Method Article
Comparative evaluation of canal transportation, centering ability, and remaining dentin thickness between Race Evo and Protaper Next Rotary systems by using CBCT in mesial curved root canals of mandibular molar teeth (A comparative inVitro Study)
https://doi.org/10.21203/rs.3.pex-2157/v1
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The aim of this study is to assess the shaping ability of Race Evo files system in comparison to Protaper Next files System (X1 #17/.04, X2 #25/.06) by evaluating: The canal transportation, centering ability, and the remaining dentin thickness in curved root canals at three root levels (apical, middle, and coronal) using CBCT.
Scientific Background:Chemo-mechanical canal preparation is a critical component of a successful root canal therapy. To achieve endodontic goals, we must always preserve the canal's initial shape and optimal form, which is accomplished by developing a continuous tapered preparation from crown to apex of the tooth and preserving the apical foramen's original spatial relationship to the periapical tissues and root surface. Elimination of bacterial biofilms and dentinal debris that contribute to endodontic pathosis is also critical as a result of insufficient cleaning especially at the apical part of teeth with curved canals (1-3).The complicated anatomy and curvatures of root canal systems, along with the intrinsic limitations of root canal enlargement tools, make root canal treatment tough and challenging. Instruments may violate canal architecture, resulting in a variety of iatrogenic problems such as ledges, perforations, and canal transport, notably during curved root canal preparation (4,5). Additionally, it may leave some sections of the root canal system untreated, allowing microorganisms to persist in these locations and contribute to endodontic failures (1).The thickness of residual dentin following intraradicular interventions is related to the root's fracture resistance. Another possible unfavorable effect of shaping is extensive dentin removal, which may render the root more susceptible to fracture when subjected to additional loads from obturation and restoration operations, or mastication (6).Walia et al.1988, suggested the use of a nickel-titanium (NiTi) alloy in the fabrication of endodontic implements (7). This ground-breaking introduction of nickel-titanium instruments eased and hastened the mechanical preparation of the root canal. They demonstrated an improvement in mechanical qualities such as superelasticity, shape memory, and cutting efficiency, hence preserving the canals' original morphologies. This resulted in a reduction in mishaps when compared to conventionally stiff stainless steel hand instruments (8,9). Since then, nickel-titanium (NiTi) tools have played a significant role in the root canal treatment, enhancing the cleaning and shaping technique and increasing their use by both general practitioners and endodontists.Numerous modifications to the NiTi instruments were made to increase their flexibility and resistance to fracture. These modifications included changing the taper along the length of the cutting blade, altering the instrument's cross-sectional design, improving the manufacturing process or substituting new alloys with improved mechanical properties, and introducing the single file concept (8,10).
Protaper Next (PTN, Dentsply Maillefer, Ballaigues, Switzerland) files are manufactured from M-Wire NiTi, which results in a microstructure actually contains martensite, enhancing the alloy's flexibility and cyclic fatigue resistance over conventional NiTi (11). PTN instruments feature an off-centered rectangular cross section. This feature creates a mechanical wave of motion that travels along the file's active length and provides decreased file engagement with dentin. This system consists of five instruments with varying tip sizes and taper profiles (X1 #17/.04, X2 #25/.06, X3 #30/.07, X4 40/.06, and X5 50/.06) (12).
Recently, Race Evo (RE; FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) has been introduced which is a sequential file system developed by FKG in 2020 for minimally invasive root canal therapy. It is made of heat-treated NiTi alloy with an electropolished surface and alternating cutting edges with a triangular cross-section design (13).
The Race Evo was created with increased flexibility, cutting efficiency, and cross-sectional design, all of which are critical for canal transportation in curved root canals. However, there is no published research on the three-dimensional (3D, e.g., volumetric) and two-dimensional (2D, e.g., canal transportation) efficiency of this newly developed rotary system on primary curved root canals. Thus, it is vital to evaluate relevant parameters, shaping quality, canal transportation, canal straightening, and unneeded hard dental tissue reduction during the curved root canals preparation in order to conduct successful long-term clinical trials using minimally invasive dentistry (14).
Due to the fact that the Race Evo System is new, and to our knowledge, no research has been conducted on it. Additionally, no studies have been carried to compare the shaping ability of Race Evo files to Protaper Next files.
Materials:
In this study, the following instruments and equipments were used::
1. Protaper Next Files System(Dentsply Maillefer, Ballaigues, Switzerland).
2. Race Evo Files System (FKG Dentaire, FKG Dentaire Sàrl ,Switzerland).
3. Sodium hypochlorite( Colorox, Tenth of Ramadan City ).
4. Acrostone (Salah El deen chemicals,Cairo,Egypt).
5. EndoRadar (Woodpecker,China).
6. Cone Beam computed tomography (CBCT).
7. EDTA (Meta Biomed – Korea)
Sample Preparation:
1. High-speed diamond round bur and Endo-Z bur will be used to prepare access cavities. (Dentsply, Maillefer, Ballaigues, Switzerland).
2. The #10 K-file will be used to locate the mesio-buccal canals and check for patency. (Dentsply, Maillefer, Ballaigues, Switzerland).
3. The teeth will be placed in a mold of silicone-based impression material to maintain a steady position in order to assess root canal curvature according to Schneider's approach. After inserting a # 10 K-file into the mesiobuccal canal, a digital radiograph will be taken using SOPIX digital sensor in a mesiodistal orientation. Photos will then be evaluated with an image analysis tool.
Schneider's method begins with a point at the level of the canal orifice (point A), then a straight line parallel to the canal's long axis until it begins to diverge (point B). The apical foramen is then marked with a third point (point C), and a straight line is drawn between points B and C.
15
The canal curvature angle is defined as the angle produced by the intersection of lines AB and BC (25). After being placed in acrylic resin molds, the curvature of the mesiobuccal root canals will be assessed again using the CBCT before canal preparation.
4.Using #15 K-file, a glide path will be created. (Dentsply, Maillefer, Ballaigues, Switzerland). 5. After flushing the #10 K-file with the apical foramen, the working length will be determined as the distance from the occlusal reference point to 1 mm short of the file length.
Placement of the samples in the resin molds:
The teeth will be fixed in acrylic resin molds that have consistent vertical and horizontal orientations.
Their buccal sides will be parallel to the front side of the block and their occlusal surfaces will be horizontal.
Pre-instrumentation scanning:
-Before canal preparation, a CBCT image will be taken for each tooth in the mold.
-Each specimen will be divided into three cross sections. The first corresponds to the 3 mm from the apical end area (representing the apical third), the second at a distance of 5 mm from the apical end (representing the middle third), and the third at a distance of 8 mm from the apical end (representing the Coronal third).
Grouping of the sample:
The teeth will be categorized into two equal groups randomly
● Group A: Race Evo File System will be used to prepare the samples.
● Group B: Protaper Next Files System will be used to prepare the samples.
Root Canal Instrumentation
- The teeth will be divided into two groups randomly (n= 15 per group).
- Pre-flaring of the coronal one-third of all teeth will be done with an SX file (.19/.04) from the Protaper gold system (Dentsply Maillefer, Ballaigues, Switzerland) at 300 rpm and 5.1 N.cm of torque.
- In Race Evo File group, root canal preparation will be performed using an endodontic smart motor at 800 RPM speed and torque of 0.5 N cm by the following sequence:
The RE1 file has a 0.15 mm tip size and a 4% taper.
the RE2 file has a 0.25 mm tip size and a 4% taper.
- In the Protaper Next group, Root canal preparation will be accomplished using an endodontic motor at 300 RPM and torque ranging from 4-5.2 N.cm. by this sequence:
-The ProTaper Next X1 of 0.17 mm tip size and a 4% taper.
- The ProTaper Next X2 of 0.25 mm tip size and a 6% taper.
-The instrumentation in both groups will be performed with a lubricant of 17 % EDTA cream. Following 2-3 in-and-out movements, the file will be removed to clean its flutes, and canal irrigation will be performed using a 25-gauge plastic syringe and 2.5% sodium hypochlorite (Clorox, Egyptian company for house detergents, 10th of Ramadan, A.R.E). This technique will be repeated in both groups until each file reaches the working length, at which point the canals will be dried with paper points.
Post instrumentation scanning:
Following root canal preparation, post-instrumentation CBCT images with the same parameters as the pre-instrumentation images will be obtained. At three different cross sections, the images will be evaluated for post-instrumentation alteration.The first corresponds to the area 3 mm from the apical end (representing the apical third), the second at a distance of 5 mm from the apical end (representing the middle third), and the third at 8 mm from the apex (representing the Coronal third). Each cut will be parallel to the horizontal plane where the mounted tooth will be placed.
6 months
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