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Aim: The aim of this study was to compare and evaluate the severity of PEP using ProTaper Gold (PTG), ProTaper Next (PTN), and F-One rotary files in single-visit endodontic (SVE) treatment. Materials and Methods: In a randomized factorial clinical trial, 150 patients indicated for endodontic treatment in maxillary molars and mandibular molars were selected. They were separated into three groups: Group 1 (PTG), Group 2 (PTN), and Group 3 (F-One). SVE treatment was done under local anesthesia. The intensity of PEP was assessed using the Visual Analog Scale (VAS) after 24, 48, 72 h, and 1 week. Finally, the data were tabulated and statistically analyzed using SPSS software. VAS was analyzed using analysis of variance test with Scheffe's post hoc test. Results: PEP was less in Group 3 (F-One) and Group 2 (PTN) as compared to Group 1 (PTG) at 24.48 h which is statistically significant (P < 0.05), whereas the difference between PTN and F-One was statistically insignificant. Conclusion: All file systems showed PEP, but the intensity of pain was minimum in F-One single rotary file system followed by PTN and PTG Multi-file systems.

Objectives: This study was aimed to evaluate the cause-effect relationship between canal preparation with ProTaper Next (PTN) and ProTaper Gold (PTG) using optimum torque reverse (OTR) motion or continuous rotation and dentinal crack formation. Materials and Methods: Fifty distobuccal roots of human maxillary first molars were divided into five groups; Group I: PTG Full rotation, Group II: PTG in OTR, Group III: PTN Full rotation, Group IV: PTN in OTR, Group V: unprepared (control group). After mechanical preparation, the distobuccal roots were sectioned horizontally at 3, 6, and 9 mm from the apex. Images were captured using a stereomicroscope at 25X to determine the presence or absence of dentinal cracks. Friedman test was used to compare between root sections followed by Wilcoxon signed-rank test for pairwise comparison. Kruskal–Wallis test was used to compare between tested rotary systems followed by pairwise comparison with Dunn Bonferroni correction (α = 0.05). Results: Crack development was significantly higher in PTG using OTR motion 36.7% followed by PTN using OTR 33.3%, while the control group showed no cracks. PTG and PTN with full rotation showed crack development with 23.3% and 13.3%, respectively. Conclusions: The type of motion kinematics used during mechanical preparation have an impact on dentinal crack formation. Nickel-titanium instruments with larger taper tend to induce more cracks.

Aim: The aim of the study is to evaluate and compare the quantity of apical debris extrusion from the root canals during biomechanical preparation by various rotary (reciprocating, Protaper Next [PTN] continuous) and manual hand filing system and by means of Crown-Down and Step Back techniques. Materials and Methods: Eighty mature, human mandibular premolars with single canals were randomly divided into four groups of twenty teeth each. Each group was instrumented using one of the four instrumentation systems: Group A: WaveOne, Group B: PTN, Group C: Hand file with Crown Down, Group D: Hand file with Step Back. Extruded debris was collected in preweighed Eppendorf tubes and the extruded irrigant was evaporated. The weight of the dry extruded debris was established by comparing the pre and post-instrumentation weight of Eppendorf tubes for each group. Results: Mean comparison of groups in different instrumentation by ANOVA presented that hand file with Step-Back technique is showed maximum amount of apical extrusion debris and continuous rotary file system showed the minimum amount of extrusion debris (P < 0.001). Conclusions: The current ex vivo study demonstrated reciprocating single file WaveOne and continuous rotary multiple file system lead to significantly less debris extrusion than manual hand file techniques. Reciprocating single file WaveOne extruded more debris than continuous rotary PTN multiple file system. More amount of debris was extruded in the group with Step-Back hand filing than Crown-Down technique.

Background: During the biomechanical preparation of the root canal by rotary file systems, stress is generated within the canal, which leads to dentinal microcrack formation. Such defects are evaluated only under the microscope. Aim: The present study aimed to evaluate dentinal microcrack formation after instrumentation with ProTaper Next (M-wire), Revo S (conventional NiTi), and WaveOne Gold (Gold-wire) file systems under the stereomicroscope. Materials and Methods: Forty single-rooted teeth free from any defect were selected and divided into four groups (Control, PTN, RS, and WOG). Experimental groups were instrumented with file system used in the study, and the control group were left unprepared. Samples were further decoronated and sectioned at 3 mm, 6 mm, and 9 mm from the apex perpendicular to the long axis and examined under a stereomicroscope at ×25 for different types of microcracks (no fracture, complete fracture, partial fracture, and other fracture). Statistical Analysis Used: Data analysis was done by the Chi-square test using the SPSS version 17.0 software. A two-sided (α = 2) P < 0.05 (P < 0.05) was considered statistically significant. Results: The null hypothesis was rejected. There was a statistically significant difference between the groups. All file systems created microcracks in the root dentin. WOG group showed an incidence of 66.7% for no fracture, PTN group had 40% for other fracture, and RS group had 60% for complete fracture. Conclusion: Single file system WOG with gold wire technology proves to be the best choice for canal preparation among the tested groups in terms of least dentinal crack formation.

Aim: The present study aimed to evaluate and compare the microcrack formation in apical root dentin as a result of root canal preparation with different nickel–titanium (NiTi) rotary systems. Materials and Methods: Sixty extracted mandibular premolar teeth with single canals were used. Apical 1 mm of roots was flattened perpendicular to the tooth axis. Forty-five teeth were prepared using ProTaper Next (PTN), ProTaper Gold (PTG), or TruNatomy files. Fifteen teeth were left unprepared as the negative control group. Images of apical surfaces of roots were obtained using a stereomicroscope at × 20 magnification. The presence of microcracks was noted with the help of the images. The data were analyzed with a Chi-square test using MiniTab 17 Statistical Software. Results: There was a statistically significant difference between the PTN and TruNatomy groups (P < 0.05). There was no statistically significant difference between the PTG group and other groups (P > 0.05). Conclusion: Whereas all rotary files created microcracks in the apical root dentin, TRN caused fewer microcracks than other NiTi rotary systems.

Aim: The aim is to compare the apical extrusion of debris during endodontic instrumentation with continuous rotation and reciprocating motion. Materials and Methods: Sixty extracted single-rooted mandibular premolar human teeth were randomly assigned to four groups of 15 teeth each. The canals were then instrumented with the following instrument systems: ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), 2Shape (TS; MicroMega, Besancon, France), Reciproc Blue (RB; VDW, Munich, Germany) and WaveOne Gold (WOG; Dentsply Sirona, Ballaigues, Switzerland). Apically extruded debris during instrumentation was collected into pre-weighed Eppendorf tubes. The Eppendorf tubes were then stored in an incubator at 70°C for 5 days. The weight of the dry extruded debris was established by subtracting the pre-instrumentation weight from postinstrumentation weight of the Eppendorf tubes. The data were analyzed using one-way analysis of variance and Tukey's Post hoc tests. Results: Among the instruments tested in the present study, the least amount of extrusion of debris was seen with TS rotary file system (Group IA) followed by RB (Group IIA) and WOG (Group IIB) (P < 0.05), the results, however, were not found to be statistically significant between them. The maximum amount of debris extrusion was observed with PTN (Group IB) with a statistically significant difference when compared to TS, RB, and WOG file system (P > 0.05). Conclusion: All instruments were associated with apical extrusion of debris with TS rotary file system associated minimum extrusion and PTN, resulting in maximum extrusion of debris.

Aim: This study aims to evaluate and compare the canal transportation and centering ability of two nickel–titanium file systems, ProTaper Next and WaveOne Gold, in comparison with ProTaper Universal in mesiobuccal canals of maxillary molars using micro-computed tomography. Materials and Methods: Seventy-five permanent maxillary first and second molars having mesiobuccal canals with curvatures between 20° and 30° were selected and subjected to pre-operative micro-computed tomographic scans. They were then divided into three groups (n = 25) based on the file system to be tested: Group 1-ProTaper universal (control), Group 2: ProTaper Next, and Group 3-WaveOne Gold. Access cavities were prepared, following which each specimen was instrumented using the specific file system. Post-instrumentation micro-computed tomographic scans were then carried out for each specimen. Pre- and post-instrumentation measurements of mesiobuccal canals were performed using the ImageJ 1.8.0 software. Canal transportation and centering ratio were calculated at three cross-section levels that corresponded to 3-mm, 6-mm, and 9-mm distance from the apical end of the root. The data obtained were then subjected to statistical analysis using ANOVA and Tukey's post-hoc tests. Results: It was seen that WaveOne Gold caused the least overall canal transportation and exhibited the highest centering ability, followed by ProTaper Next and ProTaper Universal, though the difference was not significant. Furthermore, there was no significant difference between the canal transportation and centering ability of ProTaper Universal, ProTaper Next, and WaveOne Gold at all three levels. Conclusion: None of the systems evaluated exhibited perfect centering ability and zero canal transportation. All file systems caused root canal transportation and minor changes in the root canal anatomy.

Background: Under axial loading, there is stress concentration around the cervical areas especially in the premolars because of their location in the arch. Aim: To evaluate and compare flexural fracture resistance of mandibular premolars after instrumentation with ProTaper®Universal, ProTaper Next®, OneShape®, and WaveOne® endodontic file systems. Methods: Seventy-five mandibular premolar teeth with single straight canals were divided into five different groups (n = 15): Group A: Control, Group B: ProTaper Universal (PTU), Group C: ProTaper Next (PTN), Group D: OneShape, Group E: WaveOne. The teeth were instrumented as per the manufacturer's instructions. After obturation and core placement, the teeth were placed in a customized jig mounted on a universal testing machine where force was applied at 45° on the buccal cusp and the force required to fracture the teeth was noted. Results: Amongst all the instrumented groups, WaveOne showed the highest resistance to fracture (1065.56 ± 175.05) and the control group was 1104.13 ± 188.42. All groups showed a significant difference in the fracture load values with the control group. However, there was a statistically significant (P < 0.05) difference seen with WaveOne vs PTU and WaveOne vs OneShape. Conclusions: Root canals instrumented with reciprocating motion have better flexural fracture resistance than continuous rotary motion. Mandibular premolars when instrumented with ProTaper Universal and OneShape endodontic files showed similar fracture resistance, proving that dentin removal does not depend on the number of files used.

Aim: This study aimed to comparatively evaluate the influence of working length (WL) determined by three different electronic apex locators (EALs) on the apical extrusion of debris following the instrumentation with a rotary NiTi instrumentation system. Methodology: Forty extracted human maxillary or mandibular premolar teeth with single root and canal were selected. Standardized access cavities were prepared, and the samples were divided into four groups according to the method used to determine the WL: Group I (n = 10) – actual working length (AL), Group II (n = 10) – Root ZX mini, Group III (n = 10) – CanalPro™, and Group IV (n = 10) – Propex Pixi™. Each specimen was held in a test apparatus to evaluate the apical extrusion of debris during instrumentation. Instrumentation of all the specimens was done using ProTaper Next till the size X3. The apically extruded debris was collected and calculated by subtracting the initial weight of the tube from the weight of the tube containing dried debris. The apically extruded debris weight score was calculated and tabulated and was subjected to statistical analysis using one-way ANOVA and post hoc Tukey test. Results: Group II and Group III exhibited similar results and exhibited significantly less apical extrusion of debris compared to Groups I and IV. Conclusion: WL determined by EAL (Root ZX mini and CanalPro) showed lesser apical extrusion of debris than AL determination.

Context: The presence of smear layer and debris can prevent the irrigant and sealer from penetrating the dentinal tubules thereby compromising the seal of the root canal filling. Aim: This study aims to evaluate the efficacy of XP-endo Finisher with ProTaper Next and HyFlex in smear layer and debris removal. Materials and Methods: Thirty-two extracted mandibular premolar teeth were selected and sectioned at the cementoenamel junction. The roots were then randomly divided into 4 groups. In group 1 and 2, canals were instrumented with X2 ProTaper Next (25 0.06 taper). In group 3 and 4, canals were instrumented with HyFlex system (25 0.06 taper). The canals in group 2 and 4 were further finished with XP-endo Finisher. Irrigation was carried out using 3% sodium hypochlorite during instrumentation, and 17% ethylenediaminetetraacetic acid was used as the final rinse. The roots were then split longitudinally. The canal wall was observed under the scanning electron microscope in coronal, middle, and apical thirds at a magnification of ×400 and ×1000 for evaluation of debris and smear layer, respectively. Photomicrographs were taken, and qualitative assessment for debris and smear layer removal was done. Statistical Analysis Used: The results were analyzed using Kruskal–Wallis test and Mann–Whitney U-test. Results: Lower debris and smear layer scores were seen in canal thirds instrumented with ProTaper Next and XP-endo Finisher (P < 0.01). Conclusion: The use of XP-endo Finisher as an adjuvant during shaping and cleaning produced cleaner root canal walls.

Aim: The aim of this study is to compare canal transportation and centering ratio using of Protaper Next (PTN) (Dentsply Maillefer, Ballaigues, Switzerland) and Revo-S (RS) (MicroMega, Besancon Cedex, France) compared to Protaper Universal (PTU) (Dentsply Maillefer, Ballaigues, Switzerland) nickel-titanium rotary file systems in curved root canals using cone-beam computed tomography. Materials and Methods: Ninety maxillary mesiobuccal first molar uncalcified canals with mature apex, curvature of 20°–45° (the Estrela method) and minimum 20-mm length were selected. The samples were randomly divided into three groups of 30 teeth each, respectively, Group I PTU, Group II PTN, and Group III RS Rotary systems and Instrumented according to the manufacturers' instructions. Pre- and post-instrumentation cone-beam tomographic scan was performed in same position to calculate canal transportation and centering ability at 2 mm, 5 mm, and 8 mm from the root apex. Statistical analysis was performed with ANOVA and Post-hoc Tukey test. Results: PTU had maximum mean canal transportation and minimum mean centering ratio at all levels, whereas PTN showed minimum mean canal transportation and maximum mean centering ratio. The results were statistically significant. Conclusions: In terms of canal transportation and centering ratio in the middle and coronal third of the root, PTN and RS performed better than PTU. However, in apical third, PTN performed best among all other groups.

Aim: The aim of the study was to evaluate the effect of different irrigation solutions on cyclic fatigue of ProTaper Next (PTN) rotary files. Materials and Methods: A total of 50 files were divided into 5 groups according to the environment in which cyclic fatigue test was carried out as follows: chlorhexidine (CHX) 2%, ethylenediaminetetraacetic acid 17%, saline, sodium hypochlorite 6%, and air (control group). A specially designed testing device was assembled utilizing an artificial canal made of a heat-resistant glass tube. The tube had a 1.2 mm diameter, an angle of curvature of 60°, and a radius of curvature 6 mm. Before each fatigue test, the tube was filled with fresh irrigation solution except air group, which was left dry. The mean number of cycles to failure was counted then fractography and length of broken segment were analyzed after failure. Statistical analyses were performed using one-way ANOVA test. Results: The CHX group was the most resistant to cyclic fatigue compared to all groups (P < 0.05). No significant difference was found between all other solutions or dry group (P > 0.05). Fractographic analysis of all groups showed signs of a fatigue failure. A crack site was seen followed by a striation area leading to a dimples overload area. The length of broken segments was not significantly different among all groups (P = 0.37). Conclusion: Although liquid media may function as lubrication, all irrigants except CHX failed to increase the fatigue life of PTN files when compared to dry conditions.

Introduction: Root canal preparation may cause inadvertent apical extrusion of debris causing postoperative pain. This debris varies with the instrumentation technique and design characteristics. One of the major revolutions in the design of the instruments is the introduction of files with an offset center of mass or/and rotation, which causes asymmetric rotary motion in the canal. An example is the ProTaper Next (PTN) rotary file system. In vitro studies have shown that this system extrudes lesser debris than more commonly used ProTaper Universal (PTU). However, in clinical circumstances, periapical tissues may act as a natural barrier and host immune response may affect the response. Hence, the aim of the present study was to evaluate and compare the postoperative pain after single visit endodontic treatment using PTU and PTN rotary file systems. Study Design: A total of 80 patients were assigned to two groups according to the root canal instrumentation technique used, PTU or PTN. Root canal treatment was carried out in a single appointment, and the severity of postoperative pain was assessed using visual analog scale score after 6, 24, 48, and 72 h. The association of variables (age and sex) and root canal preparation time were also evaluated and compared between the groups. Results: Postoperative pain was significantly higher in PTU group than PTN group. The highest pain was observed at 6 h interval which reduced with each time with no pain at 72 h interval in both the groups. Significantly, more amount of time was involved with PTU as compared to PTN. A significantly higher pain was observed with advancing age and in females. Conclusion: The postoperative pain was significantly higher in patients undergoing canal instrumentation with PTU rotary instruments as compared to the PTN rotary instruments.

Aim: The aim of this study was to compare the canal transportation and canal centering ability in the preparation of curved root canals after instrumentation with V-Taper 2H, ProTaper Next (PN), and Hyflex CM files using cone-beam computed tomography (CBCT). Materials and Methods: Thirty mesiobuccal canals of mandibular molars with an angle of curvature ranging from 20 to 40 were divided according to the instrument used in canal preparation into three groups of ten samples each: V-Taper 2H (Group 1), PN (Group 2), and Hyflex CM (Group 3). The teeth were instrumented according to manufacturer's guidelines up to 30 no. apical preparation. Canals were scanned using a CBCT scanner before and after preparation to evaluate the transportation and centering ratio at 3 mm, 6 mm, and 9 mm from the apex. The amount of transportation and centering ability was assessed. The three groups were statistically compared with analysis of variance and post hoc Tukey test. Results: All instruments maintained the original canal curvature with significant differences between the different files. Data suggested that V-Taper 2H files presented the best outcomes for both the variables evaluated. V-Taper 2H files caused lesser transportation and remained better centered in the canal than PN and Hyflex CM files. However, it was seen that PN caused less transportation in apical level than Hyflex CM. Conclusion: The canal preparation with V-Taper 2H showed lesser transportation and better centering ability than PN and Hyflex CM.

Aim: This study aims to evaluate and compare the incidence of dentinal defects induced by Hand Files, HyFlex CM, ProTaper Next (PTN), and One Shape during canal preparation. Materials and Methods: One hundred and fifty extracted mandibular premolar teeth with single root canal were selected. Specimens were then divided into five groups with thirty specimens each. Group I: Specimens were prepared with hand instruments. Group II: Specimens were prepared with HyFlex CM rotary files (Coltene) using a crown-down technique according to the manufacturer's instructions. Group III: Specimens were prepared with PTN rotary files (Dentsply) using a crown-down technique according to the manufacturer's instructions. Group IV: Specimens were prepared with One Shape Single file rotary system (MicroMega) using a crown-down technique according to the manufacturer's instructions. Group V: Specimens were used as a control and left unprepared. All roots were cut horizontally at 3, 6, and 9 mm from the apex. Sections were then viewed under stereomicroscope and dentinal defects were registered as “no defect,” “fracture,” and “other defects.” Statistical Analysis: Results of the study were subjected to Chi-square test. Results: Results were expressed as the number and percentage of defected, partially defected and roots with no defects in each groups. Conclusion: Hand files and One Shape file system caused less root defects compared to PTN and HyFlex file systems.