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Geometric Analysis of Maxillary First Premolar Prepared by Two Nickel

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Geometric Analysis of Maxillary First Premolar Prepared by Two Nickel JCDP Dina Al-Sudani et al 10.5005/jp-journals-10024-1510 ORIGINAL ARTICLE Geometric Analysis of Maxillary First Premolar Prepared by Two Nickel-Titanium Rotary Instruments 1Dina Al-Sudani, 2Majed Almalki, 3Saad Al-Shahrani, 4Michael Ahlquist ABSTRACT Prepared by Two Nickel-Titanium Rotary Instruments. J Contemp Dent Pract 2014;15(2):174-180. Aim: The present study was conducted with the aim of evalua- ting and comparing the shaping ability of two Nickel-titanium Source of support: Nil rotary instruments, with two disparate design features, on root Conflict of interest: None canal geometry of extracted human maxillary first premolars using microcomputed tomography. INTRODUCTION Study design: Twenty four bifurcated maxillary first premolars were divided into two groups and embedded in a rubber-based Intra-radicular microbial infection has been shown to be the impression material. Both groups were submitted to micro- main cause of apical periodontitis.1-3 Therefore, the goal of computed tomography before and after canal preparation root canal treatment is to eliminate or reduce the number (buccal and palatal) with either ProFile Vortex or Revo-S rotary instruments. Images were reconstructed and cross-sections of microorganisms to a level that will allow healing of the 4 corresponding to a distance 1, 2, 3, 4, 5, 6, and 7 mm from periapical tissues and to prevent microbial reinfection. This the anatomical apex were selected for canal transportation process involves chemomechanical cleaning and shaping as analysis. Volume changes were also measured. well as obturation of the root canal system. Results: The degree and direction of canal transportation were Root canal preparation is essential for removing necrotic non-significant for both instruments. Statistically significant pulp tissue, microorganisms, heavily infected dentin and differences were observed only between levels in the buccal canal in both groups. There was no significant difference debris, and for creating a root canal shape that will improve between the two rotary systems in regards to the volume of irrigation, placement of intracanal medications and facilitate dentin removed. the root canal filling at a high technical standard.5 However, Conclusion: Our findings showed that ProFile Vortex and many studies have reported undesirable effects after root Revo-S instruments respected the original root canal anatomy canal preparation using stainless steel files, such as zips, and behaved similarly. ProFile Vortex rotary systems produced elbows, loss of working length, instrument fractures and with innovative process were concluded to shape the upper perforations.6-9 maxillary premolar by leading minimal canal transportation, similar to Revo-S, rotary systems produced from traditional Nickel-titanium instruments (NiTi) have been intro- process. duced to avoid errors associated with stainless steel instru- 10 Keywords: Maxillary first premolar, Micro-CT, Nickel-Titanium, ments. Instruments made of such alloys show improved Rotary instrument. physical properties, including super-elasticity and the shape How to cite this article: Al-Sudani D, Almalki M, Al-Shahrani memory effect, which drastically improves canal prepara- 11,12 S, Ahlquist M. Geometric Analysis of Maxillary First Premolar tion efficiency and reduces iatrogenic errors. Over the last decade, advancements in the manufacturing 1Associate Professor and Consultant, 2,3Endodontist of nickel-titanium instruments have led to new concepts in 4Associate Professor instrument design and canal preparation.13 However, two 1Endodontic Division, Department of Restorative Dental design features have had a strong impact on the instrument Sciences, College of Dentistry, King Saud University, Saudi shaping potential: the cross-sectional design and tip confi- Arabia guration.9,14 2 Department of Dentistry, King Fahd Military Medical Complex Recently, more focus has been directed toward improving Dhahran, Saudi Arabia the alloy properties. One of the metallurgical advancements 3Department of Dentistry, Armed Forces Hospital, Dhahran Saudi Arabia is the use of a special thermomechanical process to modify the nickel-titanium raw material, such as the M-wire used in 4Department of Dental Medicine, Cariology and Endodontology Division, Karolinska Institutet, Stockholm, Sweden the production of the ProFile Vortex (Dentsply Tulsa Dental Specialties, Tulsa, Oklahoma, USA), or in the manufacturing Corresponding Author: Dina Al-Sudani, Associate Professor and Consultant, Department of Restorative Dental Sciences of files such as the twisted file (TF group; SybronEndo, College of Dentistry, King Saud University, Saudi Arabia Orange, CA, USA).13 This type of treatment has been reported e-mail: [email protected] to increase flexibility and the resistance to cyclic fatigue.13 174 JCDP Geometric Analysis of Maxillary First Premolar Prepared by Two Nickel-Titanium Rotary Instruments Fig. 1: Representative cross section before and after instrumentation showing how transportation was measured Despite the different instrument designs and metallur- design to the EndoSequence files. However, they are slightly gical advancements, root canal preparation is negatively different because the ProFile Vortex files are composed of influen ced by the anatomical variation of root canals.14 The M-Wire NiTi, have a novel design with helical angles, and root form and canal anatomy of maxillary first premolars are not electropolished.23 are highly variable. The most common anatomical features With the recent progress in the manufacturing of endo- include two roots, narrow furcation entrances, deep mesial dontic rotary instruments, a detailed analysis of their concavities and multiple canals.15 A very unique anatomical shaping ability and safety is required to understand how feature characterizing only the maxillary first premolar is design features affect performance. A variety of metho- the palatal furcation groove of the buccal root, which is a dologies have been developed and described to compare the developmental depression located at the palatal aspect of shaping and cleaning ability of different instrumentation the buccal root (Fig. 1), the prevalence of the palatal groove techniques and instruments in preparing root canals. ranges from 62 to 100%.16-18 Lack of knowledge about the Recently, microcomputed tomography (μCT) has emerged extent and thickness of the dentin in this area might lead to in the field of endodontic research. This technique is a highly excessive thinning or perforation of the dentinal wall during accurate and nondestructive method for evaluating changes either endodontic or restorative procedures, thereby increas- in the root canal geometry after root canal preparation. This ing the possibility of vertical root fractures.19-21 analytical procedure permits a three-dimensional evaluation Recently, new generations of NiTi rotary instruments of the root canal geometry before and after preparation.24-26 with higher flexibility and greater cutting efficiency have Linear and volumetric changes can be analyzed from such been introduced. Revo-S (RS; Micro-Mega, Besancon Ce- scans, including the volume of dentin removed, canal dex, France), another NiTi rotary system, was developed ‘thickness’ (diameter), prepared surface, cur-vature, canal with a distinctive asymmetric cross-section, and the manu- transportation, structure model index (SMI), and canal facturer claims that this particular instrument geometry centering ratio.14,27 facilitates canal penetration and the upward removal of The purpose of this study was to evaluate, in vitro, the debris.22 The ProFile Vortex files (Dentsply, Tulsa Dental volume of removed dentin, and canal transportation in bifur- Specialties) made of M-Wire were introduced in 2009. cated maxillary first premolars after root canal preparation These files have a triangular cross section, no radial lands, using two different rotary endodontic instruments with two a variable pitch, and a noncutting tip, which is similar in disparate design features. The Journal of Contemporary Dental Practice, March-April 2014;15(2):174-180 175 Dina Al-Sudani et al MATERIALS AND METHODS set of actions were used to binarize the root and pulp space, including threshold adjustment, morphological operation Twenty-four extracted bifurcated premolars were selected (to remove any particles inside the pulp space), despeckle based on the following criteria: closed apices, obvious (to remove speckle from the pulp space and to also remove palatal groove of buccal root, and the absence of caries, pores), and bitwise operation (to copy the region of interest to anomalies, restorations and canal obstructions. Each root the image). For the two-dimensional and three-dimensional had 20° to 40° according to Schneider’s technique. The teeth analyses, the following parameters were obtained: were stored in a 10% buffered formalin solution (Baxter Scientific Products, IL). I. Volume Changes An access cavity was prepared using #2 and #4 high- speed round carbide burrs (Meisinger, Hager & Meisinger, The preoperative volume of the canal was determined by Gmbh, Germany). To determine the working length, a the voxel number (volumetric pixel), which is automatically K-file # 10 (Dentsply-Maillefer, Ballaigues, Switzerland) converted to (3 mm) by the CT-Analyzer. The volume of was placed inside the canal until its tip was visible at the removed dentin was calculated by subtracting the volume apical foramen when examined using an operating micro- of the canal
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