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Carolina Revilla Snchez-Bretao, Lifong Zou, Sharanbir K Sidhu, Bun San Chong
Carolina Revilla
Key words NiTi les, ProTaper, Reciproc, surface damage, 3D dental scanner Snchez-Bretao, Lic
Odont, PGDip, MSc
Lifong Zou, BSc, MSc,
Aim: To assess, using the principle of three-dimensional (3D) coordinate metrology, the location and PhD
degree of surface damage or wear of two commercially available engine-driven nickel-titanium (NiTi) Sharanbir K Sidhu,
BDS, MSc, PhD,
les after clinical use. MFDS, FADM, SFHEA
Methodology: A total of 24 engine-driven NiTi endodontic les, 12 rotary (ProTaper, Dentsply Bun San Chong, BDS,
MSc, PhD, LDS, FDS,
Maillefer, Ballaigues, Switzerland) and 12 reciprocating (Reciproc, VDW, Munich, Germany), were MRD, FHEA
collected after clinical use. A coordinate measurement dental scanner was used to capture the 3D All at:
coordinate data of each endodontic le surface. The surface data were subjected to 3D analysis Institute of Dentistry, Barts
and The London School of
using a 3D free-form surface analysis software package, which involved the surface interpolation, Medicine and Dentistry,
Queen Mary, University of
registration and subtraction of each image of the scanned surface to a baseline 3D image of a London, London, UK
new, unused le. Three representative points at the coronal, middle and apical third of each sam-
Correspondence to:
ple were selected to assess any differences in surface damage or wear between the two le types. Bun San Chong,
The reproducibility of the methodology, the measurement of new, unused and used engine-driven Institute of Dentistry,
Barts and The London School
NiTi les, was tested. of Medicine and Dentistry,
Results: The reproducibility of the methodology was excellent, with a depth difference of <0.002 mm Turner Street,
London E1 2AD
for the new, unused les and <0.005 mm for used les of both types. Reciprocating les generally Tel: +44 (0) 20 7882 8147
showed greater surface damage in comparison with rotary les. Furthermore, reciprocating les Fax: +44 (0) 20 7377 7064
Email: b.s.chong@qmul.ac.uk
showed greater wear in the apical third and less wear in the coronal third. In contrast, rotary les had
greater surface damage in the coronal third, decreasing towards the apical third.
Conclusions: 3D coordinate metrology provided an objective, reproducible, more economical and
non-destructive method for assessing the surface damage or wear of engine-driven NiTi les after
clinical use. There was more damage seen with les operated in reciprocation compared with those
operated in continuous rotary motion. The le operating motion and surface contact at different
stages of root canal preparation may account for the differences in the degree and location of surface
damage.
eliminated. When it occurs, a fractured instrument surfaces. However, optical methods are not suit-
can act as an obstacle, hindering thorough canal able for reective objects such as engine-driven
decontamination, by preventing access to the root NiTi les; light reected on the edges of the le
canal system apical to the blockage. Retrieval of a will be dispersed in various directions, so the data
fractured intracanal instrument may lead to excessive acquired will not be accurate. A contact method,
tooth tissue removal, which will affect the residual based on the principle of 3D coordinate metrology,
structural strength of the tooth. Hence, instrument is more suitable; typically the scanning probe can
fracture is to be avoided due to the likely negative acquire several hundred surface points of an object
impact on the prognosis of the tooth. in a second.
Two modes of engine-driven NiTi instrument frac- Therefore, the aim of this study was to use a
tures have been described: torsional failure and cyclic newer, more economical and non-destructive
fatigue6. Fractures can occur without any visible signs method, based on the principle of three-dimensional
of wear or deformation, which may not be detected (3D) coordinate metrology, to investigate and com-
by the human eye7. The exibility and stiffness of an pare the surface damage or wear of two commer-
endodontic le, dependent on the design of the le, cially available engine-driven NiTi le systems after
including taper, cross-sectional shape, length, tip size clinical use.
and helical angle, are essential characteristics related
to the risk of fracture occurrence6,8-10. The risk of
fracture occurrence is also inuenced by the number Materials and methods
of times a root canal instrument is used; reusing an
instrument carries a potentially higher risk of fracture Two types of commercially available engine-driven
compared with using a new instrument each time11. NiTi les were assessed: rotary (ProTaper size F2,
However, even brand new, unused instruments are Dentsply Maillefer, Ballaigues, Switzerland), and
not immune to the risk of fracture12. In their quest reciprocating (Reciproc size R25, VDW, Munich,
to develop engine-driven NiTi instruments with Germany). The engine-driven NiTi les were used
increased exibility, improved cutting efciency and on similar tooth types only once, according to the
better fracture resistance, manufacturers have made manufacturers recommendations, and collected
changes to instrument design, enhanced surface from two dental practices in the United Kingdom.
treatment, altered the microstructure and through The 24 engine-driven NiTi instruments (12 for each
heat treatment adjusted the transition temperature, instrument type) were ultrasonically cleaned and
of the NiTi alloy10,13. In addition, apart from being autoclaved at the collection sites before being used
operated in continuous rotary motion, engine-driven in the study.
NiTi instruments operated in reciprocating motion Each of the engine-driven NiTi les was mounted
are now also available14. in a rigid plastic frame lled with silicone putty (Vir-
Imaging techniques utilising, for example, the tual Putty/fast set, Ivoclar Vivadent, Schaan, Liech-
scanning electron microscope (SEM) are commonly tenstein). In order to ensure the absence of any
used to assess surface characteristics. However, in gaps between the le and the putty, a light body
order to preserve the sample, a replica is normally impression material (Virtual Light body/regular set,
needed. A more economical, non-destructive and Ivoclar Vivadent) was carefully syringed around the
yet reproducible method of assessment of surface mounted le to ensure it was tight, stable and well-
characteristics deserves exploration. Three-dimen- xed (Fig 1).
sional (3D) capture, through optics or mechanics, Three-dimensional coordinate metrology was
allows the surface of any object to be digitised used to quantify surface damage and wear of the
and the geometry, such as shape and dimensions, engine-driven NiTi les. The Incise Dental Scanner
can then be measured. From the digitised data, (Renishaw, Wotton-under-Edge, Gloucestershire,
the computer algorithm generates a graphic render UK) is a purpose-built surface scanning machine,
and then image analysis software quanties any based on the novel Triact mechanism, giving high
geometrical changes between consecutive digitised dynamic performance. A compact three-axis probe
Fig 1 Engine-driven NiTi le (ProTaper, Dentsply Maillefer) mounted in a Fig 2 View of a sample placed on the
rigid plastic frame lled with silicone putty prepared for scanning. adjustable platform ready for scanning.
Fig 3 Digitised images of ProTaper (Dentsply Maillefer) les: new, unused (right); used (left). The positioning of these two
les is different since the grooves are not coincident so these two images cannot be compared and was discarded.
performs the scanning with low forces and produces characteristics for each le type, derived from the
accurate 3D coordinates. Digitised coordinates digitised images was recorded. The reproducibility
(data) are a string of discrete points; they need to of the methodology, the 3D coordinate measure-
be interpolated by a mathematical algorithm and ments of new, unused and used engine-driven NiTi
computing to render an image for visualisation and les, was tested.
image analysis. The Incise Dental Scanner (Ren- To assess the surface damage or wear, each of
ishaw) was used for surface digitisation, and the the used engine-driven NiTi les was placed in the
data analysed by using 3D free-form surface ana- mounting putty so that the most coronal groove
lysis software (Cloud, Department of Medical Phys- where the utes began was positioned upwards;
ics, University College London, London, UK), which this was to achieve uniformity in the alignment of
comprised data interpretation, surface registration the images and to allow the computer software
and subtraction, as well as measurements of surface to build an accurate superimposition of the 3D
changes. images. Where there was a discrepancy in sample
Each mounted le was placed on the platform orientation, the images could not be compared
of the Incise Dental Scanner (Fig 2) and coordi- for assessment purposes and had to be discarded
nates in XYZ-planes were set up using the com- (Fig 3). To compare the differences of consecutive
puter software to dene the area of interest to be scanned images within each le type, common areas
scanned. The scanning motion of the probe was were selected in every image, away from the cut-
bidirectional in the X-axis and the scanning speed ting edges, as they were considered to remain as
was set at 200 mm/s. For data representation pur- unchanged areas and also act as reference points for
poses, each le was divided into three sections the registration procedure. The scanned image of
coronal, middle and apical third and the high- each used engine-driven NiTi le was superimposed
est surface wear points selected and recorded for and then subtracted from the scanned image of the
each of the three sections. A new, unused engine- corresponding, new, unused le. Surface damage or
driven NiTi le of each type, scanned twice, served wear is denoted by any changes detected following
as controls. The mean difference in overall surface image subtraction.
Table 1 Reproducibility of the 3D coordinate measure- had greater surface damage in the coronal third,
ments of new, unused and used engine-driven NiTi les. The
mean differences for repeated scans of each type of les decreasing towards the apical third.
were measured over the whole scanning surface of the le
from the digitised images
Protaper 07
0.083 mm 0.007 mm 0.035 mm
Fig 4 Colour-coded image shows the depth differences, at three typical points (coronal: 0.083 mm, middle: 0.070 mm and
apical: 0.035 mm) between a used and a new, unused ProTaper (Dentsply Maillefer) le.
Reciproc 14
0.056 mm 0.177 mm 0.228 mm
Fig 5 Colour-coded image showing surface wear (coronal: 0.056 mm, middle: 0.177 mm and apical third: 0.228 mm) of a
Reciproc (VDW) le.
Table 2 Minimum, maximum, mean and standard deviation for each section (coronal, middle, apical) of the two different
le types
0.08
reported for reciprocating NiTi instruments include 0.06
less time required to prepare curved canals27 and 0.04
respecting the original canal curvature better28. It 0.02
20. Cheung GS, Peng B, Bian Z, Shen Y, Darvell BW. Defects 30. Barbieri N, Leonardi DP, Baechtold MS, Correr GM, Gab-
in ProTaper S1 instruments after clinical use: fractographic ardo MC, Zielak JC, Baratto-Filho F. Inuence of cervical
examination. Int Endod J 2005:38:802809. prearing on apical transportation in curved root canals
21. Spanaki-Voreadi AP, Kerezoudis NP, Zinelis S. Failure mech- instrumented by reciprocating le systems. BMC Oral Health
anism of ProTaper Ni-Ti rotary instruments during clinical 2015:23:15:149.
use: fractographic analysis. Int Endod J 2006:39:171178. 31. Casper RB, Roberts HW, Roberts MD, Himel VT, Bergeron
22. Wan J, Rasimick BJ, Musikant BL, Deutsch AS. A comparison BE. Comparison of autoclaving effects on torsional deforma-
of cyclic fatigue resistance in reciprocating and rotary nickel- tion and fracture resistance of three innovative endodontic
titanium instruments. Aust Endod J 2011:37:122127. le systems. J Endod 2011:37:14911602.
23. De-Deus G, Moreira EJ, Lopes HP, Elias CN. Extended cyclic 32. Hilt BR, Cunningham CJ, Shen CY, Richards N. Torsional
fatigue life of F2 ProTaper instruments used in reciprocating properties of stainless-steel and nickel-titanium les after
movement. Int Endod J 2010:43:10631068. multiple autoclave sterilizations. J Endod 2000:26:7680.
24. You SY, Bae KS, Baek SH, Kum KY, Shon WJ, Lee W. Lifespan 33. King JB, Roberts HW, Bergeron BE, Mayerchak MJ. The
of one nickel-titanium rotary le with reciprocating motion effect of autoclaving on torsional moment of two nickel-
in curved toot canals. J Endod 2010:36:19911994. titanium endodontic les. Int Endod J 2012:45:156161.
25. Gavini G, Caldeira CL, Akisue E, Candeiro GT, Kawakami 34. Plotino G, Costanzo A, Grande NM, Petrovic R, Testarelli L,
DA. Resistance to exural fatigue of Reciproc R25 les under Gambarini G. Experimental evaluation on the inuence of
continuous rotation and reciprocating movement. J Endod autoclave sterilization on the cyclic fatigue of new nickel-
2012:38:684-687. titanium rotary instruments. J Endod 2012:38:222225.
26. Pedull E, Grande NM, Plotino G, Gambarini G, Rapisarda 35. Zou L, Yang QP, Jovanovski V, Tay WM, Lynch E. Measure-
E. Inuence of continuous or reciprocating motion on cyclic ment of tooth morphology using a laser probe tted on a
fatigue resistance of 4 different nickel-titanium rotary instru- co-ordinate measuring machine. 4th International Imeko
ments. J Endod 2013:39:258261. Symposium on Laser Metrology for Precision Measurement
27. Brklein S, Benten S, Schfer E. Shaping ability of different and Inspection in Industry 1996, Proceedings, 11-20.
single-le systems in severely curved root canals of extracted 36. Zou L, Cherukara G, Hao PW, Seymour K, Samarawickrama
teeth. Int Endod J 2013:46:590597. DYD. Geometrics of tooth wear. Wear 2009:266:605608.
28. Saber SE, Nagy MM, Schfer E. Comparative evaluation of 37. Kabban M, Fearne J, Jovanovski V, Zou L. Tooth size
the shaping ability of WaveOne, Reciproc and OneShape and morphology in twins. Int J Paediatr Dent 2001:11:
single-le systems in severely curved root canals of extracted 333339.
teeth. Int Endod J 2015:48:109114. 38. Morris B, Zou L, Royle M, Simpson D, Shelton JC. Quanti-
29. Brklein S, Hinschitza K, Dammaschke T, Schfer E. Shaping fying the wear of acetabular cups using coordinate metrol-
ability and cleaning effectiveness of two single-le systems ogy. Wear 2011:271:10861092.
in severely curved root canals of extracted teeth: Reciproc
and WaveOne versus Mtwo and ProTaper. Int Endod J
2012:45:449461.