Morphological Changes of the Apical Foramen in Curved Root Canals After Use of Different Heat Treated NiTi Rotary Files: A Scanning Electron Microscopy Study

Overview

Journal Eur Endod J

Publisher Kare Publishing

Specialty Dentistry

Date 2024 Dec 20

PMID 39704632

Authors

Tahira Hamid

Azhar Malik

Ajay Kumar

Saima Hamid

Shamim Anjum

Affiliations

Soon will be listed here.

Abstract

Objective: The present study aimed to evaluate the effect of heat-treated nickel titanium (NiTi) files TruNatomy and XP- Endo Shaper on the major apical foramen deformation and enlargement in curved root canals using area, circularity, and Feret's diameter ratio.

Methods: Sixty mesio-buccal roots of maxillary and mandibular molars with Vertucci type II root canal were selected. The teeth were decoronated using a carborundum disc. The roots with a length of 13 mm were measured using a digital caliper. The preoperative scanning electron microscope images of apical roots were taken and then divided into 4 groups. Manual (K file, Mani Tochigi, Japan), ProTaper Universal (PTU, Dentsply Maillefer, Ballaigues, Switzerland), XP-Endo Shaper (XPS;FKG Dentaire SA, La Chaux-de-134 Fonds, Switzerland), and TruNatomy (TRN;Dentsply Sirona, Ballaigues, Switzerland) group. After instrumentation, the post-operative scanning electron microscope images were taken. Surface area, circularity, and Feret's diameter ratio was calculated before and after instrumentation using Image J software. For intergroup comparison of data, student's independent t-test was employed and for intra-group comparison of data, paired t-test was applied.

Results: The area after instrumentation increased in all groups but the K file and PTU show statistically significant differences compared to TRN and XPS (p<0.001). The circularity tends towards 0 in K file and PTU and canals became ellipticals after instrumentation. However, TRN and XPS showed no difference. There is no significant difference in the Feret's diameter ratio before and after instrumentation.

Conclusion: The enlargement of the major apical foramen occurs regardless of the type of file system used. The hand K files and PTU result in significant foramen deformation when instrumented up to the major apical foramen. However, TRN and XPS promote minor alterations at the foramen which are not statistically significant. (EEJ-2024-01-20).

References

de Souza Filho F, Benatti O, de Almeida O . Influence of the enlargement of the apical foramen in periapical repair of contaminated teeth of dog. Oral Surg Oral Med Oral Pathol. 1987; 64(4):480-4. DOI: 10.1016/0030-4220(87)90157-5. View

Khurana P, Nainan M, Sodhi K, Padda B . Change of working length in curved molar root canals after preparation with different rotary nickel-titanium instruments. J Conserv Dent. 2011; 14(3):264-8. PMC: 3198556. DOI: 10.4103/0972-0707.85809. View

Silva E, Menaged K, Ajuz N, Monteiro M, Coutinho-Filho T . Postoperative pain after foraminal enlargement in anterior teeth with necrosis and apical periodontitis: a prospective and randomized clinical trial. J Endod. 2013; 39(2):173-6. DOI: 10.1016/j.joen.2012.11.013. View

Arcanjo Frota M, Bernardes R, Vivan R, Vivacqua-Gomes N, Duarte M, Vasconcelos B . Debris extrusion and foraminal deformation produced by reciprocating instruments made of thermally treated NiTi wires. J Appl Oral Sci. 2018; 26:e20170215. PMC: 5777412. DOI: 10.1590/1678-7757-2017-0215. View

Noiri Y, Ehara A, Kawahara T, Takemura N, Ebisu S . Participation of bacterial biofilms in refractory and chronic periapical periodontitis. J Endod. 2002; 28(10):679-83. DOI: 10.1097/00004770-200210000-00001. View

Maricic B, Sutalo J . Asymmetry of the root canal foramen. Int Endod J. 1992; 25(3):158-64. DOI: 10.1111/j.1365-2591.1992.tb00779.x. View

Ricucci D . Apical limit of root canal instrumentation and obturation, part 1. Literature review. Int Endod J. 2004; 31(6):384-93. DOI: 10.1046/j.1365-2591.1998.00184.x. View

Schafer E, Florek H . Efficiency of rotary nickel-titanium K3 instruments compared with stainless steel hand K-Flexofile. Part 1. Shaping ability in simulated curved canals. Int Endod J. 2003; 36(3):199-207. DOI: 10.1046/j.1365-2591.2003.00643.x. View

ElAyouti A, Dima E, Judenhofer M, Lost C, Pichler B . Increased apical enlargement contributes to excessive dentin removal in curved root canals: a stepwise microcomputed tomography study. J Endod. 2011; 37(11):1580-4. DOI: 10.1016/j.joen.2011.08.019. View

10.

Ricucci D, Langeland K . Apical limit of root canal instrumentation and obturation, part 2. A histological study. Int Endod J. 2004; 31(6):394-409. DOI: 10.1046/j.1365-2591.1998.00183.x. View

11.

Marvaniya J, Agarwal K, Mehta D, Parmar N, Shyamal R, Patel J . Minimal Invasive Endodontics: A Comprehensive Narrative Review. Cureus. 2022; 14(6):e25984. PMC: 9287844. DOI: 10.7759/cureus.25984. View

12.

Neelakantan P, Vishwanath V, Taschieri S, Corbella S . Present status and future directions: Minimally invasive root canal preparation and periradicular surgery. Int Endod J. 2022; 55 Suppl 4:845-871. DOI: 10.1111/iej.13750. View

13.

Schaeffer M, White R, Walton R . Determining the optimal obturation length: a meta-analysis of literature. J Endod. 2005; 31(4):271-4. DOI: 10.1097/01.don.0000140585.52178.78. View

14.

Elnaghy A, Elsaka S, Mandorah A . In vitro comparison of cyclic fatigue resistance of TruNatomy in single and double curvature canals compared with different nickel-titanium rotary instruments. BMC Oral Health. 2020; 20(1):38. PMC: 7001210. DOI: 10.1186/s12903-020-1027-7. View

15.

Saini H, Sangwan P, Sangwan A . Pain following foraminal enlargement in mandibular molars with necrosis and apical periodontitis: A randomized controlled trial. Int Endod J. 2015; 49(12):1116-1123. DOI: 10.1111/iej.12583. View

16.

Cameron J . The synergistic relationship between ultrasound and sodium hypochlorite: a scanning electron microscope evaluation. J Endod. 1987; 13(11):541-5. DOI: 10.1016/S0099-2399(87)80034-1. View

17.

Silva Santos A, Portela F, Coelho M, Fontana C, Martin A . Foraminal Deformation after Foraminal Enlargement with Rotary and Reciprocating Kinematics: A Scanning Electronic Microscopy Study. J Endod. 2017; 44(1):145-148. DOI: 10.1016/j.joen.2017.08.013. View

18.

Zupanc J, Vahdat-Pajouh N, Schafer E . New thermomechanically treated NiTi alloys - a review. Int Endod J. 2018; 51(10):1088-1103. DOI: 10.1111/iej.12924. View

19.

Khademi A, Yazdizadeh M, Feizianfard M . Determination of the minimum instrumentation size for penetration of irrigants to the apical third of root canal systems. J Endod. 2006; 32(5):417-20. DOI: 10.1016/j.joen.2005.11.008. View

20.

Riyahi A, Bashiri A, Alshahrani K, Alshahrani S, Alamri H, Al-Sudani D . Cyclic Fatigue Comparison of TruNatomy, Twisted File, and ProTaper Next Rotary Systems. Int J Dent. 2020; 2020:3190938. PMC: 7061136. DOI: 10.1155/2020/3190938. View