44 ODEP Vol. 1, No.
Original Article ：44～51，2021
ODEP 1（1）
The Shaping Advantage of M-wire Compared
with Conventional Nickel-titanium Rotary Instruments
in Heavy Curvature Canals
Akito KASAHARA, Mika TANAKA-SATO,
Noriko MUTOH and Nobuyuki TANI-ISHII
Department of Pulp Biology and Endodontics, Kanagawa Dental University
Abstract
Background: The purpose of this study was to evaluate the shaping advantage of M-wire NiTi ProTaper
NEXT（PTN）compared with a conventional NiTi ProTaper Universal（PTU）file in heavy curvature canals.
The shaping ability was measured by the amount of canal cutting and transportation between the PTN and
conventional PTU.
Methods: Root canal shaping by the PTN and PTU was classified into two experimental groups according
to the final tip size, ISO #25 or ISO #40. Eighty-four J-shaped root canals（10°, 20°, 30° apical curvature）in
resin blocks were used.
Results: After adjusting for the level and canal wall side, the mean transportation did not significantly
decrease between the PTN and PTU with ISO #25. Significantly less deviation occurred with the PTN and
PTU between 10° and 30° using ISO #40.
Conclusions: The PTN improves file flexibility and enables accurate canal shaping for heavy curvature
canals.
Key words: M-wire, ProTaper NEXT, ProTaper Universal, shaping ability, apical curvature
Corresponding author: Nobuyuki TANI-ISHII, Department of Pulp Biology and Endodontics, Kanagawa Dental University, 82,
Inaoka-cho, Yokosuka, Kanagawa 238‒8580, Japan
TEL: ＋81‒46‒822‒9527, FAX: ＋81‒46‒822‒8856, E-mail: [email protected]
Received for Publication: June 16, 2021/Accepted for Publication: August 24, 2021
DOI: 10.11471/odep.2021‒006
Dec, 2021 The Shaping Advantage of M-wire NiTi File 45
micro-cracks during root canal formation 10,11）. Root
Introduction canal wall displacement after cutting12‒15）, fatigue resis-
tance16‒18）, and file breakage resistance19） of PTN have
Rotary dental files with a NiTi alloy containing 56％ been previously studied to determine the shaping abil-
（wt）Ni and 44％（wt）Ti have significantly changed ity. However, no report has objectively compared the
root canal preparation. The NiTi alloy has a cubic crys- different curvature canal range and shaping ability of
tal structure with an austenite phase above the shape PTN with a PTU in the same shaping system. The pur-
recovery temperature1）. The austenite phase changes pose of this study was to analyze the advantages of the
to martensite under force and temperature, but when PTN and the relationship between the amount of canal
the stress is released, the phase returns to austenite2,3）. wall removed and canal center transportation com-
Consequently, the NiTi alloy has a shape memory effect pared with a PTU.
and super-elasticity without plastic deformation, which
is advantageous for instruments used for root canal Materials and Methods
preparation.
Given the development of NiTi endodontic instru- 1 ．Simulated root canal block and experimental
ments targeted at root canals with complex anatomical design
configurations, the shape memory and super-elastic Eighty-four simulated J-shaped canal blocks with a
properties of such NiTi instruments have helped pre- curvature of 10°, 20°and 30°（apical diameter/taper: 15/
vent endodontic accidents（such as ledges, root canal 06, root canal length 19 mm（working length）, Nissin
4,5）
perforations, apical transportation, and file fractures） . Plastic Training Block S4-U1, Nissin, Kyoto, Japan）
were
Currently, unique heat and mechanical treatments can used. Three J-shaped canal blocks with different angles
be used to complement the mechanical properties of （S4-U1-10°, 20°, 30°）were cut at 19.0 mm（S4-U1-10°）,
NiTi alloys to improve flexibility and fatigue resistance. 18.5 mm（S4-U1-20°）, and 18.0 mm（S4-U1-30°）from the
In 2007, Sportwire LLC（Langley, OK, USA）devel- root canal orifice at the top of the model by IsoMet
oped a unique heat treatment process with the aim of （Buehler, Tokyo, Japan）and adjusted to allow apical
producing a more flexible NiTi alloy with better fatigue foramen penetration（Fig. 1）.
6）
resistance than conventional NiTi alloys . Additionally, We used a PTN file（Dentsply Sirona, Ballaigues,
Berendt developed a NiTi composition in which trace Switzerland）made by M-wire and a PTU file（Dentsply
elements of less than 1％ were added to produce a NiTi Sirona）as a control.
alloy7）. Under a heat treatment process, the M-wire For root canal preparation, there were two final api-
alloy converts to a rhombohedral（R）phase（intermedi- cal sizes for four groups, ISO #25（1: PTN, 2: PTU）and
ate temperature phase between austenite and marten- （3: PTN, 4: PTU）
ISO #40 . Using a J-shaped canal block,
site）and the elasticity changes with the change from measurements were made by classifying the blocks into
austenite to martensite. Therefore, the flexibility of a two groups. The apical size and file taper（diameter
8,9）
NiTi endodontic file can be enhanced by modification . increase amount/mm）of each NiTi file were PTN X1
Additionally, NiTi alloy converted to the R phase is （17/04）, X2（25/06）, X3（30/07）, X4（40/06）, and PTU
conventionally produced by cutting; however, NiTi files F1（20/04）, F2（25/06）, F3（30/06）
, and F4（40/06）,
are produced by a non-cutting rolling step, thereby which were used to set the final apical size to ISO #25
increasing the file fatigue resistance and fracture resis- and #40.
tance. Three curvature blocks（10°, 20°, 30°; each n＝7）were
The ProTaper NEXT（PTN）file used in this study used, giving a total of 21 canal blocks for each of the
is a next-generation model of ProTaper Universal （1: PTN, 2: PTU）
ISO #25 （3: PTN, 4: PTU）
and ISO #40
（PTU）, which is a modification of the conventional NiTi groups. Therefore, 84 canal blocks were tested. All root
alloy PTU and uses M-wire. PTN was developed as a canal models were attached to the Endo Training
file suitable for severely curved root canals given its Model Castillo（VDW, Frankfurt, Germany）, and root
increased flexibility and fracture resistance. Compared canal preparation was performed in a situation where
with PTU, the PTN suppresses the occurrence of the root canal morphology could not be confirmed.
46 ODEP Vol. 1, No. 1
a b c
Apical Orifice
30.2°
20.2°
10.3°
5.8 mm 5.8 mm 5.8 mm
Fig. 1 J-shaped canal blocks made of clear resin with diameter of 0.15 mm, taper of 06, and apical
curvatures of（a）10°,（b）20°, and（c）30°.
2 ．Root canal preparation reach its working length.
The canals were first scouted with an ISO #15 stain- 3）ISO #40 PTN: Using X1, X2, X3, and X4 files in
less-steel K-file（Dentsply Sirona）to check patency and sequence, select the PTN mode（300 rpm, 2.0 Ncm）,
to precisely determine the working length（19 mm）
. perform root canal cleaning with 2 ml of distilled water
The canal preparation was performed by a single oper- when exchanging files, and let the X4 file reach its
ator（specialist of JEA and JCD）using the Ni-Ti（PTN, working length.
PTU）files in strict accordance with the manufacturer’s 4）ISO #40 PTU: Using S1, S2, F1, F2, F3, and F4
recommendations for each system. files in sequence, select the PT mode（250 rpm, 3.0‒1.0
Before starting root canal preparation with the PTN Ncm）, perform root canal cleaning with 2 ml of distilled
and PTU files, flare formation in the upper third of all water when exchanging files, and save the F4 file after
root canal orifice openings and smooth file guide path it reaches its working length.
creation（glide path）up to the root apex were per- 3 ．Evaluation of the canal shaping
formed. Flare formation was performed using PTN SX The amount of resin removed in the outer and inner
and PT SX files, which are used for straight line forma- sides of the curved root canal was compared. A stereo-
tion only. Furthermore, the glide path was confirmed scopic microscope（SZX16, Olympus, Tokyo, Japan）and
up to #15 using an ISO #15 stainless-steel K file a digital camera（DP71, Olympus）were used for the
（Dentsply Sirona）
. All NiTi files were washed with measurement. The transparent root canal models
purified water using a dedicated engine（X Smart plus, before and after root canal preparation were superim-
D e n t s p l y S i r o n a）, a n d 1 m l o f E D T A - g e l G l i d e posed with digital images, and the resulting images
（Dentsply Sirona）was applied to the NiTi files. were transferred to a PC and measured. The measure-
Root canal preparation using PTN and PTU files was ment points were 1, 2, 3, 4, and 5 mm from the apex,
performed by a single dentist with more than 7 years of and the increase in the root canal width on the outer
experience using NiTi rotary files. The following proce- and inner sides was measured and statistical processing
dure was performed and files were exchanged after was performed（Fig. 2）.
every five root canal formations. Root canal center transportation was measured as
1）ISO #25 PTN: Using two X1 and X2 files sequen- the amount of root canal wall cutting in the outer and
tially, select the X Smart plus PTN mode（300 rpm, 2.0 inner sides of the curved root canal, and the median
Ncm）, perform root canal cleaning with 2 ml of distilled displacement of the root canal before and after prepara-
water by plastic syringe when exchanging files, and tion was measured. We measured ①the distance
reach the working length（19 mm）of the X2 file to between shaping and original inner canal wall, ②the
complete the root canal formation. distance between shaping and original outer canal wall,
2）ISO #25 PTU: Using S1（17/02）
, S2（20/04）, F1 and ③the canal width of the shaped canal. The canal
and F2 files in sequence, select the PT mode（250 rpm, center transportation was calculated as the centering
3.0‒1.0 Ncm）
, perform root canal cleaning with 2 ml of ratio using the equation ① －②/③16）. The shaping
distilled water when exchanging files, and let the F2 file becomes more centered as the centering ratio
Dec, 2021 The Shaping Advantage of M-wire NiTi File 47
Apex with a curvature of 10°to 30°（Table 1）.
1mm Inner side 2 ．Shaping ability of the final apical size ISO #40
2mm Even with ISO #40 and PTN, the amount of resin
removed from the inner and outer sides was less than
3mm
those in the PTU group for all root canals with a curva-
ture of 10°to 30°（Fig. 3-b, 4-b, 5-b）. For ISO #40 and
Outer side PTN, the amount of resin removed was significantly
4mm less than that of the PTU group at 1‒5 mm on the inner
5mm
side with a curvature of 10°（Fig. 3-b）and 1 mm on the
Fig. 2 outer side at 30°（Fig. 5-b）. The amount of resin
Pre-instrumentation and post-instru- removed by PTN only increased from 4 to 5 mm on the
mentation images were superimposed
inner side compared with the outer side at 20°（Fig.
and the difference between the canal
4-b） （Fig. 5-b）
and 30° . This tendency was similar to that
configuration before and after instru-
of the PTU group. The amount of resin removed by
mentation was measured in each of the
five traced levels. PTU with ISO #40 significantly increased by 1 mm on
the apex side for all curvatures, and the cutting amount
on the inner side increased from 4 to 5 mm on the apex
approaches zero. （Fig. 5-b）.
side（p＜0.05）
4 ．Statistical analysis The change in the root canal transportation was less
The amount of root canal wall cutting and root canal than 0.05 mm with the 10° to 20° curvatures using PTN,
transportation was measured using statistical analysis but 0.06 mm at the apex 4 to 5 mm into the root with
using one-way analysis of variance and a multiple com- the 30° curvature. The transportation further signifi-
parison test using the Bonferroni-Dunn test. The level （Table 2）.
cantly increased to 0.08 mm（p＜0.05）
of significance was set at p＜0.05. In contrast, the root canal transportation of PTU
showed a displacement of 0.1 mm or more on the outer
Results side of the apex side at 1 mm in all the root canals with
a curvature of 10°to 30°. In the PTU, the canal trans-
The root canal shaping ability was evaluated accord- portation on the inner side increased to 0.07 mm and
ing to the amount of resin removed and the root canal 0.08 mm at 3 and 4 mm, respectively, even with a cur-
transportation. In experimental groups 1 to 4, the vature of 10°, and the inner side displacement of the
amount of resin removed was shown by comparing root canal of 30° also increased to 0.07 mm and 0.08 mm
PTN and PTU for each curvature（10°, 20°, 30°; Figs. 3‒ at 4 and 5 mm, respectively（Table 2）.
5）. The root canal transportation was classified by PTN
and PTU files（Tables 1 and 2）
. Discussion
1 ．Shaping ability of the final apical size ISO #25
The removal of resin by PTN decreased in both the The mechanical properties of the NiTi file depend on
inner and outer sides in the ISO #25 curvatures of 10° the processing method of the file and the surface finish-
to 30° compared with the PTU（Fig. 3-a, 4-a, 5-a）
. Mean- ing method, but it has been reported that the change in
while, the amount of resin removed by PTU on the crystal structure by the heat treatment process affects
inner and outer sides was small at 10° to 20° curva- the flexibility of NiTi alloys9,20‒22）. The PTU used in this
tures. The amount of resin removed by PTU increased study has super-elasticity by the stress-induced trans-
slightly at the 30° curvature: the apex side was 1 mm formation of the martensitic phase with a monoclinic
on the outer side, and the apical side was 4 mm and 5 crystal structure to the austenite phase, which is the
mm on the inner side, although the difference was not cubic crystal structure of a conventional NiTi alloy23）.
significant（Fig. 5-a）
. Meanwhile, PTN, which is a NiTi alloy processed into
The change in the root canal transportation for both M-wire by heating and cooling, coexists with austenite,
PTN and PTU was within 0.02 mm for all root canals martensite, and R phases, and has a monoclinic marten-
48 ODEP Vol. 1, No. 1
PTN PTU PTN PTU
measurement point（mm） 5 outer side 5
measurement point（mm）
（a） （b） outer side
4 4 ＊
3 3 ＊
2 2
1 inner side 1 inner side ＊
0.3 0.2 0.1 0.0 0.1 0.2 0.3 0.3 0.2 0.1 0.0 0.1 0.2 0.3
Total amount of removed resin Total amount of removed resin
（Mean±SD（mm））at the inner and outer sides （Mean±SD（mm））at the inner and outer sides
Fig. 3Total amount of removed resin（mm）at the different levels after root canal preparation for
10° apical curvature canals by（a）ISO #25 PTN, ISO #25 PTU, and（b）ISO #40 PTN, ISO
#40 PTU
＊：Significant difference between PTN and PTU（p＜0.05）
PTN PTU PTN PTU
5 （a） outer side 5 （b） outer side
measurement point（mm）
measurement point（mm）
4 4
3 3
2 2
1 inner side 1 inner side ＊
0.3 0.2 0.1 0.0 0.1 0.2 0.3 0.3 0.2 0.1 0.0 0.1 0.2 0.3
Total amount of removed resin Total amount of removed resin
（Mean±SD（mm））at the inner and outer sides （Mean±SD（mm））at the inner and outer sides
Fig. 4Total amount of removed resin（mm）at the different levels after root canal preparation for
20° apical curvature canals by（a）ISO #25 PTN, ISO #25 PTU, and（b）ISO #40 PTN, ISO
#40 PTU
＊：Significant difference between PTN and PTU（p＜0.05）
site phase and R phase16‒18）. Because the elastic modu- was analyzed by comparing the cutting characteristics
lus is less than that of the austenite phase, the initial of PTN and PTU under a stress load（formation of a
flexibility is improved. Additionally, the M-wire NiTi curved root canal）
. The root canal formation using root
alloy is more flexible than the conventional NiTi alloy canal models with different apex curvatures of 10° to
because the austenite phase undergoes a martensitic 30° was analyzed with final apical sizes of ISO #25 and
transformation due to the stress on the file when form- ISO #40. There was a large difference in the displace-
ing a curved root canal. The stress load on the file is ment of the root canal wall between the groups. In the
19）
reduced, which reduces file corruption . ISO #25 group, there was no significant difference in
In this study, the usefulness of the M-wire NiTi alloy the amount of resin removed or canal transportation
Dec, 2021 The Shaping Advantage of M-wire NiTi File 49
PTN PTU PTN PTU
outer side 5 （b） outer side
measurement point（mm）
measurement point（mm） 5 （a）
4 4
3 3
2 2
1 inner side 1 inner side ＊
0.3 0.2 0.1 0.0 0.1 0.2 0.3 0.3 0.2 0.1 0.0 0.1 0.2 0.3
Total amount of removed resin Total amount of removed resin
（Mean±SD（mm））at the inner and outer sides （Mean±SD（mm））at the inner and outer sides
Fig. 5Total amount of removed resin（mm）at the different levels after root canal preparation for
30° apical curvature canals by（a）ISO #25 PTN, ISO #25 PTU, and（b）ISO #40 PTN, ISO
#40 PTU
＊：Significant difference between PTN and PTU（p＜0.05）
Table 1 Statistical analysis of canal transportation at different levels after root canal preparation using a final apical size
of ISO #25 in 10°, 20°, and 30° apical curvature models by PTN and PTU.
PTN PTU
apical curvature 10° 20° 30° 10° 20° 30°
level（mm）
1 0.00±0.00 0.00±0.01 0.00±0.01 0.00±0.00 －0.01±0.01 －0.02±0.01
2 0.00±0.00 －0.01±0.00 0.00±0.01 －0.01±0.01 0.00±0.00 －0.01±0.01
3 －0.02±0.00 0.00±0.01 0.00±0.00 －0.01±0.01 0.00±0.00 0.00±0.01
4 －0.02±0.00 －0.01±0.01 0.02＋0.01 －0.01±0.00 0.01±0.00 0.02±0.01
5 0.00±0.00 0.00±0.00 0.00±0.01 0.01±0.01 0.01±0.01 0.03±0.02
Mean±SD（mm）
Table 2 Statistical analysis of canal transportation at different levels after root canal preparation using a final apical size
of ISO #40 in 10°, 20°, and 30° apical curvature models by PTN and PTU.
PTN PTU
apical curvature 10° 20° 30° 10° 20° 30°
level（mm）
1 －0.03±0.02＊ －0.05±0.01＊ －0.05±0.03＊ －0.10±0.02＊ －0.10±0.03＊ －0.13±0.03＊
2 0.00±0.01 －0.02±0.01 －0.02±0.02 0.01±0.02 －0.04±0.01 －0.05±0.02
3 0.00±0.01＊ －0.01±0.01 －0.01±0.01 0.07±0.02＊ －0.01±0.01 0.01±0.01
4 0.00±0.00＊ 0.04±0.01 0.07±0.03 0.08±0.01＊ 0.03±0.01 0.07±0.02
5 0.01±0.01 0.05±0.00 0.08±0.03 0.04±0.01 0.03±0.01 0.08±0.03
Mean±SD（mm）
＊：Significant difference between PTN and PTU（p＜0.05）
50 ODEP Vol. 1, No. 1
associated with the change in the bending angle in PTN
and PTU. Conclusion
In the ISO #25 group, the amount of resin removed
by PTN and PTU was 1 to 5 mm from the apex of the The amount of canal wall removed and transported
inner and outer sides for curved root canal angles of by M-wire ISO #40 PTN was less than that by the con-
10°, 20°, and 30°. The measured value was less than ventional ISO #40 PTU in 10° to 30° curvature canals
0.05 mm. Furthermore, the root canal transportation and the original root canal form was maintained,
was less than 0.05 mm and both files could form the although there was no significant difference in the
root canal and maintain the original anatomical root shaping ability for curvature canals by both PTN and
canal morphology. The NiTi file with an ISO #25 tip PTU of ISO #25. The M-wire PTN improves file flexibil-
showed that the shaping ability of the conventional and ity and enables accurate canal shaping for wide and
M-wire type NiTi alloy files were similar and useful for heavy curvature canals.
root canal preparation of curved root canal angles
between 10° to 30°. Acknowledgements
In the ISO #40 group, the amount of resin removed We thank Ashleigh Cooper, PhD, from Edanz Group
significantly changed depending on the root canal cur- （https://en-author-services.edanzgroup.com/）for editing a
vature between the PTN and PTU files. The PTU draft of this manuscript.
increased the lateral displacement by 1 mm from the
This study was partly supported by a Grant-in-Aid for
apex, and by 4 mm and 5 mm from the apex in the
Scientific Research from the Ministry of Education, Culture,
inside of the root canal between the 10° to 30° canals.
Sports, Science and Technology of Japan（B） （No. 20390437）.
The risk of transportation and canal perforation in the
curved root canal was observed. However, the PTN The authors have no conflicts of interest related to this
maintained the original root canal morphology when the study.
amount of resin removed in the inner and outer sides
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