Original Research

ENDODONTOLOGY

To treat and to retreat Protaper universal rotary system,

the double delight
SANDHYA U. M. *
MOHAN THOMAS NAINAN **
MANGALA T. M. ***
SHARAD KAMAT ***

ABSTRACT
Aim: The aim of this study was to evaluate the efficacy of ProTaper Universal rotary system for guttapercha
removal during endodontic retreatment.
Methodology:30 extracted human maxillary anterior teeth were prepared & filled with laterally condensed guttapercha & AH plus sealer. Teeth were divided into three groups: Group A: GP removal with Hedstrom files and
xylene,and further canal preparation with stainless steel K-flex files (Kerr). Group B: GP removal was completed
using Gates Glidden drills & Hedstrom files with xylene as a solvent, followed by further canal preparation with
ProTaper Universal rotary instruments: Group C: GP removal completed with the ProTaper Universal rotary
retreatment system & repreparation of the canal accomplished with ProTaper Universal rotary instruments: The
operating time was recorded. Teeth were rendered transparent for the evaluation of the area of the remaining GP/
sealer in bucco-lingual & mesio-distal directions. Statistical analysis was performed by using repeated measures
analysis of variance & ANOVA.
Results: The ProTaper Universal technique (Group c) resulted in a smaller percentage of canal area covered by
residual GP/sealer than in groups A& B.Conclusions:In this laboratory study all the techniques left GP/sealer
remnants within the root canal. The ProTaper Universal rotary retreatment system proved to be an efficient
method of removing GP & sealer from root canals.

INTRODUCTION

driven rotary files,ultrasonic tips and files,solvents

The primary reason for a negative outcome

and heat carrying instruments. More recently,

following root canal treatment is the persistance

ProTaper Universal System including shaping,

of bacteria within the intricacies of root canal

finishing and retreatment files has been introduced

system. Root canal retreatment aims to eliminate

for this purpose.1

or to subtantially reduce the microbial load from

ProTaper retreatment files are designated as

the root canal.Complete removal of the root filling

D1,D2

enables effective cleaning,shaping and filling of the

&D3,

They

are

available

in

16mm(D1),18mm(D2) and 22mm(D3) for

root canal system.Various hand and rotary

guttapercha removal from coronal third,middle

instruments have been used for gutta-percha(GP )

third and apical third of the canals respectively.The

removal,including endodontic hand files,engine

tip diameter for D1,D2,D3 are 0.30mm,0.25mm

* Postgraduate student, ** Professor and Head of the Department, *** Professor, Department of Conservative Dentistry and Endodotics, PMNM Dental College, Bagalkot,
Karnataka-587101

42

ENDODONTOLOGY

SANDHYA U. M., MOHAN THOMAS NAINAN, MANGALA T. M., SHARAD KAMAT

and 0.20mm and their tapers are 9%,8%,&7%

of the root filling materials is accomplished in the

respectively.While others have non cutting tips,D1

following way.Coronal flaring with 3-1 GG

has working tip for initial penetration into the root

drills,followed by H-files #30,#25,#20 in a crown

canals.All three are convex in cross section.

down

manner.Root

canal

refining

was

accomplished with K-flex files with apical

AIMS AND OBJECTIVES

enlargement to size till 35 and step back till #50.

The aim of this study was to evaluate the

(Fig-5 &6)

efficacy of Pro-Taper Universal rotary system for

Group B: H-files with xylene, further canal

guttapercha removal from root canals.

preparation with ProTaper shaping & finishing

MATERIALS AND METHODS

files.SX,S1,S2 are used in a brushing motion till

Thirty extracted human maxillary anterior

working length is reached. (Fig 7 & 8)

teeth of similar tooth length were collected from

Group C:

the department of Oral surgery ,P.M.N.M Dental

College ,Bagalkot.The teeth with single straight

GP removal with ProTaper retreatment files

canal and size of apical foramen not greater than

followed by repreparation with ProTaper shaping

no 15 K file were selected for standardisation of

and finishing files. Rotary files D1,D2 and D3 are

the study.

used in a circumferential manner to reach the

Initial root canal treatment: (Fig 1 & 2)

working length. (Fig 9 & 10)

Modified step back flare technique is used.i.e.

Brushing motion,350-500 rpm are used.

Flaring the cervical third with GG 1-3(Dentsply

Maillefer).Cleaning and shaping was carried out

Repreparation accomplished with ProTaper

by sequential use of K-files upto size 30,followed

shaping and finishing instruments at 300 rpm

by step back procedure in 1mm increment to a

EVALUATION

file size of 50.Frequent irrigation with 3% sodium

CLEARING TECHNIQUE: (Fig 11a,11b,11c)

hypochlorite and RC Prep was used for removal

Teeth were rendered transparent by the

of smear layer.A working length 15mm was

following technique:Decalcification in 5% nitric

established in all teeth

acid for 7 days, dehydration in ethanol 85%, 90%,

Obturation: (Fig 3 & 4)

99%, successively for 12 hrs, 1hr, & 3hrs

Teeth were obturated with GP and AH-Plus

respectively.Then the teeth were cleared using

sealer and cold lateral compaction method and

methyl salicyclate solution.The specimens are

stored at room temperature for 30 days

observed under Stereomicroscope (at 10x

Endodontic retreatment

magnification) and photographs are taken.

Teeth were randomly divided into three

Sealer and/or GP and the area of canal in each

groups

1/3 of canal is measured using Image J 1.42a/Java

rd

1.6.0-10 Image analyser software.The ratio of

Group A: Hedstrom files and xylene,with

sealer/GP to the area of canal is then calculated.

further canal preparation using K-flex files.Removal

43

ENDODONTOLOGY

TO TREAT AND TO RETREAT-PROTAPER UNIVERSAL ROTARY SYSTEM, THE DOUBLE DELIGHT

STEREOMICROSCOPIC PHOTOGRAPHS
(Fig12a,12b,13a,13b,14a,14b)
RESULTS: Table 1 & 2
ANOVA: Table3
F ratio=0.34/0.05 =6.8
F tab =5.49
By observing the actual data it is clear that
Group C is better than other two methods at

Fig 7 & 8- Materials used for retreatment in Group B

P<0.001.
MEAN RATIO OF SEALER OR GP TO AREA
OF CANAL: Graph 1
MEAN OPERATING TIME: Graph 2

ILLUSTRATIONS

Fig - 9 & 10 Materials used for retreatment in Group C

Fig 1 & 2 -Initial root canal treatment:

Fig - 11a,11b,11c Materials used for clearing technique.

Fig 3 & 4- Obturation;

Fig 12a - Coronal one third of the specimen,12b - Middle and

apical thirds in Group A

Fig 5 & 6- Materials used for retreament in Group A

44

ENDODONTOLOGY

SANDHYA U. M., MOHAN THOMAS NAINAN, MANGALA T. M., SHARAD KAMAT

ANOVA: Table3
DEGREE OF
FREEDOM

SUM OF
EQUATION

MEAN OF
SQUARES

BETWEEN THE
METHODS

3-2=1

0.68

0.34

METHODS OF
ERROR

29-2=27

1.36

0.05

MEAN RATIO OF SEALER OR GP TO

AREA OF CANAL: Graph 1

Fig 13a - Coronal one third of the specimen,13b - Middle and

apical third in GroupB

Fig 14a - Coronal one third of the specimen,14b - Middle and

apical third in Group C

TABLE- 1 MEAN RATIO OF SEALER OR GP

TO AREA OF CANAL
GROUP A

GROUP B

GROUP C

SAMPLE 1

0.56

O.64

0.34

SAMPLE 2

0.42

0.59

0.47

SAMPLE 3

0.47

1.23

0.46

SAMPLE 4

0.52

1.02

0.23

SAMPLE 5

0.60

1.02

0.37

SAMPLE 6

0.53

0.70

0.20

SAMPLE 7

0.70

0.57

0.29

SAMPLE 8

0.60

0.65

0.43

SAMPLE 9

0.65

0.53

0.33

SAMPLE 10

0.60

0.67

0.29

TOTAL

5.65

7.27

3.57

MEAN OPERATING TIME :Graph 2

DISCUSSION
A prerequisite for successful non surgical root
canal retreatment is the adequate balance between

MEAN OPERATING TIME

complete elimination of the existing obturating

Mean operating time

GROUP A

10.23 min

GROUP B

10.25 min

GROUP C

10.20 min

material,thorough chemomechanical preparation

followed by three dimensional obturation with an
impervious seal.This demands for such a
45

ENDODONTOLOGY

TO TREAT AND TO RETREAT-PROTAPER UNIVERSAL ROTARY SYSTEM, THE DOUBLE DELIGHT

retreatment technique,which not only uncovers

Profile 0.04 taper rotary files a were used

residual necrotic tissues and bacteria but also

previously for removing gutta-percha from root

allows further cleaning and refilling of the root

canals-They were found to be inadequate in

canal system.

complete removal of GP but could reach WL in

less time. 4 ProTaper finishing files had been used

Previous studies have shown the persistance

previously for GP removal .They showed high

of bacteria in root filled teeth with or without apical

incidence of fracture of 22.7%.

periodontitis.45% of teeth without apical

ProTaper Universal system

periodontitis,78% of teeth with AP have been

shown to contain bacteria.

In the present study better performance of

ProTaper retreatment files may be due to,their flute

Different solvents have been used for GP

design which

removal, like xylene, chloroform, eucalyptol,

pulls GP out and directs it to the

orifice.Also the frictional heat plasticizes GP and

rectified turpentine oil, white pine oil. Although

allows its easy removal. It has also been shown in

xylene and Chloroform are excellent solvents of

studies that apical extrusion of debris is significantly

GP, they are proved to be toxic and

less compared to hand files. The files not only cut

carcinogenic.When chloroform dissolution of GP

GP but also superficial layer of dentin during root

was compared with rectified white turpentine oil,

filling removal. During this study only D3 was

rectified white turpentine oil was found to be

deformed after use in 5 instruments.

equally effective in dissolving GP.But it is more

toxic than chloroform.Chloroform and xylene also

For evaluation of the remaining filling

leave a thin film of GP on the canal walls which

debris,radiography and longitudinal sectioning of

reduces the action of intracanal antibacterial

the teeth have also been used.But in the present

medicaments and impair the adaptation of

study clearing technique which renders the teeth

subsequent filling material on canal walls.(Wilcox

transparent is used as it is cost effective and

and Juhlin 1994)3

sensitive enough to identify small area of residual

GP/sealer from the canal walls.1

Different rotary instruments have also been

CONCLUSION

used for GP removal like GPX drill,GG drill,

Endotec device. GPX gutta percha remover is used

ProTaper Universal system proves to be

in slow speed,has H-file like flute design.It removes

efficient method for removing guttapercha during

GP by plasticizing it with frictional heat.Endotec

endodontic retreatment when compared to other

is hand spreader which is heated at its tip to 55

methods in which hand files and chemical solvents

degree C.Canal wall cleanliness was greater with

were used.

GG followed by H- files, GPX guttapercha remover

REFERENCES

& then Endotec where as GPX was the first to reach

tried but compared with hand files, they have been

1. L.S.Gu, J.Q Ling, X.Wei andX.Y.Huang, Efficacy of ProTaper

Universal Rotary retreatment system for guttapercha removal
from root canals. International Endodontic Journal, 2008, 41,
288-295

proved to be less efficient.5

2. A.Molander, C.Reit, G.Dahlen &T.Kvist, Microbiological

WL.6Quantec SC rotary instruments have also been

46

ENDODONTOLOGY

SANDHYA U. M., MOHAN THOMAS NAINAN, MANGALA T. M., SHARAD KAMAT

retreatment, International Endodontic Journal, 2001, 34, 514-9.

status of root filled with apical radiolucencies.International

Endodontic Journal,1998, 31, 1-7

6. M.Hulsmann & S.Stotz, Efficacy cleaning ability and safety

of different devices for gutta-percha removal in root canal
retreatment,International Endodontic Journal, 1997, 30, 227233

3. Gary J.Kalpovitz, Evaluation of guttapercha solvents, Journal

of Endodontics,1990,16,539-40
4. F.Baratto Filho, E.L.Ferreira & L.F. Fariniuk, Efficiency of
the 0.04 taper Profile during the retreament of guttapercha
filled root canals, International Endodontic Journal, 2002, 35,
651-654

7. Xiangya Huang, MS, JunqiLing, PhD, and Lisha Gu, MS,

Quantitative evaluation of of debris extruded apically by using
ProTaper universal rotary system in endodontic retreatment,
JOE-Volume 33, Number 9 September 2007

5. L.V.Betti & C.M.Bramante, Quantec SC rotary instruments

versus hand files for guttapercha removal in root canal

47