out movements to reach working length (3 or 4 insertions [ins]) were applied in each group (250 rpm/3 ins, 250 rpm/4 ins, 300 rpm/3 ins, 300 rpm/4 ins, 350 rpm/3 ins, and 350 rpm/4 ins) by using an automated torque bench. Peak torques (Ncm) as well as positive and negative forces (N) were registered. Analysis of variance and Tukey post hoc tests were applied. Preliminary data for angle and stationary torque at failure were also obtained and compared with peak torque for each instrument., Results: Significant differences in peak torque (P < .0001), positive force (P < .002), and negative force (P < .0001) were found for ProTaper Next instruments overall. X2 showed the highest torque with all settings. X5 showed the highest positive force in all groups. X1 and X2 showed the highest negative forces for all groups except for 350 rpm/4 ins. Significantly lower torque (P < .0001) and positive force (P < .007) were measured in the group 350 rpm/4 ins for all instruments except for X4. In contrast, X1 showed a significantly lower negative force for 350 rpm/4 ins. Torque at failure according to American Dental Association no. 28/ISO 36030-1 was lower for X1, X2, and X3 than torque during simulated canal preparation (P < .0001)., Conclusions: Under the conditions of this study, using ProTaper Next at 350 rpm and with 4 in-and-out movements resulted in lowest levels of peak torque as well as positive and negative forces., (Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)