This document summarizes a study that compared the cyclic fatigue resistance of four nickel-titanium rotary endodontic file systems. It also evaluated their surface characteristics, fractography, and alloy matrix morphology. The study found that NRT files had the highest fatigue resistance, followed by AlphaKite, EasyShape, and ProTaper files. All files showed surface imperfections and nonmetallic inclusions within the alloy matrix. Crack initiation was found to originate from surface irregularities under fractographic analysis. Austenitic grains were smaller near the file tips compared to near the handles. The angle of curvature was confirmed to influence fatigue life, with higher angles resulting in lower cycle counts to failure.
This study evaluated the magnetic resonance imaging (MRI) artifacts caused by four types of fixed orthodontic attachments: stainless steel brackets, titanium brackets, ceramic brackets with metal slots, and stainless steel retainers. Sixty patients underwent MRI scans of four head and neck areas both with and without the attachments. Stainless steel brackets caused artifacts that made all areas non-interpretable. Titanium brackets and ceramic brackets with metal slots caused artifacts in the oral cavity for some patients but not other areas. Stainless steel retainers mainly caused artifacts in the oral cavity. The study provides guidance for when removal of fixed appliances is needed prior to MRI to avoid interfering artifacts.
This document summarizes a study examining various magnesium alloys as degradable implant materials for orthopedic applications. Five alloys (LAE442, WE43, MgCa0.8, AX30, ZEK100) were implanted into rabbit tibiae. Over 3, 6, and 12 months: 1) Weight loss and mechanical strength decreased more for calcium-containing than rare-earth alloys; 2) Histology showed less bone reaction for alloys with slower, more uniform degradation like LAE442; 3) μ-CT imaging found better bone-implant contact for LAE442 compared to MgCa0.8. The study evaluated alloy degradation rates and biocompatibility in vivo.
This document summarizes information about hip resurfacing arthroplasty. It discusses how resurfacing is best for young, active patients with good bone quality who want to conserve bone and soft tissues. However, it notes that resurfacing is not suitable for all hips. Certain factors can make a hip unsuitable for resurfacing, like severe deformity, cystic changes, or an excessively anteverted neck. The main contraindication is osteonecrosis with collapse of the femoral head. It concludes that patients must have realistic expectations, and surgeons need to have an alternative plan in case resurfacing is not possible.
Objective: The aim of the present study was to make an evaluation of inter-canine width before and after the stage of levelling and alignment in the mandible using three different orthodontic arch wires. Subjects and methods: Thirty orthodontic patients both males and females were selected and treated by the same researcher. The patients were randomly divided equally into three groups according to the type of wire that was used, so Group A, B and C will be used. Group A, this group included 10 patients treated with (CNA) wire. Group B, this group included 10 patients treated with (Cu NITI) wire. Group C, this group included 10 patients treated with (NITI) wire. Results: The results showed that inter-canine width showed no significance after the finishing of the leveling and alignment stage.
Micro-computed tomographic assessment of dentinal microcrack formation in str...DR.AJAY BABU GUTTI M.D.S
Micro-computed tomographic assessment of
dentinal microcrack formation in straight and
curved root canals in extracted teeth prepared
with hand, rotary and reciprocating instruments IEJ 2021
Repair of teeth with cracks in crowns and roots: An observational clinical studyDR.AJAY BABU GUTTI M.D.S
1) An observational clinical study investigated the survival rate of teeth with longitudinal cracks (PRCT and DRCT) that underwent composite restoration.
2) 180 cracked teeth from 99 patients were included, with 26% surviving after 5 years. Survival was better for PRCT (75%) than DRCT (48%).
3) The adhesive composite restoration technique was found to promote bone repair in most cases and reduce risk of further crack progression or extraction.
While time-consuming, it provided a promising long-term prognosis for vertical root cracks.
Objective: The aims of this study isto evaluate the inter-premolar width changes in the mandible using three different commercial orthodontic arch wires. Subjects and methods: Thirty patients including both males and females have been allocated in this study. Three orthodontic wires including NiTi, copper NiTi, and Beta-Titanium wires had been used. A special observational technique including cbct had been used to make an evaluation for the inter-premolar width before and after the aligning stage. Results: The results showed a highly significant increase in post-treatment inter premolar width in CNA and NITI groups; compared to Cu NITI group; with highly significant statistical difference (p < 0.01 respectively). Conclusion: The present study showed that there is a high significant increase in the inter-premolar width in the mandible, when comparing the wires in the groups (NiTi, CNA, and copper niti). Also, the gender of the patient does not seem to have an impact of the gender on post-treatment efficacy of each wire.
This document discusses metallic biomaterials for 3D printing of orthopedic implants. It begins with an introduction to porous prostheses for bone ingrowth fixation. The state of the art section describes the Arcam EBM 3D printing process and materials like Ti6Al4V and Co-Cr alloys. Mechanical validation tests on solid and porous samples produced by EBM show properties comparable to other fabrication methods. In vitro testing with human osteoblast cells shows good cell adhesion and growth on EBM porous structures. In vivo small animal and sheep studies demonstrate bone ingrowth and osseointegration with EBM printed implants.
This study evaluated the magnetic resonance imaging (MRI) artifacts caused by four types of fixed orthodontic attachments: stainless steel brackets, titanium brackets, ceramic brackets with metal slots, and stainless steel retainers. Sixty patients underwent MRI scans of four head and neck areas both with and without the attachments. Stainless steel brackets caused artifacts that made all areas non-interpretable. Titanium brackets and ceramic brackets with metal slots caused artifacts in the oral cavity for some patients but not other areas. Stainless steel retainers mainly caused artifacts in the oral cavity. The study provides guidance for when removal of fixed appliances is needed prior to MRI to avoid interfering artifacts.
This document summarizes a study examining various magnesium alloys as degradable implant materials for orthopedic applications. Five alloys (LAE442, WE43, MgCa0.8, AX30, ZEK100) were implanted into rabbit tibiae. Over 3, 6, and 12 months: 1) Weight loss and mechanical strength decreased more for calcium-containing than rare-earth alloys; 2) Histology showed less bone reaction for alloys with slower, more uniform degradation like LAE442; 3) μ-CT imaging found better bone-implant contact for LAE442 compared to MgCa0.8. The study evaluated alloy degradation rates and biocompatibility in vivo.
This document summarizes information about hip resurfacing arthroplasty. It discusses how resurfacing is best for young, active patients with good bone quality who want to conserve bone and soft tissues. However, it notes that resurfacing is not suitable for all hips. Certain factors can make a hip unsuitable for resurfacing, like severe deformity, cystic changes, or an excessively anteverted neck. The main contraindication is osteonecrosis with collapse of the femoral head. It concludes that patients must have realistic expectations, and surgeons need to have an alternative plan in case resurfacing is not possible.
Objective: The aim of the present study was to make an evaluation of inter-canine width before and after the stage of levelling and alignment in the mandible using three different orthodontic arch wires. Subjects and methods: Thirty orthodontic patients both males and females were selected and treated by the same researcher. The patients were randomly divided equally into three groups according to the type of wire that was used, so Group A, B and C will be used. Group A, this group included 10 patients treated with (CNA) wire. Group B, this group included 10 patients treated with (Cu NITI) wire. Group C, this group included 10 patients treated with (NITI) wire. Results: The results showed that inter-canine width showed no significance after the finishing of the leveling and alignment stage.
Micro-computed tomographic assessment of dentinal microcrack formation in str...DR.AJAY BABU GUTTI M.D.S
Micro-computed tomographic assessment of
dentinal microcrack formation in straight and
curved root canals in extracted teeth prepared
with hand, rotary and reciprocating instruments IEJ 2021
Repair of teeth with cracks in crowns and roots: An observational clinical studyDR.AJAY BABU GUTTI M.D.S
1) An observational clinical study investigated the survival rate of teeth with longitudinal cracks (PRCT and DRCT) that underwent composite restoration.
2) 180 cracked teeth from 99 patients were included, with 26% surviving after 5 years. Survival was better for PRCT (75%) than DRCT (48%).
3) The adhesive composite restoration technique was found to promote bone repair in most cases and reduce risk of further crack progression or extraction.
While time-consuming, it provided a promising long-term prognosis for vertical root cracks.
Objective: The aims of this study isto evaluate the inter-premolar width changes in the mandible using three different commercial orthodontic arch wires. Subjects and methods: Thirty patients including both males and females have been allocated in this study. Three orthodontic wires including NiTi, copper NiTi, and Beta-Titanium wires had been used. A special observational technique including cbct had been used to make an evaluation for the inter-premolar width before and after the aligning stage. Results: The results showed a highly significant increase in post-treatment inter premolar width in CNA and NITI groups; compared to Cu NITI group; with highly significant statistical difference (p < 0.01 respectively). Conclusion: The present study showed that there is a high significant increase in the inter-premolar width in the mandible, when comparing the wires in the groups (NiTi, CNA, and copper niti). Also, the gender of the patient does not seem to have an impact of the gender on post-treatment efficacy of each wire.
This document discusses metallic biomaterials for 3D printing of orthopedic implants. It begins with an introduction to porous prostheses for bone ingrowth fixation. The state of the art section describes the Arcam EBM 3D printing process and materials like Ti6Al4V and Co-Cr alloys. Mechanical validation tests on solid and porous samples produced by EBM show properties comparable to other fabrication methods. In vitro testing with human osteoblast cells shows good cell adhesion and growth on EBM porous structures. In vivo small animal and sheep studies demonstrate bone ingrowth and osseointegration with EBM printed implants.
The effect of vibration on the rate of leveling and alignmentEdwardHAngle
This study evaluated the effects of vibration therapy using an AcceleDent device on the rate of orthodontic leveling and alignment in the mandibular arch. The study found that patients who used the AcceleDent device for 20 minutes per day experienced faster leveling and alignment times compared to control groups. For leveling, the AcceleDent group achieved the desired outcome in an average of 160 days, which was 48 and 55 days faster than the study and pre-study control groups respectively. For alignment, the AcceleDent group achieved the desired outcome in an average of 93 days, which was 27 and 38 days faster than the study and pre-study control groups, though the differences for alignment were not
This study aims to measure residual stresses in bone samples after machining with varying rake angles and cutting orientations. Bone samples will be cut from bovine femurs and machined using positive and negative rake angles in parallel, perpendicular, and transverse orientations. Residual stresses will then be measured using X-ray diffraction and compared to determine which machining parameters induce the least amount of undesirable tensile residual stresses. Previous studies suggest cutting with a negative rake angle will provide the least tensile stresses, while the transverse orientation will produce the highest stresses. The results of this study could help surgeons choose machining parameters that optimize bone strength and integration with implants.
To give a genral idea to the materials used in orthopedic implant industry with their advantages and disadvantages.
Including how to identify the type of biomaterials.
Also, conclude a straightforward material rationale as a simple guideline.
This document summarizes a systematic review comparing the functional outcomes of bioabsorbable versus metallic screws in anterior cruciate ligament (ACL) reconstruction. Thirteen randomized controlled trials involving a total of 1006 patients were identified through a PubMed search. Most studies used poly-L-lactic acid bioabsorbable screws and titanium metallic screws. Functional outcomes were measured using scales like Lysholm score and IKDC score. The review found no significant differences in functional outcomes between bioabsorbable and metallic screws, though bioabsorbable screws were associated with fewer complications due to not requiring removal.
In vitro tests of adhesive and composite dental materialsSilas Toka
The document summarizes a review article on the relevance of in vitro tests of adhesive and composite dental materials. It discusses how laboratory tests are standardized according to ISO protocols to evaluate properties like depth of cure, flexural strength, water sorption and solubility. While laboratory tests provide useful data on material properties, they do not replace clinical studies. Some laboratory recommendations did not prove superior to simpler techniques in clinical trials. Additionally, unexpected clinical problems may arise that were not anticipated by laboratory testing alone, emphasizing the need to augment laboratory studies with long-term clinical evaluations.
Orthopedic Coatings: Predictions for 2025April Bright
What are the next innovations in orthopedic coatings? What orthopedic market stands to benefit the most from coatings? What’s stalling coating innovation? This session brought together the device company and coating manufacturer perspective to discuss which coatings will be used in orthopedics in the next decade.
This document discusses the use of an Er:YAG laser to treat periapical lesions by removing microbial contamination from the root apex. The study evaluated the efficacy of an Er:YAG laser on removing microbiological apical biofilm (MAB) and infected cementum from extracted human teeth with periapical lesions. Scanning electron microscopy showed that laser irradiation vaporized part of the infected cementum and MAB from irradiated areas without exposing the underlying dentin. The findings suggest the Er:YAG laser may be effective for removing MAB. However, further research is needed to evaluate its clinical use.
This document summarizes 4 articles related to dental implants. The first article discusses a case study of one-piece implant design and concludes that it eliminates structural weaknesses of two-piece implants and increases success rates of immediately loaded implants with high insertion torque. The second article discusses factors affecting dental implant success including biocompatibility, tissue interactions, osteointegration and surface treatments. The third article assesses bone quality for implants and categorizes bone quality into 4 types. The fourth article provides an overview of corrosion aspects of titanium and its alloys used in dental implants.
1) A 10-year prospective study evaluated 121 oxidized titanium implants in 46 patients. 2) After 10 years, the survival rate was 99.2% with only 1 implant failing. 3) Marginal bone loss averaged 0.7 mm over 10 years, with 11.3% of implants showing over 2 mm of bone loss and 4.7% over 3 mm of bone loss. 4) Implants with over 3 mm bone loss showed bleeding and pus on probing, indicating peri-implantitis.
Increased occurrence of dental anomalies associated with infraocclusion of de...EdwardHAngle
This study examined the relationship between infraocclusion of deciduous molars and other dental anomalies. The study analyzed 99 patients with infraocclusion from Boston and Jerusalem. It found statistically significant associations between infraocclusion and increased prevalence of tooth agenesis, microdontia of maxillary lateral incisors, palatally displaced canines, and distal angulation of mandibular second premolars. Specifically, these dental anomalies were two to seven times more common in the infraocclusion samples compared to reported prevalence in general population reference samples. The results support the hypothesis that shared genetic factors may underlie the connection between infraocclusion and other dental anomalies.
This document provides an introduction to non-destructive testing (NDT) methods. It defines NDT as using noninvasive techniques to determine the integrity of a material or structure without causing damage. The six most common NDT methods are described as visual testing, liquid penetrant testing, magnetic particle testing, ultrasonic testing, eddy current testing, and radiographic testing. Examples are given of how each method is used to inspect aircraft components, bridges, pipelines and other structures and materials. NDT plays an important role in quality control and safety across many industries.
Technique for Placement of Oxidized Titanium Implants by Oded BahatOded Bahat
This study evaluated 290 tapered, oxidized titanium implants placed in compromised bone in 126 patients over 3 years. The implants had a 99.3% survival rate after 3 years of loading. Marginal bone levels around the implants remained stable over the 3-year period. By using a customized osteotomy technique that minimized bone removal and tapered implants with an oxidized surface, the implants provided reliable support for fixed dental prostheses in grafted and ungrafted compromised bone.
Comparative evaluation of treatment of noncarious cervical hypersensitivity b...DR.AJAY BABU GUTTI M.D.S
Comparative evaluation of treatment of noncarious
cervical hypersensitivity by a fluoride varnish, a
dentin bonding agent, and Er, Cr:YSGG laser: An
in vivo study JCD 2020
1) The study tested the effects of probe/pilot hole diameter and tap size on the pullout strength of pedicle screws inserted into polyurethane foam blocks of varying densities.
2) Testing showed that probe/pilot hole diameter had a non-linear, parabolic effect on pullout strength, with an optimal size existing for a given screw size. Too large or small of a hole caused rapid decreases in strength.
3) For tap size, results demonstrated that not tapping or undertapping by 2-3 sizes did not significantly impact strength, but strength decreased exponentially as tap size increased towards the screw diameter.
This document summarizes a study on the recurrence rates of odontogenic keratocysts (OKCs) treated between 1971-1983. 44 patients with OKCs were included, with recurrence found in 8 cases (18%). All recurrences were in thin-walled cysts (Forssell group la). Decompression treatment using polyethylene drainage tubes in 12 large cysts resulted in thickening of the cyst walls and no recurrences after 7-17 years. The decompression treatment appears to reduce recurrence risks of OKCs compared to standard cystectomy alone.
The study examined 79 fractured nickel-titanium instruments from 3 endodontic clinics collected over 16 months. Scanning electron microscope analysis found that most rotary instruments failed due to fatigue fracture (78% of K3, 66% of ProTaper), while 91% of hand instruments failed by shear. Fatigue fractures generally had 1-2 crack origins, with K3 more often having 2 origins including locations along the flute compared to ProTaper which mostly had 1 origin at the cutting edge. The results indicate failure mode relates to preparation technique and instrument design.
The document describes the Digital Smile Design (DSD) protocol, a tool for treatment planning and communication in esthetic dentistry. The DSD involves taking diagnostic photos and videos of the patient's smile and face. Reference lines are drawn on the digital photos to analyze esthetic factors like the smile line, midlines, tooth proportions and positions. This information guides development of a treatment plan and waxup. The DSD facilitates communication between the dental team and provides feedback at each treatment stage. It helps explain treatment to patients and improves predictability, efficiency and outcomes in esthetic dental treatments.
This document describes a new device designed to measure dental implant stability using resonance frequency analysis. The device uses an electromagnetic actuator to deliver an impact force to the implant, triggering vibrations that are detected to determine the resonance frequency. In vitro and in vivo tests show the device provides measurements that highly correlate with a commercially available device. A clinical study using the new device found initial resonance frequency values above 10 kHz indicated implants were ready for immediate loading, while values from 4-10 kHz required more osseointegration time. The new device allows for minimum contact measurement of implant stability without additional attachment or disassembly steps.
1) The document describes techniques for producing stunning polarized light images of sliced teeth, which reveal the optical properties of enamel.
2) Teeth must be freshly extracted, cleaned, stored in immersion oil for weeks, and thinly sliced using specialized equipment to produce high-quality birefringence images under polarized light.
3) A digital SLR camera equipped with a macro lens, polarizing filters, and controlled lighting is used to capture the birefringence effects, which may be enhanced through digital post-processing due to limitations of the camera sensor's dynamic range compared to the human eye.
The effect of vibration on the rate of leveling and alignmentEdwardHAngle
This study evaluated the effects of vibration therapy using an AcceleDent device on the rate of orthodontic leveling and alignment in the mandibular arch. The study found that patients who used the AcceleDent device for 20 minutes per day experienced faster leveling and alignment times compared to control groups. For leveling, the AcceleDent group achieved the desired outcome in an average of 160 days, which was 48 and 55 days faster than the study and pre-study control groups respectively. For alignment, the AcceleDent group achieved the desired outcome in an average of 93 days, which was 27 and 38 days faster than the study and pre-study control groups, though the differences for alignment were not
This study aims to measure residual stresses in bone samples after machining with varying rake angles and cutting orientations. Bone samples will be cut from bovine femurs and machined using positive and negative rake angles in parallel, perpendicular, and transverse orientations. Residual stresses will then be measured using X-ray diffraction and compared to determine which machining parameters induce the least amount of undesirable tensile residual stresses. Previous studies suggest cutting with a negative rake angle will provide the least tensile stresses, while the transverse orientation will produce the highest stresses. The results of this study could help surgeons choose machining parameters that optimize bone strength and integration with implants.
To give a genral idea to the materials used in orthopedic implant industry with their advantages and disadvantages.
Including how to identify the type of biomaterials.
Also, conclude a straightforward material rationale as a simple guideline.
This document summarizes a systematic review comparing the functional outcomes of bioabsorbable versus metallic screws in anterior cruciate ligament (ACL) reconstruction. Thirteen randomized controlled trials involving a total of 1006 patients were identified through a PubMed search. Most studies used poly-L-lactic acid bioabsorbable screws and titanium metallic screws. Functional outcomes were measured using scales like Lysholm score and IKDC score. The review found no significant differences in functional outcomes between bioabsorbable and metallic screws, though bioabsorbable screws were associated with fewer complications due to not requiring removal.
In vitro tests of adhesive and composite dental materialsSilas Toka
The document summarizes a review article on the relevance of in vitro tests of adhesive and composite dental materials. It discusses how laboratory tests are standardized according to ISO protocols to evaluate properties like depth of cure, flexural strength, water sorption and solubility. While laboratory tests provide useful data on material properties, they do not replace clinical studies. Some laboratory recommendations did not prove superior to simpler techniques in clinical trials. Additionally, unexpected clinical problems may arise that were not anticipated by laboratory testing alone, emphasizing the need to augment laboratory studies with long-term clinical evaluations.
Orthopedic Coatings: Predictions for 2025April Bright
What are the next innovations in orthopedic coatings? What orthopedic market stands to benefit the most from coatings? What’s stalling coating innovation? This session brought together the device company and coating manufacturer perspective to discuss which coatings will be used in orthopedics in the next decade.
This document discusses the use of an Er:YAG laser to treat periapical lesions by removing microbial contamination from the root apex. The study evaluated the efficacy of an Er:YAG laser on removing microbiological apical biofilm (MAB) and infected cementum from extracted human teeth with periapical lesions. Scanning electron microscopy showed that laser irradiation vaporized part of the infected cementum and MAB from irradiated areas without exposing the underlying dentin. The findings suggest the Er:YAG laser may be effective for removing MAB. However, further research is needed to evaluate its clinical use.
This document summarizes 4 articles related to dental implants. The first article discusses a case study of one-piece implant design and concludes that it eliminates structural weaknesses of two-piece implants and increases success rates of immediately loaded implants with high insertion torque. The second article discusses factors affecting dental implant success including biocompatibility, tissue interactions, osteointegration and surface treatments. The third article assesses bone quality for implants and categorizes bone quality into 4 types. The fourth article provides an overview of corrosion aspects of titanium and its alloys used in dental implants.
1) A 10-year prospective study evaluated 121 oxidized titanium implants in 46 patients. 2) After 10 years, the survival rate was 99.2% with only 1 implant failing. 3) Marginal bone loss averaged 0.7 mm over 10 years, with 11.3% of implants showing over 2 mm of bone loss and 4.7% over 3 mm of bone loss. 4) Implants with over 3 mm bone loss showed bleeding and pus on probing, indicating peri-implantitis.
Increased occurrence of dental anomalies associated with infraocclusion of de...EdwardHAngle
This study examined the relationship between infraocclusion of deciduous molars and other dental anomalies. The study analyzed 99 patients with infraocclusion from Boston and Jerusalem. It found statistically significant associations between infraocclusion and increased prevalence of tooth agenesis, microdontia of maxillary lateral incisors, palatally displaced canines, and distal angulation of mandibular second premolars. Specifically, these dental anomalies were two to seven times more common in the infraocclusion samples compared to reported prevalence in general population reference samples. The results support the hypothesis that shared genetic factors may underlie the connection between infraocclusion and other dental anomalies.
This document provides an introduction to non-destructive testing (NDT) methods. It defines NDT as using noninvasive techniques to determine the integrity of a material or structure without causing damage. The six most common NDT methods are described as visual testing, liquid penetrant testing, magnetic particle testing, ultrasonic testing, eddy current testing, and radiographic testing. Examples are given of how each method is used to inspect aircraft components, bridges, pipelines and other structures and materials. NDT plays an important role in quality control and safety across many industries.
Technique for Placement of Oxidized Titanium Implants by Oded BahatOded Bahat
This study evaluated 290 tapered, oxidized titanium implants placed in compromised bone in 126 patients over 3 years. The implants had a 99.3% survival rate after 3 years of loading. Marginal bone levels around the implants remained stable over the 3-year period. By using a customized osteotomy technique that minimized bone removal and tapered implants with an oxidized surface, the implants provided reliable support for fixed dental prostheses in grafted and ungrafted compromised bone.
Comparative evaluation of treatment of noncarious cervical hypersensitivity b...DR.AJAY BABU GUTTI M.D.S
Comparative evaluation of treatment of noncarious
cervical hypersensitivity by a fluoride varnish, a
dentin bonding agent, and Er, Cr:YSGG laser: An
in vivo study JCD 2020
1) The study tested the effects of probe/pilot hole diameter and tap size on the pullout strength of pedicle screws inserted into polyurethane foam blocks of varying densities.
2) Testing showed that probe/pilot hole diameter had a non-linear, parabolic effect on pullout strength, with an optimal size existing for a given screw size. Too large or small of a hole caused rapid decreases in strength.
3) For tap size, results demonstrated that not tapping or undertapping by 2-3 sizes did not significantly impact strength, but strength decreased exponentially as tap size increased towards the screw diameter.
This document summarizes a study on the recurrence rates of odontogenic keratocysts (OKCs) treated between 1971-1983. 44 patients with OKCs were included, with recurrence found in 8 cases (18%). All recurrences were in thin-walled cysts (Forssell group la). Decompression treatment using polyethylene drainage tubes in 12 large cysts resulted in thickening of the cyst walls and no recurrences after 7-17 years. The decompression treatment appears to reduce recurrence risks of OKCs compared to standard cystectomy alone.
The study examined 79 fractured nickel-titanium instruments from 3 endodontic clinics collected over 16 months. Scanning electron microscope analysis found that most rotary instruments failed due to fatigue fracture (78% of K3, 66% of ProTaper), while 91% of hand instruments failed by shear. Fatigue fractures generally had 1-2 crack origins, with K3 more often having 2 origins including locations along the flute compared to ProTaper which mostly had 1 origin at the cutting edge. The results indicate failure mode relates to preparation technique and instrument design.
The document describes the Digital Smile Design (DSD) protocol, a tool for treatment planning and communication in esthetic dentistry. The DSD involves taking diagnostic photos and videos of the patient's smile and face. Reference lines are drawn on the digital photos to analyze esthetic factors like the smile line, midlines, tooth proportions and positions. This information guides development of a treatment plan and waxup. The DSD facilitates communication between the dental team and provides feedback at each treatment stage. It helps explain treatment to patients and improves predictability, efficiency and outcomes in esthetic dental treatments.
This document describes a new device designed to measure dental implant stability using resonance frequency analysis. The device uses an electromagnetic actuator to deliver an impact force to the implant, triggering vibrations that are detected to determine the resonance frequency. In vitro and in vivo tests show the device provides measurements that highly correlate with a commercially available device. A clinical study using the new device found initial resonance frequency values above 10 kHz indicated implants were ready for immediate loading, while values from 4-10 kHz required more osseointegration time. The new device allows for minimum contact measurement of implant stability without additional attachment or disassembly steps.
1) The document describes techniques for producing stunning polarized light images of sliced teeth, which reveal the optical properties of enamel.
2) Teeth must be freshly extracted, cleaned, stored in immersion oil for weeks, and thinly sliced using specialized equipment to produce high-quality birefringence images under polarized light.
3) A digital SLR camera equipped with a macro lens, polarizing filters, and controlled lighting is used to capture the birefringence effects, which may be enhanced through digital post-processing due to limitations of the camera sensor's dynamic range compared to the human eye.
This document provides guidelines for various vital pulp therapies including apexogenesis, pulpotomy, pulpal debridement, indirect pulp capping, and direct pulp capping. It outlines the indications, procedures, and objectives for each therapy. Apexogenesis involves capping a mechanically exposed pulp to encourage continued root development. Pulpotomy involves removing coronal pulp and placing a medicament to maintain pulp vitality. Pulpal debridement provides temporary pain relief before root canal treatment. Indirect pulp capping involves excavating deep caries near the pulp and placing a barrier to prevent future exposure. The document emphasizes maintaining pulp vitality, monitoring root development, and preventing periapical issues with these therapies.
surgical approach of cyanotic congenital heart diseasedibufolio
This document discusses the surgical approaches for cyanotic congenital heart disease. It begins with an introduction and overview of topics to be covered, including fetal and adult circulation physiology. It then discusses various defects such as transposition of the great arteries, tetralogy of Fallot, and total anomalous pulmonary venous return. It outlines the history of various palliative and corrective surgeries performed over time, such as Blalock-Taussig shunts, cavopulmonary connections, and arterial switch operations. It provides guidance on timing of surgeries based on disease type and clinical status. It also discusses complications of the Fontan procedure. The document aims to close gaps in understanding regarding why certain surgeries are
Este documento presenta 12 situaciones relacionadas con conceptos y enfoques pedagógicos como el enfoque por competencias, constructivismo y socioconstructivismo. En cada situación, se pide identificar cuál de las opciones se relaciona con lo descrito. El documento promueve la reflexión sobre cómo aplicar estos enfoques en la práctica docente para facilitar la construcción autónoma del conocimiento en los estudiantes.
This article describes a selective-pressure impression technique for edentulous maxilla that aims to improve palatal adaptation of dentures. The technique involves placing spacer wax over the alveolar ridges and palate, leaving parts of the palate uncovered. This creates a deeper vault on the definitive cast, compensating for shrinkage of the denture base material during processing. The resulting denture has improved contact with palatal tissues compared to standard techniques.
This document discusses root canal irrigants and disinfectants used during endodontic treatment. It describes the obstacles in removing irritants from the complex root canal system, including dentinal tubules, isthmuses, and the smear layer created during instrumentation. The ideal properties of an irrigant are outlined. Current irrigants like sodium hypochlorite, chlorhexidine, EDTA, and MTAD are described and their advantages and disadvantages compared. Advances in irrigation techniques using ultrasonics, lasers, and the EndoVac system aim to more effectively clean the canal space.
The document is a scanned receipt from a grocery store purchase on June 15th, 2022 totaling $58.37. It lists items bought including ground beef, chicken breasts, tortillas, cheese, and produce such as tomatoes, lettuce, and onions. The receipt shows the item prices, taxes, and total amount due.
A empresa de tecnologia anunciou um novo smartphone com câmera avançada, bateria de longa duração e processador rápido. O dispositivo também possui tela grande e armazenamento expandível. O lançamento está programado para o final do ano com preço inicial sugerido de US$799.
Este documento presenta diferentes técnicas para resolver conflictos. Explica que el conflicto es parte inevitable de la vida social y que existen habilidades como comprender los propios sentimientos, escuchar activamente y ofrecer opciones para la resolución. Luego describe cinco formas de resolver conflictos, estrategias para llegar a un acuerdo y principios para generar soluciones alternativas como producir múltiples opciones y diferir el juicio hasta después de generar ideas.
Big data refers to large volumes of structured and unstructured data from various sources like social media, business transactions, sensors, and devices. It has 3 key characteristics - velocity, variety, and volume. Hadoop is an open-source framework that allows storing and processing big data across clusters of commodity hardware. It uses HDFS for storage and MapReduce as a programming model to process data in parallel. Analyzing big data can provide insights for better decisions, cost reductions, and new product development.
This document provides diagnostic terminology recommended by the AAE Consensus Conference for pulpal and apical conditions. It defines normal pulp and various stages of reversible and irreversible pulpitis, as well as pulp necrosis. For apical conditions, it defines normal apical tissues and various inflammatory conditions including symptomatic and asymptomatic apical periodontitis, acute and chronic apical abscesses, and condensing osteitis. The terminology is intended to standardize descriptions of pulpal and apical diagnoses.
Este documento describe medidas de forma como la simetría, asimetría, apuntamiento y achatamiento de distribuciones de datos. Explica cómo calcular el coeficiente de asimetría de Pearson y Fisher para determinar si una distribución es simétrica o asimétrica, y el coeficiente de curtosis de Fisher para determinar si una distribución es mesocúrtica, leptocúrtica o platicúrtica. También presenta ejemplos prácticos de cálculos de estos coeficientes.
1. The document discusses non-surgical retreatment for failed root canals. It covers the causes of failure, steps of retreatment including coronal disassembly, negotiation of missed canals, removal of obturating materials, managing blocks/ledges, and non-surgical perforation repair.
2. Key steps include finding and negotiating missed canals using radiographs, microscopy, and ultrasonics, removing silver points, gutta percha, and posts using various instruments, and managing blocks and ledges with precurved files and scratching.
3. Materials used for non-surgical perforation repair include MTA due to its biocompatibility and ability to form a calc
The document evaluates the number of cycles to fracture (NCF) of two types of rotary nickel-titanium (NiTi) endodontic instruments - Twisted File (TF), which is manufactured by twisting, and RaCe files, which are manufactured by grinding. The study found that:
1) TF instruments had a significantly higher NCF than RaCe files in both static and dynamic cyclic fatigue tests, indicating greater resistance to fracture.
2) RaCe files required significantly greater loads to bend, showing they are less flexible than TFs. Less flexible instruments have a lower NCF.
3) Both instrument types fractured in a ductile manner and showed no plastic deformation, but TFs manufacturing
This document discusses and compares several nickel titanium rotary root canal instrumentation systems, including Lightspeed, ProFile, EndoSequence, and K3. It provides details on their designs and evaluations of their efficacy, such as cleaning ability, preparation time, risk of ledging or instrument separation. Studies found that while rotary systems reduced preparation time compared to manual instrumentation, there were few differences in cleaning efficacy or healing of periapical lesions between methods. Later generation systems like EndoSequence and ProFile were found to have improved shaping ability and reduced risk of canal transportation.
This study compared the effects of 6 nickel-titanium rotary file systems (OneShape, ProTaper Universal, ProTaper Next, Reciproc, Twisted File Adaptive, and WaveOne) on root canal geometry changes in severely curved mesial root canals of mandibular molars. The root canals were scanned using cone-beam computed tomography before and after instrumentation to assess changes. The Reciproc system removed significantly more dentin than the OneShape, ProTaper Universal, and Twisted File Adaptive systems. However, there were no significant differences among the groups regarding transportation, curvature changes, surface area changes, or centering ability. All 6 file systems similarly straightened root canal curvature and produced similar canal transportation
Effect of immersion in sodium hypochlorite on the cyclic fatigue resistance o...Nadeem Aashiq
This study evaluated the cyclic fatigue resistance of three rotary instrument systems - Sequence, HyFlex EDM, and ProTaper Next (PTN) - after immersion in 5.25% sodium hypochlorite (NaOCl) solution for different time periods. The instruments immersed in NaOCl showed lower cyclic fatigue resistance than the non-immersed controls. HyFlex EDM instruments demonstrated the highest resistance to fatigue, while Sequence instruments had the lowest. Immersion in NaOCl negatively impacted the fatigue life of the instruments, with longer immersion times further reducing resistance. The study found that NaOCl immersion can decrease the fatigue performance of rotary instruments.
Ultrasonic inserts can be used for various applications in endodontics including surgical endodontics and non-surgical endodontics. Piezoelectric ultrasonic inserts vibrate linearly and are preferred over magnetostrictive inserts. They are classified based on design and use. Applications include root-end cavity preparation for surgery, removing obstructions like posts or separated instruments, and improving irrigant flow and effectiveness. Different tip designs are suited to specific tasks. Proper power settings and technique are important for safe and effective use.
This study analyzed defects in 378 nickel-titanium rotary endodontic files after clinical use over 6 months. Almost 50% of files showed visible defects, with 21% fractured. Fractures were categorized as resulting from either torsion or flexural fatigue based on the presence of accompanying defects. More files fractured due to torsion (56%), exhibiting unwinding near the fracture site, compared to flexural fatigue fractures with no defects (44%). The results suggest torsional failures from excessive apical force were more common than flexural fatigue in curved canals.
Various heat treated ni ti rotary instrtuments evaluated-in-s-shpaed-simulate...luis Cabrera Piña
This study evaluated the performance of four heat-treated nickel-titanium rotary instruments (Twisted Files, WaveOne, Hyflex CM, and V Taper 2H) in shaping S-shaped simulated resin canals. Micro-computed tomography was used to analyze transportation and changes in canal volume after instrumentation. All instruments caused more transportation at coronal versus apical curvatures, except Twisted Files which transported most at the apex. Hyflex CM resulted in the most conservative canal preparations overall with the least transportation, especially at the apical curve. Amongst heat-treated nickel-titanium instruments, CM-wire based Hyflex CM and V Taper 2H created the most favorable canal shapes in resin canals.
Class on "Porcelain layering on zirconia coping"
Presentation by Prof. Dr. Marco Ferrari MD, DMD, PhD.
http://www.dentalevo.it/dentistry-materials/porcelain-layering-zirconia-coping/
IRJET- Free Vibration Analysis of BeamsIRJET Journal
The document analyzes the free vibration of beams with different cross-sections, materials, and support conditions. It presents analytical equations based on Euler-Bernoulli beam theory to calculate the natural frequencies of beams. Tables show the fundamental natural frequencies of steel and aluminum beams with circular and rectangular cross-sections in cantilever and simply supported conditions, as calculated analytically and using ANSYS software. The results from both methods show good correlation. Plots of natural frequency versus geometric parameters like diameter and depth are also presented. The study aims to determine the most efficient cross-section and material for structural design by comparing the vibration characteristics.
silver nanoparticles relation on properties of silicone elastomerdellasain
The document summarizes two journal articles on the effect of adding nanoparticles like silver and titanium dioxide to maxillofacial silicone elastomers.
The first article studied the effect of adding silver nanoparticles at 20 ppm on the tear strength, hardness, and color stability of Teksil 25 silicone. It found silver nanoparticles decreased hardness but did not significantly change tear strength or color stability.
The second article examined how different concentrations of titanium dioxide nanoparticles (2%, 4%, 6%) affected the mechanical and anti-aging properties of MDX4-4210 silicone. It concluded 6% TiO2 improved tensile strength, tear strength, hardness and provided better anti-aging protection against thermal, UV and stress fatigue compared to
The study compared the cyclic fatigue resistance of two nickel-titanium rotary glide path files: ProGlider and One G. Twenty files of each system were subjected to cyclic fatigue testing using a dynamic testing device with a standardized artificial canal. The time and number of cycles to failure were recorded. ProGlider files demonstrated statistically significantly higher cyclic fatigue resistance than One G files. The higher resistance of ProGlider is likely due to it being manufactured from M-wire alloy, which has been shown to improve cyclic fatigue resistance over conventional nickel-titanium.
Comparative study between k-files use from stainless steel or nickel titanium...AD Dental
This study compared the manual widening of root canals with different degrees of curvature using Kerr file needles made of stainless steel or nickel-titanium alloy versus ProTaper cutters. The root canals were simulated with curvatures of 30, 45, 60, and 90 degrees and radii of 3, 4, and 5 mm based on 46 real patient cases. The results showed that Kerr files made of steel produced the greatest deviations from the natural root canal trajectory, while nickel-titanium alloy and ProTaper instruments produced less deviation. The highest modifications occurred with rigid instrumentation of extreme anatomies. Mathematically, nickel-titanium instruments, especially ProTaper, were shown to achieve more uniform widening of curved root
Influence Of Surface Roughness On Ultra-High-Cycle Fatigue Of Aisi 4140 Steel.IJERA Editor
Low and high-cycle fatigue life regimes are well studied and are relatively well understood. However, recent fatigue studies on steels have shown that fatigue failures can occur at low amplitudes even below the conventional fatigue limit in the ultra-high-cycle fatigue range (life higher than 107 cycles). Fatigue life in the regime of 106 to 108 cycles-to-failure in terms of the influence of manufacturing processes on fatigue strength is examined. Specifically, the influence of surface roughness of turned surfaces of AISI 4140 steel specimens on fatigue strength in the giga cycle or ultra-high-cycle fatigue range is evaluated. The fatigue experiments were carried out at room temperature, with zero mean stress, on a rotating-bending fatigue testing machine of the constant bending moment type. The fatigue strength of the specimens were determined using the staircase (or up-and-down) method.
Laboratory tests for niti rotary filesNivedha Tina
The document discusses various methods used to test the cyclic fatigue resistance of nickel-titanium rotary endodontic instruments. It summarizes the limitations of using glass or metal tubes to test instruments, as the tubes do not sufficiently constrain instrument movement to standardize the radius and angle of curvature. Alternatively, some studies used machined grooves or blocks to constrain instruments, but these did not reliably control the trajectory or point of maximum curvature. The best approach is to manufacture artificial canals directly based on each instrument's unique size and taper, using computer-controlled milling, to precisely standardize the testing conditions.
This randomized clinical trial compared the clinical efficiency of premium heat-activated copper nickel-titanium (Tanzo Cu-NiTi) archwires and NT3 superelastic nickel-titanium (NiTi) archwires during initial orthodontic alignment in adolescents. 50 patients were randomly assigned to receive either Tanzo Cu-NiTi archwires or NT3 superelastic NiTi archwires. The primary outcome was alignment efficiency measured using Little's irregularity index at 4-week intervals. Secondary outcomes included changes in arch width and incisor inclination. The study found no significant differences between the two archwire types in terms of alignment efficiency, arch width changes, or incisor inclination changes. Both archwire
This document provides a classification and overview of endodontic instruments. It discusses diagnostic instruments used to examine the dental pulp, as well as instruments for accessing canals, exploring canals, extirpating pulp, and enlarging root canals. Key points include the standardized sizing of root canal files according to ISO guidelines, modifications made to traditional K-files and H-files to increase flexibility and cutting efficiency, and the use of different materials like carbon steel for initial penetration of narrow canals. The document provides details on various instruments and their functions at different stages of root canal treatment.
Comparison of root microcrack formation after root canal preparation using tw...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
1) The study investigated the effect of temperature variations on the spring forces and corrosion behavior of nickel-titanium closed-coil springs used in orthodontics.
2) Heating the springs to 55°C increased the spring force by 30%, but returning to 37°C recovered the initial force level. Cooling to 15°C decreased the force by 46%.
3) Corrosion testing found that as temperature increased, the corrosion potential decreased and corrosion density increased, indicating lower corrosion resistance at higher temperatures.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
-------------------------------------------------------------------------------
Find out more about ISO training and certification services
Training: ISO/IEC 27001 Information Security Management System - EN | PECB
ISO/IEC 42001 Artificial Intelligence Management System - EN | PECB
General Data Protection Regulation (GDPR) - Training Courses - EN | PECB
Webinars: https://pecb.com/webinars
Article: https://pecb.com/article
-------------------------------------------------------------------------------
For more information about PECB:
Website: https://pecb.com/
LinkedIn: https://www.linkedin.com/company/pecb/
Facebook: https://www.facebook.com/PECBInternational/
Slideshare: http://www.slideshare.net/PECBCERTIFICATION
Thinking of getting a dog? Be aware that breeds like Pit Bulls, Rottweilers, and German Shepherds can be loyal and dangerous. Proper training and socialization are crucial to preventing aggressive behaviors. Ensure safety by understanding their needs and always supervising interactions. Stay safe, and enjoy your furry friends!
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
1. Cyclic Fatigue Testing and Metallographic Analysis
of Nickel-Titanium Rotary Instruments
Chiara Pirani, DDS, MS, PhD,* Pier Paolo Cirulli, DDS,* Stefano Chersoni, DDS, MS, PhD,*
Lorenzo Micele, DSc, PhD,†
Oddone Ruggeri, DSc,†
and Carlo Prati, MD, DDS, PhD*
Abstract
Introduction: The aim of this study was to compare
cyclic fatigue resistance of four nickel-titanium rotary
systems and to evaluate their surface, fractographic,
and matrix morphology. Methods: Four models of
endodontic rotary files (EasyShape [Komet/Gebr. Brass-
eler, Lemgo, Germany], ProTaper [Dentsply Maillefer,
Ballaigues, Switzerland], NRT [MANI Inc, Toshigi-Ken,
Japan], and AlphaKite [Komet/Gebr. Brasseler]) were
subjected to fatigue testing in artificial canals with angle
of curvature of 45
and 60
and a radius of curvature of
5 mm until fracture occurred. Nickel-titanium (NiTi) alloy
properties were investigated by light microscopy, envi-
ronmental scanning electron microscopy (ESEM), and
energy dispersive x-ray spectrophotometry (EDS).
ESEM analysis was conducted on new files to examine
surface characteristics and on fractured samples to iden-
tify the crack origin and the fractographic features.
Results: Analysis of variance testing revealed signifi-
cant differences (P .001) among the groups. NRT files
had the highest fatigue resistance followed by Alpha-
Kite, EasyShape, and ProTaper. All the new files pre-
sented surface imperfections. Fractographic analysis
found the crack initiation to originate at the level of
surface irregularities. Optical microscope inspection of
the NiTi alloy matrix disclosed different-sized nonme-
tallic inclusions among models. EDS analysis of these
inclusions showed that they were composed of carbon
and oxygen in addition to nickel and titanium. Under
light microscopy, austenitic grains appeared larger
near the handle and smaller near the tip in all instru-
ments. Conclusions: NRT files presented the longest
fatigue life. All samples showed surface irregularities
and nonmetallic inclusions. Austenitic grains were
smaller near the tip than near the handle. The angle
of curvature was confirmed to influence the fatigue
life of NiTi instruments. (J Endod 2011;37:1013–1016)
Key Words
Cyclic fatigue, environmental scanning electron microscope, fracture, NiTi instruments,
TiN coating
Nickel-titanium (NiTi) root canal files were first introduced in 1988 by Walia et al
(1) to overcome the rigidity of stainless steel instruments and thereby improve
the instrumentation of curved canals (1). NiTi is far more flexible than stainless steel,
and its superelasticity reduces the restoring force (2), thereby allowing improved canal
shaping and reduced transportation (3). Despite the many advantages of NiTi instru-
mentation, unexpected fractures may occur during clinical use (4, 5), and the
impairment of the outcome of root canal treatment results from the impossibility of
removing the instrument (5). According to Sattapan et al (6), two different separation
mechanisms occur in rotary instruments: torsional (ductile) and fatigue (brittle) frac-
ture. Instruments separated by torsional stresses usually present macroscopic plastic
deformation (7), whereas instruments fractured by fatigue generally exhibit no specific
macroscopic pattern (6).
Although several clinical and laboratory studies have investigated the cumulative
effects of multiple tensile-compressive stresses on the incidence of cyclic fatigue and
instrument separation for NiTi files (5, 6, 8, 9), little is known on how surface and
alloy features affect NiTi instrument fracture.
The aim of the present study was to compare the cyclic fatigue resistance of NiTi
endodontic rotary files in simulated 45
and 60
curved canals and to correlate their
fatigue life with their surface, matrix, and fractographic features. The tested null hypoth-
esis was that there are no differences between the NiTi instruments examined.
Materials and Methods
The cyclic fatigue testing was conducted in a manner similar to that performed by
Lopes et al (10, 11). Two 16-G stainless steel needles (LG Forniture, Osimo, Italy) were
bent to obtain artificial canals with a 5-mm radius of curvature, curvature angles of 45
and 60
, and an overall length of 22. NiTi instruments were tested for cyclic fatigue in
a stainless steel apparatus composed of a base and a vertical axis. The vertical axis
contained a structure that allowed the movement of the 16:1 reduction handpiece
powered by a torque-controlled electric stepper motor (Xsmart; Dentsply Maillefer,
Baillagues, Switzerland). At the apparatus base, a bench vise was used to hold the arti-
ficial canals. This device ensured standardized placement of the NiTi instruments in the
artificial canals. All the instruments were mounted on the electrical handpiece and were
inserted 22 mm into the steel canal. A silicone stop (Endo Stopper, Kumapan, Bourges,
France) was mounted on each instrument to easily mark the correct length of the part
introduced into the artificial canal.
From the Departments of *Dental Sciences, Alma Mater Studiorum; and †
Metal Sciences, Electrochemistry and Chemical Techniques, Alma Mater Studiorum, Univer-
sity of Bologna, Bologna, Italy.
Address requests for reprints to Dr Chiara Pirani, Department of Dental Sciences, Alma Mater Studiorum, University of Bologna, Via San Vitale 59, 40125 Bologna,
Italy. E-mail address: chiara.pirani4@unibo.it
0099-2399/$ - see front matter
Copyright ª 2011 American Association of Endodontists.
doi:10.1016/j.joen.2011.04.009
Basic Research—Technology
JOE — Volume 37, Number 7, July 2011 Cyclic Fatigue and Metallographic Analysis of NiTi Instruments 1013
2. The electrical handpiece was standardized to rotate the instru-
ments at a nominal speed of 300 rpm, with a maximum torque of 3
N/Cm. Cyclic fatigue testing was conducted on four different groups
(n = 22) of instruments: (1) group A: Mani NRT 25/.06 (MANI Inc,
Toshigi-Ken, Japan), (2) group B: ProTaper Universal F2 (Dentsply
Maillefer, Ballaigues, Switzerland), (3) group C: EasyShape 25/.06 (Ko-
met/Gebr. Brasseler, Lemgo, Germany), and (4) group D: AlphaKite 25/
.06 (Komet/Gebr. Brasseler).
Files were divided into eight subgroups (n = 11) and tested in the
curved 45
and 60
artificial canals until fracture occurred. Time to
fracture was recorded visually with a 1/100-second digital stopwatch
(Oregon Scientific SL928D, Tualatin, OR). During the test, the stainless
steel artificial canals were filled with glycerine to reduce the friction of
the instrument against the canal walls.
Results were analyzed statistically using SPSS software (SPSS, Oak-
brook, IL). One-way and two-way analysis of variance (ANOVA) and
Tukey Honestly Significant Difference (HSD) test were calculated to
determine any statistical difference amongst groups. The significance
was determined at the 95% confidence level.
Fractured fragments were collected and analyzed under ESEM
(EVO50 EP; Carl Zeiss NTS GmbH, Oberkochen, Germany) with magni-
fication ranging from 400Â to 10,000Â. Unused instruments were
examined for surface details under ESEM with magnification ranging
from 100Â to 5,000Â at the tip and 4 mm from the tip. Each sample
was then embedded in epoxy resin, wet ground with 180 to 320 grit size
silicon carbide (SiC) papers, and polished with a 9-mm diamond paste.
Specimenswere thenetched with 60% nitric acid, 10% fluorhydric acid,
and 30% aceticacid at room temperature for 5 seconds (12) to disclose
the microstructure of the NiTimatrix.All the etched sampleswereexam-
ined with an optical microscope (Zeiss AXIO,Carl ZeissNTS GmbH) and
analyzed with ESEM equipped with EDS (EDS Oxford Inca Energy 350;
Oxford Instruments, Abingdon, Oxfordshire, UK).
The images of the new and fractured samples were examined in
a double-blind manner by two trained operators; a consensus was
reached between the two examiners regarding any discrepancies.
Results
The mean and standard deviation of the number of cycles to frac-
ture for each group are listed in Table 1. One-way ANOVA analysis re-
vealed significant differences between all g roups tested, both at 45
and 60
(P .001). The Tukey HSD test showed that there were signif-
icant differences between all groups at 45
and at 60
(P .001)except
between groups C and D at 60
(P = .077).
Two-way ANOVA analysis and its post hoc test (Tukey HSD)
showed how every tested instrument broke significantly earlier in the
60
artificial curved canal than in the 45
curved canal (P .001).
It confirmed the results of one-way analysis and showed significant
differences between all the combinations for 45
and 60
(P
.001), except between groups B and C at 60
(P = .003) and between
groups C and D at 60
(P = .370).
The crack origin in every sample was identified to be at the level of
superficial manufacturing defects, mainly milling grooves (Fig. 1A). At
high magnification, fatigue striations were found close to the crack initi-
ation area (Fig. 1B). Far from the crack initiation site, a dimpled surface
was observed, indicating ductile fracture in which breakage occurred
after plastic deformation. Dimples were similar in size and density in
all models except Mani Files in which they were more numerous and
shallow. In all samples examined, microvoids and inclusions were de-
tected in proximity of the dimple centers (Fig. 1C).
ESEM analysis of unused instruments disclosed surface defects
such as debris, pits, metal strips, longitudinal scratches, and milling
grooves in all samples (Fig. 1D). A comparative observation of the pres-
ence and size of milling grooves, notches of the cutting edges, cavities,
and scratches revealed that NRT files presented a smoother surface than
ProTaper, EasyShape, and AlphaKite files.
Optical microscope observations of etched surfaces indicated
inclusions randomly distributed in the matrix of the NiTi alloy of all
instruments examined (Fig. 1E and F). Differences were found
comparing the inclusions in the four different models of files; although
ProTaper, AlphaKite, and EasyShape files showed much the same size
and density of inclusions, Mani Files presented smaller inclusions
with a much greater density.
Observation of the etched instruments at low magnification dis-
closed the austenitic grains of the NiTi alloy matrix. Austenitic grains ap-
peared larger in the portion of the instrument near the handle (Fig. 1G)
and smaller near the tip of the file (Fig. 1H) in all samples.
The EDS analysis conducted on the inclusions showed their chem-
ical composition, disclosing carbon and oxygen in addition to nickel
and titanium, whereas EDS analysis of the NiTi matrix confirmed
a composition of roughly 55% nickel and 45% titanium.
Discussion
The fracture process of rotary NiTi files is of clinical interest
because instrument separation may impair clinical outcomes given the
difficulty in removing the separated file (13). A disadvantage of NiTi alloy
isitslowultimatetensileandyieldstrength comparedwithstainlesssteel,
making it more susceptible to fracture at lower loads (14).
The tested null hypothesis was rejected. The results of the present
study revealed that NRT files resisted fatigue fracture for a longer time,
showing higher flexural strength, whereas ProTaper F2 resisted signif-
icantly less time than the other instruments. Cycles to fracture decrease
as the diameter of the instrument increases (15, 16). ProTaper F2 has
a variable taper, .08 from D1 to D3 and .06 from D4 to D14. A diameter
of 0.55 mm was calculated to be at 4 mm from the tip in ProTaper,
whereas in AlphaKite, EasyShape, and NRT files, the same diameter
was at 5 mm.
AsdescribedbyPruettetal (15), the maximumarea ofstressinthe
instrument is close to the arc midpoint of the canal. In the present study,
this area was approximately at 4 to 5 mm from the tip of the artificial
canal. Becauseevery instrument at thislevel hasa comparable diameter,
the instruments could be compared.
Test results corroborated the conclusion that the canal curvature
angle with the same radius influencesthe cyclicfatigue resistance of NiTi
instruments. The greaterthe angle of curvature, the lower the number of
cycles the endodontic files can tolerate until fracture occurs (17).
Crystalline materials always contain inclusions within the grains or
the grain boundaries. Under the influence of an applied load, these
inclusions may fracture or debond, producing pores or voids (18).
Ounsi et al (19) observed voids in the fracture surface of NiTi files,
assuming them to be caused by the Kirkendall effect. In the micrographs
TABLE 1. Mean and Standard Deviation of the Number of Cycles to Fracture for Each Group at 45
and at 60
NRT ProTaper EasyShape AlphaKite
45
3923.1 Æ 192.4 2746.7 Æ 109.1 3010.1 Æ 299 3361.8 Æ 236.9
60
957.7 Æ 59.2 571.5 Æ 92.3 704.9 Æ 70.3 782.3 Æ 62.4
Basic Research—Technology
1014 Pirani et al. JOE — Volume 37, Number 7, July 2011
3. Figure 1. (A) A micrograph (5,000Â) of the crack initiation site. The milling groove from which the fracture originated (white arrow) is visible. Parallel stri-
ations typical of cyclic fatigue are detectable. (B) A micrograph (5,000Â) showing fatigue striations. (C) A high-magnification (10,000Â) micrograph of dimpled
surface. Holes (black arrow) and inclusions (white arrow) are evident. (D) A high-magnification (5,000Â) micrograph of the cutting edge of a ProTaper
Universal F2 with deep milling grooves (white arrow), metal rollover, and notching of the cutting blade (black arrow). (E) A micrograph of lattice inclusions
in a Komet file. (F) A micrograph of lattice inclusions in a Mani File. The inclusions are smaller and have greater density compared with other instruments. (G) An
optical micrograph of the austenitic grains of the lattice of an EasyShape file at the handle. (H) An optical micrograph of the austenitic grains of the lattice of an
EasyShape file at the tip; the grain size progressively decreases from the handle to the tip of the instrument.
Basic Research—Technology
JOE — Volume 37, Number 7, July 2011 Cyclic Fatigue and Metallographic Analysis of NiTi Instruments 1015
4. examinedin the presentwork,inclusions wereoftenfound at the levelof
these pores, suggesting instead they could be produced by the debond-
ing of nonmetallic inclusions. ESEM, EDS, and optical microscope anal-
ysis were performed on these inclusions. The inclusions are assumed to
be essentially titanium carbides and NiTi oxides (Ti4Ni2Ox) formed
during vacuum melting of NiTi alloy in a graphite crucible (20, 21).
Because inclusions in NRT files are much more concentrated and
smaller than those in the other models, this may suggest differences
in the manufacturing method. It is well known that crack
propagation is much enhanced by large nonmetallic inclusions acting
as nucleation sites of void in ductile fracture (22, 23). By contrast,
small inclusions could slow or stop propagation of the crack acting
as pinning points. A pinning point in the material serves to halt
a dislocation movement, requiring a greater amount of force to be
applied to overcome the barrier (24).
The austenitic grain size of the NiTi alloy can also influence crack
propagation. Crack nucleation along grain boundaries caused by locally
concentrated stress is known to subside with decreasing grain size.
Therefore, a smaller grain size can increase the yield strength of a metal
(18). All the samples in this study showed smaller austenitic grains near
the tip where the stresses are mostly concentrated and the risk of fracture
is higher. It is possible that the swaging process of the NiTi wire could
have compressed the austenitic grains, thereby producing smaller grains.
Examination of unused files showed structural defects and imper-
fections in all samples. The surface of the instruments showed cavities,
debris,longitudinalscratches,irregularcuttingedges,andmillingmarks.
These defects may weaken the cutting efficiency of the instruments and
make them more vulnerable to fracture (25), serving as notches that
would concentrate the stress (26, 27). The fractographic analysis
conducted in this work seemed to confirm the influence of superficial
defects as an important aspect in the resistance of NiTi files, at least in
terms of the fatigue life of the instruments. In fact, almost every file
examined showed a crack initiation site at the level of a superficial
defect. These findings indicate that a smoother surface could improve
fatigue life resistance, and the use of electropolishing procedures has
been suggested (28) to produce a surface with fewer structural defects
that could enhance fracture resistance.
Ourresults lead to the consideration that surfaceandalloy features
of NiTi instruments should be considered as fundamental characteris-
tics that can influence fatigue resistance of the files. Thus, the quantity of
superficial defects should be reduced during manufacturing processes,
and the quality of the NiTi alloy should be improved in order to obtain
a diminished risk of fracture.
In conclusion, the four different brands of NiTi rotary instruments
presented similar fractographic characteristics and mechanical
behavior, which is typical of metals being subjected to fatigue loads.
There are significant differences in the fatigue resistance of the files
tested, probably because of the different surface and alloy features.
Acknowledgments
The authors thank Dr Antonio Manzo for statistical analysis
and Dr Iuri Boromei of SMETEC for scanning election microscopy.
The authors deny any conflicts of interest related to this study.
References
1. Walia HM, Brantley WA, Gerstein H. An initial investigation of the bending and
torsional properties of Nitinol root canal files. J Endod 1988;14:346–51.
2. Peters OA. Current challenges and concepts in the preparation of root canal systems:
a review. J Endod 2004;30:559–67.
3. Gergi R, Rjeily JA, Sader J, Naaman A. Comparison of canal transportation and
centering ability of twisted files, Pathfile-ProTaper system, and stainless steel
hand K-files by using computed tomography. J Endod 2010;36:904–7.
4. Kosa DA, Marshall G, Baumgartner JC. An analysis of canal centering using mechan-
ical instrumentation techniques. J Endod 1999;25:441–5.
5. Parashos P, Gordon I, Messer HH. Factors influencing defects of rotary
nickel-titanium endodontic instruments after clinical use. J Endod 2004;30:
722–5.
6. Sattapan B, Nervo GJ, Palamara JEA, Messer HH. Defects in rotary nickel-titanium
files after clinical use. J Endod 2000;26:161–5.
7. Yum J, Cheung GS, Park JK, Hur B, Kim HC. Torsional strength and toughness of
nickel-titanium rotary files. J Endod 2011;37:382–6.
8. Zelada G, Varela P, Martin B, Bahıllo JG, Magan F, Ahn S. The effect of rotational
speed and the curvature of root canals on the breakage of rotary endodontic instru-
ments. J Endod 2002;28:540–2.
9. Spanaki-Voreadi AP, Kerezoudis NP, Zinelis S. Failure mechanism of ProTaper
nickel-titanium rotary instruments during clinical use: fractographic analysis. Int
Endod J 2006;39:171–8.
10. Lopes HP, Ferreira AA, Elias CN, Moreira EJ, de Oliveira JC, Siqueira JF Jr. Influence
of rotational speed on the cyclic fatigue of rotary nickel-titanium endodontic instru-
ments. J Endod 2009;35:1013–6.
11. Lopes HP, Elias CN, Vieira VT, et al. Effects of electropolishing surface treatment on
the cyclic fatigue resistance of BioRace nickel-titanium rotary instruments. J Endod
2010;36:1653–7.
12. Gallardo JM, Herrera EJ, G€umpel P, Strittmatter J. Metallographic characteriza-
tion of a NiTiCu shape memory alloy. Praktische Metallographie 1999;36:
594–608.
13. Crump MC, Natkin E. Relationship of broken root canal instruments to
endodontic case prognosis: a clinical investigation. J Am Dent Assoc 2002;
80:1341–7.
14. Parashos P, Messer HH. Rotary NiTi instruments fracture and its consequences.
J Endod 2006;32:1031–43.
15. Pruett JP, Clement DJ, Carnes DL. Cyclic fatigue testing of nickel-titanium endodontic
instruments. J Endod 1997;23:77–85.
16. Gambarini G. Cyclic fatigue of nickel-titanium rotary instruments after clin-
ical use with low- and high-torque endodontic motors. J Endod 2001;27:
772–4.
17. Zelada G, Varela P, Martın B, Bahıllo JG, Magan F, Ahn S. The effect of rotational
speed on root canals on the breakage of rotary endodontic instruments. J Endod
2002;28:540–2.
18. ASM Handbook Volume 12: Fractography. Materials Park, OH: ASM International;
1987.
19. Ounsi HF, Al-Shalan T, Salameh Z, Grandini S, Ferrari M. Quantitative and qual-
itative elemental analysis of different nickel-titanium rotary instruments by using
scanning electron microscopy and energy dispersive spectroscopy. J Endod
2008;34:53–5.
20. Alexandrou G, Chrissafis K, Vasiliadis L, Pavlidou E, Polychroniadis EK. SEM obser-
vation and differential scanning calorimetric studies of new and sterilized nickel-
titanium rotary endodontic instruments. J Endod 2006;32:675–9.
21. Toro A, Zhou F, Wu MH, Van Geertruyden W, Misiolek WZ. Characterization of non-
metallic inclusions in superelastic NiTi tubes. J Mater Eng Perform 2009;18:
448–58.
22. LeMay I. Failure mechanism and metallography: a review. In McCall J, French P, eds.
Metallography in Failure Analysis. New York: Plenum Press; 1978:1–31.
23. Beremin FM. Cavity formation from inclusions in ductile fracture of a 508 steel.
Metallurgical Transaction 1981;12:723–31.
24. Askeland D, Phule P. The Science of Engineering of Materials. 4th ed. Florence, KY:
Brooks/Cole-Thompson Learning; 2003.
25. Kim HC, Yum J, Hur B, Cheung GS. Cyclic fatigue and fracture characteristics of
ground and twisted nickel-titanium rotary files. J Endod 2010;36:147–52.
26. Alapati SB, Brantley WA, Svec TA, Powers JM, Nusstein JM, Saehn GS. SEM observa-
tions of nickel-titanium rotary endodontic instruments that fractured during clinical
use. J Endod 2005;31:40–3.
27. Alexandrou G, Chrissafis K, Vasiliadis L, Pavlidou E, Polychroniadis EK. Effect of heat
sterilization on surface characteristics and microstructure of Mani NRT rotary
nickel-titanium instruments. Int Endod J 2006;39:770–8.
28. Bonaccorso A, Sch€afer E, Condorelli GG, Cantatore G, Tripi TR. Chemical analysis of
nickel-titanium rotary instruments with and without electropolishing after cleaning
procedures with sodium hypochlorite. J Endod 2008;34:1391–5.
Basic Research—Technology
1016 Pirani et al. JOE — Volume 37, Number 7, July 2011