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53]
Original Article
Abstract
Aim: To compare the fracture resistance exhibited by teeth after primary endodontic treatment and retreatment.
Materials and Methods: One hundred freshly extracted human teeth were selected. 20 samples served as control
(untreated). Eighty experimental samples were divided into two groups (n = 40) for instrumentation using rotary Protaper
NEXT (PTN) or reciprocating WaveOne (WO) files and obturated using warm lateral compaction. Half of the samples (n =
20) from each group were subjected to a load. The remaining half were subjected to retreatment using Protaper universal
retreatment files (RFs) followed by a file larger than the master apical file used in groups 1 and 2 and reobturated. Group
A: Control, Group B: PTN + obturation, Group C: WO + obturation, Group D: RF + PTN + obturation and Group
E: RF + WO + obturation. The retreatment specimens were also subjected to load and the readings acquired were
statistically analyzed.
Result: When compared between the groups, control group exhibited the highest fracture resistance (P < 0.01). When multiple
tests were performed, Group E exhibited significantly less fracture resistance (P < 0.01).
Conclusion: Endodontic treatment and retreatment both results in lowering the fracture resistance of a tooth.
Keywords: Fracture resistance; Protaper NEXT; retreatment; WaveOne
cracks, apical stress, and strain concentrations resulting Initial endodontic treatment
in VRF.[10,11] Group B: Instrumentation with Protaper NEXT
A total of 40 specimens were instrumented by PTN files
Recently, newer generation NiTi instruments have been till full sequence X2. These files were used in outward
designed that is the Protaper NEXT (PTN) and WaveOne brushing manner at 300 rpm/2.6 nm. Three percent sodium
(WO) (PTN; Dentsply Tulsa Dental, Tulsa, OK). PTN files are hypochlorite and ethylenediaminetetraacetic acid (EDTA)
uniquely designed such that the center of mass and the was used as an irrigant and lubricant alternatively between
center of rotation are offset.[11,12] each file and recapitulation.
The WO (Dentsply Maillefer) NiTi single-file system Group C: Instrumentation with WaveOne
functions in reciprocating motion. The counterclockwise A total of 40 specimens were instrumented by WO Primary
engaging angle is 5 times the clockwise disengaging file (25/.08) (Dentsply Maillefer, Ballaigues, Switzerland) in
angle and is designed to be less than the elastic limit of pecking motion, using X Smart Plus endomotor (Dentsply-
the file. These instruments are manufactured with M-Wire Maillefer). These files were used in outward brushing manner
technology which may increase flexibility and resistant to at 300 rpm/2.6 nm. Three percent sodium hypochlorite and
cyclic fatigue.[10,11,13] EDTA was used as an irrigant and lubricant alternatively
between each file and recapitulation.
Retreatment procedure aims to remove the entire
obturating material.[12,14] Various techniques have been
Obturation for Group B and C
advocated to remove obturating materials which may
After complete instrumentation, final irrigation was
require more mechanical manipulation leading to more
performed with 10 mL of 17% aqueous EDTA (Prime Dental
radicular dentine removal and subsequent dentinal
Products, India) followed by 10 mL of sodium hypochlorite
defects.[13-15]
to remove the organic and inorganic smear layer. The canals
Studies show that the Protaper universal retreatment files were dried with sterile absorbent paper points. Following
(RFs) are ineffective for removing the entire obturating the manufacturer’s instructions, the AH plus sealer
material and have suggested the use of supplementary files (DentsplyDeTrey GmbH, Konstanz, Germany) was mixed
for better removal of root canal filling residues.[15,16] and applied with master cone Gutta-percha within the root
canal and obturated using lateral condensation technique.
Hence, the current study was designed to compare Excess Gutta-percha was sheared off and condensed with a
the fracture resistance exhibited by teeth after initial heated plugger 1 mm below the canal opening. The orifice
endodontic treatment and retreatment using rotary PTN was sealed with Coltosol (Coltene-Whaledent, Cuyahoga
and reciprocating WO file systems. Falls, OH, USA) and the teeth were stored at 37°C in 100%
humidity for 2 weeks.
MATERIALS AND METHOD
Retreatment technique
Specimen selection Twenty samples from group 1 and 2 underwent retreatment
Freshly extracted human mandibular premolars (for (Group D and E) after 30 days. Protaper Universal RFs
orthodontic treatment) with single straight canal were (D1-D3; Dentsply Maillefer), were used at 300 rpm and
selected. Confirmation of single canal was done by bucco- 3 N/cm torque to remove the bulk of root canal filling.
lingual and mesio-distal angulated radiographs. The Endosolv R (Septodent, Cedex, France) was used as the
samples were decoronated to length of 15 mm with a solvent subsequently after each RFs.
diamond disk under water. The teeth were examined with
a stereomicroscope under ×10 magnification to detect Group D
craze lines or cracks which were excluded from the study. After removal of bulk Gutta-percha, the residual root filling
The bucco-lingual and mesio-distal diameter of the roots was removed using PTN X3 and X4 files.
were measured with Vernier calliper and standardization
was done. Performing the above procedure resulted in 100 Group E
samples. After removal of bulk Gutta-percha, the residual root filling
was removed using WO large file.
Group A
A total of 20 teeth were uninstrumented. Reobturation of Group D and E
The canals are irrigated and obturated as described earlier
In the remaining 80 samples, hand instrumentation was with standardized master cone (40/.06). The teeth were
done till #20 k-file. stored at 37°C in 100% humidity for 2 weeks.
by WO having mean value of 212.79 N than PTN with Financial support and sponsorship
mean value of 272.58 N. This is in agreement with a Nil.
study conducted by Pawar et al.[4] which showed that WO
significantly decreased the fracture resistance of teeth Conflicts of interest
when compared to PTN. There are no conflicts of interest.