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COMPARATIVE EVALUATION OF DENTINAL MICROCRACK

FORMATION DURING ROOT CANAL PREPARATION BY


DIFFERENT NiTi ROTARY INSTRUMENTS, RECIPROCATING
SINGLE FILE SYSTEM AND SELF ADJUSTING FILE AN IN
VITRO STEREOMICROSCOPE STUDY
INTRODUCTION:
Biomechanical preparation of root canals is one of the main steps in achieving
endodontic success due to enabling bacterial elimination, removal of debris, and
facilitating obturation.1 However, preparation procedures could also damage the root
dentin resulting in fractures or craze lines.2 During enlarging procedures microcracks
or craze lines that form could propagate with repeated stress application by occlusal
forces, which may result in root fracture. 3 It seems useful to examine the root surface
and dentin at multiple levels to determine the development of cracks.4
NEED FOR STUDY:
Vertical root fracture is one of the frustrating complications of root canal treatment,
which often results in tooth extraction.1 The root fracture might occur as a result of a
microcrack or craze line that propagates with repeated stress application by occlusal
forces.1 In the previous studies of dentinal microcrack formation by different file
systems, newer file system like Protaper next and One endo files were not used since
they are recently introduced so this in vitro study will include this recently introduced
file systems and compare the dentinal microcrack formation while using different
NiTi rotary files including Protaper next and One endo file, reciprocating files and
Self Adjusting File.

AIMS AND OBJECTIVES:


The aim of this in vitro study is to compare the dentinal microcrack formation during
root canal preparations by different NiTi Rotary files, Reciprocating single file system
and the Self Adjusting File.
MATERIALS AND METHODS:
SOURCE OF DATA:
Study will be conducted in the Department of Conservative Dentistry & Endodontics.
INCLUSION CRITERIA:
Hundred human permanent mesial roots of mandibular molar will be included.
Mandibular molar with root angulation 20 to 30 0 which will be determined using the
technique described by Schneider.
EXCLUSION CRITERIA:
Teeth having defects like pre-existing cracks or craze lines which will be inspected
under stereomicroscopy at 12X magnification.
Teeth having defects like root resorption, root caries, root fracture, calcification, open
apex which will be evaluated in intraoral periapical radiograph.
Teeth having severely curved root, which will be determined according to Schneider
technique.

METHODOLOGY:
SELECTION OF TEETH:
The study sample comprises of 100 freshly extracted human permanent mesial roots
of mandibular molar. All teeth will be thoroughly cleaned and washed and will be
then stored in 0.1% thymol solution until further use.
PREPARATION OF SPECIMEN:
The teeth will be decoronated at CEJ as well as distal roots of all teeth will be
removed by using a diamond coated bur under water coolant.1
All roots will be inspected under stereomicroscopy at 12X magnification to detect any
pre-existing craze lines or cracks.1
A silicon impression material will be used for coating the cemental surface of roots to
simulate periodontal ligament space. Then, all roots will be embedded in acrylic
blocks.1
CLEANING AND SHAPING:
Canal patency will be established using a size 15K-file in mesial canals. 1The working
length of each canal will be determined as 0.5mm short of the length with 15k-file
visible at major diameter of apical foramen.
Seventy roots will be then prepared using different NiTi rotary, reciprocating single
file system and Self Adjusting Files to appropriate master apical file size. And 10
roots will be left unprepared and will be used as control.
Irrigation of canal will be done with the help of 5.25% NaOCl & 17% EDTA & final
rinse of 5 ml of distilled water.

Teeth will be divided into 5 groups of different file system and one control group.
Each group will contain 20 teeth.
Group I

Protaper Next

Group II Waveone
Group III Hyflex
Group IV Neolix NiTi
Group V Twisted file Adaptive
SECTIONING METHOD:
Each group containing 20 teeth will be sectioned perpendicular to the long axis at 9,
6 and 3 mm which will be measured using vernier caliper from the apex using a
diamond coated saw under water cooling.1
MICROSCOPIC EXAMINATION:
Digital images of each section will be captured at 40X magnification using a digital
camera attached to a stereomicroscope.1
STATISTICAL ANALYSIS:
The data that will be collected after completion of study and will be analysed by
appropriate statistical tests.
REVIEW OF LITERATURE:
1) Oguz Yoldas et al (2012)1 compared the dentinal microcrack formation while
using hand files, 4 brands of nickel-titanium (NiTi) rotary files and the self adjusting
file and concluded that all rotary files created microcracks in the root dentin, whereas

the SAF file and hand instrumentation presented with satisfactory results with no
dentinal microcracks.
2) Bier et al (2012)1 showed dentinal damage (microcracks) in teeth that were
prepared with several nickel-titanium (NiTi) rotary instruments with the exception of
S-Apex rotary files. They found the highest defect ratio when ProTaper was used,
whereas no defect was observed with hand files.
3) Ellemieke S. Hin et al (2013)5 observed the incidence of cracks in root dentin after
root canal preparation with hand files, self-adjusting file (SAF), ProTaper, and Mtwo
and concluded instrumentation of root canals with SAF, Mtwo and ProTaper cause
damage to root canal dentin, SAF has a tendency to cause less dentinal cracks as
compared with ProTaper or Mtwo.
4) Rui Liu et al (2013)4 compared the incidence of root cracks observed at the apical
root surface and or in the canal wall after canal instrumentation with 3 single-file
systems and the Pro-Taper system and concluded that Nickel-titanium instruments
may cause cracks on the apical root surface or in the canal wall; the Self-Adjusting
File and Reciproc files caused less cracks than Pro-Taper and One-Shape files.
5) C.G Adorno et al (2013)6 evaluated the potential effects of endodontic procedures
on crack initiation and propagation in apical dentin and concluded that root canal
procedures can potentially initiate and propagate cracks within the root canal in the
apical region.
6) V.Ashwinkumar et al (2014)3 compared dentinal microcrack formation while
using Ni-Ti hand k-files, ProTaper hand and rotary files and the WaveOne
reciprocating file and concluded that ProTaper rotary files were associated with

significantly more microcracks than ProTaper hand file and WaveOne Primary
reciprocating files. Ni-Ti hand k-files did not produce microcracks at any levels inside
the root canals.
REFERENCES:
1) Oguz Yoldas, Sehnaz Yilmaz, Gokhan Atakan et al; Dentinal microcrack formation
during root canal preparations by different NiTi rotary instruments and the Self
Adjusting File. J Endod 2012; 38:232-235.
2) Carlos Alexandre Souza Bier, Hagay Shemesh, Mario Tanomaru-Filbo et al; The
ability of different Nikel-titanium rotary instruments to induce denitinal damage
during canal preparation. J Endod 2009; 35:236-238.
3) V. Ashwinkumar, J. Krithikadatta, S. Surendran et al; Effect of reciprocating file
motion on microcrack formation in root canals an SEM study. Int Endod J 2014;
47:622-627.
4) Rui Liu, Ben Xiang Hou, Paul R. Wesselink, Min-Kai Wuet al; The incidence of root
micro-cracks caused by 3 different single-file systems versus the ProTaper system. J
Endod 2013; 39:1054-1056.
5) Ellemieke S. Hin, Min-Kai Wu, Paul R. Wesselink et al; Effects of Self -Adjusting
File, Mtwo, and ProTaper on the root canal wall. J Endod 2013; 39:262-264.
6) C. G. Adorno, T. Yoshioka, P. Jindan et al; The effect of endodontic procedures on
apical crack initiation and propagation ex vivo Int Endod J 2013;46:763-768.