Effect of apical preparation on different needle depth penetration

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Effect of apical preparation on different needle depth

penetration

Alexia Vinel, Aline Sinan, Melanie Dedieu, Sara Laurencin Dalicieux, Franck

Diemer, Marie Georgelin-Gurgel

To cite this version:

Alexia Vinel, Aline Sinan, Melanie Dedieu, Sara Laurencin Dalicieux, Franck Diemer, et al.. Effect of

apical preparation on different needle depth penetration. GIORNALE ITALIANO DI ENDODONZIA,

2016, 30 (2), pp.96 - 100. �10.1016/j.gien.2016.09.004�. �hal-01790448�

ORIGINAL

ARTICLE/ARTICOLO

ORIGINALE

Effect

of

apical

preparation

on

different

needle

depth

penetration

Influenza

della

preparazione

apicale

sulla

profondita

` di

penetrazione

di

differenti

aghi

da

irrigazione

Alexia

Vinel

,

Aline

Sinan

,

Me

´lanie

Dedieu

,

Sara

Laurencin-Dalicieux

,

Franck

Diemer

*

,

Marie

Georgelin-Gurgel

a

Faculte´ deChirurgiedentairedeToulouse,PlateautechniquedeRechercheenOdontologie, CHUdeToulouse,France

b

InstituteofMetabolicandCardiovascularDiseases,UMR1048,France

c_{Unite´ deFormationetRecherched’Odonto-Stomatologied’Abidjan,Coˆted’Ivoire} d

INSERMU563,De´partementLML,CPTPToulouseFrance

e_{InstitutCle´mentAder,CNRSUMR5312,Toulouse,France} f

CentredeRechercheenOdontologieClinique,EA-4847Clermont-Ferrand,France Received1June2016;accepted13September2016

Availableonline21October2016

KEYWORDS Apicalshape; Irrigation; Needle; Nickel—titanium; Instruments. Abstract

Aim: Shapingshouldbecomplementedbyantisepticsolution.Theseareoftendeliveredusinga needleandsyringe.Butapicalpenetrationoftheirrigationsolutionisofonly1mmbeyonditstip. Theaimofourstudywastoevaluatetheinfluenceoftheapicalpreparationonthepenetration depthofsomeneedles.

Methodology: 24 teethwere divided randomly into two groupsand prepared in continuous rotation (350rpm)with Revo-S1

orProTaper1

tosizes AS 30, 35and 40 and F1,F2 and F3 respectively.Fourtypesofendodonticneedleswereused.Threesizesofstainlesssteelneedles:

PeerreviewunderresponsibilityofSocieta` ItalianadiEndodonzia.

* Correspondingauthorat:HeadofEndodonticandRestorativeDepartment,3chemindesMaraichers,31062Toulouse,France. Fax:+33561254719.

E-mail:franck.diemer@univ-tlse3.fr(F.Diemer).

Availableonlineatwww.sciencedirect.com

ScienceDirect

jo ur na l h o m ep a ge : w w w.e ls e v i er.c o m / lo c at e /gi e

http://dx.doi.org/10.1016/j.gien.2016.09.004

1121-4171/ß2016Societa` ItalianadiEndodonzia.ProductionandhostingbyElsevierB.V.ThisisanopenaccessarticleundertheCCBY-NC-ND license(http://creativecommons.org/licenses/by-nc-nd/4.0/).

Introduction

Endodonticcleaningneedstoremoveallpulptissue, micro-organismsanddentindebrisfromthecanalduringrootcanal shaping.1_{However,itwasshownthatthecanalpreparationis}

influenced by the great variability of rootcanal anatomy. Indeed the instruments (both manual and rotary) do not reachcertainareassuchascracks,crevices,isthmus, acces-sorycanalsandapicaldeltas.2,3

Theactionoftheinstrumentsshouldbecomplementedby antisepticsolution.3Theseareoftendeliveredusinganeedle andsyringe.Butstudiesindicatethattheapicalpenetration oftheirrigationsolutionisofonly1mmbeyondthetipofthe needle.2,4_{Theaimofourstudywastoevaluatetheinfluence}

oftheapicalpreparationonthepenetrationdepthofsome needles.

Materials

and

methods

24teethfromthetoothbankoftheEndodonticDepartment oftheDentalFacultyofToulousewereselected.Only single-rootedteethhavingamatureapexandarootcurvatureless than 158 were included in this study. Those with cracked roots,rootcaries,resorbedorimmatureapexorendodontic treatmentwereexcluded.

Theteethweredividedrandomlyintotwogroupsof12. Theaccesscavitywasperformedusing aturbine,diamond bur(diameter12)andendo-Z1

(ref801-012FGandE0152FG StonerFrance,Toulouse,France).Thentheinitial penetra-tionwas performedusing Kfiles diameter 10(Micro-Mega, Besancon, France). Working length (WL) was determined under a stereo-microscope (Wild M3B, Leica, Heerbrugg, Switzerland)at 16 magnification. When this filereached

PAROLECHIAVE Preparazioneapicale; Irrigazione; Aghi; Nichel-titanio; Strumenti.

25,27and30gaugeandoneofnickel—titaniumneedle:30Gauge.Eachneedlewasinsertedand itslengthofpenetrationmeasuredbeforetherootcanalpreparationandafterthefinishingfiles. Results: Multivariate analysis of variance showed significant differences for the finishers (p<0.0001) and the kind of needle (p<0.0001). The PLSD Fisher’stest can highlight the differencesbetweenthesixtypesofapicalshapingused(independentlyoftheneedletype).The samedifferenceswereobservedbetweenthefourtypesofneedle(independentlyoftheapical finish)(p=0.0232).

Varianceanalysisbetweenthefourdifferentneedlesisstatisticallysignificantforeachapical shaping(p<0.00016).Varianceanalysisamongthesixtypesoffinishisstatisticallysignificant foreachtypeofneedle(p<0.00014).

Conclusions: Thisstudyshowsthattheapicalpreparationinfluencesthepenetrationdepthof needles.The27gaugeneedlesreachthelastmillimetreonlywiththeRevo-S1

systemshaped withAS40.Finally,the30gaugeneedlesreachitforallfinishersexcepttheProTaper1

F1. ß2016Societa` ItalianadiEndodonzia.ProductionandhostingbyElsevierB.V.Thisisanopen accessarticleundertheCCBY-NC-NDlicense(http://creativecommons.org/licenses/by-nc-nd/ 4.0/).

Riassunto

Scopo: Lapreparazionecanalaredovrebbeessereintegratadall’utilizzodisoluzioni antisetti-che.Queste vengonorilasciateall’interno del canaleutilizzandospecifiche siringheed aghi endodontici,malapenetrazioneapicaledellasoluzioneirrigantee` diappena1mmoltrelapunta dell’ago.Loscopodelnostrostudioe` statoquellodivalutarel’influenzadellapreparazione apicalesullaprofondita` dipenetrazionedialcuniaghiendodontici.

Materialiemetodi: 24dentisonostatidivisicasualmenteinduegruppiepreparatiinrotazione continua(350rpm)conRevo-S1oProTaper1a6differentidimensionidipreparazione,AS30, AS35eAS40eF1,F2eF3rispettivamente.Sonostatiutilizzatiquattrotipidiaghiendodonzia,tre inacciaioinossidabiledidifferentidimensioni:25,27e30gaugeeunoinnichel-titanioda30 Gauge.Ogniagoe` statoinseritonelcanaleelasualunghezzadipenetrazionemisurataprimae dopolapreparazionecanalare.

Risultati: L’analisimultivariatadellavarianzahamostratodifferenzesignificativeperil’ultimo strumentoutilizzato(p<0,0001)eiltipodiago(p<0,0001).IltestdiFisherhaevidenziato delledifferenzetraiseidifferentitipidisagomaturaapicaleutilizzati(indipendentementedal tipo diago) etraiquattro tipi diaghi utilizzati(indipendentemente dellafinitura apicale) (p=0,0232).L’analisidellavarianzae` statisticamentesignificativatraiquattroaghidiversiper ognidifferentetipodisagomaturaapicale(p<0,00016)etraiseidifferentitipidirifinitura perognitipodiago(p<0,00014).

Conclusioni: In conclusione,questostudio dimostrache lapreparazione apicaleinfluenza la profondita` dipenetrazionedegliaghidairigazione.Gliaghicalibro27raggiungonoilmillimetro apicalesoloconilsistemadiRevo-S1ditaglia40.Gliaghicalibro30raggiungonoilmillimetro apicalepertuttiglistrumentidapreparazioneapicaleutilizzatitrannecheperilProTaper1F1. ß2016Societa` ItalianadiEndodonzia.ProductionandhostingbyElsevierB.V.Cetarticleest publie´ enOpenAccesssouslicenceCCBY-NC-ND( http://creativecommons.org/licenses/by-nc-nd/4.0/)

theapicalforamen,halfamillimetrewasremovedto deter-minetheworkinglength.

Secondly, root canals were prepared using nickel—tita-niumfilesincontinuous rotationataspeedof350rpm (X-Smart1, Dentsply, Konstanz, Germany). Each group was shapedwith a nickel—titanium systemdedicated to initial treatment:the first with Revo-S1

(Micro-Mega, Besancon, France),the secondwith ProTaper1

(Maillefer, Ballaigues, Switzerland).RevoS1

-sequencewasusedwithaflaringfile (EndoFlare1

,Micro-Me´ga,Besanc¸on,France)inthecoronal part(3—4mmmaximum),thenSC1shapedthe2/3ofWLand theotherfilesreachedtheWL(SC2,SU,AS30,AS35andAS 40).

ProTaper1

sequencewasusedwiththeSx1

inthecoronal partandalltheotherfiles reachedtheWL(S1,S2,F1,F2 andF3).2mLof2.6%NaOClwasusedbetweeneach instru-ment.

Fourtypesofendodonticneedleswereused.Threesizes ofstainlesssteelneedles:25,30gauge(IrrigationProbe1,

Kerr Hawe, Bioggio, Switzerland)and 27 gauge (Endonee-dle1

,Elsodent,G-Pharma,CergyPontoise,France)andone sizeofnickel—titaniumneedle:30Gauge(Stropko1

, Sybro-nEndo,Orange,CA).Eachneedlewasinsertedanditslength ofpenetrationmeasuredbeforetherootcanalpreparation andafterthefinishingfiles:AS30,AS35andAS40for Revo-S1

,andF1,F2andF3forProTaper1

.Thedepthof penetra-tionwasindicatedbyadoublerubberstopontheneedleand measured on a Polydentiagauge (Mezzovico, Switzerland) withtheaccuracyofaquarterofamillimeter.

AnalysisofthevarianceandPLSDFisher’stestsweredone with Statview5.0software(SasInstitute, Orange,CA)and alphariskfixedat5%.

Results

Penetrationdepthofeachneedleismeasuredandthe dis-tance between the needle tip and the working length is calculated (Fig. 1). The PLSD Fisher’s test can highlight thedifferencesbetweenthesixtypesofapicalshapingused (independently of the needle type) (Table 1). The same differenceswereobservedbetweenthefourtypesofneedle (independentlyoftheapicalfinish)(p=0.0232).

Multivariate analysisof varianceshowed significant dif-ferencesforthefinishers(p<0.0001)andthekindofneedle (p<0.0001)(Table2).

Figure1 Meandifferencedepthtoworkinglengthdependingonneedleandapicalfinish.

Table1 PLSDFisher’stestforthefinishingparameter. Meandiff. P-value Significance AS30vsAS35 0.677 <0.0001 S AS30vsAS40 1.199 <0.0001 S AS30vsF1 0.525 0.0003 S AS30vsF2 0.429 0.0030 S AS30vsF3 0.975 <0.0001 S AS35vsAS40 0.522 0.0004 S AS35vsF1 1.202 <0.0001 S AS35vsF2 0.248 0.0904 NS AS35vsF3 0.298 0.0422 S AS40vsF1 1.724 <0.0001 S AS40vsF2 0.771 <0.0001 S AS40vsF3 0.224 0.1226 NS F1vsF2 0.953 <0.0001 S F1vsF3 1.500 <0.0001 S F2vsF3 0.547 0.0002 S

Table2 Needlesabletoreachbiologicalgoalsdependingon apicalshaping.(N1:SibronEndoStropkoNiTi30G;N2:Kerr Stainlesssteel30G;N3:KerrStainlesssteel25G;N4:Elsodent EndoneedleStainlesssteel27G).

F1 F2 F3 AS30 AS35 AS40 Recommended needle No N1 N2 N1 N2 N1 N1 N2 N1 N2 N4

Variance analysisbetween thefour different needles is statistically significant for each apical shaping (p<0.00016)

Finally,accordingtotheapicalfinishing,alltheneedles did not reach the working length minus one millimetre correspondingtobiologicalcriteriadefinedpreviously.

Varianceanalysisamongthesixtypesoffinishis statisti-callysignificantforeachtypeofneedle(p<0.00014).

Discussion

Thisstudyshowsthattheapicalpreparationinfluencesthe penetrationdepthofneedles.

Natural teeth were chosen to take into account the variabilityofrootcanalanatomy5_{andtheinfluenceof}

shap-ing.The teethchosenhadlowcurvature.The resultswere notinfluencedbytheangleandradiusofcurvature.Greater curvaturescouldblocktheneedleaboveleadingto increas-ingdifferencesbetweentheneedles.

A totalof 12 teeth per group werechosen as in other similar studies.6,7 This is a small number but leads to a sufficient statisticalpower totake intoaccount the varia-bilityofmeasurement.

Determining the working length was performed using stereo-microscopethatallowsaccuratevisualizationofthe file whenit reachesthe apex.6 _{This technique is reliable,}

reproducible and avoids any bias or electronic measuring secondarytoradiographicinterpretation.

Measurementofworkinglengthastheneedlepenetration depthisdoneusingagauge.Adigitalcallipercouldbeused.6 Itsaccuracyreachesone-tenthofamillimetreincontrastto thegaugewhoseaccuracyisonlyaquarterofamillimetre. However it was decided to use the gauge because it is a frequentlyusedclinicaltool.8

Needles of three diameterswere used to evaluate the differentpenetrationdepthsdependingonthesize.Wealso comparedtwo needlesofthesamediameterbutdifferent material(stainlesssteelandnickeltitanium).Forthesame gauge,representingtheexternaldiameteroftheneedle,the

penetrationcapacityisdifferentdependingonthealloyof the needle (p=0.0179). The use of a super-elastic alloy thereforeoptimizesthepenetrationoftheirrigationneedle. However the design of these apical needles is different (Fig.2)withatruelateraldeflectionfortheKerr’s30gauge stainlesssteelandasidedischargefortheSibron’s30gauge NiTiEndo.

AlthoughtheprotocoloftheRevo-Shasnoflaringtool,9 one(EndoFlare1

,Micro-Mega,Besanc¸on,France)wasadded intothesequencetomimictheProTaper1

’sone.Thisflaring tooleliminates interference and initial constraints of the canal.Itthereforefacilitatestheactionofendodontic instru-mentsandtheneedleinsertion.Itslackofusewouldlittleor notchangeneedle penetrationmeasuresperformedduring thefinalapicalpreparationofthecanal.Theaveragelength oftoothpreparationis21.60mm.Thecanallengthisabout 13mmlong,whichcorrespondstoadiameterofpreparation forthecanalentranceof0.97mmwellabovethepreparation with an EndoFlare1 even with a penetration of 4mm (0.63mm).

Conclusion

Ourstudyshowsthattheapicalpreparationinfluencesthe penetrationdepthofneedlesthatreach thebiological cri-teria.Theminimumapicalpreparationshouldvary depend-ingon thetypeofneedle used.ItappearsthattheRevo-S systemreachesthesecriteriaregardlessoftheapicalfinish usedfor30gaugeneedlesorwiththeAS40finisherfor27 gaugeneedleswhereastheProTapersystemrequiresatleast aF2preparationandtheuseof30gaugeneedle.

Similarly,differentneedletypesshouldbeuseddepending ontheapicalpreparation.25gaugeneedlesareinconsistent withsuchbiologicalcriteria.Thoseover27reachitonlywith theRevo-SsystemshapedwithAS40.Finally,the30gauge needlesreachitforallfinishers(AS30,AS35,AS40,F2and F3)excepttheF1.Butpassiveultrasonicirrigationmaybean adjunctive treatment for improving theroot canalsystem cleaning.4

Figure2 PhotographyandSEMpictureofendodonticneedle’stipdesign.

Conflict

of

interest

Theauthorshavenoconflictsofinteresttodeclare.

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