Comparative evaluation of remaining dentin thickness with

three different rotary Ni-Ti File systems: an in vitro CBCT study

Durga Bhavani Panithini1,*, Sita Rama Kumar M2, Girija S Sajjan3, Madhu Varma K3, Kalyan Satish R3, Manishaa B1
1
Postgraduate Student, 2Reader, 3Professor, Department of Conservative Dentistry and Endodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh,
India – 534202.

Article History Abstract

Background: Endodontic therapy and its success depend on effective cleaning
Received 4th June 2021 and shaping the root canal without deviating from the original anatomy.
Received revised Ideally, during root canal preparation, the instruments should always confine
23rd August 2021 to and retain the original shape of the canal to maximize the cleaning
Accepted 10th September2021 effectiveness and minimize unnecessary weakening of tooth structure to
Available online
achieve the optimal result. The remaining dentin thickness in endodontically
6th February 2022 treated teeth is a significant factor, which is responsible for its longevity.
Aim: This study aimed to evaluate the remaining dentin thickness after
*Correspondence instrumentation with ProTaper Next (PTN), TruNatomy (TN), and Neohybrid
(NH) file systems using cone-beam computed tomography.
Durga Bhavani Panithini
Materials and methods: Thirty extracted single-rooted mandibular
Postgraduate Student premolars were decoronated and divided into three experimental groups with
Department of Conservative Dentistry and ten in each. Groups I, II, and III were assigned to the file systems ProTaper Next
Endodontics (PTN), TruNatomy (TN), and Neohybrid (NH), respectively. Cone-beam
Vishnu Dental College computed tomographic pre-scans were taken, followed by the biomechanical
Bhimavaram, Andhra Pradesh preparation with the respective file systems. Post CBCT scans were taken and
India - 534202 compared with pre-scans for remaining dentin thickness. The data obtained
E-mail: [email protected] were statistically analyzed.
DoI: http://dx.doi.org/10.37983/IJDM.2022.4102
Results: Among the three file systems, TruNatomy rotary files resulted in
significantly less dentin removal (p<0.05). The majority of the intergroup
comparisons showed significant differences in remaining dentin thickness
after biomechanical preparation at 3, 6, and 9mm.
Conclusion: TruNatomy (TN) exhibited the maximum remaining dentin
thickness followed by Neohybrid (NH) and comparatively minimum with
ProTaper Next (PTN) file systems.
Keywords: Cone-beam computed tomography (CBCT), Neohybrid, ProTaper
Next, Remaining Dentin Thickness, TruNatomy.

1. Introduction offset mass of rotation with a variable taper. Its off-

centered design gives the file snake-like "swaggering
The success of root canal treatment varies on effective effects" that decrease the screw effect and the taper lock
cleaning and shaping of the root canal system without minimizing the contact between a file and dentin [4].
deviating from the original anatomy [1]. Cleaning and TruNatomy (TN) and Neohybrid (NH) file systems that
shaping techniques, regardless of instrumentation were introduced recently are made up of special Ni-Ti
approach, always result in dentin removal from canal alloys and are subjected to various thermal treatments
walls. Excessive canal flaring can diminish dentin processes. TruNatomy (TN) (Dentsply Sirona, Ballaigues,
thickness, resulting in less residual dentin thickness and Switzerland) file system is characterized by different
an increased risk of vertical root fractures [2]. NiTi geometries, sizes, memory, and specific metallurgical
rotary instruments made root canal preparation easier treatment. It is designed from a 0.8 mm NiTi wire that is
and faster than manual instrumentation, resulting in heated by a special treatment, resulting in super-elastic
reliable and predictable root canal shaping. These properties and less memory. Also, this wire has been
instruments can improve both the morphological claimed to provide minimally invasive instrumentation
characteristics and safety of canal shaping because of the because of its geometry, regressive tapers, and slim design
alloy's unique properties [3]. The ProTaper Next (PTN) [5,6]. Neohybrid (NH) (Orikam Healthcare India Private
(Dentsply Sirona Endodontics, Ballaigues, Switzerland) Limited) files are made of CTA (controlled thermal
is an innovative NiTi file system made from M-Wire activation) wire with an off-centered rectangular cross-
technology. It has a rectangular cross-section and an section that improves flexibility. Further, its swaggering

6 International Journal of Dental Materials 2022;4(1):6–10 © 2022 by the IJDM

Durga Bhavani P. et al. Remaining dentin thickness with three different rotary Ni-Ti File systems

movement minimizes the engagement between the file (25/0.04 taper) till the working length with EConnect S
and canal dentin, effectively reducing the taper lock and (Eighteeth, China) Endo motor. All the instruments and
screw-in forces inside the canal [7]. techniques of usage were according to the manufacturing
instructions. Biomechanical preparation was done using
A noninvasive Cone-beam computed tomography the respective files, and irrigation was done with 2ml of
(CBCT) is used to evaluate the canal anatomy and 3% sodium hypochlorite (NaOCl) (Parcan, Septodont
compare the canal shape before and after preparation. Healthcare PVT LTD., India) for 1 min, and recapitulation
Using Cone-beam computed tomography (CBCT), proper was done after every instrument. After the
cross-sections of roots are provided, and 3-dimensional instrumentation of the root canal was completed, 2 ml of
CBCT images are reconstructed simultaneously with 17% ethylenediaminetetraacetic acid (EDTA) (Dent Wash,
more precision than other routine techniques [8]. Prime Dental PVT LTD., India) was applied for 1 min to
Limited research is available on the comparison of the remove the smear layer. Then, the canal was flushed again
efficiency of TruNatomy (TN) and Neohybrid (NH) files with 2 ml of 3% NaOCl and 2 ml of 0.9% normal saline
in maintaining the remaining dentin thickness. solution for 1 min each to remove remnants of EDTA.
Considering the factors mentioned above, Remaining
dentin thickness after instrumentation with ProTaper
2.4 Final scanning and evaluations
Next (PTN), TruNatomy (TN), and Neohybrid (NH) Ni-Ti
The teeth were again prepared for post-operative CBCT
rotary file systems using CBCT were evaluated in this
scanning using the same parameters, and the pre
study.
instrumentation data stored were compared with post-
instrumentation data using CBCT software (Kodak 9000
2. Materials and Methods DICOM Software CS 9000 3D). Three axial tomograms
2.1 Selection and specimen preparation were selected for each specimen. The first corresponds to
A total of thirty freshly extracted human single-rooted the area located at 3 mm (apical third), the second at 6
mandibular premolar teeth for orthodontic treatment mm (middle third), and the third at 9 mm (cervical third)
purposes were gathered for the study. The calculation from the root apex. The remaining dentin thickness was
of sample size was based on a previous study using G determined by subtracting the un instrumented canal
power software at 80% confidence and a p-value set at from the instrumented canal, calculating the shortest
less than 0.05 [1]. Teeth with any previous endodontic distance from the outer wall to the inside canal wall on
treatment, fractures, pathological root resorptions, mesial and distal aspects at the levels of 3, 6, and 9mm of
calcifications, and immature teeth were excluded from pre and post instrumentation [1] (Figure 1-3). Matam et
the study. The presence of a single root and canal al. used the formula RDT = D1–D2, where D1 is the pre
without any curvatures in each tooth was confirmed on instrumentation dentin thickness and D2 is the post
radiovisiography (Digora, The Dental Imaging Company instrumentation dentin thickness [9,10].
Ltd). The samples were standardized to a length of
16mm by decoronation using a double-faced diamond 2.5 Statistical analysis
disc (KG Sorensen, Barueri, SP, Brazil). The root canal The data were subjected to statistical analysis using the
length was measured by the penetration of a size 10 K- Statistical Package for the Social Sciences IBM SPSS
file (Mani, Japan) until it reached the apical foramen and Statistics version 22.0 software and Oneway Analysis of
then subtracting 0.5 mm. Teeth were arbitrarily divided Variance test for intragroup comparison and Tukey's post
into three groups (n=10) and were embedded in the hoc test for intergroup examination.
putty blocks to obtain a constant position.
3. Results
2.2 Initial scanning
The template was horizontally fitted to chin support TruNatomy rotary files significantly resulted in a lesser
with its occlusal plane parallel to the plate. A pre-CBCT amount of dentin removal among the three file systems
(CS 9000 3D, Rainbow CT, South Korea) scan was done (p<0.05). (Table 1). One-way ANOVA showed no
for all teeth before instrumentation with the exposure significant difference in the intragroup comparison of
period of 3.0 seconds at 75 kV and 2.0 mA. The scanned group I and group II at 3,6 and 9mm. In contrast, a
images were stored in the computer's hard disk for significant difference (p=0.001) is observed in group III at
further comparison between pre and post 3,6 and 9mm (Table 1).
instrumentation data using DICOM software.
In post hoc analysis, Group I showed significant
2.3 Root canal preparation differences with Groups II at 3mm, 6 mm, and 9 mm
After initial scans, root canals were instrumented as (p=0.003, p=0.001, and 0.030, respectively). Also, Group I
follows. Group 1: Canals were shaped using ProTaper exhibited a significant difference with Group III at 3 mm
Next (PTN) rotary files (X1; 20/0.04 taper and X2; (p=0.000). However, no significant differences were
25/0.06 taper) Group 2: Canals were shaped using observed between Group II and III at different levels
TruNatomy (TN) rotary file (25/0.04 taper) Group 3: (Table 2).
Canals were shaped using Neohybrid (NH) rotary file

International Journal of Dental Materials 2022;4(1):6–10 © 2022 by the IJDM 7

Remaining dentin thickness with three different rotary Ni-Ti File systems Durga Bhavani P. et al.

Table 1. Intragroup comparison of amount of dentin removal after biomechanical preparation with three
different file systems at 3, 6, and 9 mm.
Groups Levels Mean Standard Deviation p-Value
3mm 0.31 0.20
Group I (PTN) 6mm 0.29 0.19 0.683
9mm 0.26 0.13
3mm 0.17 0.06
Group II (TN) 6mm 0.13 0.04 0.099
9mm 0.17 0.07
3mm 0.14 0.06
Group III (NH) 6mm 0.23 0.11 0.001
9mm 0.25 0.10

Table 2. Inter-group comparison of amount of dentin removal after biomechanical preparation with three
different file systems at 3, 6, and 9mm.
levels Groups Mean difference Standard Error Significance*
Group II 0.14 0.04 0.003
Group I
3mm Group III 0.17 0.04 0.000
Group II Group III 0.03 0.04 0.750
Group II 0.16 0.04 0.001
Group I
Group III 0.06 0.04 0.339
6mm
Group II Group III 0.10 0.04 0.055
Group II 0.09 0.03 0.030
Group I
Group III 0.10 0.03 0.954
9mm
Group II Group III 0.08 0.03 0.060
*The mean difference is significant at the level of 0.05.

4. Discussion
An ideally prepared root canal should have a
progressively tapering conical shape that preserves the
apical foramen and the original canal shape [3]. The
thickness of the remaining root dentin following
intraradicular procedures may be the most important
iatrogenic factor that may lead to compromised fracture
resistance of the root [3,10]. This study was performed on
single-rooted, single canal mandibular premolars to avoid
bias [9]. In this study, CBCT was used to evaluate the
remaining root dentin thickness. There are several
methodologies to evaluate different instrumentation
techniques in preparing root canals. But one of the latest
innovations in the medical field is the use of CBCT for
study purposes and this scientific tool that could develop
potential in endodontic research. Moreover, the quality of
the three-dimensional images obtained by CBCT scanning
is an accurate and efficient method of assessing root canal
instrumentation [2,11,12]. The advantages of NiTi
instruments in root canal preparation are well
Figure 1-3. A Showing pre-instrumentation documented. However, their cutting ability is a complex
images; B. Showing post-instrumentation interrelationship of multiple parameters such as the
images of 1. ProTaper Next (PTN), 2. cross-sectional design, helical and rake angles,
TruNatomy (TN), and 3 .Neohybrid (NH) at the metallurgical properties, and surface treatments of the
region of 9mm from the apex. instrument [13].
8 International Journal of Dental Materials 2022;4(1):6–10 © 2022 by the IJDM
Durga Bhavani P. et al. Remaining dentin thickness with three different rotary Ni-Ti File systems

In the present study, three file systems, namely, 5. Conclusion

ProTaper Next (PTN), TruNatomy (TN), Neohybrid
(NH) rotary file systems were used. The results of this Within the limitations of this study, it was concluded that
study found that the mean value with more amount of maximum remaining dentin thickness was seen with
remaining dentin thickness after biomechanical TruNatomy (TN) followed by Neohybrid (NH), and
preparation at 3, 6, and 9 mm from apical foramen was comparatively minimum with ProTaper Next (PTN) file
seen in Group II (TN) followed by Group III (NH) and systems.
less in Group I (PTN). The results of this study were
similar to the study done by Suhashini Ramanathan et Conflicts of interest: Authors declared no conflicts of
al., who observed that the M two system removed less interest.
amount of dentin and better maintained the original
shape of the root canal (P < 0.05) than ProTaper Next Financial support: None
(PTN), and Protaper universal systems [14]. It can be
mainly attributed to the progressive taper of the References
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How to cite this article: Panithini DB, Sita Rama Kumar M,

Sajjan GS, Madhu Varma K, Kalyan Satish R, Manishaa B.
Comparative evaluation of remaining dentin thickness with
three different rotary Ni-Ti File systems: an in vitro CBCT
study. Int J Dent Mater. 2022; 4(1): 6-10.
DoI: http://dx.doi.org/10.37983/IJDM.2022.4102

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