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Background/purpose: Reciprocating single-file systems are the latest nickel-titanium instruments and little information is available concerning the shaping ability of these new systems. Comparison of these single-file systems with well-known rotary multi-file systems is necessary. The purpose of this study was to compare the shaping ability of single-file system (WaveOne, WO) versus multiple-file system (ProTaper Next, PTN) in severely curved canals., Materials and Methods: A total of 20 severely curved canals were prepared with WO or PTN. Micro-computed tomography was used to scan the specimens before and after instrumentation. Differences between two groups in canal surface area, volume, Structure Model Index (SMI), thickness, straightening, the ratio of uninstrumented surface area and canal transportation were evaluated., Results: The outline of the canals after preparation showed smooth taper in both groups. Canal surface area, volume, SMI, Thickness and canal curvature were significantly increased after preparation in both groups, and no significant difference was found between groups. At apical third, canals prepared with WO showed larger values of transportation compared with those in PTN group in the direction of main curvature. Approximately 29-34% of the root canal surface remained uninstrumented after preparation and no significant difference was noticed between groups., Conclusion: Both of the two instrument systems maintained the original outline of the canals well. The canals prepared with PTN had less transportation and were better centered in the apical region.

Introduction: The purpose of this study was to compare the incidence of dentinal crack formation after root canal preparation using ProTaper Next, OneShape, and Hyflex electrodischarge machining (HEDM)., Materials and Methods: A total of 75 extracted mandibular premolars were selected. The root canals were instrumented using ProTaper Next, OneShape, and HEDM rotary files. All roots were horizontally sectioned at 3, 6, and 9 mm from apex with slow-speed saw under water cooling. The sections were observed under a stereomicroscope at ×25 to determine the absence or presence of crack. Data were analyzed using post hoc test and one-way ANOVA., Results: ProTaper Next and HEDM produced significantly less cracks than OneShape., Conclusion: Within the limitation of this in vitro study, it can be concluded that nickel-titanium instruments may cause cracks on the root surface. ProTaper Next and HEDM tend to produce less number of cracks as compared to OneShape., Competing Interests: There are no conflicts of interest.

Objective: The purpose of this study was to evaluate the impact of glide path preparation on the incidence of dentinal defects after preparation of severely curved canals using ProTaper Next, F6 SkyTaper, and One Shape instruments., Method and Materials: One hundred and forty human mandibular molars with mesiobuccal canals with angles of curvatures ranging between 25 and 35 degrees and radii ranging between 4 and 9 mm were assigned to seven homogenous groups (n = 20 teeth per group). In half of the teeth of each of the seven groups a manual glide path (size 15) was created prior to instrumentation. The root canals were instrumented using the three different types of instruments to an apical size 25. One group served as control as no canal preparation was performed. Roots were sectioned horizontally at 3, 6, and 9 mm from the apex and evaluated under a microscope using 25-fold magnification. The presence of dentinal defects (complete/incomplete cracks) was noted and analyzed using Fisher's exact test., Results: No defects were observed in the controls. All canal preparations created dentinal defects. More incomplete and complete cracks were found in the apical (n = 4) and the middle (n = 3) canal third than in the coronal (n = 1), without any significant differences between the three instruments (P > .05). Prior glide path preparation had no significant impact on the incidence of dentinal defects (P > .05)., Conclusion: A glide path preparation seems not to be mandatory to reduce the risk of dentinal defects formation when using the tested instruments in severely curved canals.

Aim: To determine the effect of photon-initiated photoacoustic streaming (PIPS) on the extrusion of debris using multiple-file (ProTaper Next-PTN) and single-file (One Shape-OS) continuous rotary systems in curved canals in human molar teeth., Methodology: Sixty extracted maxillary first molar teeth with curved mesial roots, mature apices and of similar lengths were selected. Teeth having canals with apical diameters larger than size 15 were discarded. The teeth were randomly divided into four experimental groups (n = 15 teeth per group) according to the file used and irrigation systems: (i) OS with PIPS with a 2940 nm Er:YAG laser (0.3 W, 15 Hz, and 20 mJ), (ii) OS with conventional needle irrigation (CNI) with a 27-G needle, (iii) PTN with PIPS and (iv) PTN with CNI. The PIPS and CNI was applied during each file change for 20 s. Total irrigation and activation time was 1 min, and a total volume of 7.5 mL of bidistilled water was used as the irrigant. The apically extruded debris was collected into pre-weighed Eppendorf tubes. The tubes were then stored in an incubator at 70 °C for 5 days. The weight of dry extruded debris was assessed by subtracting the initial weight of the tube from the final weight. The results were analysed statistically using one-way analysis of variance and Tukey's post hoc tests. Bonferroni correction was used to compare the groups., Results: The PIPS irrigation technique was associated with significantly more debris extrusion than the CNI system (P < 0.05). The single-file (One Shape-OS) rotary system was associated with more debris than the multiple-file (ProTaper Next-PTN) rotary systems when the same irrigation system was used (P > 0.05). The total amount of debris extruded apically by PIPS activation was significantly greater than that by CNI (P < 0.05)., Conclusions: All file and irrigation systems extruded debris apically. PIPS activation was associated with significantly more extrusion debris in curved canals compared with no activation., (© 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

Aim: The current study compared the fracture resistance of samples instrumented by two rotary files and a reciprocating file, obturated with gutta-percha and AH Plus., Materials and Methods: A total of 60 freshly extracted mandibular premolar teeth with single roots and single canals were acquired and decoronated at or below the cementoenamel junction. The samples were randomly divided into four groups ( n = 15). Group 1 control (noninstrumented/obturated), and for Groups 2-4 root canal instrumentation was done by EndoStar E5 (EE5), ProTaper NEXT (PTN), and WaveOne, respectively. Following instrumentation, the samples were obturated using gutta-percha cones and AH Plus sealer using lateral compaction. A week later, vertical load was applied to the specimen's canal in each group until fracture. The loads required for fracture were recorded and statistically analyzed., Results: The mean loads required to fracture (Newton; N) for the four groups were; 388.54 (±29.93), 310.35 (±26.05), 328.40 (±20.67), and 278.54 (±34.16). The loads exhibited highly significant difference ( P < 0.0001; analysis variance). The following Tukey's post hoc test confirmed, both samples in Groups 2 and 3 required similar loads for fracture ( P > 0.05) and significantly higher than Group 4 ( P < 0.01)., Conclusion: The samples instrumented by EE5 and PTN exhibit similar fracture resistance., Competing Interests: There are no conflicts of interest.

Aim: This study compared the efficacy of ProFile Vortex (PV) with that of ProTaper Next (PTN) for the removal of root canal filling material., Materials and Methods: Twenty-six mesial canals of extracted mandibular first molars were instrumented, obturated with gutta-percha and sealant, and randomly allocated to a PTN (X3, X2, or X1) or PV group. The percentage of remaining material, amount of dentin removed, and extent of transportation were assessed using micro-computed tomography. The total time required for removal of material was calculated., Results: Both systems were effective for material removal ( p  ≤ 0.001). Less time was required to remove material using PV (256.43 ± 108.95 s) than using PTN (333.31 ± 81.63 s; p  ≤ 0.05). PV and PTN files removed approximately 84% and 78% of the filling material, respectively ( p  > .05). There was no significant canal transportation in either group. PV and PTN files removed 1.32 ± 0.48 mm 3 and 1.63 ± 0.67 mm 3 of the dentin, respectively ( p  = .18)., Conclusion: Our findings suggest that PV is as effective as PTN for removal of root canal filling material. Therefore, PV can be considered for use in endodontic retreatment, although more effective files or techniques are still required.

Objectives: The aim of this study was to compare root canal volume change and canal transportation by Vortex Blue (VB; Dentsply Tulsa Dental Specialties), ProTaper Next (PTN; Dentsply Maillefer), and ProTaper Universal (PTU; Dentsply Maillefer) nickel-titanium rotary files in curved root canals., Materials and Methods: Thirty canals with 20°-45° of curvature from extracted human molars were used. Root canal instrumentation was performed with VB, PTN, and PTU files up to #30.06, X3, and F3, respectively. Changes in root canal volume before and after the instrumentation, and the amount and direction of canal transportation at 1, 3, and 5 mm from the root apex were measured by using micro-computed tomography. Data of canal volume change were statistically analyzed using one-way analysis of variance and Tukey test, while data of amount and direction of transportation were analyzed using Kruskal-Wallis and Mann-Whitney U test., Results: There were no significant differences among 3 groups in terms of canal volume change ( p > 0.05). For the amount of transportation, PTN showed significantly less transportation than PTU at 3 mm level ( p = 0.005). VB files showed no significant difference in canal transportation at all 3 levels with either PTN or PTU files. Also, VB files showed unique inward transportation tendency in the apical area., Conclusions: Other than PTN produced less amount of transportation than PTU at 3 mm level, all 3 file systems showed similar level of canal volume change and transportation, and VB file system could prepare the curved canals without significant shaping errors., Competing Interests: Conflict of Interest: No potential conflict of interest relevant to this article was reported.

Comparison of the ability of newly designed rotary files to eliminate viable Enterococcus faecalis populations from long oval root canals of extracted human teeth to that of the self-adjusting file (SAF). One hundred caries-free, single-rooted, long oval teeth were contaminated with E. faecalis. The teeth were randomly distributed into four groups (n = 25) as follows: G.1, manual; G.2, SAF; G.3, ProTaper Next; and G.4, BT-Race. Two microbial samples were obtained from each tooth with sterile paper points, (s1) before and (s2) after instrumentation. The relative reduction in colony-forming units (CFUs) from s1 to s2 measurements was calculated and compared among the groups using parametric Kruskal-Wallis one-way anova on ranks and Dunn's method (a = 0.05). The results indicated a descending order of the groups with regard to efficacy as follows: BT-Race, Next, SAF and manual. The statistical analysis showed that the relative percentage reduction (RR) of CFUs was lower in the manual group than in the other groups, while the SAF group showed a significantly lower RR than the BT-Race group (P < 0.05). The efficacy in reduction of the microbiological load of viable E. faecalis from long oval root canals was different between the tested endodontic systems., (© 2016 Australian Society of Endodontology Inc.)

Introduction: To assess the amount of debris extruded apically during instrumentation of distal canals of extracted primary molars by three instrument systems [ProTaper Universal (PTU), ProTaper NEXT (PTN), and self-adjusting file (SAF)] compared with conventional stainless steel hand K-files (HF, control)., Materials and Methods: Primary mandibular molars (n = 120) with a single distal canal were selected and randomly divided into four groups (n = 30) for root canal instrumentation using group I, HF (to size 0.30/0.02 taper), group II, PTU (to size F3), group III, PTN (to size X3), and group IV, SAF. Debris extruded during instrumentation was collected in preweighed Eppendorf tubes, stored in an incubator at 70°C for 5 days and then weighed. Statistical analysis was performed by one-way analysis of variance (ANOVA), followed by Turkey's post hoc test (p = 0.05)., Results: All the groups resulted in extrusion of debris. There was statistically significant difference (p < 0.001) in the debris extrusion between the three groups: HF (0.00133 ± 0.00012), PTU (0.00109 ± 0.00005), PTN (0.00052 ± 0.00008), and SAF (0.00026 ± 0.00004)., Conclusion: Instrumentation with SAF resulted in the least debris extrusion when used for shaping root canals of primary molar teeth., Clinical Significance: Debris extrusion in primary teeth poses an adverse effect on the stem cells and may also alter the permanent dental germ. Debris extrusion is rarely reported for primary teeth and it is important for the clinician to know which endodontic instrumentation leads to less extrusion of debris.

Introduction: To evaluate the incidence of microcrack formation canal preparation with two rotary nickel-titanium systems Mtwo and ProTaper Next along with the self-adjusting file system., Materials and Methods: One hundred and twenty mandibular premolar teeth were selected. Standardized access cavities were prepared and the canals were manually prepared up to size 20 after coronal preflaring. The teeth were divided into three experimental groups and one control group ( n = 30). Group 1: The canals were prepared using Mtwo rotary files. Group 2: The canals were prepared with ProTaper Next files. Group 3: The canals were prepared with self-adjusting files. Group 4: The canals were unprepared and used as a control. The roots were sectioned horizontally 3, 6, and 9 mm from the apex and examined under a scanning electron microscope to check for the presence of microcracks. The Pearson's Chi-square test was applied., Results: The highest incidence of microcracks were associated with the ProTaper Next group, 80% ( P = 0.00), followed by the Mtwo group, 70% ( P = 0.000), and the least number of microcracks was noted in the self-adjusting file group, 10% ( P = 0.068). No significant difference was found between the ProTaper Next and Mtwo groups ( P = 0.368) while a significant difference was observed between the ProTaper Next and self-adjusting file groups ( P = 0.000) as well as the Mtwo and self-adjusting file groups ( P = 0.000)., Conclusion: All nickel-titanium rotary instrument systems were associated with microcracks. However, the self-adjusting file system had significantly fewer microcracks when compared with the Mtwo and ProTaper Next., Competing Interests: There are no conflicts of interest.

Aim: This study was intended to evaluate the amount of apically extruded debris following root canal preparation with three different instrumentation systems., Materials and Methods: Sixty mandibular incisor teeth were selected and randomly divided into three groups ( n = 20/group) according to the instrumentation system used: the ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), the Twisted File Adaptive (TFA; SybronEndo, Orange, CA, USA), and the WaveOne Gold (WOG; Dentsply Maillefer, Ballaigues, Switzerland). All apically extruded debris was collected and dried in preweighed glass vials. The mean weight of the apically extruded debris was obtained using a microbalance. The time for root canal preparation was also recorded. The data were analyzed using a one-way analysis of variance., Results: The mean weights of apically extruded debris were 0.00035 ± 0.00014 g (PTN); 0.00023 ± 0.0001 g (TFA); and 0.00019 ± 0.0001 g (WOG) ( P < 0.01). The mean preparation time value was 301,13 ± 62.14 s (PTN); 234.27 ± 34.88 s (TFA); and 239.8 ± 58.6 s (WOG) ( P < 0.05)., Conclusions: The PTN system extruded more debris than the TFA and WOG systems. The TFA and WOG systems were faster than the PTN system., Competing Interests: There are no conflicts of interest.

Introduction: Maintenance of original canal anatomy with proper disinfection is our primary goal to achieve during root canal instrumentation. Surfactants are added to irrigating solution to promote deeper penetration into dentinal tubules., Aim: The aim of this study was to evaluate the influence of addition of surfactants to Sodium Hypochlorite (NaOCl) and Ethylenediaminetetraacetic Acid (EDTA) on transportation of root canal., Materials and Methods: Fifty human mandibular molars with mesial root curvatures of 10° - 40° were selected and embedded in silicone impression material to simulate mandibular arch form to facilitate imaging process and maintain reproducibility of images. Before instrumentation, root canals were scanned by using Cone Beam Computed Tomography (CBCT) imaging (Carestream, India). The canals were then prepared with the ProTaper Next (PTN) system (Dentsply Maillefer, Ballaigues, Switzerland), using one of the following irrigation regimens during the instrumentation and were divided into five groups based on irrigation regimens followed: G1 (n=10)-irrigation with saline solution(control); G2 (n=10)-irrigation with 2.5% NaOCl; G3 (n=10)-irrigation with 2.5% NaOCl added with surfactant; G4 (n=10)-irrigation with 17% EDTA; G5 (n=10)-irrigation with 17% EDTA added with surfactant. Post-instrumentation scans were obtained with similar parameters and position as pre-instrumentation scans by CBCT imaging. Transportation of the root canals were then analysed at three cross-sectional planes of pre-instrumentation and post-instrumentation images at 2 mm, 5 mm, 8 mm from the apical end of the root. The data was statistically analyzed using Analysis of Variance (ANOVA) and Tukey post hoc test (p<0.05)., Results: The mean transportation values were higher in G5. Transportation in G3 and G5 was not significantly different compared to G2 and G4 respectively (p<0.05)., Conclusion: Instrumentation using irrigating solutions added with surfactant like 1% cetrimide maintained the canal curvature well.

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.)

Aim: To assess and compare the mechanical properties of TRUShape (TRS) with several nickel-titanium rotary instruments., Methodology: Cyclic fatigue, torsional resistance, flexibility and surface microhardness of TRS (size 25, 0.06v taper), ProTaper Next X2 (PTN X2, size 25, 0.06 taper), ProTaper Gold (PTG F2; size 25, 0.08 taper) and ProTaper Universal (PTU F2; size 25, 0.08 taper) instruments were evaluated. The topographical structures of the fracture surfaces of instruments were assessed using a scanning electron microscope. The cyclic fatigue resistance, torsional resistance and microhardness data were analysed using one-way analysis of variance (anova) and Tukey's post hoc tests. The fragment length and bending resistance data were analysed statistically with the Kruskal-Wallis H-test and Mann-Whitney U-tests. The statistical significance level was set at P < 0.05., Results: PTN and PTG instruments revealed significantly higher resistance to cyclic fatigue than TRS and PTU instruments (P < 0.001). PTN instruments revealed significantly higher torsional resistance compared with the other instruments (P < 0.001). PTG instrument had significantly higher flexibility than the other tested brands (P < 0.05). However, for microhardness, the PTU had significantly higher surface microhardness values compared with other tested brands (P < 0.05)., Conclusions: TRS instruments had lower resistance to cyclic fatigue and lower flexibility compared with PTG and PTN instruments. TRS, PTG and PTU instruments had lower resistance to torsional stress than PTN instruments. TRS and PTG instruments had comparable surface microhardness., (© 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

Background: The technique of alternating rotation has been used with NiTi rotary instruments to increase the resistance to fracture compared with conventional continuous rotation. However, it is still not clear what type of instrumentation could provide better results in the preservation of the original canal anatomy., Aim: The aim of this study is to determine the influence of the type of rotation on canal transportation and centering ability using cone-beam computed tomography (CBCT) imaging., Materials and Methods: In total, 50 mesial canals of mandibular molars with curvatures between 30° and 60° were divided into two experimental groups ( n = 25 each) according to the type of movement employed with the ProTaper Next (PTN) instruments: Group A (alternating rotation) and Group B (continuous rotation). Canals were scanned before and after instrumentation using a CBCT scanner to evaluate root canal transportation and the centering ratio at 3, 5, and 7 mm from the apex. Data were analyzed statistically using Student's t -test; the significance level was set at P < 0.05., Results: There was no significant difference between the groups in canal transportation or the centering ratio at any of the three studied cross sections (3, 5, and 7 mm)., Conclusions: PTN instruments promoted minimal apical transportation and remained relatively centered within the root canal, with no significant difference between alternating and continuous rotation., Competing Interests: There are no conflicts of interest.

Aim: To compare the centring ability and transportation of ProTaper Next (PTN), ProTaper Universal (PTU), Race 123 and RevoS using micro-computed tomography (μCT)., Methodology: Sixty mesial root canals of thirty mandibular molars were divided virtually into coronal, middle and apical thirds, and two reproducible reference points were marked on the external surface of the roots creating 360 measurement points. Samples were randomly allocated to four NiTi instrumentation techniques. Group 1: PTU up to F2 (n = 16), group 2: PTN up to X2 (n = 18), group 3: Race 123 up to T2 (n = 12) and group 4: RevoS up to SU (n = 14). To reproduce a clinical situation, samples were prepared on a phantom head using a surgical operating microscope. Samples were scanned pre- and postoperatively using μCT to compare and calculate the transportation and centring ratio. The data were analysed using parametric statistics., Results: In the coronal and middle third of the root canals, there were significant differences in centring between PTN and PTU (coronal P < 0.001), PTN and RevoS (coronal P < 0.001), Race and PTU (coronal P < 0.01), Race and RevoS (coronal P < 0.01), PTN and RevoS (middle P < 0.01) and Race and RevoS (P < 0.05). Furthermore, there were significant differences in centring between PTN root canal preparations and other instruments in the apical third (PTN and PTU P < 0.01, PTN and Race P < 0.001, PTN and RevoS P < 0.001). In terms of transportation, in the coronal third, there was a significant difference between PTN and PTU (P < 0.05). However, there were no significant differences between the other instruments. In the middle third, significant differences were observed between PTN and PTU (P < 0.05), PTN and RevoS (P < 0.05), Race and PTU (P < 0.05) and Race and RevoS (P < 0.05). However, there were no significant differences between other systems. There was no significant difference in terms of transportation between the four systems in the apical third., Conclusions: ProTaper Next prepared more centred root canal shapes when compared with Race, PTU and RevoS. In the coronal and middle third of the root canals, the differences in centring between PTN and PTU/RevoS were significant. PTN root canal preparations were more centred than those achieved with all other instruments in the apical third., (© 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

Purpose: The aim of this study was to compare the cleanliness of root canal walls after retreatment using ProTaper Next (PTN), ProTaper Universal Retreatment (PTR) nickel-titanium (NiTi) systems and Hedström hand files in curved mesial canals of mandibular molar teeth and the time required for gutta-percha and sealer removal., Materials and Methods: Ninety mandibular molar teeth with curved mesial roots were instrumented up to #35.04 with Mtwo NiTi rotary instruments and obturated using the continuous wave of condensation technique. Removal of gutta-percha and sealer was performed using one of the following: PTN and PTR NiTi systems and Hedström hand files. Samples were placed on the VistaScan phosphor plates in the mesio-distal direction and the radiographs were taken. The digital radiographs were analyzed using AutoCAD software. Also, the total time required for gutta-percha removal was calculated by a chronometer., Results: The total retreatment time was significantly shorter in the PTN and PTR groups compared with the manual group (p<0.05). There was a significant difference between the groups according to the total residual gutta-percha and sealer (p<0.05). The PTN and PTR groups left significantly less gutta-percha and sealer remnant than the manual group (p<0.001)., Conclusion: Within the limitations of this study, the PTN and PTR groups showed less residual gutta-percha and sealer than the manual group. The NiTi rotary systems were significantly faster than the manual group in the time required for gutta-percha and sealer removal., Competing Interests: Conflict of interest: None declared.

Objectives: To compare the dimensions of gutta-percha (GP) cones of ProTaper Next (25/0.06) and WaveOne (25/0.08) in relation to their corresponding instruments of the same dimension, respectively., Materials and Methods: Two groups of GP cones were made with 25 cones in each group. Group 1 consisted of 25 GP cones # 25/0.06 (ProTaper Next). Group 2 consisted of 25 GP cones # 25/0.08 (WaveOne). Measurements were done at D1 (1 mm short of the tip), D3 (3 mm short of the tip), and D11 (11 mm short of the tip) for GP cones of both groups and were compared with their corresponding instruments., Results: Group 1 (ProTaper) 25/.06 GP points showed greater diameters than those of the corresponding instrument, which was statistically significant. Group 2 (WaveOne) 25/0.08 GP points showed greater diameters than those of the corresponding instrument which was statistically significant whereas it was nonsignificant at level D1., Conclusion: Diameters of both ProTaper Next and WaveOne GP cones were greater than their corresponding instruments. Hence, there are chances of under obturation with both systems., Competing Interests: There are no conflicts of interest.

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.)

Background. The aim of this study was to compare the dentinal defects caused by Reciproc, TF Adaptive and ProTaper Next NiTi rotary file systems during the retreatment procedure. Methods. A total of 150 mandibular incisors with straight and single root canals were included in the present study. All the root canals were prepared up to an apical diameter 0.40 mm using stainless steel files. Thirty teeth were randomly stored as the negative control group. A total of 120 specimens were obturated with gutta-percha and AH Plus sealer using vertical compaction technique. Thirty specimens with root canal filling were randomly separated for the only-filled group. Then the teeth were randomly divided into 3 groups; Reciproc, TF Adaptive and ProTaper Next. The retreatment procedure was performed with these NiTi files. Then 150 specimens were cut perpendicular to tooth axis at 3-, 6-, and 9-mm distances from the apex, and examined to determine the presence of any cracks at ×25 under a stereomicroscope. Chi-squared test was used at 5% significance level. Results. All the tested NiTi file systems were found to cause significantly more dentinal defects compared to unprepared and only-filled groups (P<0.05). No statistically significant differences were found between the groups in terms of dentinal defects (P>0.05). No correlation was found between the slice levels and the dentinal defect distribution (P>0.05). Conclusion. Within the limitations of present study, all the tested NiTi file systems were found to cause significantly more dentinal defects compared to unprepared and only-filled groups.

Aims: The aim of this study was to quantify the debris extruded apically from teeth using rotary and reciprocation instrumentation systems., Subjects and Methods: Eighty extracted human mandibular premolars with single canals and similar lengths were instrumented using ProTaper Universal (40, 06; Dentsply Maillefer, Ballaigues, Switzerland), ProTaper Next (40, 06; Dentsply Maillefer, Ballaigues, Switzerland), WaveOne (40, 06; Dentsply Maillefer, Ballaigues, Switzerland), and Reciproc (R40; VDW GmbH, Munich, Germany). Debris extruded during instrumentation was collected into preweighed Eppendorf tubes, which were then stored in an incubator at 70°C for 5 days. The final weight of the Eppendorf tubes with the extruded debris was calculated after obtaining the mean of three consecutive weights obtained for each tube., Statistical Analysis Used: Statistical analysis was performed using SPSS version 16.0 software. The groups were compared using the Kruskal-Wallis test for all variables., Results: There was no statistically significant difference between the groups ( P = 0.1114). However, the ProTaper Universal group produced more extrusion and ProTaper Next produced least debris extrusion among the instrument groups ( P > 0.05)., Conclusions: All instrumentation techniques were associated with extruded debris., Competing Interests: There are no conflicts of interest.

Aim: To investigate the influence of interrupted rotation on cyclic fatigue of two nickel-titanium rotary instruments., Methodology: Cyclic fatigue of 300 new ProTaper Next size X1; X2 and Mtwo size 10, .04 taper; size 15, .05 taper; size 20, .06 taper and size 25, .06 taper instruments was tested in continuous or interrupted rotation. Fifty files of the same brand and size were randomly assigned to five groups (n = 10). Group 1 instruments were tested in continuous rotation; groups 2 and 3 in paused rotation for 1 s every 10 or 20 s, respectively; groups 4 and 5 in interrupted rotation for 5 s every 10 or 20 s, respectively. Cyclic fatigue was expressed in time to fracture (TtF) in an artificial canal with 60° angle and 5 mm radius of curvature. The fracture surface was examined with a scanning electron microscope (SEM). Data were evaluated by two-way analysis of variance., Results: Cyclic fatigue of groups 2 and 4 of ProTaper Next X2 and Mtwo size 25, .06 taper was significantly lower than that of group 1 of the same instruments (P < 0.01). ProTaper Next X2 had significantly reduced cyclic fatigue in groups 3 and 5 (P < 0.05). No differences were found by interrupting the rotation for 1 or 5 s in all instruments (P > 0.05). Fatigue of other instruments was not affected by interrupted rotation (P > 0.05)., Conclusions: Interrupted rotation reduced cyclic fatigue resistance of ProTaper Next X2 and Mtwo size 25, .06 taper, especially when a higher number of interruptions was performed., (© 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

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.)

Aim: To evaluate the amount of apically extruded debris after root canal instrumentation with ProTaper Next and HyFlex instruments in curved root canals., Methodology: Forty extracted mandibular first molar teeth with curved mesial roots and of similar lengths were instrumented using ProTaper Next or HyFlex instruments. The extruded debris was collected into pre-weighed Eppendorf tubes. The tubes were stored in an incubator at 68 °C for 5 days. The tubes were weighed to obtain the final dry weight of the extruded debris. The weight of the extruded debris was determined by subtracting the initial weight from the final weight. Distribution of data was determined by Shapiro-Wilk test. Continuous variables were compared with the Independent Sample t-test or Mann-Whitney U-test. The significance level was set at P = 0.05., Results: Both instruments were associated with apical debris extrusion. The HyFlex group had significantly less debris extrusion than the ProTaper Next group (P = 0.014)., Conclusion: HyFlex CM was associated with significantly less apical extrusion than ProTaper Next., (© 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

Introduction: Success of any endodontic treatment depends on strict adherence to 'endodontic triad'. Preparation of root canal system is recognized as being one of the most important stages in root canal treatment. At times, we inevitably end up damaging root dentin which becomes a Gateway for infections like perforation, zipping, dentinal cracks and minute intricate fractures or even vertical root fractures, thereby resulting in failure of treatment. Several factors may be responsible for the formation of dentinal cracks like high concentration of sodium hypochlorite, compaction methods and various canal shaping methods., Aim: To compare and evaluate the effects of root canal preparation techniques and instrumentation length on the development of apical root cracks., Materials and Methods: Seventy extracted premolars with straight roots were mounted on resin blocks with simulated periodontal ligaments, exposing 1-2 mm of the apex followed by sectioning of 1mm of root tip for better visualization under stereomicroscope. The teeth were divided into seven groups of 10 teeth each - a control group and six experimental groups. Subgroup A & B were instrumented with: Stainless Steel hand files (SS) up to Root Canal Length (RCL) & (RCL -1 mm) respectively; sub group C & D were instrumented using ProTaper Universal (PTU) up to RCL and (RCL -1mm) respectively; subgroup E & F were instrumented using ProTaper Next (PTN) up to RCL & (RCL -1 mm) respectively. Stereomicroscopic images of the instrumentation sequence were compared for each tooth. The data was analyzed statistically using descriptive analysis by 'Phi' and 'Cramers' test to find out statistical significance between the groups. The level of significance was set at p< 0.05 using SPSS software., Results: Stainless steel hand file group showed most cracks followed by ProTaper Universal & ProTaper Next though statistically not significant. Samples instrumented up to 1mm short of working length (RCL-1mm) showed lesser number of cracks., Conclusion: All groups showed cracks formation, the stainless steel group being the highest. Working 1mm short of apex reduces the incidence of crack formation.

Aim: To compare the smear layer and debris removal in root canals instrumented with two different kinematic motions after ultrasonic and sonic irrigation activation., Materials and Methods: Eighty freshly extracted teeth were selected for the study and randomly divided the samples into two groups (n = 40) for instrumentation with either rotary ProTaper NEXT (PTN) or reciprocating WaveOne (WO) file systems. These (n = 40) were further divided into two groups (n = 20) where the final irrigant was activated using either Ultrasonics (Passive Ultrasonic Irrigation; PUI) or Sonics (EndoActivator; EA). Group 1: PTN + EA; Group 2: PTN + PUI; Group 3: WO + EA; and Group 4: WO + PUI. During instrumentation, a total of 4 ml of 5.25% NaOCl was used for irrigation. The final irrigation protocol included NaOCl and Smear Clear Solution. The samples were processed by scanning electron microscopic examination for debris and smear layer scoring, and statistical analysis was done., Results: The mean debris and smear layer score was less in the group instrumented by PTN with sonic activation of the irrigant., Conclusion: A combination of PTN instrumentation with sonic irrigation activation by EA is more effective in debris and smear layer removal in the groups tested.

Aims: The purpose of this study was to evaluate the resistance to torsional failure and cyclic fatigue resistance of ProTaper Next (PTN), WaveOne, and Mtwo files in continuous and reciprocating motion., Settings and Design: Randomized control trial in a tertiary care setting., Subjects and Methods: A total of 10 new size 25.06 taper PTN X2, 25.06 taper Mtwo files, and 25.08 taper WaveOne primary files each was selected. A custom fabricated cyclic fatigue testing device with a 70° angle of curvature and 3 mm width; curvature starting at 6 mm from the tip was used. All instruments were rotated and reciprocated till fracture occurred and time till fracture of each instrument was recorded in seconds. For torsional failure testing 5 mm tip of each file was embedded in composite resin block and uniform torsional stresses (300 rpm, 2.0 Ncm) were applied repetitively by an endodontic motor with auto stop mode until file succumbed to torsional failure. Number of load applications leading to failure was recorded., Statistical Analysis Used: Data were analyzed using t-test for equality of means, Pearson correlation, and ANOVA test., Results: All the files showed superior resistance to cyclic fatigue in reciprocating motion when compared with continuous rotation mode. WaveOne primary files displayed maximum resistance to cyclic fatigue both in continuous and reciprocating motion. WaveOne primary files also demonstrated maximum resistance to torsional failure followed by PTN with Mtwo files exhibiting least resistance., Conclusions: Operating files in reciprocating motion enhances their cyclic fatigue resistance. WaveOne files showed maximum resistance to cyclic fatigue and torsional failure due to their cross-sectional diameter coupled M-Wire technology.

Aim: In the present study, the effectiveness of three rotary and two manual nickel titanium instrument systems on mechanical reduction of the intracanal Enterococcus faecalis population was evaluated., Methods: Mandibular premolars with straight roots were selected. Teeth were decoronated and instrumented until 20 K file and irrigated with physiological saline. After sterilization by ethylene oxide gas, root canals were inoculated with Enterococcus faecalis. The specimens were randomly divided into five groups for canal instrumentation: Manual Nitiflex and Hero Shaper nickel titanium files, and rotary Hyflex CM, ProTaper Next, and K3XF nickel titanium files. Intracanal bacterial sampling was done before and after instrumentation. After serial dilution, samples were plated onto the Mitis Salivarius agar. The c.f.u. grown were counted, and log10 transformation was calculated., Results: All instrumentation systems significantly reduced the intracanal bacterial population after root canal preparation. ProTaper Next was found to be significantly more effective than Hyflex CM and manual Nitiflex and Hero Shaper. However, ProTaper Next showed no significant difference with K3XF., Conclusion: Canal instrumentation by all the file systems significantly reduced the intracanal Enterococcus faecalis counts. ProTaper Next was found to be most effective in reducing the number of bacteria than other rotary or hand instruments., (© 2014 Wiley Publishing Asia Pty Ltd.)

Aim: To compare the cyclic fatigue resistance of ProTaper Gold (PTG, Dentsply Tulsa Dental Specialities, Tulsa, OK, USA), ProTaper Next (PTN, Dentsply Tulsa Dental Specialities) and ProTaper Universal (PTU, Dentsply Tulsa Dental Specialities) instruments at different levels., Methodology: A total of 72 files were used to evaluate the cyclic fatigue of PTU (F2), PTN (X2) and PTG (F2) at 5 mm (n = 12) and 8 mm (n = 12) from the tip in 3-mm-radius steel canals with a 60° angle of curvature. The time to fracture was recorded. The Kolmogorov-Smirnov test was used to assess the normality of the samples distribution, and the statistical analysis was performed using the independent sample t-test (P < 0.01)., Results: Significant differences were found amongst the instruments 5 mm from the tip (P < 0.01). The PTG files had the highest CF resistance, and the PTN files displayed greater CF resistance than the PTU files. No significant differences were found between the PTG and PTN files 8 mm from the tip (P > 0.01). The PTG and PTN files demonstrated greater CF resistance than the PTU files (P < 0.01)., Conclusions: The PTG instruments were the most resistant 5 and 8 mm from the tip; however, at 8 mm, there was no difference between the PTG and PTN instruments. The PTU files had the lowest CF resistance at all levels., (© 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

Background: Complete cleaning of the root canal is the goal for ensuring success in endodontics. Removal of debris plays an important role in achieving this goal. In spite of advancements in instrument design, apical extrusion of debris remains a source of inflammation in the periradicular region., Aim: To comparatively evaluate the amount of apically extruded debris with V-Taper, ProTaper Next, and the self-adjusting File (SAF) system., Materials and Methods: Sixty-four extracted human mandibular teeth with straight root canals were taken. Access openings were done and working length determined. The samples were randomly divided into three groups: Group I - V-Taper files (n = 20), Group II - ProTaper Next (n = 20), Group III - SAF (n = 20). Biomechanical preparation was completed and the debris collected in vials to be quantitatively determined. The data obtained was statistically analyzed using ANOVA and post hoc Tukey's test., Results: All the specimens showed apical debris extrusion. SAF showed significantly less debris extrusion compared to V-Taper and ProTaper Next (P < 0.001). Among Groups I and II, ProTaper Next showed lesser debris extrusion as compared to V-Taper, but it was not significant (P = 0.124)., Conclusion: The SAF showed least amount of apical debris extrusion when compared to newer rotary endodontic instruments. This indicates that the incidence of inter-treatment flare-ups due to debris extrusion would be less with the SAF.

Objectives: The aim was to evaluate dentinal crack formation after root canal preparation with ProTaper Next system (PTN) with and without a glide path., Materials and Methods: Forty-five mesial roots of mandibular first molars were selected. Fifteen teeth were left unprepared and served as controls. The experimental groups consist of mesiobuccal and mesiolingual root canals of remaining 30 teeth, which were divided into 2 groups (n = 15): Group PG/PTN, glide path was created with ProGlider (PG) and then canals were shaped with PTN system; Group PTN, glide path was not prepared and canals were shaped with PTN system only. All roots were sectioned perpendicular to the long axis at 1, 2, 3, 4, 6, and 8 mm from the apex, and the sections were observed under a stereomicroscope. The presence/absence of cracks was recorded. Data were analyzed with chi-square tests with Yates correction., Results: There were no significant differences in crack formation between the PTN with and without glide path preparation. The incidence of cracks observed in PG/PTN and PTN groups was 17.8% and 28.9%, respectively., Conclusions: The creation of a glide path with ProGlider before ProTaper Next rotary system did not influence dentinal crack formation in root canals.

Background: Various root canal systems are available commercially with each manufacturer stating superior characteristics of their respective systems. Fifth generation root canal systems claim to have better flexibility and superior debris elimination due to their offset design. This study aims to compare the effects of fifth generation rotary systems on canal curvature, transportation and centering ratio of curved mesial root canals of mandibular molar via cone-beam computed tomographic (CBCT) imaging., Materials and Methods: A total of 60 mandibular first molars with an angle of curvature ranging from 20 to 40° of the mesiobuccal root were divided into three groups with 20 canals each. Before instrumentation, the groups were balanced with respect to the angle and radius of canal curvature based on CBCT images taken. All root canals were shaped to an apical size of 25: OneShape (OS) (Micro Mega, Besancon, France), ProTaper Next X2 (PTN) (Dentsply Maillefer), Revo S(RS) (Micro Mega, Besancon, France). CBCT assessment was done post instrumentation. SPSS version 16 software was used for statistical analysis. The significance level was set at P = 0.05., Results: The OS system maintained better canal centricity and less transportation as compared to PTN and RS. There was no significant difference among the three groups in canal curvature after instrumentation., Conclusions: All file systems used straightened the root canal curvature similarly. OS instrumentation exhibited superior performance compared with the RS and PTN systems with respect to transportation and centering ratio.

Objectives: The aim of this study was to compare the amount of apically extruded debris during preparation with ProTaper Universal (Dentsply Maillefer, Ballaigues, Switzerland), ProTaper Next (Dentsply Maillefer), a reciprocating single-file (WaveOne; VDW GmbH, Munich, Germany), and a self-adjusting file (SAF; ReDent Nova, Ra'anna, Israel)., Materials and Methods: Fifty-six intact mandibular premolar teeth were randomly assigned to four groups. The root canals were prepared according to the manufacturers' instructions using the ProTaper Universal, ProTaper Next, WaveOne, and SAF. Apically extruded debris was collected in preweighted Eppendorf tubes during instrumentation. The net weight of the apically extruded debris was determined by subtracting the preweights and postweights of the tubes. The data were statistically analyzed using the one-way analysis of variance and the least significant difference tests at a significance level of P < 0.05., Results: A measurable amount of debris was apically extruded in all groups, and the amounts of debris extrusion in the groups were statistically significant (P < 0.001). The ProTaper Next and WaveOne groups resulted in less debris extrusion than the ProTaper Universal group (P < 0.05), and the SAF group resulted in the least debris extrusion., Conclusions: Within the limitations of the present study, it can be concluded that all systems extruded debris beyond the apical foramen.