A Comparison of Three Nickel Titanium Rotary Systems, EndoSequence, ProTaper Universal, and Profile GT, for Canal-cleaning Ability

Authors:
Anne E. Williamson, DDS, MS, Allan J. Sandor, DDS, and Bruce C. Justman, DDS
J Endod 2009;35:107109

Contents
Introduction 1. Aim Material & methods Results Discussion Conclusion References

Introduction
Canal preparation is one of the major steps in root canal treatment and is directly related to concomitant disinfection and subsequent obturation. In recent years, nickel-titanium rotary root canal preparation systems such as the EndoSequence the ProTaper Universal and the ProFile GT , along with several others, have altered the techniques of canal instrumentation. NiTi instruments have been shown to be superior to stainless steel (SS) in terms of cutting efficacy, flexibility, and torsional resistance.

AIM
The purpose of this study was to compare cleaning effectiveness of root canal preparation under scanning electron microscopy (SEM) using three different rotary NiTi instrumentation systems: the ProTaper Universal variable taper, the ProFile GT .04 taper, and EndoSequence .04 taper.

Materials & methods

Thirty-six mesiobuccal roots from extracted mandibular molars selected for this study. The teeth were randomly divided into three groups. Each group had two teeth not instrumented that served as controls. Access cavities are prepared. Canal patency was established by placing a K-Flex #15 SS hand file. Straight-line access was achieved for the EndoSequence and ProFile systems with the use of Gates Glidden drills #2 through #4. The ProTaper rotary system replaces the Gates Glidden drills with rotary shaping files. All teeth were prepared to a #40 master apical file following the individual manufacturers instructions. All three systems were used in the traditional crowndown technique.

All samples were decoronated, and the mesial root was longitudinally split buccolingually for evaluation under SEM to determine canal cleanliness. All teeth were analyzed with the SEM at 20.0 kV and 500X magnification in the middle third of the canal. Five independent examiners using the following 5-score index performed the analysis of the SEM images (Fig. 1):

(A) SEM image of a sample with a mean score of 1.8 (few agglomerations of debris). (B) SEM image of a sample with a mean score of 1.2 (clean root canal wall, only a few small debris particles). (C) SEM image of a sample with a mean score of 2.8 (many agglomerations of debris covering less than 50% of the root canal wall). (D) SEM image with a mean score of 4.2 (more than 50% of the root canal wall covered by debris). (1) score 1: clean root canal wall, only few small debris particles; (2) score 2: few small agglomerations of debris; (3) score 3: many agglomerations of debris covering less than 50% of the root canal wall; (4) score 4: more than 50% of the root canal wall covered by debris; and (5) score 5: complete or nearly complete root canal wall covered by debris. The nonparametric Kruskal-Wallis test was used to determine whether a statistical difference existed among the three groups of instruments followed by a weighted kappa to measure observer agreement.

Results
Kruskal-Wallis Test (Average of 5 Examiners) Group ES PF PT Control n 9 10 8 6 Mean SD 2.8 3.0 3.4 5.0 1.1 1.3 1.0 Median Lower Quartile 2.4 2.0 3.4 1.4 3.3 2.5 Upper Quartile 3.6 3.6 4.1 -

Discussion
The EndoSequence is a rotary file with a reamer-like design incorporating alternate contact point geometry. The manufacturer states that removing radial lands increases cutting efficiency, increases flexibility, and reduces drag, therefore lowering the torque requirements of the files. EndoSequence has a significantly higher rate of file separation when compared with the Profile system. No file separations occurred in our study. In this study, SEM evaluation of the root canal surfaces showed areas of the canal walls covered by a smear layer and debris in all groups. Canals of all of the specimens showed the existence of uninstrumented surfaces

regardless of the rotary system used. Complete canal cleanliness was not achieved by any of the techniques and instruments investigated. This study did not compare the ability of NaOCl to remove debris with that of other irrigants;

Conclusion
After root canal preparation with three different NiTi rotary instruments, no statistically significant differences in canal wall cleanliness at the midroot level between any groups were found. All sections showed a comparable level of cleanliness and freedom of smear layer, with some scattered debris. Under the conditions of this study, the EndoSequence, ProFile, and ProTaper rotary instrument systems were equally effective in root canal debridement.

REFERENECES
1.Haikel Y, Serfaty R, Bleicher P, Lwin TT, Allemann C. Effects of cleaning, chemical disinfection, and sterilization procedures on the mechanical properties of endodontic instruments. J Endod 1997;23:15 8. 2. Short JA, Morgan LA, Baumgartner JC. comparison of canal centering ability of four instrumentation techniques. J Endod 1997;23:5037. 3. Peters OA, Laib A, Gohring TN, Barbakow F. Changes in root canal geometry after preparation assessed by highresolution computed tomography. J Endod 2001; 27:1 6.