Flat-oval root canal preparation with Self-Adjusting File instrument: a micro-CT study

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Oral Presentation performed at the SkyScan User Meeting 2011 in Leuven, Belgium.

Oral Presentation performed at the SkyScan User Meeting 2011 in Leuven, Belgium.

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  • 1. Thank you very much. It is an honor to be here with you today. I would like to thankSkyScan for this invitation and to the University of São Paulo in the person of Prof.Manoel for the oportunity to be here. 1
  • 2. A tooth is basically made up of two parts: the crown and the root. Different tissuesmake up each tooth. The enamel, the dentin, that supports the enamel, and the pulpthat is a soft tissue located within a tooth, in a place called pulp cavity that is dividedinto root canal and pulp chamber. 2
  • 3. Root canal treatment is a dental procedure which is undertaken to treat the infectedpulp of a tooth. The ultimate goal of root canal preparation is to remove the innerlayer of the dentin while allowing an irrigant solution to reach the entire length of theroot canal. 3
  • 4. To achieved this goal, different shaping techniques and instruments are available. 4
  • 5. In the last 15 years, root canal preparation with rotary instruments has becomepopular. 5
  • 6. Although many technical advances have been made in endodontics, canalpreparation is still adversely influenced by the highly variable anatomy, especially inoval, flat, or curved root canals 6
  • 7. In flattened canals, rotary files have failed to perform adequate cleaning and shapingleaving untouched fins or recesses on the buccal and/or lingual aspects of the borecreated by the instrument. 7
  • 8. Recently, The Self-Adjusting File has been devised with the purpose of sidesteppingsome of the limitations of rotary instruments. 8
  • 9. The SAF is a hollow file designed as a compressible pointed cylinder composed of athin nickel-titanium lattice. During its operation, the file is designed to adapt itselfthree-dimensionally to the shape of the root canal. 9
  • 10. The purpose of this study was to evaluate the root canal preparation in flattened rootcanals of mandibular incisors treated with either rotary or SAF, using three-dimensional µCT analysis. 10
  • 11. Forty single-rooted human mandibular incisor teeth were used. Before experimentalprocedure, each specimen was vertically positioned on a metal holder in the centreof the stage and scanned in a desktop X-ray microfocus CT scanner SkyScan 1174v2 11
  • 12. Then, half of the sample was instrumented using rotary intruments and the other halfusing Self Adjusting File 12
  • 13. Then, all sample was re-scanned using the same initial parameters. 13
  • 14. Images were reconstructed from the apex to the level of the cementoenameljunction (NRecon v1.6.1.5; SkyScan) providing axial cross sections of the innerstructure of the samples. For each tooth, evaluation was done for the full canal lengthin approximately 400 slices per specimen 14
  • 15. CTAn v1.10.1.0 software (Skyscan) was used for three-dimensional analysis of volumeand surface area. Increases of all analyzed parameters were calculated by subtractingthe scores for the treated canals from those recorded for the untreated counterparts 15
  • 16. OnDemand 3D software (Cybermed Inc., Irvine, CA, USA) was used for the analysis ofthe fifteen superimposed cross-sections images of each specimen (n=300 per group)regarding the percentage of instrumented and non-instrumented walls. The rootcanal preparation was classified into two categories: (a) cross-section in which thewhole perimeter or almost all perimeter was treated (80% or more of the perimetertreated) and (b) cross-section in which most of the perimeter was untreated (20% orless of the perimeter treated). 16
  • 17. OnDemand 3D software (Cybermed Inc., Irvine, CA, USA) was used for the analysis ofthe fifteen superimposed cross-sections images of each specimen (n=300 per group)regarding the percentage of instrumented and non-instrumented walls. The rootcanal preparation was classified into two categories: (a) cross-section in which thewhole perimeter or almost all perimeter was treated (80% or more of the perimetertreated) and (b) cross-section in which most of the perimeter was untreated (20% orless of the perimeter treated). 17
  • 18. OnDemand 3D software (Cybermed Inc., Irvine, CA, USA) was used for the analysis ofthe fifteen superimposed cross-sections images of each specimen (n=300 per group)regarding the percentage of instrumented and non-instrumented walls. The rootcanal preparation was classified into two categories: (a) cross-section in which thewhole perimeter or almost all perimeter was treated (80% or more of the perimetertreated) and (b) cross-section in which most of the perimeter was untreated (20% orless of the perimeter treated). 18
  • 19. CTVol software (Skyscan) was used for three-dimensional visualization and qualitativeevaluation of the pre- and post-instrumented canals. Color-coded root canal models(green indicates preoperative, red postoperative canal surfaces) enabled qualitativecomparison of the matched root canals before and after shaping. 19
  • 20. Despite the mean increase of the canal volume was significantly higher with SAF (1.47± 0.67 mm3) than rotary instrumentation (2.32 ± 1.0 mm3) (P = .04), the same was notobserved with the surface area (P > .05). Within group, volume and surface areashowed significant statistical difference between pre- and postoperative results (P <.05). 20
  • 21. The percentage of mechanically untreated canal walls at coronal, middle and apicalthird, calculated by using superimposed µCT data sets, were 8%, 35%, and 15% forSAF group and 38%, 56%, and 25% for rotary group. There was statistically significantdifference between the instrumented and the non-instrumented walls betweengroups at coronal and middle thirds 21
  • 22. Cross sections and tridimensional analysis showed that the use of SAF resulted in amore homogenous preparation of the root canal walls compared to rotaryinstruments. 22
  • 23. 23
  • 24. 24
  • 25. It can be concluded that in the coronal third of the canal, mean increases of area andvolume of the root canal, as well as the percentage of prepared walls, weresignificantly higher with SAF than rotary instrumentation. By using SAF instrument,flat-oval-shaped canals of mandibular incisors were homogenously andcircumferentially prepared. 25
  • 26. 26