Comparison of root microcrack formation after root canal preparation using two continuous rotational file systems and two reciprocating systems –An Invitro study

IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 11 Ver. VI (Nov. 2015), PP 15-18
www.iosrjournals.org
DOI: 10.9790/0853-141161518 www.iosrjournals.org 15 | Page
Comparison of root microcrack formation after root canal
preparation using two continuous rotational file systems and two
reciprocating systems –An Invitro study
1
Arjun B Ravi,2
Prabath Singh V P,3
Sreeram SR,4
MadhuHariharan,
5
Razdan TR
1,2,3,4,5
Department of Conservative Dentistry and Endodontics, Amrita School of Dentistry; Amrita Institute of
Medical Sciences; Kochi; India
Abstract:
Aim:To compare the incidence of dentinal defects after preparation with reciprocating (Reciproc and
WaveOne) and fullsequence rotary ProTaper Universal and Protaper Next instruments.
Materials and methods:One hundred human mandibular premolars were randomly assigned to 5 groups (n =
20 teeth per group). The root canals were instrumented by using the reciprocating single-file systems Reciproc
and WaveOneand the fullsequence rotary protaper universal andProTaper nextinstruments.One group was left
unprepared as control. Roots were sectioned horizontally at 3, 6, and 9 mm from the apex and the sections were
then observed under a stereomicroscope. The absence/presence of cracks was recorded, and the data were
analysed with a chi-square test. The significance level was set atP= .05.
Results:The control group Protaper universal, protaper next, waveone and reciproc caused cracks in 0%, 50%,
35%, 15% and 20% of samples, respectively. A statistically significant difference was found between the
reciprocating file groups(WaveOne and reciproc) and the continuous rotation group (ProTaper universal and
protaper next) (P< .05). However, no significant difference was found among the 2 reciprocating file groups
and 2 continuous rotation group(P >.05).
Conclusions:Dentinal micro cracks are produced irrespective of motion kinematics andsuch an incidence is
less with instruments working in reciprocating motion compared with those working in continuous rotation.
Key words:Dentinal defects, nickel-titanium instruments, reciprocation, root canal preparations.
I. Introduction
Vertical root fracture (VRF) in endodontically treated teeth is one of the most frustrating complications
of root canal therapy, which results in tooth or root extraction(1). Because its effects are catastrophic,
identifying the etiologic factors of VRF in an endeavour to improve its prevention becomes important(2).
During biomechanical preparation, a canal is shaped by the contact between instruments and dentin
walls. These contacts create many momentary stress concentrations in dentin. Such stress concentrations may
induce dentinal defects and micro cracks or craze lines(3). These, in turn, were associated with increased VRF
susceptibility because applied stresses caused by root canal obturation, retreatment, and repeated occlusal forces
can be exponentially amplified at the tip of those defects and can initiate or propagate into cracks (3).
In the last decade, advances in nickel-titanium (NiTi) instruments have added a new dimension to root
canal treatment. Recently, single-file systems in rotary and reciprocating motion were introduced(4). Various
file systems differing in their design features such as the NiTi core diameter, cross-sectional shape, rake angle,
and flute depth may affect the behaviour of the file and, therefore, may influence the generation of
cracks(5).ProTaper rotary files (DentsplyMaillefer, Ballaigues, Switzerland) are popular instruments that are
characterized by an increasing taper design, convex triangular cross-section throughout their active portion, and
a negative rake angle(6). Their design facilitates active cutting motion and removes relatively more dentin
coronally compared with other systems. ProTaper rotary files were reported to create more dentin damage than
other rotary instruments(7).
Recently, ProTaper Next (DentsplyMaillefer) instruments have been introduced that have an off
centered rectangular design and progressive and regressive percentage tapers on a single file, which is made
from M-Wire technology. Having an off-centered rectangular design decreases the screw effect, dangerous taper
lock, and torque on any given file by minimizing the contact between the file and the dentin(8).
The Reciproc and WaveOne files are used in a reciprocal motion that requires special automated
devices. Reciproc files are available in different sizes (ie, 25.08, 40.06, and 50.05), whereas WaveOne consists
of the sizes 21.06, 25.08, and 40.08. The reciprocating movement relieves stress on the instrument by special
counterclockwise (cutting action) and clockwise (release of the instrument) movements and, therefore, reduces

Comparision of root microcrackformation after root canal preparation using two continuos…
the risk of cyclic fatigue caused by tension and compression. The angles of reciprocating are specific to the
design of the particular instruments (9).
Single file endodonticsand reciprocating motion are the two major modifications inmodern endodontics
but their bearing on the root canal wall is not fully elucidated.Hence a study was designed which was aimed to
compare the incidence of dentinal defects after preparation with reciprocating (Reciproc and WaveOne) and
fullsequence rotary (ProTaper Universal and Protaper Next) instruments.
II. Materials and Methods
Extracted human mandibular premolars with straight roots were selected for this study. Teeth with
open apices or anatomic irregularities were excluded. All roots were observed in a stereomicroscope under
25xmagnification (Stemi SV6; Zeiss, Jena, Germany) to exclude any external defects or cracks and were
discarded if any of these characteristics were found.Mesiodistal and buccolingual radiographs were taken to
verify the presence of a single canal. The width of the canal on both angles was measured at 9 mm from the
apex. According to these criteria, 100 mandibular premolars were selected. To ensure standardization, the teeth
were sectioned under water cooling with a low-speed saw (Isomet; Buehler Ltd, Lake Bluff, IL) 16 mm from the
apex. As suggested previously (10), the root was covered with a single layer of aluminium foil and inserted in
acrylic resin (Imicryl, Konya, Turkey) set in an acrylic tube. The root was then removed from the acrylic tube,
and the aluminium foil suspended from the root surface. A light body silicon-based material (Oranwash;
ZhermackSpA, Rovigo, Italy) was used to fill the space created by the foil and to simulate the periodontal
ligament, and the root was replaced to the impression material. Twenty teeth were left unprepared as the
negative control group, and the remaining 80 teeth were assigned to 1 of 4 root canal shaping groups.
The working length of the canals was determined by inserting a size 10 K- file(VDW, Munich,
Germany) into the root canal terminus until the file was just visible through the foramen and subtracting 1 mm
from this measurement. A glide path was performed via a size 15 K file (VDW, Munich, Germany). The apical
preparation was completed with respective instruments corresponding to size 40.Each instrument was used in 5
canalsand the root canals were irrigated with 1% solution of sodium hypochlorite between each instrument
change.A 27-G needle was used for irrigation. Around 12 mL sodium hypochlorite solution was used for each
root. After completion of the procedure, canals were rinsed with 2 mL distilled water. All roots were kept moist
in distilled water throughout the experimental procedures. A single experienced operator performed all the
procedures. The root canal shaping procedures were performed according to the manufacturer’s instructions for
each instrument system as follows:
1. Group 1: For each ProTaper Universal file, Canals were prepared in a crown-down fashion with the aid of an
XSMART motor (DentsplyMaillefer) with rotational speed (250 rpm) and the torque limit programmed in the
file library of the motor were used. The sequence was as follows: SX, S1, S2, F1, F2, F3, and F4. The first 3
shaping files were used with a brushing motion away from the root concavities before light resistance was
encountered, and the last 4 finishing files were used until the working length was reached.
2. Group 2:The ProTaper Next files were usedwith the aid of an XSMART motor (DentsplyMaillefer)with
rotational speed and the torque limit programmed in the file library of the motor.Thefiles were used in the
sequence ProTaper Universal SX followed byProTaper Next X1, X2, X3, and X4. Each file was used with a
brushing motion similar to that used with the ProTaper Universal files.
3. Group 3: A primary reciprocating WaveOne file with a tip size of 40 and a taper of 0.08 was used in a
reciprocating, slow in-and-out pecking motion until reaching the full working length according to the
manufacturer’s instructions. The flutes of the instrument were cleaned after 3 in-and-out-movements (pecks).
Reciprocating motor (VDW Silver; VDW, Munich, Germany) with the manufacturer’s configuration setup for
wave one files was used.
4. Group 4:A R40 Reciproc file with size 40 at the tip and taper of 0.06 over the first 3 mm was used in a
reciprocating, slow in-and-out pecking motion until reaching the full working length according to the
manufacturer’s instructions. The flutes of the instrument were cleaned after 3 in-and-out-movements (pecks).
III. Sectioning and microscopic observation
All of the roots were sectioned perpendicular to the long axis at 3, 6, and 9 mm from the apex using a
low-speed saw (Isomet; Buehler Ltd, Lake Bluff, IL) under water cooling. Digital images of each section were
captured at 25x magnification using a digital camera attached to a stereomicroscope (Stemi SV6; Zeiss, Jena,
Germany). In each group, a total of 50 slices were blindly examined for cracks. To define crack formation, 2
different categories were made (ie ‘‘no crack’’ and ‘‘crack’’) to avoid the confusing description of root cracks.
‘‘No crack’’ was defined as root dentin without cracks or craze lines either at the internal surface of the
root canal wall or the external surface of the root. ‘‘Crack’’ was defined as all lines observed on the slice that
either extended from the root canal lumen to the dentin or from the outer root surface into the dentin (11).

IV. Statistical Analysis
Results were expressed as the number and percentage of defected roots in each group. A chi-square test
was performed to compare the appearance of defective roots between the experimental groups by using the
SPSS/PC version 15 (SPSS Inc, Chicago, IL). The level of significance was set at 0.05.
V. Results
No complete fracture was observed in any of the samples tested.Figure 1shows the percentage of roots
with defects. Unprepared canals (ie, the control group) showed no roots with defects Figure 2 (A). There was a
statistically significant difference between NiTi file groups and the control group, which presented no defects
(P< .05). Among the NiTi file groups, the least number of craze lines and partial cracks (‘‘other defects’’) were
observed in the WaveOne group, whereas the maximum number of such defects was observed in the rotary
ProTaper universal group Figure 2 (B).The Reciproc and WaveOne instruments caused less cracks than the
ProTaper and ProTaper Next files and there was statistically significant difference in crack formation between
the groups(p<.05).
There was no statistically significant difference between the Reciproc and Waveone group and also
between the protaper universal and protaper next groups (P> .05).
Figure 1
(A) Cross section at the 6-mm level without anydentinal defects.(B)partial/incomplete crack
VI. Discussion
VRF of endodontically treated teeth is perhaps the most undesirable/frustrating clinical experience.
Root canal–treated teeth present with greater probability of VRF. Predisposing factors include the loss of
healthy tooth substance as a result of caries or trauma, moisture loss in pulpless teeth, previous cracks in dentin,
or loss of alveolar bone support (2). Moreover, previous studies have reported an insignificant difference in the
moisture content and mechanical properties of vital and endodontically treated teeth (12). Mostly, VRF is a
result of the gradual propagation of tiny cracks in tooth structure and not an immediate effect of root canal
therapy. Various canal instrumentation techniques have been found to induce the formation of such cracks,
resulting in VRF during sustained function (5,13).
This ex vivo study compares the incidence of dentinal crack formation with reciprocating single-file
systems and continuous rotation file systems. The final apical diameter achieved with the 4-instrument system
used were similar(ieupto size 40),and this standardisation improved the reliability of the results. The
0%
10%
20%
30%
40%
50%
60%
Protaper Universal Protaper Next Waveone Reciproc
Series 1
Series 1
(A) (B)

methodology used was adapted from previous published research(4). Periodontal ligament simulation is
important because it acts as a major stress absorber and should influence the outcome of such studies(14). The
current study revealed no defects in the control group, and this implies that the methodology adopted did not
induce damage. All 4 instrumentation techniques used in this study led to the development of dentinal cracks.
Under the present experimental framework, the WaveOne and Reciproc files resulted in significantly less
dentinal cracks compared with the continuous rotationalProTaper universal and Protaper Next systems. Active
rotating movement results in a high level of stress concentrations in root canal walls that may result in higher
incidence of crack formation(15).
Reciprocating motion was found to be more centered in the canal(16), and by repeating the CW and
CCW rotation, reciprocating motion allows continuous release of the file when it is engaged in the inner surface
of the root canal during the cutting and shaping procedure(17). Furthermore, flexural and torsional stresses
acting on the dentin are also reduced as the CCW motion disengages the instrument blades and reduces stresses
(15).
WaveOne presented with the least number of dentinal cracks in this study. M-wire technology imparts
more flexibility to WaveOne instruments and that might contribute to lesser dentinal cracks in this group (15).
Also, the investigated WaveOne files have a noncutting modified tip and a unique cross-sectional design along
the length of their active portions (a modified convex triangular cross-section at the tip end and a convex
triangular cross-section at the coronal end) (18).
Sectioning could induce damage, but in the present study we speculated that it did not induce such
defect because no cracks was found in the control group. However, future studies using advanced methods like
optical coherence tomography or infrared thermography will possibly eliminate the sectioning procedure and
would be less destructive.
VII. Conclusion
Though the exact duplication of in vivo conditions is difficultwithinthe limitations of this investigation,
it could be concluded that dentinal micro cracks are produced irrespective of motion kinematics andsuch an
incidence is less with instruments working in reciprocating motion compared with those working in continuous
rotation.
References
[1]. Tsesis I, Rosen E, Tamse A, et al. Diagnosis of vertical root fractures in endodontically treated teeth based on clinical and
radiographic indices: a systematic review. J Endod 2010;36:1455–8.
[2]. Tamse A. Vertical root fractures in endodontically treated teeth: diagnostic signs and clinical management. Endod Top 2006;13:84–
94.
[3]. Wilcox LR, Roskelley C, Sutton T. The relationship of root canal enlargement to finger-spreader induced vertical root fracture. J
Endod 1997;23:533–4.
[4]. RohitKansal,Akhil Rajput, et al. Assessment of Dentinal Damage during Canal Preparation Using Reciprocating and Rotary Files. J
Endod 2014;40:1443-6.
[5]. Kim HC, Lee MH, Yum J, et al. Potential relationship between design of nickeltitanium rotary instruments and vertical root
fracture. J Endod 2010;36:1195–9.
[6]. Bergmans L, Van Cleynenbreugel J, Beullens M, et al. Smooth flexible versus active tapered shaft design using NiTi rotary
instruments. IntEndod J 2002;35:820–8.
[7]. Souza Bier CA, Shemesh H, Tanomaru-Filho M, et al. The ability of different nickel titanium rotary instruments to induce dentinal
damage during canal preparation.JEndod 2009;35:236–8.
[8]. Ruddle CJ. The ProTaper endodontic system: geometries, features, and guidelines for use. Dent Today 2001;20:60–7.
[9]. Varela-Patino P, Ibanez-P arraga A, Rivas-Mundina B, Cantatore G, Otero XL, Martin Biedma B. Alternating versus continuous
rotation: a comparative study of the effect on instrument life. J Endod 2010;36:157–9.
[10]. Liu R, Kaiwar A, Shemesh H, et al. Incidence of apical root cracks and apical dentinal detachments after canal preparation with
hand and rotary files at different instrumentation lengths. J Endod 2013;39:129–32.
[11]. Shemesh H, Bier CA, Wu MK, et al. The effects of canal preparation and filling on the incidence of dentinal defects. IntEndod J
2009;42:208–13.
[12]. Sedgley CM, Messer HH. Are endodontically treated teeth more brittle? J Endod 1992;18:332–5.
[13]. Soros C, Zinelis S, Lambrianidis T, Palaghias G. Spreader load required for vertical root fracture during lateral compactionex vivo:
evaluation of periodontal simulation and fracture load information. Oral Surg Oral Med Oral Pathol Oral RadiolEndod
2008;106:e64–70.
[14]. Hin ES, Wu MK, Wesselink PR, Shemesh H. Effects of self-adjusting file, Mtwo, and ProTaper on the root canal wall. J Endod
2013;39:262–4.
[15]. Berutti E, Chiandussi G, Paolino DS, et al. Canal shaping with WaveOne Primary reciprocating files and ProTaper system: a
comparative study. J Endod 2012;38:505–9.
[16]. Franco V, Fabiani C, Taschieri S, et al. Investigation on the shaping ability of nickeltitanium files when used with a reciprocating
motion. J Endod 2011;37:1398–401.
[17]. Yared G. Canal preparation using only one Ni-Ti rotary instrument: preliminary observations. IntEndod J 2008;41:339–44.
[18]. B€urklein S, Hinschitza K, Dammaschke T, Schafer E. Shaping ability and cleaning effectiveness of two single file systems in
severely curved root canals of extractedteeth: reciproc and wave one versus Mtwo and ProTaper. IntEndod J 2012;45: 449–61.

Comparison of root microcrack formation after root canal preparation using two continuous rotational file systems and two reciprocating systems –An Invitro study

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Comparison of root microcrack formation after root canal preparation using two continuous rotational file systems and two reciprocating systems –An Invitro study