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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

Analysis of the registry of toxic effects of chemical substances (RTECS) files and conversion of the data in these files for input to the environmental chemicals data and information network (ECDIN).

A data bank for environmental chemicals, ECDIN, is being developed at the Joint Research Centre of the European Communities in cooperation with universities and research institutes in the nine member states as a part of the Environmental Research Programme of the EC. During the pilot phase of the project, data from the Registry of Toxic Effects of Chemical Substances have been incorporated into the data bank. Conversions of the data into ECDIN input format was necessary before inclusion of the toxicity data in ECDIN, and the computer programs used for this format conversion have produced various statistics for the contents of the RTECS files. Analyses of the data in three editions of RTECS are presented.

Environmental Pollutants

Comparison of six files to prepare simulated root canals. 1.

A total of 300 simulated root canals of various angles and positions of curvature in clear resin blocks were prepared by hand using either K-files, K-Flex files, Flexofiles, Flex-R files, Hedstrom files or Unifiles. Each file type was used to prepare 50 canals employing a linear filing motion and an anticurvature stepback technique. Part 1 of this two-part report describes the efficacy of the files in terms of preparation time, instrument failure, loss of canal length and weight loss from the blocks. Two-way analysis of variance confirmed that there was significant variation for each parameter between instruments, between canal types, and with interaction between instruments and canal types. Overall, preparation with Hedstrom files was significantly quicker than with any other file, whilst preparation with K-files and K-Flex files took significantly longer. Fracture and deformation of instruments occurred substantially less often with Flex-R and Hedstrom files, but significantly more often with Unifiles. Loss of working distance occurred with all file types, but was significantly greater in canals prepared with K-files. Unifiles and Hedstrom files were responsible for significantly more weight loss than the other files, whilst K-files produced significantly less weight loss. Canals with rough undulating walls were created most often by Hedstrom files and Unifiles. Overall, under the conditions of this study, Flexofiles, Flex-R files and Hedstrom files appeared to be substantially more effective than K-files, K-Flex files and Unifiles.

Analysis of Variance

Observations of acoustic streaming fields around an oscillating ultrasonic file.

The steady acoustic streaming generated around straight and precurved oscillating ultrasonic files driven by the Piezon-Master 400 unit was examined in the free field and in small channels using a stereomicroscope. In addition, the effect of file-wall contact on streaming production was also investigated. The results indicated that the ultrasonic files can generate acoustic streaming both in the free field and in the small channel. Higher velocity streaming was observed when smaller size files were employed and when the file was precurved. Light file-wall contact did not totally inhibit streaming while severe file-wall contact inhibited movement of the file and, as a result, no streaming was observed. The positions and length scales of the streaming vortices appeared to be influenced by the presence of boundaries. In the free field, two rows of vortices were situated along the sides of the file while in the small channel, the vortices were positioned above the surface of the file. These results indicated that it is possible for acoustic streaming to occur in a confined space as in a root canal provided that severe file-wall contact is avoided. It is therefore recommended that light filing or allowing the file to freely vibrate during some stage of treatment should be carried out in order to generate streaming in the root canal.

Humans

Comparison of endodontic file tip quality.

Tip angulation and four visual characteristics denoting manufacturing quality of endodontic files were studied. One-hundred eighty K-type, Hedstrom, and Flex-type files from two manufacturers (Kerr and Mallefer) were evaluated. Photomicrographs (x 115) were made of each file. Two evaluators examined the photomicrographs. Tip angulation was studied to determine if files were compliant with ANSI/ADA Specification Nos. 28 and 58. The four visual characteristics compared in the study were symmetry versus asymmetry, smooth versus irregular, tip configuration, and shoulder configuration. Statistical analysis was made using the chi-square method. Mallefer files appear to be more in conformity with specifications for tip angle and more meticulously manufactured than Kerr files. Kerr Hedstrom files appear to conform less often to tip angle specifications than Kerr K-type or K-Flex files. K-type and Flex-type file tips appear to be better manufactured than Hedstrom file tips. Certification status of a file manufacturer did not correlate with a higher level of compliance with tip angulation specifications or with a better machined file tip.

Chi-Square Distribution

Comparison of six files to prepare simulated root canals. 2.

A total of 300 simulated root canals of various angles and positions of curvature in clear resin blocks were prepared by hand using either K-files, K-Flex files, Flexofiles, Flex-R files, Hedstrom files or Unifiles. Each file type was used to prepare 50 canals employing a linear filing motion and an anticurvature stepback technique. Part 2 of this two-part report describes the efficacy of the files in terms of the prevalence of canal aberrations, the amount and direction of canal transportation and the overall postoperative canal shape. Hourglass shaped canals were found in 4.5% of curved canals, the majority of these being created by K-files and K-Flex files. Perforations were seen in 6.3% of curved canals, the majority being produced by Flex-R files and K-files. Excessive removal of material from along the inner aspect of the canal curve occurred in 10.4% of canals, by far the majority being created by Hedstrom files. Transportation of canals was a consistent finding with all instruments. Two-way analysis of variance revealed how significant differences in the absolute magnitude of transportation occurred between instruments, between canal types and by an interaction between instrument and canal type. In general, transportation was towards the outer aspect of the canal curve at the end-point of preparation and the zip and elbow, but towards the inner aspect at the beginning of the curve. Further towards the orifice, transportation reverted to the outer aspect of the canal curve.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance

Effect of precurving on the performance of endosonic K files.

This study compared the performance of precurved and straight endosonic files. Size 15, 20, and 25 endosonic K files were precurved to different degrees (20 to 90 degrees) and the resultant oscillatory pattern showed no significant difference compared with corresponding straight files. Endovue blocks were prepared with either a #15, 20, or 25 endosonic file which was either straight or precurved. Those blocks prepared with precurved files had a continuous taper while blocks prepared with straight files had constrictions along their lengths. Finally, a curved root of a human natural tooth had windows prepared along its length so that the oscillatory pattern of the file could be observed. The precurved file oscillated more freely than a straight file as observed by the presence of antinodes along the file and the accumulation of dentin chips within the canal. The results of this study suggest that it is advantageous to precurve endosonic files before using them in curved canals.

Dental Cavity Preparation

Machining efficiency of Flex-R, K-Flex, Trio-Cut, and S Files.

Many root canal instruments with several different designs have been introduced during recent years. This article evaluates the machining properties of four such instruments: the Flex-R, K-Flex, Trio-Cut, and S file. There are large variations in the machining properties of these instruments. The results are comparable to findings when evaluating conventional root canal files which show that the Hedstrom file is much more efficient when considering removal of material than the K file. The Flex-R file, K-Flex file, and Trio-Cut file are similar in design. The two former brands perform in a similar fashion, while the Trio-Cut file is less efficient than any of the evaluated K files. The S file performs as a Hedstrom file which can be expected from its similarity in design to that instrument.

Equipment Design

Effectiveness of different endodontic files for preparing curved root canals: a scanning electron microscopic study.

In this study, the effect of using four endodontic files from different manufacturers on the final shape of 80 prepared curved root canals of extracted single-rooted teeth were comparatively analyzed with scanning electron microscopy. The instruments tested were Tri-files, Flex-R files, Flexofiles and conventional K-type files. All files were used with in and out linear movements with a circumferential motion starting with a size 15 file. Final preparation of the apical thirds was performed with a size 30 file. Shaping effectiveness of the tested files was qualitatively evaluated in terms of respect for conservation of the apical constriction and the presence or absence of ledging, specially in the apical third of the root canals. A well-centered and tapered preparation without apical transportation or ledging was detected when Tri-file or Flex-R files were used. Conversely, the use of Flexofile or conventional K-type files resulted in frequent alteration of the initial pattern of the root canals, showing an hour-glass preparation with alteration of the apical constriction and ledge formations.

Dental Cavity Preparation

Streaming patterns produced around endosonic files.

Acoustic microstreaming is known to be an important phenomenon associated with the use of clinically available endosonic systems. However, it has proved difficult to calibrate its pattern and effectiveness around the oscillating file. An in-vitro model system consisting of slow setting plaster was developed to demonstrate the activity of streaming around both ultrasonically and sonically activated files. For ultrasonic files, streaming occurred mainly in front of and behind the file, in contrast to the sonic file, where the plaster was disturbed evenly around it. With both types of file most activity occurred around the file tip, and became reduced towards the driver. Streaming patterns associated with the ultrasonic device were found to be dependent on the power setting of the instrument and whether the side of the file was constrained or lightly touched. The sonic device produced a large disturbance around the freely oscillating tip. Under load this streaming occurred along the whole length of the file, and was unaffected by constraint. This investigation demonstrated that streaming does occur with the instruments currently available, although it is dependent on their operating conditions. Clinical users of such equipment should be aware of the characteristic three-dimensional patterns of streaming that occur around these endosonic files, in order to maximize their efficiency.

Acoustics

Information retrieval for teaching files: a preliminary study.

A computer algorithm for information retrieval from an electronic teaching file has been developed. This index enables the user to retrieve cases from a teaching file, based on the input of a combination of features. The algorithm is based on nearest neighbor analysis, and is programmed in the "C" language. A teaching file with this index is very easy to use as a reference resource for diagnosing unknown cases. A model was developed for a preliminary test of how likely a user would be to review a teaching file case that is the same diagnosis as an unknown case, thereby reducing uncertainty of diagnosis. The model used 110 cases of arthritis radiographs of hands scored by a skeletal radiologist. The result of the model suggests that the correct diagnosis would be reviewed 83% of the time. A standard method of reducing uncertainty of diagnosis (the maximum likelihood discriminant function) would have picked the correct diagnosis 78% of the time. The results indicate that a teaching file with the computer index is a practical tool for dealing with the uncertainty in diagnosis of unknown cases. The computer index could be included with videodisc-based teaching files (such as the American College of Radiology files). Using teaching files as a reference for interpreting unknown cases may reduce interobserver variability.

Algorithms

Effect of precurving endosonic files on the amount of debris and smear layer remaining in curved root canals.

Endosonic files are prone to constraint; this reduces their efficiency, particularly in the apical third and in curved root canals. Precurving the file may reduce constraint, thereby improving the file's ability to debride. This investigation was undertaken to compare both straight and precurved endosonic files as to debris and smear layer removal. Thirty-six curved root canals were randomly allocated into six groups. Each group was prepared using a step-down technique, then instrumented with either a straight or precurved endosonic file of size 15, 20, or 25. The tooth roots were split and examined under the scanning electron microscope. Blind examinations were made for debris and smear layer removal and evaluation scores were analyzed using a log linear approach. The root canals instrumented with the precurved files had a significantly lower debris score than those prepared with straight files. Precurving did not affect smear layer removal. In conclusion, precurving of files decreased the amount of debris but did not affect smear layer removal.

Dental Cavity Preparation

Torsional properties of twisted and machined endodontic files.

The torsional properties of conventionally twisted K-type endodontic files and recently developed machined K-type endodontic files were compared. File sizes 10 through 40 were subjected to torsional load in clockwise and counterclockwise directions independently. Results showed that a statistically significant reduction in clockwise rotation occurred at failure with all of the machined files except size 10. Counterclockwise rotation at failure was also significantly lower for the machined files in sizes 10 through 30. There was no difference in torsional strength between the file types regardless of rotation direction. Therefore, machined files exhibit less ductility than twisted files prior to fracture and may be more susceptible to torsional failure clinically.

Dental Stress Analysis

A systematic approach to preventing intracanal breakage of endodontic files.

This study was conducted to determine the effectiveness of a method to prevent intracanal breakage of endodontic files. An application schedule with a predetermined number of periods of use for K-files of all sizes was implemented at the author's clinic for a 3-year period. All the files used under this schedule were discarded after the predetermined periods of use, whether they displayed any deformity or not. During the 3-year period, 1933 files (53.7 per month) were discarded after preparation of 3269 root canals. There were 5 file fractures (0.1 per month) compared with 1.4 fractures per month before the adaptation of this system. The monthly average of files discarded during the 3-year research period was 53.7. Before the adoption of the trial system, the monthly average of discarded files was 76.5. It is concluded that the experimental system effectively reduced the incidence of intracanal instrument fractures and the total number of files consumed.

Dental Instruments

Development of an integrated filing system for endoscopic images.

A new integrated filing system for endoscopic images has been developed, comprising a main image filing system and subsystems located at different stations. A hybrid filing system made up of both digital and analog filing devices was introduced to construct this system that combines the merits of the two filing methods. Each subsystem provided with a video processor, is equipped with a digital filing device, and routine images were recorded in the analog image filing device of the main system. The use of a multi-input adapter enabled simultaneous input of analog images from up to 8 video processors. Recorded magneto-optical disks make it possible to recall the digital images at any station in the hospital; the disks are copied without image degradation and also utilised for image processing. This system promises reliable storage and integrated, efficient management of endoscopic information. It also costs less to install than the so-called PACS (picture archiving and communication system), which connects all the stations of the hospital using optical fiber cables.

Analog-Digital Conversion