Ya Shen

The full abstract for this thesis is available in the body of the thesis, and will be available when the embargo expires.

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The full abstract for this thesis is available in the body of the thesis, and will be available when the embargo expires.

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Objective: The aim of the study was to develop a model of testing cyclic fatigue resistance of TruNatomy instruments of undergoing rotational and axial movement at body temperature, taking into consideration the size of the canal and location of the curvature.Methods: Prime and Medium files were subjected to cyclic fatigue testing in simulated canals (at 37°C) using a model with either rotational movement only or rotational and axial movement simultaneously. Prime files were tested in 30/.04 and 30/.06 sized canals and Medium files were tested in 38/.04 and 40/.06 sized canals. The location of the curvature was unique for each canal, either in the apical, middle or coronal aspect of the canal.Results: Files tested in the rotation and axial movement groups had a higher number of cycles to failure (NCF) compared to the rotation only group. Prime files had a higher NCF than Medium files. Files tested in apical curvatures had a higher NCF than files tested in middle and coronal curvatures.Conclusion: Since rotational and axial movement of files led to greater fatigue resistance compared to rotational movement alone, future studies on fatigue resistance should implement a model with rotational and axial movement, as it is more comparable to a clinical scenario. Since Prime files had a higher NCF than Medium files, it is important to properly select the file for a particular canal. Apical curvatures led to greater fatigue resistance than curvatures in the coronal and middle third. Therefore, it is important that even when using a very flexible and fatigue resistant file, a proper glide path is developed and a suitable file size is selected when navigating these more coronal curvatures.

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Objectives: The present study examined the defect characteristics of clinically used, discarded nickel titanium rotary retreatment instruments, and analyzed the impact of clinical use on their metallurgical properties.Materials and methods: 92 XP Endo Shaper (XPS; FKG Dentaire) and 20 XP Endo Finisher-R (XPFR; FKG Dentaire) instruments with structural deformation or separation were collected from four specialty endodontic offices over a 20-month period. The types of defects and their relative locations were recorded. The lateral and fractured surfaces of the separated instruments were examined with scanning electron microscopy. Differential scanning calorimetry was used to investigate the thermal behavior of new, as well as deformed and/or fractured instruments.Results: 77 (84%) XP Endo Shapers and 4 (20%) XP Endo Finisher-Rs had an area with structural deformation while 15 (16%) XP Endo Shapers and 16 (80%) XP Endo Finisher-Rs were fractured. All unfractured, deformed XP Endo Finisher-Rs showed unwinding close to the coronal end of the flute. Fractures in the XP Endo Shapers and XP Endo Finisher-Rs were often close to the coronal end of the flutes or the expanding segments of the instruments. Most of the XP Endo Shaper fractures were because of torsional failure (67%), while XP Endo Finisher-Rs failed predominantly by cyclic fatigue (81%). The austenite finishing temperature of XP Endo Finisher-R (40°C) was higher than that of XP Endo Shaper (35°C). Both XP Endo Shaper and XP Endo Finisher-R exhibited 2-stage phase transformation.Conclusion: Torsional failure was more prevalent in XP Endo Shaper instruments and fatigue failure was more prevalent in XP Endo Finisher-R instruments. Among the investigated instruments, XP Endo Finisher-Rs were more likely to separate without warning whereas XP Endo Shapers frequently exhibited plastic deformation. The latter may be used as a pre-separation forewarning sign during clinical retreatment.Clinical significance: The failure mode of XP Endo Shaper and XP Endo Finisher-R used clinically for retreatment, appeared to be different. Plastic deformation, the forewarning sign of instrument separation, occurs when XP Endo instruments are used for retreatment

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Introduction: Endodontic treatments aim to prevent or heal apical periodontitis. Some infections are persistent, which are mainly caused by bacterial invasion and colonization in canal walls and dentinal tubules. Some of these bacteria have the ability to form biofilms. Eradicating biofilms play a critical role in endodontic treatment. Mechanical instrumentation alone cannot eliminate biofilms. Because they render areas that cannot be touched by rotary files such as lateral canals, fins, and isthmuses, other chemical aids are necessary to maximize bacterial reduction. The most commonly used root canal irrigant is sodium hypochlorite (NaOCl). Studies have shown supplementing NaOCl with contemporary different agitation devices may optimize endodontic treatment outcomes. Objective: The aim of this study was to compare the antibacterial effects of different agitation devices on single and multispecies biofilms in dentin canals using confocal laser scanning microscopy (CLSM).Hypotheses: There are no differences between root canal agitation devices in eliminating single and multispecies biofilms in dentin canals. Methods: Dentin blocks were prepared from human root dentin. To form biofilms, Enterococcus faecalis and plaque were introduced into dentinal tubules using centrifugation and incubation. After three weeks, two infected dentin samples were placed at 8 mm and 16 mm in a customized model. Samples were randomly divided into eight groups according to the agitation device used: Syringe needle irrigation (SNI), EndoActivator (EA), passive ultrasonic irrigation (PUI), and EDDY, with 2.5% and 6% NaOCl concentrations. Samples were stained and observed using CLSM to quantify the proportions of killed bacteria in dentin canals. Results: There were no significant differences (p > 0.05) between single- and multispecies biofilms. The killing of biofilms in dentin tubules was more effective when NaOCl was agitated. NaOCl concentration, location of infected dentin and agitation device used each played a role in the killing efficacy. There were no significant differences between the killing efficacies of EDDY and PUI.Conclusions: EDDY was as effective as PUI when used with concentrated NaOCl and demonstrated enhanced antibacterial effects against mono- and multispecies biofilms in the dentinal tubules. Apical portion with low antimicrobial efficiency remains a concern.

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Aim: The presence of apical vapor lock during irrigation has been shown to have a negative impact on debris and smear layer removal. The aim of this study was first, to compare apical vapor lock formation during positive pressure syringe irrigation following conventional, ProTaper Gold and conservative, V-taper nickel-titanium instrumentation. The second aim was to evaluate effectiveness of apical vapor lock elimination by sonic, ultrasonic and manual dynamic agitation, once established. Methods: Thirty-six single rooted teeth were instrumented with either ProTaper Gold F2 (25/0.08) or V-taper (25/0.06). In the first part of the study, incidence of apical vapor lock formation was evaluated radiographically following irrigation with sodium hypochlorite and cesium chloride (contrast agent). In the second part, apical vapor lock elimination was evaluated using manual dynamic agitation with 50 strokes of a well-fitting gutta-percha cone. Sonic agitation was performed with the EndoActivator, while ultrasonic agitation was carried out using a piezoelectric unit and a ISO size 15 U-File. Results: Following positive pressure irrigation, apical vapor lock was detected radiographically in 75.0% of total cases, specifically 72.2% and 77.8% of samples instrumented with V-taper and ProTaper Gold, respectively. Manual dynamic agitation eliminated apical vapor lock in 92% of samples, significantly more effective when compared to sonic and ultrasonic agitation.Conclusion: Apical vapor lock was equally detected after conservative and conventional rotary instrumentation using V-taper and ProTaper Gold, respectively. Manual dynamic agitation was effective at eliminating apical vapor lock.

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Objective: The aim of this study was to determine whether the cyclic fatigue resistance (CFR) of WaveOne (WO), WaveOne Gold (WOG), Reciproc (RE), and Reciproc Blue (REB) are affected by the location of the canal’s curvature. The phase transformation behaviors of the reciprocating file systems were also investigated. Methods: The reciprocating files were subjected to CFR testing in five artificial canals with a 60o angle of curvature and a 3 mm radius of curvature. The location of the curvature was unique for each canal. Each file was inserted 16 mm into the canal and operated until fracture occurred. The time to fracture was recorded and the length of the fractured fragment was measured. The surface of the fractured fragment was evaluated with scanning electron microscopy. Differential scanning calorimetry was used to characterize the file’s thermal behavior. Results: Reciprocating files have significantly decreased CFR in canals with middle- and coronally-located curvatures compared to those with apically-located curvatures (p 0.05). There were no significant differences in the fractured fragment length between the file systems (p > 0.05) except between WOG and RE in the canal with an orifice to curvature distance of 11 mm (p
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Introduction: The study aim was to evaluate the effect of five different root canal curvature locations on the fatigue resistance of thermomechanically treated nickel-titanium (NiTi) files and traditional NiTi files at body temperature.Material and Methods: EndoSequence (ES), EndoSequence (ESCM), K3, K3XF, and Vortex Blue (VB) NiTi files (size 25/.04) were subjected to fatigue testing inside artificial canals with a curvature of 60°, a 3-mm radius, and five different curvatures. Each instrument was rotated until fracture occurred. The number of cycles to failure (Nf) was recorded, the length of the fractured tips was measured, and the fractured surface of the fragments were examined by scanning electron microscopy. The phase transformation behaviour of NiTi files was also examined.Results: ESCM files had the highest fatigue resistance, followed by the VB, K3XF, K3 and ES files (p
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Objectives: This study aimed to evaluate and compare the fatigue resistance of ProTaper Gold (PG) and ProTaper Universal (PU) in artificial single and double curvature canals in 5% sodium hypochlorite (NaOCl) at body temperature. Methods: PG and PU files (size F1) were subjected to fatigue tests inside two different custommade ceramic artificial canals. The first one was a single curvature canal (group 1: 60° curvature, 5 mm radius) and the second was a double curvature canal (group 2: first [coronal] curve of 60° curvature and 5-mm radius and the second one [apical] of 30° curvature and 2 mm radius). The artificial canals were milled in an InCoris ZI zirconium oxide disc (Dentsply Sirona, Bensheim, Germany) using the inLab MC X5 Digital CAD/CAM System (Dentsply Sirona). The first 19 mm of each file tip was introduced into the artificial canal which was immersed in either distilled water or 5% NaOCl at body temperature (37oC). The total number of cycles to failure (NCF) was recorded, and the length of the detached fragments was measured. Data were analyzed using t-test and multiple linear regression analyses. Results: The fatigue performance of PG is better than that of PU (P
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Objective: Endodontic nickel-titanium (NiTi) files are submitted to a combination of cyclic fatigue and torsional stresses when used in a root canal, which could lead to their fracture. The purpose of this study was to evaluate the effect of various degrees of cyclic fatigue preloading on the torsional failure and of torsional preloading on the cyclic fatigue life of heat-treated HyFlex EDM NiTi files (Coltene/Whaledent, Altstätten, Switzerland).Methods: The mean number of cycles until failure (Nf) of HyFlex EDM and HyFlex CM NiTi (Coltene/Whaledent) files (size #40, taper 0.04 for both files) was examined in a 5mm radius and 60° single curve. Torque and distortion angle at the failure of new instruments and instruments stressed to 50% and 75% of the Nf were measured according to ISO 3630-1. Other new files were preloaded at 5%, 15%, 25% and 50% of the mean distortion angle before the fatigue test. After torsional preloading, the Nf was examined. The fracture surface of each fragment was examined with a scanning electron microscope.Results: The fatigue resistance of HyFlex EDM files was higher than that of HyFlex CM files (P
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Introduction: The goal of chemical irrigation in endodontics is to maximize the reduction of microbes and necrotic tissue remnants in the root canal system. Enterococcus faecalis is most frequently associated with persistent endodontic infections. Sodium hypochlorite (NaOCl) is the most commonly used root canal irrigant. Heating NaOCl has a positive effect on the tissue dissolving abilities of the solution. Objective: The aim of this study was to compare the killing effectiveness of two different sodium hypochlorite concentrations (2 % vs. 5.25 %) at two different temperatures (20 °C vs. 60 °C) against two strains of E. faecalis biofilm at different ages of maturation (3 days vs. 3 weeks), in a previously described dentin block model. Hypotheses: Temperature, concentration, the exposure time, the age of the biofilm nor the strain of E. faecalis have no effect on the killing efficacy of NaOCl on E. faecalis.Methods: Dentin blocks were prepared from human root dentin. Two E. faecalis strains were introduced into dentinal tubules by centrifugation and incubated to form biofilms. After 3 days and 3 weeks of growth, the E. faecalis dentin biofilm samples were exposed to sterile water, 2 %, and 5.25 % NaOCl for 3 and 10 minutes at room temperature (20 °C) and at 60 °C. After the exposure, the proportions of killed bacteria in dentin canals were assessed by viability staining and confocal laser scanning microscopy.Results: The killing efficacy of E. faecalis in dentin tubules was affected by an increase in temperature of the NaOCl solution. The concentration of the NaOCl solution and exposure time to the irrigant played a role in the killing efficacy of NaOCl. Overall, 5.25 % NaOCl demonstrated a greater effect on the killing efficacy on E. faecalis, except when NaOCl is used at 60 °C with an exposure time of 10 minutes. There was no significant difference (p>0.5) between the two different strains of E. faecalis or between the 3-day and 3-week old biofilms in their sensitivity to the bactericidal effect of NaOCl.Conclusion: Bacterial killing by NaOCl is enhanced by an increase in temperature and concentration.

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Objective: The purpose of this study was to compare the flexibility and cyclic fatigue of ProTaper Universal (PTU; Dentsply Tulsa Dental Specialties, Tulsa, OK) and ProTaper Gold (PTG; Dentsply Tulsa Dental Specialties, Tulsa, OK) in relation to their phase transformation behavior, as well as to determine the effect of cyclic fatigue on the nanohardness with a nanoindentation method. Hypotheses: PTG and PTU have similar flexibility and fatigue resistance. Cyclic fatigue has no effect on the hardness of both PTG and PTU NiTi rotary endodontic instruments.Methodology: PTU and PTG instruments were subjected to rotational bending at a curvature of 40° and a radius of 6mm. The number of cycles to fracture (NCF) was recorded. According to the ISO 3630-1 specification, 45° bending tests was used to determine the flexibility. Unused and fractured instruments were studied by differential scanning calorimetry. The hardness and modulus of elasticity of new files, fractured instruments and instruments stressed to 50% of the NCF for sizes S1, F1 and F2 were measured with the use of a nanoindenter. Results: PTG had a cyclic fatigue resistance superior to PTU in all sizes (P <.001 the="" fractured="" files="" of="" both="" ptu="" and="" ptg="" showed="" typical="" fracture="" pattern="" fatigue="" failure.="" bending="" load="" results="" for="" were="" significantly="" lower="" than="" that="" differential="" scanning="" calorimetry="" analyses="" instruments="" had="" a="" higher="" austenite="" finish="" temperature="" there="" no="" significant="" differences="" in="" between="" unused="" subjected="" to="" process.="" statistically="" nanohardness="" elastic="" modulus="" groups="" conclusions:="" within="" limitation="" this="" study="" more="" flexible="" resistant="" files.="" exhibited="" different="" phase="" transformation="" behavior="" which="" may="" be="" attributed="" special="" heat="" treatment="" history="" instruments.="" process="" effect="" on="" hardness="" niti="" instrument.="" suitable="" preparing="" canals="" with="" sudden="" curvature.="">
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Objective: To evaluate the torsional and cyclic fatigue behavior of post-machining heat-treated K3XF and conventional K3 nickel titanium (NiTi) instruments. Methodology: New K3XF and K3 files size 25/0.04 (n = 15) were tested in torsion and fatigue tests until fracture to determine the mean number of cycles to failure (NCF) and torque to failure. The cyclic torsional loading experiment was conducted; K3XF and K3 files (n = 30 in each group) were programmed to repeatedly rotate from zero angular deflection to 180° and then return to zero torque. Each rotation was defined as one cycle. Each file was subjected to 10 cycles of torsional loading. Fifteen files from each group were subsequently tested in torsion until fracture. Also, fifteen files subjected to cyclic torsional loading were examined using a three-point bending apparatus to obtain the mean number of cycles to failure. The fracture surface was examined with a scanning electron microscope. The crack-initiation sites and the percentage of dimple area of the whole fracture cross-sectional area were recorded.Results: There was no statistically significant difference between the new K3 and K3XF instruments in the maximum torque or maximum angular deflection. For the previously cycled files, K3XF demonstrated higher torque at fracture values than K3 Instruments (P
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Introduction: This in vitro study aimed to evaluate and compare the fatigue resistance of ProFile Vortex® (VX) and Vortex Blue® (VB) files in two different artificial double curvature canals (DC1 and DC2) and in an artificial single curvature canal (SC). The bending moment of VX and VB was assessed.Methods: The bending moment (g·cm) was used to measure flexibility of VX and VB (size 25/.04, length: 25mm) according to ISO 3630-1 specifications. Both files types were tested for cyclic fatigue failure inside canals containing: a single curvature (SC: 60⁰ curvature, 5 mm radius) and two canals with different double curvature (DC); [DC1: coronal curvature of 60⁰ and 5 mm radius, and apical curvature of 30⁰ and 2 mm radius; DC2: coronal curvature of 60⁰ and 5 mm radius, and apical curvature of 60⁰ and 2 mm radius]. The number of cycles to failure (NCF) was recorded and the fracture surface of all fragments was examined with a scanning electron microscope (SEM) to confirm cyclic fatigue failure and for qualitative analysis of pattern of fracture.Results: VX and VB followed slightly different trajectories in the identical canals, especially in double curvature canals. The mean bending moment value was significantly lower for VB than for VX (p .05). In the SC group, VB had NCF superior to VX (p .05). Multiple crack origins were observed for the majority of files fractured in DC1 and DC2 canals. Conclusions: DC1 and DC2 canals demonstrated a more stressful and challenging anatomy than the SC canal for VX and VB. In double curvature canals, degree of curvature and radius, and the file’s flexibility may affect the mean NCF.

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