Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, Rome, Italy
Introduction
The aim of the present study is to evaluate the torsional resistance and the operative torque of two different files and to introduce the concept of “torque range”, that indicates the difference between torque at failure and operative torque.
Materials and Methods
20 ProTaper Next® (PTN) X1 and 20 EdgeFile® X7 17.04 were randomly divided into two equal groups (n = 10) and were subjected to the following two tests: operative torque recorded during root canal shaping of a single-rooted mandibular premolar and a torsional test performed at 300 rpm while the apical 3 mm of each file were firmly secured. The torque range was calculated from the difference between “Operative torque” and “torque at fracture.” A statistical t-test was performed to determinate the difference. Statistical significance was set at P < 0.05.
Results
EdgeFile X7 instruments reached the working length significantly faster and with less torque generated (P < 0.05) compared to PTN. In torsional static resistance (torque at failure), the two files demonstrated no significant different values (P > 0.05). The range between the mean values of maximum torque at failure and operative torque, “torque range,” was twice bigger for EdgeFile X7 instruments.
Conclusions
The EdgeFile X7 has a wider “torque range” when compared to PTN X1. This new concept could be a relevant innovation to match in vivo and in vitro studies and to obtain a more clinically relevant result.
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 (mm3). 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.
Objectives
This in vivo study evaluated the operative torque and preparation time of ProTaper NEXT (Dentsply Maillefer; Ballaigues, Switzerland) and EdgeFile X7 (EdgeEn-do; Albuquerque, New Mexico, United States) rotary systems during root canal prepa-ration of maxillary premolars.
Materials and Methods
Ten double-rooted maxillary premolars with independent canals were selected. Each canal in each tooth was prepared with one of the rotary systems (n = 10), ProTaper NEXT or EdgeFile X7. The instruments were rotated at 300 rpm with maximum torque set at 2 N.cm using an electric motor (KaVo; Biberach, Germany) that automatically recorded torque values at every 1/10th of a second (ds).
Statistical Analysis
Operative torque (N.cm) and preparation time (s) of the first shaping instrument (size 17/.04) of both rotary systems were recorded and statistical-ly compared using the Mann– Whiney U test with a significance level set at 5%.
Results
No instrument exhibited flute deformation or underwent intracanal fail-ure. No differences were found between the instruments regarding the maximum (peak) torque values (p > 0.05). EdgeFile X7 17/.04 required significantly less prepa-ration time (3.75 seconds interquartile range [IQR]: 3.2–9.0) than ProTaper NEXT X1 (15.45 seconds IQR: 8.35–21.1) (p < 0.05). The median operative torque values of Pro-Taper NEXT X1 (0.26 N.cm; IQR: 0.18–0.49) were significantly higher compared with EdgeFile X7 17/.04 (0.09 N.cm; IQR: 0.05–0.17) (p < 0.05).
Conclusions
Although no difference was found between the median peak torque values of ProTaper NEXT X1 and EdgeFile X7 17/.04 instruments, the operative torque and instrumentation time results were impacted by their different designs and alloys during clinical preparation of root canals.
Click Here for Full Article: In Vivo Evaluation of Operative Torque Generated by Two Nickel-Titanium Rotary Instruments during Root Canal Preparation
This study explores how heat treatment less significantly influences (increasing or decreasing) torsional resistance when compared to the high increase in flexibility and fatigue resistance reported in many published articles. Moreover, torsional fracture occurs extremely rapidly when an instrument’s tip becomes blocked.
Introduction
The main mechanisms of nickel-titanium (NiTi) endodontic instrument fracture have been revealed as two modes of failure, one being torsional failure and the other cyclic fatigue. The former contributes to a significant proportion of failures.1 Cyclic fatigue fracture is caused by repetitive compressive and tensile stresses on the outermost fibres of a file rotating in a curved root canal, and torsional failure occurs when the tip of the instrument binds to the canal wall, even in a straight root canal.1
Cyclic fatigue resistance of NiTi instruments has been assessed extensively.2 In contrast, there is less information available on torsional fracture resistance tests.3 The main method of testing for static rotational fracture is the comparison of the torsional resistance of the instruments as described by ISO 3630-1. According to this specification, the 3 mm file tip must be fixed with brass and a rotational speed of 2 rpm applied to create a continuous torsional load until fracture occurs.3
Torsional load can be limited during intra-canal rotary instrumentation by the torque-controlled endodonticmotor: torque settings can be selected to prevent excessive torsional load on the instruments. It has been shown that the correct preset torque value for each instrument is very difficult to determine.4 If it is too high, safety becomes dependent on the clinician’s skill in avoiding over-engagement and/or blockage of the file. If it is too low, the rotary instrument will be loaded by repeated locking and release through use of the torque-controlled motor or auto-reverse function. However, in narrow canals, where instruments are subject to higher torsional stresses than in wider canals, the chance of experiencing these repetitive torsional loads is increased.
To this point, torque value at failure according to the ISO test has not been commonly used to determine torque settings in torque-controlled motors. In most cases, values are higher than torque at failure. As a consequence, the concept that the use of a preset torque value that is considered safe (i.e. capable of preventing shear fracture of the instrument) is not completely accurate. Therefore, NiTi rotary instruments should ideally exhibit a good resistance to torsion in all cases and in curved canals should also be flexible and resistant to cyclic fatigue.
Many factors can affect resistance to torsion, including design, dimensions, manufacturing process and motion.5 In the present study, two NiTi rotary instruments, similar in dimensions and design, were tested to compare torque at failure. The null hypothesis was that any differences found would be related to different manufacturing processes.
Methodology
The following instruments from two different systems were tested and compared: ProTaper Next (Dentsply Maillefer) and EdgeFile X7 (EdgeEndo). For each brand, ten 17/0.04 instruments were subjected to a repetitive torsional test. The test was performed using a torque-controlled endodontic motor (MASTERsurg, KaVo). The motor allowed for precise recording of torque values during the instruments’ use. The accuracy and reliability of the device had been validated in a previous study.6 To perform the test, the apical 3 mm of each file was firmly secured, embedded in a resin block produced with a mixed autopolymerising resin (DuraLay, Reliance Dental Manufacturing). Each file was then rotated clockwise at a speed of 300 rpm until fracture occurred. The torque limit was set at 5.5 N cm, to ensure recording measurements ranging from 0.1 to 5.5 N cm. The torque values at failure were recorded by the integrated software of the motor and analysed using spreadsheet software. The data was analysed using one-way analysis of variance and a Tukey test with a significance level of α = 5%.
Results
Table 1 shows the results from the present study. The ProTaper Next files demonstrated no significantly different levels of resistance in terms of maximum torque at failure compared with the EdgeFile X7 instruments (p < 0.05). Similarly, no statistically significant differences were found between the two instruments in terms of time to failure (p < 0.05).
Table 1: torque at failure (N/cm)
Maximum torque (SD )
Time to failure ( seconds)
Edge ENDO X7
0, 57 (± 0,1)
0,42 (± 3,5 )
Protaper Next
0,51 (± 0,1)
0,39 (± 2,9)
Discussion
The ISO torsional resistance static test was developed more than 50 years ago to test manual stainless-steel instruments and is probably not ideal for testing rotary instruments that rotate at speeds much higher than 2 rpm or for the specific motors with torque control and auto-reverse mode.7 Therefore, in the present study, torsional resistance was assessed by using a different speed: the clinical speed (300 rpm).
The tested instruments were similar in dimension and design but had been produced through different manufacturing processes (alloys and heat treatments). According to the manufacturer’s website, EdgeFile X7 files exhibit a higher flexibility and a greater resistance to cyclic fatigue than competitors’ instruments do. In stainless-steel instruments, flexibility and torsional resistance are usually inversely proportional, which is mainly due to the mass and/or dimensions of the instruments. The greater the mass, the more rigid and resistant to static torsion the instrument is.8 In the present case, mass and dimensions were very similar, and torsional resistance was similar, showing no statistically significant difference between the two instruments. The null hypothesis was therefore rejected.
Hence, the present study showed that heat treatment does not significantly influence torsional resistance in contrast to the high increase in flexibility and fatigue resistance derived from heat treatment as reported in many published articles.9, 10
References:
Sattapan B, Nervo GJ, Palamara JE, Messer HH. Defects in rotary nickel-titanium files after clinical use. J Endod. 2000 Mar;26:161–5.
Plotino G, Grande NM, Cordaro M, Testarelli L, Gambarini G. A review of cyclic fatigue testing of nickel-titanium rotary instruments. J Endod. 2009 Nov;35(11):1469–76.
Pedullà E, Grande NM, Plotino G, Gambarini G, Rapisarda E. Influence of continuous or reciprocating motion on cyclic fatigue resistance of 4 different nickel-titanium rotary instruments. J Endod. 2013 Feb;39(2):258–61.
Gambarini G. Advantages and disadvantages of new torque-controlled endodontic motors and low-torque NiTi rotary instrumentation. Aust Endod J. 2001 Dec;27(3):99–104.
Xu X, Eng M, Zheng Y, Eng D. Comparative study of torsional and bending properties for six models of nickel-titanium root canal instruments with different cross-sections. J Endod. 2006 Apr;32(4):372–5.
Gambarini G, Seracchiani M, Piasecki L, Valenti Obino F, Galli M, Di Nardo D, Testarelli L. Measurement of torque generated during intracanal instrumentation in vivo. Int Endod J. 2019 May;52(5):737–45.
Pedullà E, Lo Savio F, La Rosa GRM, Miccoli G, Bruno E, Rapisarda S, Chang SW,Rapisarda E, La Rosa G, Gambarini G, Testarelli L. Cyclic fatigue resistance,torsional resistance, and metallurgical characteristics of M3 Rotary and M3 ProGold NiTi files. Restor Dent Endod. 2018 Apr 23;43(2)
Gambarini G, Testarelli L, Galli M, Tucci E, De Luca M. The effect of a new finishing process on the torsional resistance of twisted nickel-titanium rotary instruments. Minerva Stomatol. 2010 Jul-Aug;59(7-8):401-6.
Braga LC, Faria Silva AC, Buono VT, de Azevedo Bahia MG. Impact of heat treatments on the fatigue resistance of different rotary nickel-titanium instruments. J Endod. 2014;40(9):1494–7
Plotino G, Testarelli L, Al-Sudani D, Pongione G, Grande NM, Gambarini G. Fatigue resistance of rotary instruments manufactured using different nickel-titanium alloys: a comparative study. 2014;102(1):31–5
Dr. Andy Dosanjh – The University of Detroit Mercy
A pilot study conducted at the University of Detroit Mercy showed EdgeFile files to have significantly greater cycles compared to competing files. The purpose of this study was to examine the effect of different temperature changes on the cyclic fatigue of EdgeFile, Vortex Blue, and ESX rotary NiTi instruments. The three groups of NiTi rotary files were tested in a metal block that simulated a canal curvature of 60˚ and 5 mm radius of curvature. The block was submerged in a controlled-temperature water bath filled with water at four different temperatures. Thirty files from each experimental group were tested in the block at each of the four temperature cycles, and rotated at 500 rpm. Time to file fracture was recorded, and converted to number of cycles to fracture (NCF).
Vortex Blue files showed a significant decrease in NitTI cyclic fatigue as temperature increased from 3˚C to 60˚C. ESX files showed a significant decrease in NCF as temperature increased from 3˚C to 37˚C. EdgeFile files showed a significant increase in NitTI cyclic fatigue from 3˚C to 22˚C, and a significant decrease in NCF from 22˚C to 37˚C. For each temperature tested, EdgeFile files showed higher NCF than Vortex Blue files, and Vortex Blue files showed higher NitTI cyclic fatigue than ESX files. The findings showed that temperature does have an effect on the number of cycles to fracture for all rotary NiTi endodontic files tested. The findings from the study suggest that with the exception of files that are already in a martensitic phase, an irrigant chilled below room temperature seems favorable to increase NiTi cyclic fatigue.
In this in vitro study, temperature was found to have a significant effect on the cyclic fatigue of the NiTi rotary files tested. At each tested temperature, NCF of EdgeFile files were higher than NCF of Vortex Blue files, which was higher than NCF of ESX files. At all temperatures, EdgeFile files were found to have significantly higher cyclic fatigue than Vortex Blue files, which had significantly higher cyclic fatigue than ESX files. Since the cyclic fatigue of various file types was found to be significantly affected by temperature, future cyclic fatigue studies are recommended to be conducted at body temperature. Consideration should be taken in interpretation of studies conducted at room temperature.
Methods
Three groups of nickel-titanium rotary files (EdgeFile [EdgeEndo, Albuquerque, NM], Vortex Blue [Dentsply Tulsa Dental Specialties, Tulsa, OK], and ESX [Brasseler USA, Savannah, GA]) of size #25 with .04 taper and 25 mm length were tested in a metal block that simulated a canal curvature of 60˚ and 5 mm radius of curvature. The block was submerged in a controlled-temperature water bath filled with water at 3˚C ± 0.5˚C, 22˚C ± 0.5˚C, 37˚C ± 0.5˚C, and 60˚C ± 0.5˚C. Thirty files from each experimental group were tested in the block at each of the four temperature cycles, and rotated at 500 rpm. Time to file fracture was recorded, and converted to number of cycles to fracture (NCF). Statistical analysis was completed using a one-way ANOVA with post-hoc Tukey test.
Results
Vortex Blue files showed a significant decrease in NCF as temperature increased from 3˚C to 60˚C. ESX files showed a significant decrease in NCF as temperature increased from 3˚C to 37˚C. EdgeFile files showed a significant increase in NCF from 3˚C to 22˚C, and a significant decrease in NCF from 22˚C to 37˚C. For each temperature tested, EdgeFile files showed higher NCF than Vortex Blue files, and Vortex Blue files showed higher NCF than ESX files.
Conclusions
In this in vitro study, temperature was found to have a significant effect on the cyclic fatigue of the NiTi rotary files tested. At each tested temperature, NCF of EdgeFile files was higher than NCF of Vortex Blue files, which was higher than NCF of ESX files. Future cyclic fatigue studies should consider being conducted at body temperature.
One hundred twenty nickel-titanium rotary endodontic files were used for each of the three experimental file groups: EF (EdgeFile files; EdgeEndo, Albuquerque, NM), VB (Vortex Blue files; Dentsply Tulsa Dental Specialties, Tulsa, OK), and ESX (ESX files; Brasseler USA, Savannah, GA). All files were size #25 with .04 taper and 25 mm length, and were sterilized before use. The entire length of each file was placed into a simulated canal in a metal block, which was submerged in a water bath. The files were rotated at 500 rpm (which is within the recommended range of rotational speeds in the directions for use of each file system) with the use of an endodontic motor (Tulsa E3 motor). The metal block was made of tempered steel with a milled canal that simulated a 60˚ canal curvature and 5 mm radius of curvature, and a width of 1.5 mm. A digital thermometer was used to measure the temperature of the water before initiating testing of each file. Within each group of 120 files, files were randomly subdivided for testing at the four different temperature cycles, with 30 files per temperature cycle. The four different temperature cycles were ice water (3˚ ± 0.5˚C), room temperature (22˚ ± 0.5˚C), body temperature (37˚ ± 0.5˚C), and hot water (60˚C ± 0.5˚C). A picture of the setup is shown in Figure 1. A video record was made of each file rotation, and time to fracture was recorded in seconds. This was identified by visual and/or audible sound of fracture. Time to fracture was converted into NCF.
Figure 1. Water bath and electric motor setup
Results
A one-way ANOVA with post-hoc Tukey test was used to compare the cyclic fatigue of the instruments at different temperatures. The results are graphically shown in Figure 2. When the temperature cycle increased from 3˚C to 22˚C, the average NCF significantly (p<0.01) decreased for both VB and ESX, from 4842 (SD=1136) and 932 (SD=163) to 2062 (SD=358) and 466 (SD=66), respectively. However, the NCF significantly (p<0.05) increased for EF from 6185 (SD=2143) to 7243 (SD=2088). When the temperature cycle increased from 22˚C to 37˚C, all files showed a significant (p<0.01) decrease in the NCF, to averages of 1233 (SD=218), 271 (SD=55), and 1675 (SD=384) for VB, ESX, and EF, respectively. Further increasing the temperature from 37˚C to 60˚C caused a significant (p<0.01) reduction in the NCF for VB to an average of 651 (SD=111). ESX and EF also had reductions in their NCF to respective averages of 218 (SD=45) and 901 (SD=201), but these were not statistically significant. At each temperature, EF had a significantly (p<0.01) higher NCF than VB. VB had a significantly (p<0.01) higher NCF than ESX.
Discussion
Temperature has a significant effect
The findings of this study showed that temperature has a significant effect on the number of cycles to fracture for all rotary NiTi endodontic files tested. This is in agreement with previous studies (6, 7) where increasing the temperature was found to decrease the NCF. However, this study examined a greater variety of temperatures than the other studies.
This is of importance, because cyclic fatigue studies are usually conducted in an ex vivo setting where temperature is not considered as a variable. Future studies can be made more clinically relevant by being conducted at body temperature instead of room temperature. The NCF for the ESX and Vortex Blue files nearly halved when the temperature was increased from room temperature to body temperature, while that for EdgeFile files decreased by over four times. This large difference in NCF is apparent when compared to the other files.
For example, when compared to Vortex Blue files, at room temperature the NCF of EdgeFile files was over 3.5 times higher. When heated to body temperature, the NCF of EdgeFile files was only 1.35 times higher than Vortex Blue files; however, this was still significant. The metallurgic properties of endodontic files appear to affect their NCF in addition to temperature.
File types were selected to get a variation in metallurgy. The EdgeFile files are predominantly in a martensitic phase at room temperature, which is responsible for their lack of ‘shape memory.’ Further cooling of the EdgeFile files to 3˚C resulted in a decrease in the NCF. This decrease in NCF may be due to a mechanism similar to how traditional metals become more ‘brittle’ as they cool, causing them to fracture. Heating most likely caused a transition to an austenitic phase, reducing the NCF. Although there was a reduction in the NCF from 37˚C to 60˚C, this was not found to be statistically significant. Both the ESX and Vortex Blue files at least doubled their NCF when they were placed in ice water, since they may possess more austenitic phase at room temperature compared to EdgeFile files. By cooling them, they transitioned to a more martensitic phase. The difference in NCF for ESX files from 37˚C to 60˚C was not significant. This may be due to the files already being in mostly an austenitic phase at body temperature; consequently, further heating did not have an effect.
Using a heated NaOCl irrigant, however, has been shown to be effective for disinfection and tissue dissolution (2, 3). According to our findings, the use of a heated irrigant during file instrumentation may increase the incidence of file separation due to the reduction in NCF that may result. Furthermore, exposure of NiTi files to heated NaOCl may cause more corrosion leading to faster separation (9). Therefore, a heated NaOCl irrigant may be best suited as a final step in the irrigation protocol. In an in vivo study by de Hemptinne et al. (10), room temperature NaOCl solution injected into a canal increased temperature to 30.9˚C after only 10 seconds. The temperature of a heated solution decreased from 56.4˚C to 45.4˚C after 5 seconds and took a minute to decrease down to 37˚C. This rapid equilibration of temperature makes it especially important to test cyclic fatigue of instruments at body temperature instead of at room temperature, since irrigant at room temperature quickly equilibrates to body temperature when used in the root canal space. This experimental model used a metal block to simulate a root canal. The effects of conduction and insulation of heat are likely different in this model than those of root dentin, and may be a factor for in vivo results.
Notably, this study only examined cyclic fatigue; torsional fatigue and cutting effectiveness of files are also important aspects of a file’s performance. Future studies should examine the effects of temperature and file metallurgy on these characteristics.
Conclusion
In conclusion, when placed in a water bath, ESX files showed a decrease in NCF when heated from 3˚C up to 37˚C, but no significant difference was seen from 37˚C to 60˚C; Vortex Blue files showed the same, except they continued to have a reduction in NCF to 60˚C. EdgeFile files showed an increase in NCF from 3˚C to 22˚C, and a marked decrease in NCF from 22˚C to 37˚C. There was no statistically significant difference in NCF from 37˚C to 60˚C.
At all temperatures, EdgeFile files were found to have significantly higher NCF than Vortex Blue files, which had significantly higher NCF than ESX files.
Since the cyclic fatigue of various file types was found to be significantly affected by temperature, future cyclic fatigue studies are recommended to be conducted at body temperature. Consideration should be taken in interpretation of studies conducted at room temperature.
References
1. Montalveo D, Alçada FS, Fernandes FMB, et al. Structural Characterisation and Mechanical FE Analysis of Conventional and M-Wire Ni-Ti Alloys Used in Endodontic Rotary Instruments. Scientific World Journal 2014; Article ID 976459: 1-8.
2. Sirtes G, Waltimo T, Schaetzle M, et al. The Effects of Temperature on Sodium Hypochlorite Short-Term Stability, Pulp Dissolution Capacity, and Antimicrobial Efficacy. J Endod 2005; 31(9):669-671.
3. Dumitriu D, Dobre T. Effects of Temperature and Hypochlorite Concentration on the Rate of Collagen Dissolution. J Endod 2015; 41(6):903-906.
4. Shen Y, Zhou HM, Zheng YF, et al. Current Challenges and Concepts of the Thermomechanical Treatment of Nickel-Titanium Instruments. J Endod 2013; 39(2):163-172.
5. Merkel D, Brinkmann E, Wiens D, et al. In situ cooling with ice water for the easier removal of self-expanding nitinol stents. Endosc Int Open
2015;03:E51–E55.
6. Jamleh A, Yahata Y, Ebihara A, et al. Performance of NiTi endodontic instrument under different temperatures. Odontology 2015; 1-5.
7. de Vasconcelos RA, Murphy S, Carvalho CAT, et al. Evidence for Reduced Fatigue Resistance of Contemporary Rotary Instruments Exposed to Body Temperature. J Endod 2016; 42(5): 782-787.
8. Vera J, Ochoa-Rivera J, Vazquez-Carcaño, et al. Effect of Intracanal Cryotherapy on Reducing Root Surface Temperature. J Endod 2015; 41(11):1884-1887.
9. Peters OA, Roehlike JO, Baumann MA. Effect of Immersion in Sodium Hypochlorite on Torque and Fatigue Resistance of Nickel-Titanium Instruments. J Endod 2007; 33(5):589-593.
10. de Hemptinne F, Slaus G, Vandendael M, et al. In Vivo Intracanal Temperature Evolution during Endodontic Treatment after the Injection of Room Temperature or Preheated Sodium Hypochlorite. J Endod 2015; 41(7):1112-1115
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