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Official Publication of Cumhuriyet University Faculty of Dentistry
RESEARCH ARTICLE
A RT ICL E IN F O ABS T R AC T
Article history: Objectives: The purpose of this in-vitro study was to investigate the residual root canal filling
Received 30 June 2014 material after retreatment of root canals using stainless steel hand files, and four nickel-
Accepted 19 October 2014 titanium retreatment instruments.
Materials and Methods: Seventy five extracted mandibular premolars were instrumented and
filled. The samples were randomly divided into 5 groups (n=15) and retreated using Hedström
files, Mtwo R, R-Endo, ProTaper Universal Retreatment, and D-RaCe systems. The roots were
Keywords:
Endodontics digitally radiographed, then grooved split longitudinally to investigate the area of remaining
Nickel filling material. The time of retreatment and the instruments fracture were also recorded.
Titanium Results: The Hedström files left less filling material than the rotary retreatment instruments
Retreatment but a significant difference was found only in the middle third (p< 0.01). The apical third had
the most residual gutta-percha and sealer compared to the coronal and middle thirds. The
retreatment time for the D-RaCe and ProTaper Universal Retreatment groups were significantly
shorter than other groups (p< 0.01). Eight Mtwo R files, 2 ProTaper Universal Retreatment files
and 1 R-Endo file were fractured.
Conclusions: All groups left residual root canal filling material inside the root canal walls.
Nickel-titanium rotary retreatment instruments were faster than Hedström files but had a
higher risk of instruments fracture.
Corresponding author at: Dr. Hakan GOKTURK, Gaziosmanpaşa University Faculty of Dentistry, Department of Endodontics, Tokat, Turkey. Phone:
+90-356-212 42 22, Fax:+90-356 212 42 25, E-mail: gokturk82@hotmail.com
This study was presented as a poster in Conference ENDOBALTIC (23-24 November 2012). The authors deny any conflicts of interest related to this
study. This study was supported by the Projects Management Office of the University of Ondokuz Mayıs University, Turkey (PYO.DİS.1904.10.007).
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Gokturk, et al.: Root canal retreatment with rotary instruments
filling material from the root canal to allow first few millimeters (1-3mm) of the canal
effective shaping, cleaning and filling of the orifice, and R1, R2 and R3 devoted to each
root canal.1 Only if the gutta-percha and root canal third to a size #25, with.08.,06
sealer can be removed entirely and the canal and.04 tapers, respectively. System has an
reached to the apical foramen, can be applied optional finishing file Rs (#30.04). The files
an appropriate retreatment procedures.1,2 have an inactive tip, no radial land, and a
triangular cross-section with three equally
Hand files, solvents, engine-driven
rotary files, ultrasonic instruments, spaced cutting edges.13
heat-carrying, and lasers are helpful The aim of this study was to investigate
instruments to remove especially gutta- the residual root canal filling material
percha.1,3-8 Recently, nickel-titanium (NiTi) after the retreatment of root canals using
rotary instruments have been produced for stainless steel hand files (Hedström files),
retreatment procedure. A few examples of and four NiTi retreatment instruments
these systems is the R-Endo Retreatment (R-Endo, Mtwo R, PTUR, D-RaCe).
(MicroMega, Besançon, France), the Mtwo
R (VDW, Munich, Germany), the ProTaper
Universal Retreatment (PTUR) (Dentsply MATERIAL AND METHODS
Maillefer, Ballaigues, Switzerland), and
the D-RaCe (FKG, Dentaire Sa, La Chaux- The research proposal was submitted to
de-Fonds- Switzerland). Only several review by the Ethics in Samsun Clinical
studies9,10 have investigated the efficacy of Research Ethics Committee of the Ondokuz
D-RaCe instruments. Mayıs University of Turkey (No. 2009-20),
and the study design was approved.
D-RaCe system has 2 files, DR1 (#30.10)
and DR2 (#25.04). DR1 has an active tip
and is used for two thirds of the root. Specimen Preparation
DR2 has an in-active tip and is used for A total of 75 extracted human mandibular
the apical third. The system files have a premolars with similar length having one
triangular cross section with alternating single straight root canal, and no previous
cutting edges.10 root canal treatment, calcification,
Mtwo R system has 2 instruments, resorption were used for the present study.
R1 (#15.05) and R2 (#25.05) The Mtwo Only teeth with fully formed apices were
R instruments have an increasing pitch selected. To confirm the canal anatomy,
length, an S-shaped cross-section in the preoperative digital radiographs of each root
apical–coronal direction and a cutting tip. were taken by two directions (mesiodistal
The system files are used for the entire and buccolingual). Access cavity was
working length (WL).11 opened with a high-speed hand tools with
copious water spray. To obtain similar canal
PTUR system consists of 3 instruments: width, teeth were selected according to the
D1 (#30.09), has an active tip, and is used following criteria; only roots in which a
for the coronal third. D2 (#25.08), and D3
size #10 K-file (VDW, Munchen, Germany)
(#20.07) have inactive tips and are used for
could slightly pass the apex but size a #15
the middle and apical thirds, respectively.
K-file firmly seated at the apical foramen
The system files have a convex, triangular
were included in this study. The WL was
cross-section.12
established by extracting 0.5 mm from the
R-Endo system consists of 4 tip of size #10 K-file visualized on the apical
instruments: Re (#25.12) to prepare the foramen. The crowns were removed with
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Gokturk, et al.: Root canal retreatment with rotary instruments
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Gokturk, et al.: Root canal retreatment with rotary instruments
third, and R3 was used for the apical third. extrusion of filling material, barely
All instruments were used to remove filling detectable; 2=moderate extrusion of filling
material in a brushing circumferential material, easily detectable; and 3=extrusion
movement. The instruments were used at of considerable amount of filling material.16
300 rpm.
Evaluation of Residual Filling Material
Group Hedström Files
The samples were digitally radiographed
Gates–Glidden (Main Inc. Tochigi, Japan) in mesiodistal and buccolingual directions.
size 3 and subsequently size 2 were used to The images were transferred to a PC and
remove coronal and middle filling material NetCAD (NetCAD 5.0 GIS for Windows,
at 800 rpm. Hedström file (Thomas Ak Engineering Computer LLC., Ankara,
Hedström, Pneumat, Bourges, France) size Turkey) was used to evaluate the area
#25 and #20 were used to remove apical of remaining gutta-percha and sealer in
filling using a circumferential quarter-turn the root canal. Each root canal was then
push-pull filling motion. divided into coronal, middle and thirds.
The canals was irrigate with 3 mL of The amount of residual filling material
5.25% NaOCl at each instrument change. in each third was determined in square
Ten mL of 5.25% NaOCl was used for final millimeters (mm2) with NetCAD. The area
irrigation. of each third of the root canal, as measured
in either the mesiodistal or buccolingual
All instruments were used to prepare
projections, was considered as 100%. The
three root canals only. Instruments
total area of radio-opaque material in each
were examined after every use; under a
third of each projection was measured. The
stereomicroscope at 10X magnification
values were used to calculate the total area
(Leica MZ 12.5, Heerbrugg, Germany)
of the canal and the residual filling material
for signs of deformation. Any deformed
instruments were discarded and also as a percentage (Figure 1).
recorded. The roots were grooved with a diamond
A single operator prepared all specimens. disk, split longitudinally without damaging
Retreatment procedure was concluded the inner layer of dentine around the canal
to have been complete when the WL was
achieved, the canal walls were clear and
no more canal filling material could be
removed with the instruments used. The
retreatment time in seconds was calculated
only in the active retreatment procedures,
not including time for irrigation and change
of instruments.
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Gokturk, et al.: Root canal retreatment with rotary instruments
and both root halfs photographed under a correction. The intraclass correlation
stereomicroscope with 10X magnification. coefficient (ICC, p) was calculated to
Each third of the roots were evaluated estimate the congruity of radiographic and
separately for residual filling material. The split longitudinally techniques.
areas of residual filling material on the
canal walls were calculated in mm2 using
NetCAD (Figure 2). RESULTS
The amount of remaining filling material
Statistical Analysis for each group is presented in Table 1. All
instruments left gutta-percha and sealer
Statistical analysis for residual filling
material, and retreatment time was inside the root canal.
performed with ANOVA, Kruskal–Wallis There was no significant difference
and Mann–Whitney U-tests with Bonferroni among the groups in the apical and coronal
canal third when evaluating residual filling
material with the split longitudinally
technique (p> 0.05). In the middle third,
the Hedström files group left less filling
material than the other groups but a
significant difference was not found
between the D-RaCe, PTUR and R-Endo
groups (p> 0.05).
The roots retreated with Hedström files
left less filling material inside the root canals
than the other groups but a significant
difference was not found in radiographic
technique (p> 0.05). The apical third had
Figure 2. View of both root halves under the most residual gutta-percha and sealer
stereomicroscope with 10X magnification. compared to the coronal and middle thirds.
Table 1. The amount of residual gutta-percha and sealer (%) for each group by means of
split longitudinally and radiographic analysis.
Groups Split Longitudinally Radiographic
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Gokturk, et al.: Root canal retreatment with rotary instruments
When each method for evaluation of However, removing as much filling material
residual filling material on the root canal as possible from root canal systems seems
was statistically compared, the ICC value essential in order to expose residual necrotic
was 0.54 for the coronal thirds (95% tissue or bacteria that may be responsible
Confidence Interval=0.369-0.689). The for periapical inflammation and failure.
ICC value was 0.80 for middle thirds (95% Decoronation allows specimen
CI=0.709-0.873), and 0.41 for apical thirds standardization by eliminating some
(95% CI=0.208-0.585), as shown in Table 2. variables, such as root canal access and
This means that for the two methods, the dental crown anatomy, thus providing a
coronal, middle, and apical thirds had below more credible comparison of the suggested
average agreement, good agreement, below retreatment techniques.18 Therefore in this
average agreement, respectively. study, the teeth were standardized to 15 mm,
Three D-RaCe (DR2), 6 Mtwo R (4 Mtwo so that different lengths could not create an
R1 and 2 Mtwo R2), 4 PTUR (D3), 9 R-Endo impact on the results.14 Thus, the volume
(4 R2, 5 R3) and 2 hand files (1 #20 of gutta-percha and sealer was tried to be
Hedström, 1 #25 Hedström) showed visible equal in all samples. The root canals were
signs of plastic deformation. Eight Mtwo obturated using a cold lateral condensation
R files (5 Mtwo R1, 3 Mtwo R2), 2 PTUR technique since this technique has been
files (D3) and 1 R-Endo (R3) were fractured used in many similar researches.16,19,20
during retreatment procedures (Table 3). Each instrument was used according to the
manufacturers’ recommendations.
The retreatment time with the D-RaCe
and PTUR groups were significantly shorter Sealer and gutta-percha cannot be
than the other groups (p< 0.01). Manual distinguished between each other using
instrumentation with Hedström files was radiographs.21 Therefore, sealer and gutta-
significantly slower than the other groups percha were considered together.
(p< 0.01). Mtwo R and R-Endo groups were In some previous retreatment
significantly faster than the Hedström files studies10,22-24, root canals were reshaped
group (p< 0.01) (Table 3). after retreatment.In this study, further
enlargement was not performed because
of to investigate only the efficacy of
DISCUSSION retreatment files.
Retreatment of previously filled root canals The results of this present study
is the first of choice for the management showed that none of the group guaranteed
of insufficient root canal treatment.17 complete removal of gutta-percha and
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Gokturk, et al.: Root canal retreatment with rotary instruments
Table 3. Time (s) required for retreatment and the number of procedural errors.
Groups File type Deformed Fractured Time (s)
DR2 (#25.04) 3 0
Mtwo R2 (#25.05) 2 3
D2 (#25.08) 0 0
D3 (#20.07) 4 2
Re (#25.12) 0 0
R1 (#25.08) 0 0
R2 (#25.06) 4 0
R3 (#25.04) 5 1
Gates Glidden 2 0 0
# 20 Hedström 1 0
# 25 Hedström 1 0
**
Values are expressed as mean±SD. (**p<0.01).
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Gokturk, et al.: Root canal retreatment with rotary instruments
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Gokturk, et al.: Root canal retreatment with rotary instruments
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Gokturk, et al.: Root canal retreatment with rotary instruments
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Gokturk, et al.: Root canal retreatment with rotary instruments
Efficacy of ProTaper Universal rotary 28. Unal GC, Kaya BU, Taç AG, Keçeci AD.
retreatment system for gutta-percha A comparison of the efficacy of
removal from root canals. Int Endod conventional and new retreatment
J 2008;41:288-295. instruments to remove gutta-percha
20. Tasdemir T, Er K, Yildirim T, Celik in curved root canals: an ex vivo
D. Efficacy of three rotary NiTi study. Int Endod J 2009;42:344–350.
instruments in removing gutta- 29. Masiero AV, Barletta FB. Effectiveness
percha from root canals. Int Endod J of different techniques for removing
2008;41:191–196. gutta-percha during retreatment. Int
21. Schirrmeister JF, Hermanns P, Meyer Endod J 2005;38:2-7.
KM, Goetz F, Hellwig E. Detectability 30. Schirrmeister JF, Wrbas KT, Schneider
of residual Epiphany and gutta- FH, Altenburger MJ, Hellwig E.
percha after root canal retreatment Effectiveness of a hand file and three
using a dental operating microscope nickel-titanium rotary instruments
and radiographs--an ex vivo study. for removing gutta-percha in curved
Int Endod J 2006;39:558-565. root canals during retreatment.
22. Saad AY, Al-Hadlaq SM, Al-Katheeri Oral Surg Oral Med Oral Pathol Oral
NH. Efficacy of two rotary NiTi Radiol Endod 2006;101:542-547.
instruments in the removal of Gutta- 31. Schirrmeister JF, Wrbas KT,
Percha during root canal retreatment. Meyer KM, Altenburger MJ,
J Endod 2007;33:38-41. Hellwig E. Efficacy of different
23. Giuliani V, Cocchetti R, Pagavino G. rotary instruments for gutta-percha
Efficacy of ProTaper universal removal in root canal retreatment.
retreatment files in removing filling J Endod 2006;32:469-472.
materials during root canal retreatment. 32. Zmener O, Pameijer CH, Banegas G.
J Endod 2008;34:1381-1384. Retreatment efficacy of hand versus
24. Aydin B, Köse T, Calişkan MK. automated instrumentation in oval-
Effectiveness of HERO 642 versus shaped root canals: an ex vivo study.
Hedström files for removing gutta- Int Endod J 2006;39:521-526.
percha fillings in curved root canals: 33. Hammad M, Qualtrough A, Silikas N.
an ex vivo study. Int Endod J Three-dimensional evaluation of
2009;42:1050-1056. effectiveness of hand and rotary
25. Kfir A, Tsesis I, Yakirevich E, instrumentation for retreatment of
Matalon S, Abramovitz I. The efficacy canals filled with different materials.
of five techniques for removing root J Endod 2008;34:1370–1373.
filling material: microscopic versus 34. Só MV, Saran C, Magro ML, Vier-
radiographic evaluation. Int Endod J Pelisser FV, Munhoz M. Efficacy of
2012;45:35-41. ProTaper retreatment system in root
26. Zuolo ML, Imura N, Ferreira MO. canals filled with gutta-percha and
Endodontic retreatment of thermafil two endodontic sealers. J Endod
or lateral condensation obturations 2008;34:1223-1225.
in post space prepared teeth. J Endod 35. Hülsmann M, Bluhm V. Efficacy,
1994;20:9-12. cleaning ability and safety of
27. de Carvalho Maciel AC, Zaccaro different rotary NiTi instruments in
Scelza MF. Efficacy of automated root canal retreatment. Int Endod J
versus hand instrumentation during 2004;37:468–476.
root canal retreatment: an ex vivo 36. Barrieshi-Nusair KM. Gutta-percha
study. Int Endod J 2006;39:779-784. retreatment: effectiveness of nickel-
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Gokturk, et al.: Root canal retreatment with rotary instruments
How to cite this article: Hakan Gokturk, Ali Cagin Yucel, Aziz Sisman. Effectiveness of Four Rotary
Retreatment Instruments During Root Canal Retreatment. Cumhuriyet Dent J 2015;18(1):25-36.
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