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The standardized-taper root canal preparation--Part 2. GT file selection and safe handpiece-driven file use.
AIM: To present guidelines on GT file selection, and safe operation. SUMMARY: It is not necessary to remove excessive dentine for effective root canal preparation. GT files allow safe, standardized preparation, and should be selected to fit the case in hand. Small Root canals should be prepared with 0.06 and 0.08 taper GT files, whilst Large Root canals should be prepared with 0.10 GT or 0.12 Accessory GT files. The greatest challenge is un-learning habits acquired from traditional instrumentation methods. GT files should be used with light touch, and without up-down pumping motions. Spin speeds should be controlled below 300 r.p.m. for routine preparation. GT files are subject to fatigue and should be tracked to avoid overuse. It is recommended that GT files are discarded after the equivalent of five root canal preparations. For severe curvatures, GT files should be single-case tools. KEY LEARNING POINTS: The standard GT file set comprises three instruments of 0.06, 0.08 and 0.10 taper. All are size 20 at the tip, and have a maximum diameter of 1 mm. Accessory GT files have a standard taper 0.12, and maximum diameter of 1.5 mm. They are available in tip sizes 35, 50 and 70. Large Roots are lower canines, upper anteriors, upper and lower single-rooted premolars, palatal roots of upper molars and distal roots of lower molars. They should be prepared with 0.10 GT or 0.12 Accessory GT files. Small Roots are lower incisors, multirooted premolars, buccal roots of upper molars and mesial roots of lower molars. They should be prepared with 0.06 or 0.08 GT files. All GT files should be used with light force and at the correct spin speed. GT files should be discarded after the equivalent of five root canal uses.
Bicuspid↗
Machining efficiency of endodontic K files and Hedstrom files.
Methods for the objective evaluation of the machining property of endodontic files were described earlier. These methods were used in this investigation to assess the characteristics of machining of 7 different brands of K files and 10 brands of Hedstrom files. The results show that there are large variations in amounts of material removed by the files. These variations are large between brands of instruments as well as between files of the same brand. Thus, among the 510 files evaluated, the file with the highest machining quality was more than 40 times as effective as the least effective instrument. The highest values among K files were obtained with files manufactured by Maillefer followed by Antaeos, Healthco, JS Dental, Brasseler, and Miltex. Among the Hedstrom files, the most efficient brands were Antaeos and Zipperer followed by Healthco, Hygenic, JS Dental, Miltex, Maillefer, Union Broach, and the least efficient Brasseler. The files did not wear noticeably during these testing procedures. These results clearly indicate that the provider needs more information from the manufacturer in regard to machining and cutting in order to intelligently select instruments. It is suggested that procedures be agreed upon to evaluate machining and cutting of root canal files in order to provide the endodontist with better information about instruments.
Dental Instruments↗
A comparison of the ability of K-files and Hedstrom files to shape simulated root canals in resin blocks.
A total of 50 simulated root canals in clear resin blocks with various degrees and positions of curvature were prepared by either K-files or Hedstrom files. Each file type was used to prepare 25 canals employing an in/out circumferential filing motion. The efficacy of the files was assessed by instrumentation time, deformation and fracture of instruments, and loss of working distance. The shape of the prepared canals was assessed by direct observation and from composite photographic prints produced by superimposing negatives of the canals obtained before and after preparation. Overall, canal shaping with Hedstrom files was quicker and more effective. Both file types prepared straight canals in an appropriate manner but the majority of prepared curved canals were hourglass in shape. In general, K-files created zips which were wider and thus more pronounced than those produced by Hedstrom files. Wide 'danger zones' were also regularly created. The location of the aberrations depended largely on the original shape of the canal and in particular on the position of the beginning of the canal curve. Under the conditions of this study, the manipulation of K-files and Hedstrom files in a simple in/out circumferential filing motion proved an unsatisfactory method of shaping simulated curved root canals in resin blocks.
Dental Cavity Preparation↗
Cutting efficiency of Hedstrom, S and U files made of various alloys in filing motion.
The cutting efficiency for sizes 25 and 35 stainless steel Hedstrom S and U files from 10 manufacturers, and titanium-alloy Hedstrom S and U files from five manufacturers, tested for linear (filing) motion under standardized conditions were determined. Special plastic samples having well-defined abrasive properties were used as the substrate and constant pressure was applied until the instruments were blunt. The depth of the groove achieved by filing was used to measure cutting efficiency. For both sizes there were significant differences in the cutting efficiency of files made by the various manufacturers (P < 0.001). Hedstrom files made of stainless steel, made by VDW, gave the best cutting efficiency for sizes 25 and 35. Overall, under the conditions of this study. Hedstrom files had better cutting efficiency than S or U files. Likewise, stainless steel files provided better cutting efficiency than instruments made of titanium alloys.
Alloys↗
Endodontic complications of root canal therapy performed by dental students with stainless-steel K-files and nickel-titanium hand files.
Straightening of curved canals is one of the most common procedural errors in endodontic instrumentation. This problem is commonly encountered when dental students perform molar endodontics. The purpose of this study was to compare the effect of the type of instrument used by these students on the extent of straightening and on the incidence of other endodontic procedural errors. Nickel-titanium 0.02 taper hand files were compared with traditional stainless-steel 0.02 taper K-files. Sixty molar teeth comprised of maxillary and mandibular first and second molars were treated by senior dental students. Instrumentation was with either nickel-titanium hand files or stainless-steel K-files. Preoperative and postoperative radiographs of each tooth were taken using an XCP precision instrument with a customized bite block to ensure accurate reproduction of radiographic angulation. The radiographs were scanned and the images stored as TIFF files. By superimposing tracings from the preoperative over the postoperative radiographs, the degree of deviation of the apical third of the root canal filling from the original canal was measured. The presence of other errors, such as strip perforation and instrument breakage, was established by examining the radiographs. In curved canals instrumented by stainless-steel K-files, the average deviation of the apical third of the canals was 14.44 degrees (+/- 10.33 degrees). The deviation was significantly reduced when nickel-titanium hand files were used to an average of 4.39 degrees (+/- 4.53 degrees). The incidence of other procedural errors was also significantly reduced by the use of nickel-titanium hand files.
Dental Instruments↗
[Can medical files be used to audit hospital health care? Results of a regional audit of hospital file quality].
OBJECTIVES: The clinical audit method based on a retrospective analysis of medical files can be used to assess hospital health care. The reliability of the results obtained depends on the validity of the data in the file and its completeness. The aim of this work was to assess the quality of this information source. METHODS: The simplified ANDEM/ANAES from was proposed to 47 medical information departments of public and private hospitals participating in the public health care service in the Provence-Alples-Côte d'Azur region. The audit was conducted on a sample of hospital stays during a regular 6-month quality control assessment of hospital health care activity. RESULTS: Analysis of the 467 forms returned by 39 hospitals, showed that the quality of medical file recordings should be improved as a large amount of data or important documents were missing: reason for hospitalization (recorded on 74.1% of files), operation report (found in 83.2% of files) and discharge summary (found in 66.6% of files). CONCLUSION: Clinical audits would be compromised in certain hospitals by the use of medical files. Efforts to improve the quality of hospital medical files should be a priority.
Evaluation Studies as Topic↗
Root canal shaping with manual stainless steel files and rotary Ni-Ti files performed by students.
AIM: To investigate root canal shaping with manual stainless steel files and rotary Ni-Ti files by students. METHODOLOGY: Two hundred and ten simulated root canals with the same geometrical shape and size in acrylic resin blocks were prepared by 21 undergraduate dental students with manual stainless steel files using a stepback technique or with rotary Ni-Ti files in crown-down technique. Preparation length, canal shape, incidence of fracture and preparation time were investigated. RESULTS: Zips and elbows occurred significantly (P < 0.001) less frequently with rotary than with manual preparation. The correct preparation length was achieved significantly (P < 0.05) more often with rotary Ni-Ti files than with manual stainless steel files. Fractures occurred significantly (P < 0.05) less frequently with hand instrumentation. The mean time required for manual preparation was significantly (P < 0.001) longer than that required for rotary preparation. Prior experience with a hand preparation technique was not reflected in an improved quality of the subsequent engine-driven preparation. CONCLUSIONS: Inexperienced operators achieved better canal preparations with rotary Ni-Ti instruments than with manual stainless steel files. However, rotary preparation was associated with significantly more fractures.
Chi-Square Distribution↗
A comparison of Greater Taper files, ProFiles, and stainless steel files to shape curved root canals.
OBJECTIVE: The purpose of this study was to evaluate the ability of engine-driven nickel-titanium files to maintain the original curvature of root canals during canal preparation. STUDY DESIGN: A total of 36 simulated curved canals on resin blocks were instrumented with Greater Taper (GT) files, ProFiles, and stainless steel files. With the mounting device, which can reproduce the same position of the resin blocks and the camera, the unprepared and prepared canals were accurately compared by means of a double-exposure photographic technique. The analysis of variance test was used for the statistical analysis of data obtained. RESULTS: The canals prepared by means of a ProFile with a 6% taper up to the working length were excellent in taper and in maintaining the original curvature. The canals prepared with GT files were also found to be excellent in taper and in maintaining the original curvature; however, these canals showed a slight enlargement toward the inner side at the beginning of the curvature. The canals prepared with stainless steel files showed nontapered widening and severe transportation. CONCLUSION: The canals prepared with GT files and ProFiles were excellently tapered and maintained the original curvature of the canals in comparison with the ones prepared with stainless steel files.
Analysis of Variance↗
Evaluation of success rate of endodontic treatment performed by students with stainless-steel K-files and nickel-titanium hand files.
A previous study by our group found nickel-titanium (NiTi) 0.02 hand files maintained the original canal shape better than similar stainless-steel K-files (SS-K). Inexperienced dental students used both file types on molar teeth. The purpose of this study was to compare the 1-yr success rate of endodontic treatment of the same teeth used in our previous study. Twelve-month follow-up radiographs were compared with the immediate follow-up radiographs. Both sets of radiographs were taken with the same customized stent. Quantification of osseous changes using digital imaging was used. Thus, a reliable numerical estimation (densitometric ratio) of disease and healing processes could be established. Sixty-seven percent of the patients returned for the 12-month radiographs (19 NiTi vs. 21 SS-K). Immediate postoperative periapical status was found to be similar (p > 0.05). Teeth instrumented with the NiTi files demonstrated a higher mean change in densitometric ratio, compared with SS-K files (p < 0.05). Further tests of success (values: > or =0) and failure (value: < or =0) with the Fisher exact test showed more success (decreasing radiographic density) with NiTi files and more failures (increasing radiographic density) with SS-K type files (p < or = 0.03). This study indicates that maintaining the original canal shape after instrumentation leads to a better prognosis of endodontic treatment.
Absorptiometry, Photon↗
Data file standard for flow cytometry. Data File Standards Committee of the Society for Analytical Cytology.
This data file standard for flow cytometry (FCS) provides a detailed description of a data file structure designed such that the file can include all of the information necessary to describe fully: 1) the instrument used to obtain the data; 2) the sample measured; 3) the data obtained; and 4) the results of analysis of the data. The file may contain one or more data sets. Each data set includes data from a single sample or acquisition run. Each data set consists of a minimum of four parts--HEADER, TEXT, DATA, and ANALYSIS--all of which are required. The file is structured such that the parts of a data set do not have to be in any particular order, except for the HEADER, which must always be first. The HEADER contains pointers to the beginning and end of each of the other three parts. The file is written as a continuous byte stream, with no line or page formating. The HEADER, TEXT, and ANALYSIS parts are written in ASCII format and the DATA part can be written in ASCII, binary integer or floating point. This Standard, noted as FCS2.0, is based on a standard proposed by Murphy and Chused (Cytometry 5:553-555, 1984). Data written utilizing their proposed format (FCS1.0) is compatible with the format described here. Future versions of the standard will maintain compatibility with older versions.
Flow Cytometry↗
Cleaning of endodontic files, Part I: The effect of bioburden on the sterilization of endodontic files.
Ninety-two new endodontic files were randomly assigned to five groups with varying parameters of contamination, cleaning method, and sterilization (steam or chemical). Files were instrumented in bovine teeth to accumulate debris and a known contaminant, Bacillus stearothermophilus. Positive controls produced growth on both T-soy agar plates and in T-soy broth. Negative controls and experimental files (some with heavy debris) failed to produce growth. The results showed that there was no significant difference between contaminated files that were not cleaned before sterilization and contaminated files that were cleaned before sterilization. Bioburden present on endodontic files does not appear to affect the sterilization process.
Animals↗
OTS: a program for converting Noldus Observer data files to SDIS files.
A program for converting Noldus Observer data files (ODF) to sequential data interchange standard (SDIS) files is described. Observer users who convert their data files can then take advantage of various flexible and powerful data modification and computational procedures available in the Generalized Sequential Querier, a program that assumes SDIS-formatted files.
Behavior↗
A model of a computer file for the intensive neonatal practice "Neonatal Intensive Computer File".
INTRODUCTION: The use of computer methods for processing the databases gathered in a neonatal intensive care unit has more than 20 years experience. During the past years various systems for data management in accordance with the nature of the work have been designed. AIM: The aim was to create a method for quick and easy processing of variable clinical material in an uniform format. REQUIREMENTS: The method allows the arrangement of the entire primary information into a standardized database suitable for computer processing, following up an unlimited number of parameters, calculating derivative indices, representing and evaluating data by means of graphic trends, surveying current clinical information not only for routine practice, but also for research purposes. RESULTS: We developed a computer file type method. This is a method enabling the systematic and well arranged structuring of the newborn's history, the recordings of the monitoring and life-supporting equipment, the data from clinical, laboratory examinations and all the other implemented diagnostic-therapeutic procedures, family, social and possibly legal background. CONCLUSION: The proposed method Neonatal Intensive Computer File (NICF) was applied successfully in the management the data of the above mentioned project (Grant L-444, MES-Sofia): organizes the entire information into a form suitable for the everyday clinical practice and for research studies. Neonatal Intensive Computer File (NICF) gives ample possibilities for quick and reliable evaluation of the condition of the newborn infant and the effect of the applied treatment. The introduced panel (complex) of indices with possibilities for its expansion allows early detection of advancing and threatening disturbances, characterizes the type and pinpoints the exact time and location of the disturbances occurring in the system ventilator-patient-physician. The graphic trends visualize the variation of the indices and contributes to the quick evaluation and orientation in them. They are considerably more informative than the single time registered values of any indicator or index. Optimizes the management of the applied ventilation/oxygenation technique and overall treatment, facilitates the timely decision-making process (the change and/or the choice of new therapeutic alternatives) Facilitates the statistical analysis of the total accumulated data or a selected part of it. Allows the use of the same clinical material for the needs of multiple research projects guaranteeing precision and reliability. The accumulated databases (information bank) are important for future prospective and retrospective studies not only in the clinical but also in the social field. The information yielded by Neonatal Intensive Computer File (NICF) can be used for prognostic projections and conclusions in terms of the current condition and outcome as well as ad vitam.
Databases, Factual↗
Pex, analytical tools for PDB files. I. GF-Pex: basic file to describe a protein.
Pex are created to extract numeric and string descriptions of protein structures from PDB files. This concerns covalent bond lengths and angles, secondary structures, residues in interaction, H-bond lengths and geometry, etc. Several kinds of Pex are generated: (1) general feature (GF-Pex); (2) H-bond (H-Pex); and (3) accessible surface (AS-Pex) and force potential (FP-Pex). We describe the general principles of Pex and detail the GF-Pex files. Using the GF-Pex of 131 proteins, we analyze the mean residue frequencies, the straight phi/psi distribution and the major kinds of secondary structures in proteins. Thomas et al. (this issue) analyzes the main chain H-bonds in those proteins. The GF-Pex and H-Pex files of the 131 proteins can be downloaded from the CBMN site (http://www.fsagx.ac.be/bp/). Proteins 2001;43:28-36.
Algorithms↗
High-throughput screening of historic collections: observations on file size, biological targets, and file diversity.
At Pfizer Central Research, high-throughput screening has been an important source of new leads for drug discovery for a decade. Our experience with over 150 high-throughput screens can address questions about necessary file size, how well particular biological targets fare (with particular reference to protein-protein interactions), and what file diversity means in practice.
Databases, Factual↗
X-File: a program for maintaining a radiographic teaching file.
Software designed for entry, retrieval, and maintenance of radiographic case-file data on a microcomputer offers considerable help in maintaining such records in a radiology department. The case files are based on the Index for Roentgen Diagnoses, published by the AmericanCollege of Radiology. The terms and code numbers of the index are included in the software, so that the user need only enter the diagnostic term desired; the code numbers and exact terminology are assigned automatically. The software is written for an IBM-compatible microcomputer. Residents and staff radiologists have been using the program for the past two years to store and find both confirmed cases and other interesting cases. The system's capacity exceeds 70,000 entries on a 20-megabyte had disk. The program has five features not found in previous similar programs and not attainable with manual methods.
Hospital Information Systems↗
A comparison of Flex-R files and K-type files for enlargement of severely curved molar root canals.
A double exposure radiographic technique is introduced and used to evaluate the magnitude of apical canal transportation that occurs during preparation procedures. The balanced force technique and a step-back method for cleaning and shaping root canals were evaluated in mesiobuccal root canals from 80 extracted human molar teeth with curvatures ranging from 30 to 73 degrees. Pre- and posttreatment file positions were examined from clinical and proximal radiographic views by computer digitization. Statistical analysis indicated significantly less apical transportation with the use of the balanced force technique when compared with a step-back technique in canals exhibiting both more and less than 45 degrees of curvature.
Dental Pulp Cavity↗