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This systematic review was registered in PROSPERO (CRD42017075917) and aimed to investigate whether the available clinical evidence supports the hypothesis that reciprocating motion results in a lower incidence of nickel-titanium files fracture compared to continuous rotation. Clinical studies that reported the incidence of fracture of engine-driven nickel-titanium files were included. The main exposure was the kinematics, and the primary outcome was the incidence of files fracture. The overall incidence of files fracture was 2.27%, with a trend for higher incidence with rotary motion (2.43%) than with reciprocating (1.0%), though without significant differences. Multiple meta-regression models revealed that the use of nickel-titanium files in more than four teeth and less proficient operators were associated with a higher incidence of file fracture. There was no difference in the clinical incidence of fracture of nickel-titanium instruments between reciprocating and rotary motions; however, other factors were identified.

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This study aimed to evaluate the influence of large apical preparations with Reciproc (REC), Hyflex CM (HCM) and Twisted File Adaptive (TFA) systems using micro-computed tomography (MCT). Ninety mesiobuccal (MB) and distobuccal (DB) root canals of maxillary molars (n = 45) were scanned using MCT before and after the shaping procedures. The root canals (n = 15) were prepared until REC 40.06, HCM 40.04 and TFA 35.04. The root canal transportation (RCT), centring ability (CA), change in volume of the root canal and at different levels (VC), remaining dentine thickness (RDT), removal of dentine wall (RDW) and working time (WT) were evaluated. Data were analysed using the Kruskal-Wallis and Dunn tests, and the one-way ANOVA and Tukey tests with a level of significance set at 5%. No significant difference among the instruments was found regarding the RCT, CA, RDT, RDW and WT (P > 0.05), in larger apical preparations in curved MB and straight DB canals of maxillary molars.

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This ex vivo study assessed the effectiveness of two activation modes to increase the intracanal temperature of 5.25% NaOCl solution and the time for a preheated-irrigant to return to its initial temperature. Ten single-rooted extracted human teeth were used. Thermocouples were adapted to the root surface and the temperature was registered following two activation modes: ultrasound (US) and thermal. Furthermore, a preheated-solution (45°C/60°C) was flushed into root canal to test the time needed to return to its initial temperature. Data were analysed using two-way ANOVA and Tukey's post-hoc tests (P = 0.05). Statistical analysis showed differences between the activation modes. US and thermal activation increased from 37 to 40.4°C and to 62.8°C respectively in 60 s. Time for preheated-irrigant to return to its initial temperature was longer for 60°C. Preheating irrigant at 60°C and using thermal activation to keep it warm may represent a further step of the irrigation protocol.

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OBJECTIVE: To evaluate the efficacy of different sonic and ultrasonic devices in the elimination of debris from canal irregularities in artificial root canals. MATERIALS AND METHODS: A resin model of a transparent radicular canal filled with dentin debris was used. Five groups were tested, namely: Group 1 - ultrasonic insert 15.02; Group 2 - ultrasonic insert 25/25 IRRI K; Group 3 - ultrasonic insert 25/25 IRRI S; Group 4 - sonic insert 20/28 Eddy on a vibrating sonic air-scaler handpiece; Group 5 - 20.02 K-file inserted on a Safety M4 handpiece. Two different irrigants (5% sodium hypochlorite and 17% EDTA) and 3 different times of activation (20, 40, and 60 seconds) were tested. Means and standard deviations were calculated and statistically analyzed with the Kruskal-Wallis and Wilcoxon tests (p<0.05). RESULTS: No statistically significant differences were found between the two irrigants used. Group 4 removed more debris than the other groups (p<0.05). Groups 1, 2, and 3 removed more debris than group 5 (p<0.05). A statistically significant difference (p<0.05) was found for the time of activation in all groups and at all canal levels, except between 40 and 60 seconds in group 4 at coronal and middle third level (p>0.05). CONCLUSIONS: No significant differences were found between 5% sodium hypochlorite and 17% EDTA. When the time of activation rises, the dentin debris removal increases in all groups. Both sonic and ultrasonic activation demonstrate high capacity for dentin debris removal.

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Abstract Objective To evaluate the efficacy of different sonic and ultrasonic devices in the elimination of debris from canal irregularities in artificial root canals. Materials and Methods A resin model of a transparent radicular canal filled with dentin debris was used. Five groups were tested, namely: Group 1 - ultrasonic insert 15.02; Group 2 - ultrasonic insert 25/25 IRRI K; Group 3 - ultrasonic insert 25/25 IRRI S; Group 4 - sonic insert 20/28 Eddy on a vibrating sonic air-scaler handpiece; Group 5 - 20.02 K-file inserted on a Safety M4 handpiece. Two different irrigants (5% sodium hypochlorite and 17% EDTA) and 3 different times of activation (20, 40, and 60 seconds) were tested. Means and standard deviations were calculated and statistically analyzed with the Kruskal-Wallis and Wilcoxon tests (p<0.05). Results No statistically significant differences were found between the two irrigants used. Group 4 removed more debris than the other groups (p<0.05). Groups 1, 2, and 3 removed more debris than group 5 (p<0.05). A statistically significant difference (p<0.05) was found for the time of activation in all groups and at all canal levels, except between 40 and 60 seconds in group 4 at coronal and middle third level (p>0.05). Conclusions No significant differences were found between 5% sodium hypochlorite and 17% EDTA. When the time of activation rises, the dentin debris removal increases in all groups. Both sonic and ultrasonic activation demonstrate high capacity for dentin debris removal.

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Effective irrigant delivery and agitation are prerequisites to promote root canal disinfection and debris removal and improve successful endodontic treatment. This paper presents an overview of the currently available technologies to improve the cleaning of the endodontic space and their debridement efficacy. A PubMed electronic search was conducted with appropriate key words to identify the relevant literature on this topic. After retrieving the full-text articles, all the articles were reviewed and the most appropriate were included in this review. Several different systems of mechanical activation of irrigants to improve endodontic disinfection were analysed: manual agitation with gutta-percha cones, endodontic instruments or special brushes, vibrating systems activated by low-speed hand-pieces or by sonic or subsonic energy, use of ultrasonic or laser energy to mechanically activate the irrigants and apical negative pressure irrigation systems. Furthermore, this review aims to describe systems designed to improve the intracanal bacterial decontamination by a specific chemical action, such as ozone, direct laser action or light-activated disinfection. The ultrasonic activation of root canal irrigants and of sodium hypochlorite in particular still remains the gold standard to which all other systems of mechanical agitation analyzed in this article were compared. From this overview, it is evident that the use of different irrigation systems can provide several advantages in the clinical endodontic outcome and that integration of new technologies, coupled with enhanced techniques and materials, may help everyday clinical practice.

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Abstract Effective irrigant delivery and agitation are prerequisites to promote root canal disinfection and debris removal and improve successful endodontic treatment. This paper presents an overview of the currently available technologies to improve the cleaning of the endodontic space and their debridement efficacy. A PubMed electronic search was conducted with appropriate key words to identify the relevant literature on this topic. After retrieving the full-text articles, all the articles were reviewed and the most appropriate were included in this review. Several different systems of mechanical activation of irrigants to improve endodontic disinfection were analysed: manual agitation with gutta-percha cones, endodontic instruments or special brushes, vibrating systems activated by low-speed hand-pieces or by sonic or subsonic energy, use of ultrasonic or laser energy to mechanically activate the irrigants and apical negative pressure irrigation systems. Furthermore, this review aims to describe systems designed to improve the intracanal bacterial decontamination by a specific chemical action, such as ozone, direct laser action or light-activated disinfection. The ultrasonic activation of root canal irrigants and of sodium hypochlorite in particular still remains the gold standard to which all other systems of mechanical agitation analyzed in this article were compared. From this overview, it is evident that the use of different irrigation systems can provide several advantages in the clinical endodontic outcome and that integration of new technologies, coupled with enhanced techniques and materials, may help everyday clinical practice.

Resumo A irrigação do canal radicular é coadjuvante na desinfecção e remoção de debris, contribuindo para o sucesso do tratamento endodôntico. Este artigo apresenta uma visão geral das tecnologias atuais indicadas para melhorar a limpeza e desbridamento do canal radicular. Foi realizado um levantamento bibliográfico eletrônico no site Pubmed utilizando palavras-chave específicas ao tema a fim de abordar literatura relevante. Após busca eletrônica, artigos completos foram revisados e os mais apropriados ao tema foram incluídos nesta revisão. Diferentes sistemas de ativação mecânica foram considerados: agitação manual com cone de guta-percha, instrumentos e escovas endodônticas, sistemas de vibração ativados por peças manuais em baixa rotação ou por energia sônica e subsônica, ultrassom, laser, assim como sistemas de irrigação que utilizam pressão apical negativa. Além disso, esta revisão descreve outros meios indicados para ampliar a descontaminação endodôntica por meio de agentes químicos como ozônio e desinfeção por meio de luz. A ativação ultrassônica do hipoclorito de sódio ainda permanece o padrão ouro e nos estudos é usada como controle na comparação aos demais sistemas que empregam agitação mecânica. A presente revisão mostra vantagens de diversos sistema de irrigação e associações entre eles, podendo aumentar a efetividade da irrigação endodôntica.

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INTRODUCTION: The purpose of this study was to evaluate the cyclic fatigue resistance of 3 different nickel-titanium reciprocating instruments. METHODS: A total of 45 nickel-titanium instruments were tested and divided into 3 experimental groups (n = 15): group 1, WaveOne Primary instruments; group 2, Reciproc R25 instruments; and group 3, Twisted File (TF) Adaptive M-L1 instruments. The instruments were then subjected to cyclic fatigue test on a static model consisting of a metal block with a simulated canal with 60° angle of curvature and a 5-mm radius of curvature. WaveOne Primary, Reciproc R25, and TF Adaptive instruments were activated by using their proprietary movements, WaveOne ALL, Reciproc ALL, and TF Adaptive, respectively. All instruments were activated until fracture occurred, and the time to fracture was recorded visually for each file with a 1/100-second chronometer. Mean number of cycles to failure and standard deviations were calculated for each group, and data were statistically analyzed (P < .05). Instruments were also observed through scanning electron microscopy to evaluate type of fracture. RESULTS: Cyclic fatigue resistance of Reciproc R25 and TF Adaptive M-L1 was significantly higher than that of WaveOne Primary (P = .009 and P = .002, respectively). The results showed no statistically significant difference between TF Adaptive M-L1 and Reciproc R25 (P = .686). Analysis of the fractured portion under scanning electron microscopy indicated that all instruments showed morphologic characteristics of ductile fracture that were due to accumulation of metal fatigue. CONCLUSIONS: No statistically significant differences were found between the instruments tested except for WaveOne Primary, which showed the lowest resistance to cyclic fatigue.

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