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Milestone Education Nic Rc Blue Root Canal File

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Secondary Root Canal Treatment with Reciproc Blue and K-File: Radiographic and ESEM-EDX Analysis of Dentin and Root Canal Filling Remnants

Affiliations

  • PMID: 32570806
  • PMCID: PMC7355850
  • DOI: 10.3390/jcm9061902

Free PMC article

Secondary Root Canal Treatment with Reciproc Blue and K-File: Radiographic and ESEM-EDX Analysis of Dentin and Root Canal Filling Remnants

Carlo Prati  et al. J Clin Med. .

Free PMC article

Abstract

Secondary root canal treatment requires the complete removal of filling materials with different chemical-physical properties. A newly developed single-use NiTi instrument (Reciproc Blue, RB) may be more effective in root canal retreatment. The aim of the present study was to evaluate morphology and composition of remnants after retreatment with RB compared to traditional K-File technique, in canals obturated with Thermafil/AH Plus. Twenty-four single-rooted human teeth were shaped with NiTi obturated with AH-Plus/Thermafil and retreated using RB NiTi instruments or manual K-Files. Radiographs were taken to evaluate endodontic space and radiopacity of residual filling-material before/after procedures. After retreatment, samples were longitudinally split and observed by environmental scanning electron microscopy connected to energy dispersive X-Ray spectroscopy (ESEM-EDX) to analyze the debris/remnant position, microchemistry, and dentinal surface morphology. Time for retreatments was recorded and compared using one-way ANOVA (p-value = 0.05). Radiopaque filling residuals were found in both groups. RB system resulted statistically faster than manual K-File in retreatment procedure (p < 0.001). Root canal space radiographic appearance obtained after retreatment with RB was wider than K-File (p < 0.05). ESEM-EDX revealed 4 different morphological dentin area. Area-1: debris-free with typical Ca, P, and N composition of dentin and detected in 70% of the surface. Area-2: presence of deproteinized smear layer free from N and debris in 15% of the surface. Area-3: a thick packed smear layer N-free and with fine debris consisting of trace elements from sealer in 10% of the surface. Area-4: packed with debris and trace elements. No difference was observed between both instruments regarding root canal space appearance and ESEM-EDX analysis. Both systems were able to remove filling material but created a dentine morphology composed of packed debris and filling materials embedded into the smear layer. Dentin surface composition resulted in collagen depleted by irrigation procedures. The reciprocating system required less time to complete retreatment.

Keywords: ESEM-EDX; K-file; NiTi instruments; Reciproc Blue; periapical X-Ray; retreatment.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1

Plastic custom container to fit root sample during treatment and retreatment procedure. The system was used to simulate clinical condition and allow periapical radiographies.

Figure 2
Figure 2

Retreatment working time. Manual technique required statistically significant more time than RB. In both techniques the clinical parameter to step the retreatment procedure was the absence of debris from instrument removed from root canals.

Figure 3
Figure 3

EDX spectra of sealer and carrier used in the present study.

Figure 4
Figure 4

Dentine areas identified on root canal walls of secondary root canal treatments performed in the present study. The presence of specific elements inside the composition of sealer or gutta-percha (i.e., Zr, W, Zn etc.) was used as trace element to confirm the remnant presence (i.e., sealer or gutta-percha, or dentin smear layer).

Figure 5
Figure 5

ESEM-EDX analysis at 100× magnification performed at the coronal medium and apical third of root retreated using a RB instrumentation. Coronal third revealed some areas filled with high electron dense remnants. Medium and apical third presented few debris, dentin smear layer (Ca and P) and some open and clean (no smear plugs) dentinal tubules. EDX analysis performed at 3000× magnifications on one area with electron dense remnants located at the coronal thread revealed a higher presence of Zn, Zr, and W, attributable to sealer and gutta-percha. Similarly, EDX at 3000× magnifications in one area located at the medium third with fewer electron dense debris revealed reduced presence of elements attributable to sealer (W). EDX at one area at the apical third revealed a high concentration of smear layer, with higher presence of Ca and P and low presence elements attributable to the sealers (W). Interestingly, traces of Ti were identified in correspondence of some areas with high electron dense remnants, which may be attributable to recurrent instrumentation (over instrumentation) of RB files in those sites.

Figure 6
Figure 6

ESEM-EDX analysis at 100× magnifications performed at the coronal medium and apical third of root retreated using a manual instrumentation technique. Both coronal and medium third revealed few filling debris. Differently, apical third presented a higher presence of filling debris (evidenced as highly electron-dense deposits). EDX at 3000× on dentin areas free from filling deposits showed a limited presence of W, attributable to the sealer.

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Source: https://pubmed.ncbi.nlm.nih.gov/32570806/

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