World Journal of Dentistry

Register      Login

VOLUME 14 , ISSUE 9 ( September, 2023 ) > List of Articles


Evaluation of Fracture Resistance of Endodontically Treated Teeth after Retreatment with Different Retreatment Files Systems: An In Vitro CBCT Study

Kunal Bedi, Swapnil

Keywords : AH Plus sealer, Cone-beam computed tomography, Mtwo retreatment files, NeoEndo retreatment files, ProTaper retreatment files

Citation Information : Bedi K, Swapnil. Evaluation of Fracture Resistance of Endodontically Treated Teeth after Retreatment with Different Retreatment Files Systems: An In Vitro CBCT Study. World J Dent 2023; 14 (9):809-814.

DOI: 10.5005/jp-journals-10015-2282

License: CC BY-NC 4.0

Published Online: 13-10-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Aim: To assess residual filling material in the root canals and the tooth's resistance to fracture posttreatment utilizing retreatment files, namely Professional Taper (ProTaper), Mtwo, and NeoEndo. Materials and methods: A total of 90 human-extracted mandibular premolars with one root and a single canal were selected for this study. Samples were decoronated, followed by chemomechanical preparation, and thereafter, using the lateral compaction method, root canals were obturated. The samples were divided into three groups (n = 30)—retreatment file systems, namely ProTaper, Mtwo, and NeoEndo. All three groups were subjected to cone-beam computed tomography (CBCT) evaluation to assess remnants of obturating material inside the canals, and the same samples were further assessed for fracture resistance using the universal testing machine (UTM). The collected data was then evaluated using statistical analysis using the Kruskal–Wallis and post hoc Bonferroni tests. Results: There were significant differences among the tested groups in the cervical thirds following statistical analysis (p < 0.05). The last residual material was found using ProTaper R (0.9280 ± 0.39707), followed by NeoEndo R (1.1000 ± 0.29814), and the maximum by Mtwo R (1.3500 ± 0.21904). In terms of fracture resistance after retreatment using ProTaper, Mtwo, and NeoEndo retreatment file systems, no significant differences were observed. Conclusion: All the tested nickel-titanium (Ni-Ti) retreatment files performed satisfactorily in removing the material from the obturated canals. The filling material could not be entirely removed from any of the file systems. ProTaper R left the least amount of filling material in the cervical third. No statistically significant difference was displayed in terms of the fracture resistance among the respective groups. Clinical significance: Retreatment is necessary in order to save a tooth that has undergone erroneous root canal treatment. To save time retreatment rotary files are being widely used these days. But these files may weaken the tooth by excessive removal of tooth structure. The current study provides clinically relevant knowledge about the different retreatment file systems available, providing in-depth insight into the effective and efficient management of challenging endodontic retreatment cases.

  1. Das S, De Ida A, Das S, et al. Comparative evaluation of three different rotary instrumentation systems for removal of gutta-percha from root canal during endodontic retreatment: an in vitro study. J Conserv Dent 2017;20(5):311–316. DOI: 10.4103/JCD.JCD_132_17
  2. Reda R, Zanza A, Bhandi S, et al. Surgical-anatomical evaluation of mandibular premolars by CBCT among the Italian population. Dent Med Probl 2022;59(2):209–216. DOI: 10.17219/dmp/143546
  3. Dioguardi M, Stellacci C, La Femina L, et al. Comparison of endodontic failures between nonsurgical retreatment and endodontic surgery: systematic review and meta-analysis with trial sequential analysis. Medicina (Kaunas) 2022;58(7): DOI: 10.3390/medicina58070894
  4. Kasam S, Mariswamy AB. Efficacy of different methods for removing root canal filling material in retreatment - an in-vitro study. J Clin Diagn Res 2016;10(6):ZC06–ZC10. DOI: 10.7860/JCDR/2016/17395.7904
  5. Apicella MJ, Loushine RJ, West LA, et al. A comparison of root fracture resistance using two root canal sealers. Int Endod J 1999;32(5):376–380. DOI: 10.1046/j.1365-2591.1999.00240.x
  6. Sedgley CM, Messer HH. Are endodontically treated teeth more brittle? J Endod 1992;18(7):332–335. DOI: 10.1016/S0099-2399(06)80483-8
  7. Resende LM, Rached-Junior FJ, Versiani MA, et al. A comparative study of physicochemical properties of AH Plus, Epiphany, and Epiphany SE root canal sealers. Int Endod J 2009;42(9):785–793. DOI: 10.1111/j.1365-2591.2009.01584.x
  8. Al-Zubaidi SM, Almansour MI, Alshammari AS, et al. Root and canal morphology of mandibular premolars in a saudi subpopulation: a cone-beam computed tomography study. Int J Dent 2022;2022:4038909. DOI: 10.1155/2022/4038909
  9. Pawar AM, Thakur B, Metzger Z, et al. The efficacy of the Self-Adjusting File versus WaveOne in removal of root filling residue that remains in oval canals after the use of ProTaper retreatment files: A cone-beam computed tomography study. J Conserv Dent 2016;19(1):72–76. DOI: 10.4103/0972-0707.173204
  10. Chauhan R, Tikku A, Chandra A. Detection of residual obturation material after root canal retreatment with three different techniques using a dental operating microscope and a stereomicroscope: An in vitro comparative evaluation. J Conserv Dent 2012;15(3):218–222. DOI: 10.4103/0972-0707.97940
  11. de Carvalho Maciel AC, Zaccaro Scelza MF. Efficacy of automated versus hand instrumentation during root canal retreatment: an ex vivo study. Int Endod J 2006;39(10):779–784. DOI: 10.1111/j.1365-2591.2006.01148.x
  12. Ozer SY. Detection of vertical root fractures of different thicknesses in endodontically enlarged teeth by cone beam computed tomography versus digital radiography. J Endod 2010;36(7):1245–1249. DOI: 10.1016/j.joen.2010.03.021
  13. Patel S, Durack C, Abella F, et al. Cone beam computed tomography in endodontics - a review. Int Endod J 2015;48(1):3–15. DOI: 10.1111/iej.12270
  14. Watanabe H, Honda E, Tetsumura A, et al. A comparative study for spatial resolution and subjective image characteristics of a multi-slice CT and a cone-beam CT for dental use. Eur J Radiol 2011;77(3):397–402. DOI: 10.1016/j.ejrad.2009.09.023
  15. Celikten B, Uzuntas CF, Gulsahi K. Resistance to fracture of dental roots obturated with different materials. Biomed Res Int. 2015;2015:591031. DOI: 10.1155/2015/591031
  16. Touré B, Faye B, Kane AW, et al. Analysis of reasons for extraction of endodontically treated teeth: a prospective study. J Endod 2011;37(11):1512–1515. DOI: 10.1016/j.joen.2011.07.002
  17. Hassanloo A, Watson P, Finer Y, et al. Retreatment efficacy of the epiphany soft resin obturation system. Int Endod J 2007;40(8):633–643. DOI: 10.1111/j.1365-2591.2007.01261.x
  18. Kim HC, Kwak SW, Cheung GS, et al. Cyclic fatigue and torsional resistance of two new nickel-titanium instruments used in reciprocation motion: Reciproc versus WaveOne. J Endod 2012;38(4):541–544. DOI: 10.1016/j.joen.2011.11.014
  19. Gu LS, Ling JQ, Wei X, et al. Efficacy of ProTaper Universal rotary retreatment system for gutta-percha removal from root canals. Int Endod J 2008;41(4):288–295. DOI: 10.1111/j.1365-2591.2007.01350.x
  20. Ricks-Williamson LJ, Fotos PG, Goel VK, et al. A three-dimensional finite-element stress analysis of an endodontically prepared maxillary central incisor. J Endod 1995;21(7):362–367. DOI: 10.1016/S0099-2399(06)80971-4
  21. Wilcox LR, Roskelley C, Sutton T. The relationship of root canal enlargement to finger-spreader induced vertical root fracture. J Endod 1997;23(8):533–534. DOI: 10.1016/S0099-2399(97)80316-0
  22. Zandbiglari T, Davids H, Schäfer E. Influence of instrument taper on the resistance to fracture of endodontically treated roots. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101(1):126–131. DOI: 10.1016/j.tripleo.2005.01.019
  23. Sathorn C, Palamara JE, Palamara D, et al. Effect of root canal size and external root surface morphology on fracture susceptibility and pattern: a finite element analysis. J Endod 2005;31(4):288–292. DOI: 10.1097/01.don.0000140579.17573.f7
  24. Er K, Tasdemir T, Siso SH, et al. Fracture resistance of retreated roots using different retreatment systems. Eur J Dent. 2011;5:387–379. PMID: 21912497.
  25. Purba R, Sonarkar SS, Podar R, et al. Comparative evaluation of retreatment techniques by using different file systems from oval-shaped canals. J Conserv Dent 2020;23(1):91–96. DOI: 10.4103/JCD.JCD_167_20
  26. Khedmat S, Azari A, Shamshiri AR, et al. Efficacy of ProTaper and Mtwo retreatment Files in removal of Gutta-percha and GuttaFlow from root canals. Iran Endod J 2016;11(3):184–187. DOI: 10.7508/iej.2016.03.007
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.