An In Vitro comparison of three different techniques to create a glide path prior to nickel titanium rotary instrumentation

Abstract

The preparation of a glide path prior to the use of rotary nickel titanium instrumentation reduces torsional stress and the risk of rotary nickel titanium instrument separation. The objective of this in vitro study was to evaluate 3 different glide path preparation techniques in respect of:  Percentage change of curvature from original canal anatomy; and  The occurrence of aberrations in canal anatomy (ledging, zipping and elbows). One hundred and twenty S-shaped Endo-Training-Blocks were selected. The canals were injected with India ink dye. The blocks were indexed with 3 bur marks and placed into a template before pre-instrumentation images were acquired digitally. The blocks were randomly divided into four groups of thirty each. Glide paths were prepared by a single operator with stainless steel hand K-files only, up to ISO size 20 (group 1, control), stainless steel hand K-files in the M4 reciprocating hand-piece up to ISO size 20 (group 2), hand K-files to ISO size 10 then NiTi rotary PathFiles (group 3) and hand K-files to ISO size 10 then NiTi rotary X-Plorer files (group 4). After glide path preparation the blocks were replaced into the template and post-instrumentation images were digitally acquired. Percentage change of curvature from original canal anatomy: Pre-instrumentation and post-instrumentation images were imported into Rhinoceros software to determine the end points of the canal curves and calculate the percentage change of canal curvature for the radii of apical and coronal curves. The data was collected and tabulated. Differences in canal curvature modification were statistically analysed with respect to logarithmic transformed change from baseline using ANCOVA (p<0.001) with logarithmic transformed pre-instrumentation values as covariate. After establishing preparation differences, both for change from baseline (pre-instrumentation) for apical and coronal curves, specific differences were tested using Fisher’s LSD for pairwise comparisons. Prepared groups differed significantly (p<0.001) and in particular, group 1 (Hand K-files) (control) and group 2 xiii (Hand K-files in M4 Safety reciprocating hand piece) differed significantly from all the other groups while group 3 (Hand K-files and PathFiles) and group 4 (Hand K-files and X-Plorer files) did not differ significantly. Group 3 (Hand K-files and PathFiles) and group4 (Hand K-files and X-Plorer files) were also superior to group1 (Hand K-files) (control) and group2 (Hand K-files in M4 Safety reciprocating hand piece). The occurrence of aberrations in canal anatomy (ledging, zipping and elbows): Pre-instrumentation and post-instrumentation images were superimposed using Adobe Photoshop software. The images were imported into a PowerPoint presentation and examined by three different blinded clinicians independently, for the presence of aberrations. There were no differences between the examiners in their assessment of the images. The data was collected and tabulated. The incidence of canal aberrations was analysed using Fisher’s exact test (p<0.05). The groups differed significantly regarding the number of aberrations (p=0.005). In particular, group 1 (control) (Hand K-files) and group 2 (Hand K-files in the M4 reciprocating hand piece) did not differ statistically (p=0.254; 20% and 6.67%). However group 2 (hand K-files in the M4 reciprocating hand piece) also did not differ significantly from group 3 (Hand K-files and PathFiles) and Group 4 (Hand K-files and X-Plorer files) (p=0.326). There were no aberrations detected in the rotary NiTi groups (group 3 and group 4).