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Determination of Root Canal Curvatures Before and After Canal Preparation (Part II PDF
Determination of Root Canal Curvatures Before and After Canal Preparation (Part II PDF
Determination of Root Canal Curvatures Before and After Canal Preparation (Part II PDF
ORIGINAL RESEARCH
Keywords
canal curvature, root canal preparation, shaping,
straightening.
Correspondence
Dr David Sonntag, Department of Operative
Dentistry, Philipps-University Marburg, GeorgVoigt-Str. 3, 35033 Marburg, Germany. Email:
sonntag@mailer.uni-marburg.de
doi: 10.1111/j.1747-4477.2006.00003.x
Abstract
The aim of this paper is to present a new method based on numeric calculus to
provide data on any type of root canal curvature at any point of the long axis of
the canal. Twenty severely curved, simulated root canals were prepared with
rotary FlexMaster and Profile instruments in the crown-down technique
and manually in the step-back technique. The inner and outer curvatures were
registered in a system of coordinates before and after preparation in increments
of 0.5 mm. Using an equalising function, the curvatures were first represented
in graphic and algebraic form. The maximum and the mean curvature as well as
the length of the arc from the apical foramen to the point of maximum curvature were determined mathematically. An increase in maximum curvature was
registered for all four shaping systems investigated. The radius of the inner curvature decreased by 0.51.2 mm in the manual systems as a result of the preparation. The Profile system displayed the smallest changes in radius (0.9 mm)
even with the outer curvature, and manual preparation with stainless steel files
the most pronounced change (1.8 mm). The point of maximum curvature at
the inner curvature was displaced by 1.6 mm to the apical foramen through
manual preparation with Ni-Ti files. At the outer curvature, the maximum displacement (1.8 mm) recorded was also the result of preparation with Ni-Ti hand
files, while a displacement of only 0.3 mm to the apical foramen was recorded
with the other systems. The method offers a means of determining curvatures
precisely without random specification of reference points. The method is also
capable of registering only minor changes in curvature in the two-dimensional
long axis of the canal.
Introduction
The objective of root canal preparation is to clean and
shape the canal. The root canal should be conically prepared but changed as little as possible in its original shape.
However, no rotary preparation technique available to
date is fully capable of preventing modifications to canal
morphology, such as zips, elbows, transportation or
straightening.
Displacement of the canal axis or excessive removal of
material at the inner curvature may result in stripping or
perforation (1). The prognosis of teeth damaged in this
16
D. Sonntag et al.
Table 1 Sequence in which the four systems were used by the operators
Operator No.
1st preparation
2nd preparation
3rd preparation
4th preparation
1
2
3
4
5
Hand Ni-Ti
FlexMaster
Prole
Hand SS
Prole
FlexMaster
Hand Ni-Ti
Hand SS
Prole
FlexMaster
Prole
Hand SS
Hand Ni-Ti
FlexMaster
Hand Ni-Ti
Hand SS
Prole
FlexMaster
Hand Ni-Ti
Hand SS
17
D. Sonntag et al.
After each change of instrument the root canals were irrigated with water to remove debris.
The working length of the industrially produced blocks
was set at 18 mm, corresponding to a distance of 1 mm
from the apical foramen. The working length of each
instrument was set by the students themselves with rubber stoppers prior to the start of treatment and was
checked in the course of treatment. Preparations were
performed with a new set of instruments for each preparation system. The conicity was 2% (taper 0.02) with
manual preparation, and 4% (taper 0.04) with rotary
preparation.
Manual preparation was performed with stainless steel
or Ni-Ti K-files with a working length of 25 mm. For optimised canal preparation, the stainless steel instruments
were pre-bent by the students and applied with slight apically directed pressure with a 1/8 turn clockwise and
counterclockwise direction (14).
Rotary preparation was done with 25 mm long Ni-Ti
FlexMaster files and Profile instruments, which were
lightly coated with Glyde (Dentsply De Trey, Konstanz,
Germany) before being inserted into the canal. Both systems were driven at 250 rpm by a torque-controlled lowspeed motor (Endo IT control; VDW, Munich, Germany)
adapted to the individual instruments. Between each
change of instruments the canals were irrigated with
water. If necessary, the canals could be recapitulated with
a previously used, smaller file.
The instrument application sequence is shown in
Tables 2 and 3.
All prepared root canals were photographed once again
with a digital camera in standardised position and the
image data were stored in the PC. In contrast to the first
photo, however, the canals were not dye-penetrated and
the blocks were photographed against a black background.
Table 2 Instruments and working sequence in manual shaping technique
Instrument
Sequence
Pre-are
Full working length (18 mm)
SS or Ni-Ti K-le
1
r( x )
2
d
1 + dx y( x )
Pre-are
Crown-down (to working length)
Apical preparation (18 mm)
Apical preparation (18 mm)
18
Instrument
Sequence
D. Sonntag et al.
x2
arc length b =
dy
1 + dx , with x1 and x2 signifying
dx
x1
x2
k( x )dx.
x1
Statistical analysis
Statistical analysis of the collected data and production
of the graphics were performed with SPSS 11.0 statistics
software (SPSS, Inc., Chicago, USA). Statistical tests
designed to reveal significant differences were renounced
on account of the small number of cases. Median values
and the 1st and 3rd quartile of the collected data were
represented.
Figure 2 Superimposed images of a root canal before and after instrumentation with stainless steel les. Dark lines, canal prior to preparation;
light lines, canal after preparation.
10
11
12
13
0.1
0.2
y
Figure 3 Curvature of the inner curve of the canal from Figure 2. Continuous line, curvature before preparation; dotted line, curvature after preparation.
The point of maximum curvature was transported further around the apex through the instrumentation.
19
D. Sonntag et al.
10
11
12
13
0.1
0.2
y
Figure 4 Curvature of the outer curve of the canal shown in Figure 2. Continuous line, curvature before preparation; dotted line, curvature after preparation. The increase in curvature is reected in the greater distance of the point of maximum curvature from the X-axis.
Median
value
1st quartile
3rd quartile
0.999808
0.999730
0.999803
0.999038
0.999839
0.999885
0.999895
0.999703
0.999693
0.999520
0.999760
0.997229
Results
Correlation coefficient
The degree of accuracy (correlation coefficient) was calculated for each curve as a measure of the adaptation quality
of the selected regression approach. The median value of
all curves was 0.999767, with the lowest value found to be
0.995343 and the highest value 0.999970. The values for
the individual curvatures before and after preparation are
shown in Table 4.
Intra-examiner reliability
Intra-examiner reliability was verified by having the outer
and the inner curve measured twice in the Profile instrument group by one examiner at an interval of 14 days. The
aim was to compare the reliability of the results measured
for the radius of the maximum curvature. Comparison of
the 20 individual values revealed an agreement rate of
90%. The kappa value was 0.849 (Table 5).
Inter-examiner reliability
Inter-examiner reliability was verified by having the outer
and the inner curve measured in the Profile instrument
group by two different examiners. To allow the kappa test
20
D. Sonntag et al.
Table 5 Intra-examiner agreement for the radius of the maximum root curvature (mm) in the Prole instrument group (% agreement: 90; kappa: 0.849)
2nd Examination
1st Examination
4.04.49 mm
4.54.99 mm
5.05.49 mm
5.55.99 mm
Totals
4.04.49 mm
4.54.99 mm
5.05.49 mm
5.55.99 mm
Totals
0
0
0
0
0
1
5
0
0
6
0
1
8
0
9
0
0
0
5
5
1
6
8
5
20
Table 6 Inter-examiner agreement for the radius of the maximum root curvature (mm) in the Prole Instrument group (% agreement: 85; kappa: 0.755)
2nd Examiner
1st examiner
4.04.49 mm
4.54.99 mm
5.05.49 mm
5.55.99 mm
Totals
4.04.49 mm
4.54.99 mm
5.05.49 mm
5.55.99 mm
Totals
0
1
0
0
1
0
4
0
0
4
0
0
10
2
12
0
0
0
3
3
0
5
10
5
20
Table 7 Curvature radii of both curves (mm) before and after manual preparation; arc lengths (mm) to point of maximum curvature before and after manual
preparation
5.8
5.8
8.3
8.7
4.2
4.4
4.8
3.8
8.7
8.5
3.9
3.4
5.5
5.6
8.1
8.5
4.1
4.1
4.4
4.0
8.5
9.0
2.6
3.3
Table 8 Curvature radii of both curves (mm) before and after rotary preparation; arc lengths (mm) to point of maximum curvature before and after rotary
preparation
5.4
5.5
8.0
8.1
4.0
3.6
5.1
4.5
8.1
9.0
2.8
3.3
5.5
5.8
8.2
8.4
4.2
4.2
5.0
4.9
8.3
8.5
3.9
3.9
Discussion
In the present investigation, the inner and outer canal curvature was measured in a system of coordinates before
and after root canal preparation. The curves were mea21
D. Sonntag et al.
2.0
2.0
1.0
0.0
*16
1.0
O18
2.0
0.0
*16
1.0
O18
2.0
3.0
3.0
N
5
Hand Ni-Ti
5
Rotary FM
Hand SS
Rotary ProFile
Rotary FM
Hand Ni-Ti
Figure 5 Preparation-induced change in the radius of the maximum curvature of the inner curve.
Hand SS
Rotary ProFile
Figure 7 Change in arc length from the apical foramen to the point of maximum curvature of the inner curve in millimetres.
2.0
1.0
O6
0.5
Arc length, outer canal wall (mm)
1.0
1.0
0.0
1.0
2.0
*13
0.0
0.5
1.0
1.5
*4
2.0
O1
O3
3.0
2.5
O9
N
O10
N
5
Hand Ni-Ti
Rotary FM
Hand SS
Rotary ProFile
Figure 6 Preparation-induced change in the radius of the maximum curvature of the outer curve.
Figure 8 Change in arc length from the apical foramen to the point of maximum curvature of the outer curve in millimetres.
22
D. Sonntag et al.
1.0
0.5
*13
0.0
0.5
1.0
1.5
*4
2.0
O10
2.5
5
Hand Ni-Ti
Rotary FM
Hand SS
Rotary ProFile
1.5
O11
1.0
0.5
0.0
O3
0.5
1.0
N
Rotary FM
Hand Ni-Ti
Hand SS
Rotary ProFile
Figure 10 Preparation-induced change in the radius of the mean curvature of the outer curve in millimetres.
Conclusions
The presented method enables instrumentation-induced
changes in the curvature of the small and large curve to be
precisely described. In view of the good reproducibility of
the measurements, the method can provide more valid
results than can be obtained with data expressed in angles.
24
D. Sonntag et al.
The method is thus a suitable means of verifying canal curvature retention after root canal instrumentation.
Further radiographic investigations are needed to
confirm the applicability of this method to clinical
investigations.
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