• Journal of Korean Dental Science
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• v.15 no.2
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• pp.112-120
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• 2022

In this article, the contemporary root canal treatment procedure using nickel-titanium (NiTi) instruments was reviewed to understand the correlations between the properties of files and safety of the clinical usage. Literatures were reviewed according to the process of clinical procedure of the root canal preparation, mainly for shaping during orifice flaring, glide-path preparation, and main canal instrumentation. Considering the reasons for NiTi file fracture, clinically implacable issues and ideas were discussed to reduce the fracture risk and increase clinical efficiency of the NiTi file systems. Various kinds of NiTi file systems have their own characteristics and properties given from their geometries and heat treatments and so on. Proper selection and careful usage of the NiTi file systems may reduce the risk of file fracture and increase the efficiency of NiTi file systems. Understanding of the clinical implications from the mechanical properties and characteristics of the engine driven NiTi instruments may decrease the risk of NiTi file fractures and increase the success rate in root canal treatment.

• Restorative Dentistry and Endodontics
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• v.48 no.4
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• pp.38.1-38.10
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• 2023

Objectives: The aim of this study was to examine the use of hand or rotary files by pre-graduation (fourth- and fifth-year) and postgraduate students in endodontic treatments and to determine the incidence of file fracture and the management of cases with broken instruments. Materials and Methods: A total of 2,168 teeth undergoing primary endodontic treatment were included in this study. It was determined that 79 of these teeth resulted in broken tools. In the case of broken tools, the education level of the treating clinician, the tooth that was being treated, the canal and fracture level, the curvature of the tooth and the management of the broken instrument were recorded. Periapical radiographs of the patients were used to calculate curvature following the Schneider method. Results: There was no significant difference in the incidence of broken tools according to education level (p > 0.05). The incidence of file fracture in molar teeth (73.4%) was higher than in other teeth (p < 0.05). More files were broken in the mandibular molar MB canal (20.25%) and in the apical third of the canals (72.1%). The risk of instrument fracture was high in teeth with moderate (44.3%) and severe (38%) curvature canals. The management of apically broken (80%) files mostly involved lefting (p < 0.05). Conclusions: There was no statistically significant difference between fourth-year students, fifth-year students and postgraduate students in terms of instrument fracture.

• Journal of radiological science and technology
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• v.41 no.1
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• pp.61-66
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• 2018

The recent 3D printing technology is used in various medical, manufacturing, and education fields and is more efficient in terms of production process, time, and cost than existing production. Especially in fracture surgery, interest and research have been focused on improving accuracy, shortening of operation time and recovery time, and reducing reoperation. However, because of the financial and technical problems of the 3D printer and the file conversion program, the 3D printing is made directly at the hospital, and it is not generally used for diagnosis of fracture and surgical research. In this study, to solve those problems, clavicle CT imaging was switched into Osirix Open Source DICOM Viewer, Stereolithography file conversion programs and commercial Terarecon 3D DICOM Viewer, file conversion programs, and then clavicle fracture model was directly made through 3D printer of fused filament fabrication wire additive processing method, and then the accuracy of the shape was compared and analyzed. Clavicle fracture models printed in two methods were blind-tested on clinicians of general hospitals' orthopedics and radiologic technicians with over 10 years of experiences, and then their analysis opinions of resolution reviews were analyzed. The result showed no difference. The 3D printing model with open source DICOM STL file conversion program used was applicable to clinical, so it is considered useful in precision diagnosis of fracture and operation plans.

• Restorative Dentistry and Endodontics
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• v.37 no.4
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• pp.201-206
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• 2012

Objectives: The purpose was to investigate the preference and usage technique of NiTi rotary instruments and to retrieve data on the frequency of re-use and the estimated incidence of file separation in the clinical practice among general dentists. Materials and Methods: A survey was disseminated via e-mail and on-site to 673 general dentists. The correlation between the operator's experience or preferred technique and frequency of re-use or incidence of file fracture was assessed. Results: A total of 348 dentists (51.7%) responded. The most frequently used NiTi instruments was ProFile (39.8%) followed by ProTaper. The most preferred preparation technique was crown-down (44.6%). 54.3% of the respondents re-used NiTi files more than 10 times. There was a significant correlation between experience with NiTi files and the number of re-uses (p = 0.0025). 54.6% of the respondents estimated experiencing file separation less than 5 times per year. The frequency of separation was significantly correlated with the instrumentation technique (p = 0.0003). Conclusions: A large number of general dentists in Korea prefer to re-use NiTi rotary files. As their experience with NiTi files increased, the number of re-uses increased, while the frequency of breakage decreased. Operators who adopt the hybrid technique showed less tendency of separation even with the increased number of re-use.

• Restorative Dentistry and Endodontics
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• v.43 no.1
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• pp.5.1-5.9
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• 2018

Objectives: This study evaluated the amount of remaining root canal filling materials after retreatment procedures performed by undergraduate students using manual, rotary, and reciprocating techniques through micro-computed tomographic analysis. The incidence of instrument fracture and the instrumentation time were also evaluated. Materials and Methods: Thirty maxillary single rooted teeth were prepared with Reciproc R25 files and filled with gutta-percha and AH Plus sealer by the continuous wave of condensation technique. Then, the specimens were assigned to 3 groups (n = 10), according to the retreatment technique used: manual, rotary, and reciprocating groups, which used K-file, Mtwo retreatment file, and Reciproc file, respectively. Retreatments were performed by undergraduate students. The sample was scanned after root canal filling and retreatment procedures, and the images of the canals were examined to quantify the amount of remaining filling material. The incidence of instrument fracture and the instrumentation time were recorded. Results: Remaining filling material was observed in all specimens regardless of the technique used. The mean volume of remaining material was significantly lower in the Reciproc group than in the manual K-file and Mtwo retreatment groups (p < 0.05). The time required to achieve a satisfactory removal of canal filling material and refinement was significantly lower in the Mtwo retreatment and Reciproc groups (p < 0.05) when compared to the manual K-file group. No instrument fracture was observed in any of the groups. Conclusions: Reciproc was the most effective instrument in the removal of canal fillings after retreatments performed by undergraduate students.

• Restorative Dentistry and Endodontics
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• v.29 no.3
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• pp.267-272
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• 2004

The purpose of this in vitro study was to evaluate the effect of surface defects and cross-sectional configuration of NiTi rotary files on the fatigue life under cyclic loading. Three NiTi rotary files ($K3^{TM},{\;}ProFile^{\circledR},{\;}and{\;}HERO{\;}642^{\circledR}$) with ＃30/.04 taper were evaluated. Each rotary file was divided into 2 subgroups : control (no surface defects) and experimental group (artificial surface defects), A total of six groups of each 10 were tested. The NiTi rotary files were rotated at 300rpm using the apparatus which simulated curved canal (40 degree of curvature) until they fracture. The number of cycles to fracture was calculated and the fractured surfaces were observed with a scanning electron microscope. The data were analyzed statistically. The results showed that experimental groups with surface defects had lower number of cycles to fracture than control group but there was only a statistical significance between control and experimental group in the $K3^{TM}$ (p<0.05), There was no strong correlation between the cross-sectional configuration area and fracture resistance under experimental conditions. Several of fractured files demonstrated characteristic patterns of brittle fracture consistent with the propagation of pre-existing cracks. This data indicate that surface defects of NiTi rotary files may significantly decrease fatigue life and it may be one possible factor for early fracture of NiTi rotary files in clinical practice.

• Restorative Dentistry and Endodontics
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• v.31 no.2
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• pp.96-102
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• 2006

There are various factors affecting the fracture of NiTi rotary files. This study was performed to evaluate the effect of cross sectional area, pecking motion and pecking distance on the cyclic fatigue fracture of different NiTi files. Five different NiTi $files-Profile^{(R)}$ (Maillefer, Ballaigue, Switzerland), $ProTaper^{TM}$(Maillefer, Ballaigue, Switzerland), $K3^{(R)}$ (SybronEndo. Orange, CA) , Hero $642^{(R)}$ (Micro-mega, Besancon, France), Hero $Shaper^{(R)}$ (Micro-mega, Besancon, France)-were used. Each file was embedded in temporary resin, sectioned horizontally and observed with scanning electron microscope. The ratio of cross-sectional area to the circumscribed circle was calculated. Special device was fabricated to simulate the cyclic fatigue fracture of NiTi file in the curved canal,. On this device, NiTi files were rotated (300rpm) with different pecking distances (3 mm or 6 mm) and with different motions (static motion or dynamic pecking motion) . Time until fracture occurs was measured. The results demonstrated that cross-sectional area didn't have any effect on the time of file fracture. Among the files, $Profile^{(R)}$ took the longest time to be fractured. Between the pecking motions, dynamic motion took the longer time to be fractured than static motion. There was no significant difference between the pecking distances with dynamic motion, however with static motion, the longer time was taken at 3mm distance. In this study, we could suggest that dynamic pecking motion would lengthen the time for NiTi file to be fractured from cyclic fatigue.

• Restorative Dentistry and Endodontics
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• v.45 no.2
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• pp.22.1-22.10
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• 2020

Objectives: This study investigated the influence of glide path size and operating kinetics on the time to reach the working length and the fracture resistance of Twisted File (TF) and Endostar E3 files. Materials and Methods: A total of 120 mandibular single-rooted premolars were selected. Two methods of kinetic motion (TF adaptive and continuous rotary motion) and file systems (TF and Endostar E3) were employed. The files were used in root canals prepared to apical glide path sizes of 15, 20, and 25. The time taken to reach the working length and the number of canals used before the instrument deformed or fractured were noted. Fractured instruments were examined with scanning electron microscopy. Results: The TF system took significantly more time to reach the working length than the Endostar E3 system. Both systems required significantly more time to reach the working length at the size 15 glide path than at sizes 20 and 25. A greater number of TFs than Endostar E3 files exhibited deformation, and a higher incidence of instrument deformation was observed in adaptive than in continuous rotary motion; more deformation was also observed with the size 15 glide path. One TF was fractured while undergoing adaptive motion. Conclusions: No significant difference was observed between continuous rotary and adaptive motion. The TF system and adaptive motion were associated with a higher incidence of deformation and fracture. Apical glide path sizes of 20 and 25 required significantly less time to reach the working length than size 15.

• Restorative Dentistry and Endodontics
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• v.30 no.3
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• pp.184-192
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• 2005

Intracanal separation of the rotary files is a serious concern in modern endodontic practice. The objective of this study was to compare the life span and fracture patterns of three NiTi rotary files in molar teeth Mesiobuccal roots of upper molar (n = 150) and mesial roots of lower molar (n = 150) were divided into three groups and each group was prepared with Profile, ProTaper, and K3 respectively. Every file was used until separation and/or deterioration of the cutting blade was happened, and then the number of canals to separation and/or unwinding were recorded. Radiographs and Scanning electon microscope (SEM) photographs were taken to evaluate the patterns of separation. The results were as follows: 1. There were no significant differences in numbers of canals to separation and/or unwinding among the groups. 2. Comparing between flaring files, K3 showed significant lower numbers of canals to separation and/or unwinding (p < 0.05), and there was no significant difference between shaping files 3. Separations of instruments were occurred at the midpoint of curvatures within the canals 4. In SEM observations, ductile fractures were seen in most of cases, characterized by shallow dimples. Additional researches is needed to provide a new guideline that informs the appropriate number of times to use NiTi files.

• The Journal of the Korean dental association
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• v.54 no.8
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• pp.640-650
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• 2016

Nickel-Titanium (NiTi) rotary instruments have brought a big step toward "efficient" practice of endodontic procedure. The rotary files help clinicians to reduce their working time and also increase the clinical success rate with minimal procedural errors. However, NiTi instruments still have a few drawbacks including unpredictable fatigue fracture. Clinicians may reduce the potential risk of instruments fracture by following some clinical guidelines for rotary instruments. In some clinical cases of instruments fracture, we may try to remove the instruments' fragments or bypass the fragment to reach the apical canal. In some limited cases, the fractured instruments' fragments would not jeopardize the clinical prognosis of root canal treatment. Nevertheless, it is impossible to be overemphasized that the prevention of file fracture is much easier than the removal of fracture fragment. Clinicians need to understand the fracture mechanisms and, in clinic, need to discard the used instruments timely.