A comparative assessment of the effectiveness of mechanical treatment of root canals of different groups of teeth with machine tools

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The results of the study. The main task of modern endodontics is to remove infected dentin from the root canal, giving the canal an optimal shape and preserving its anatomy. In endodontics, the success of envy depends on many factors, one of the key ones will be the mechanical treatment of root canals. In modern endodontics, various rotating machine tools are actively used for root canal treatment, which makes it possible to increase the level of mechanical treatment and the quality of endodontic treatment. Modern rotating machine tools are represented by a file system of the same length and taper, the same working part, the only difference they have is the diameter. The S-flexi (Geosoft) system for mechanical root canal treatment has been developed on a titanium-nickel alloy skeleton using special temperature treatment, which gives the S-flexi endodontic system unique properties and characteristics. The system is designed for primary endodontic treatment. The system uses a unique heat treatment of titanium-nickel alloy Heat Control, which gives the instruments greater flexibility and memory effect. The S-flexi system is versatile and suitable for all types of channels, the taper of the 0.4 system allows a gradual and safe expansion of the root canal avoiding perforation. The special shape of the cutting edges and the asymmetrical rotation in the channel create ideal conditions for the evacuation and removal of sawdust. The use of a special heat treatment system strengthens the structure of the tool, which prevents tool breakage and increases its stability, the shortened shank of the tool improves access to teeth. The S-flexi system was applied to the endodontic model of tooth 3.1 with a complex system of root canals, namely one mouth with bifurcation into two channels buccal and lingual, which converge into one apical opening. Previously, mechanical treatment was carried out in the root canal and a carpet was created with hand tools. After that, each channel was traversed by the S-flexi system from 15 to 30 tool sizes with a bill of lading of 0.4. To estimate the area of treatment of the channel walls with tools using the Sketch and Calc application, the area of the colored root canal was calculated. After the mechanical treatment, the area of the dye-free areas on the walls of the root canal was calculated. According to our data, the efficiency of instrumental treatment of the root canal walls with S-flexy tools was 58%. The results of root canal treatment show that the system copes well with the complex anatomy of root canals due to its inherent characteristics of increased flexibility and memory effect, it is worth noting that the system is easy to operate and perform mechanical processing. The system shows good results in the estuarine and mid-apical parts of the canal. But in the apical part of the canal, especially where anatomically two channels merge into one, the system failed to process the apical part well. The ProFile system (Dentsplay) is used in endodontic practice, the uniqueness of the system is that it was one of the first to be subjected to special heat treatment and reduction of titanium in its composition, which gave the system a unique property of flexibility. ProFile belongs to the first generation of rotary nickel-titanium tools. The tool is passive-cutting, has a fixed taper along the entire length of the blades, a right angle of the cutting edges and a non-aggressive tip. The tool has passive radial faces, which ensures that the tool is centered in the bend of the root canal. The non-aggressive tip of the tool reduces the risks of creating a step in the apical part and perforating the lateral wall of the root canal. ProFile was applied to the 1.4 endodontic tooth model with two roots and two root canals that do not connect to each other. Previously, the channel was traversed with a hand tool to create a carpet, after which the channels were traversed sequentially by the ProFile system from 15 to 30 sizes with a taper of 0.4. Before the machining, the area of the colored surfaces of the root canal was calculated in the Sketch and Calc application, which was After the machining, the area of the dye-free areas was calculated using the Sketch and Calc application, which accounted for 42% of the total area of the root canal based on the results of digital image analysis. As a result of processing, the ProFile system showed a rather dubious result, given that the root canal system did not present anatomical difficulties, was straight and had no branches. Only in the area of the mouth of the root canal did the system do well, in the rest of the root canal the system showed poor results, especially in the apical part. The ProTaper Next (Dentsply) system is designed for difficult-to-pass root canals, the Next system is the first generation in the protaper line. The ProTaper Next system uses titanium-nickel alloy and the patented M-WIRE technology, which gives the system unique characteristics in terms of flexibility and tool strength. The system was originally developed for difficult-to-pass root canals. The system is based on the undulating movement of the tool, which makes it possible to better center the tool in the canal, which frees up more space for dentine filings. The ProTaper Next system was tested on a 2.6 endodontic tooth model, which has 3 roots. To analyze the effectiveness of the ProTaper Next system, a buccal-medial root with two root canals was selected, buccal-medial and buccal-buccal, the channels have two mouths and one apex on the model. Before machining, the area of the grown root surfaces is calculated in the Sketch and Calc application. After mechanical processing, the area of the areas where there was no dye left was 51%, which was calculated using the Sketch and Calc application based on the results of digital image analysis. Before using the ProTaper Next system, pretreatment with mechanical hand tools was performed. Using ProTaper Next in the root canals, the system showed good results, especially in the mouth and in the apical third of the buccal-mesial canal. When machining the buccal canal, the system showed a controversial result. In the oral part, the system copes very well, in the apical third of the root, the system copes poorly, the system lacks flexibility and a working surface that could effectively process the anatomically complex part of the root canal, the apical part of the buccal canal has a lot of dye left, which indicates poor contact of the instrument with the walls of the root canal. The Mtwo (VDW) system is designed for primary endodontic treatment. The S-shaped cross-section of the instrument is formed by two active cutting blades that give it exactly this specific shape. Each blade is a long, almost vertical spiral, which gives the tool a double cutting effect and ensures movement along the channel. The tip of the Mtwo does not screw in, but moves safely along the natural morphology of the channel. This allows you to safely clean even curved root canals. The shank shortened by 5 mm gives more space for file input. The Mtwo system was tested on a specialized 3.6 tooth endodontic model with two roots and 3 root canals. There are two root canals in the buccal-medial root, the buccal-medial and lingual, previously the root canals were traversed with hand tools, after which the Mtwo system was applied. After the mechanical treatment, the area of the root canal areas where there was no dye left was preliminarily calculated using the Sketch and Calc application for digital photography, which amounted to 60%. The system showed a good result, almost all the dye was removed from the walls of the root canals, the apical third and the apical part were almost completely cleared of dye. Conclusion. The study showed that we are all testing S-flexi (Geosoft), Profiles (Dentsply), ProTaper Next (Dentsply), and Mtwo (VDW) machine tools for root canal treatment, which are convenient and safe for use in endodontics. The use of new generation systems with improved flexibility and alignment of the instrument in the root canal increases the level of endodotic treatment several times. The S-flexi and Mtwo systems showed high results of 58% and 60% of the total root canal treatment area compared to other tested systems, the use of S-flexi and Mtwo systems at endodontic reception will increase the level of endodontic treatment and prevent errors during root canal mechanical treatment.

About the authors

Valeriy Valentinovich Kuznetsov

Voronezh State Medical University named after N.N. Burdenko

Email: valera_kuznetsov00@mail.ru
ORCID iD: 0009-0005-5904-3552

4rd year student of the Institute of Dentistry

Russian Federation, 10 Studencheskaya str., Voronezh, 394036, Russia

Elena Vladimirovna Vusataya

Burdenko Voronezh State Medical University

Email: lena-elena099@mail.ru
ORCID iD: 0000-0002-5057-5545

Cand. Sci. (Med.), Associate Professor of the Department of therapeutic dentistry

Russian Federation, 10 Studencheskaya str., Voronezh, 394036, Russia

Ekaterina Sergeevna Bratchikova

Burdenko Voronezh State Medical University

Author for correspondence.
Email: EkaterinaBB@mail.ru
ORCID iD: 0009-0001-0153-5862

4rd year student of the Institute of Dentistry

Russian Federation, 10 Studencheskaya str., Voronezh, 394036, Russia

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