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98]

Original Article

Stereomicroscopic evaluation of dentinal defects

induced by new rotary system: ProTaper NEXT
Deepa Deepak Shori, Pratima Ramakrishna Shenoi, Arshia R Baig, Rajesh Kubde, Chetana Makade,
Swapnil Pandey1
Department of Conservative Dentistry and Endodontics, Vidya Shikshan Prasarak Mandals Dental College and Research Centre,
Nagpur, Maharashtra, 1Private Practitioner, Raipur, Chattisgarh, India

Abstract
Introduction: The objective of this study was to evaluate dentinal defects formed by new rotary system Protaper nextTM (PTN).
Introduction
Materials and Methods
Methods: Sixty single-rooted premolars were selected. All specimens were decoronated and divided into four
groups, each group having 15 specimens. Group I specimens were prepared by Hand K-files (Mani), Group II with ProTaper
Universal (PT; Dentsply Maillefer), Group III with Hero Shaper (HS; Micro-Mega, Besancon, France), and Group IV with PTN
(Dentsply Maillefer). Roots of each specimen were sectioned at 3, 6, and 9mm from the apex and were then viewed under a
stereomicroscope to evaluate presence or absence of dentinal defects.
Results In roots prepared with hand files (HFs) showed lowest percentage of dentinal defects (6.7%); whereas in roots prepared
Results:
with PT, HS, and PTN it was 40, 66.7, and 26.7%, respectively. There was significant difference between the HS group and the
PTN group (P < 0.05).
Conclusion: All rotary files induced defects in root dentin, whereas the hand instruments induced minimal defects.
Conclusion
Keywords: Dentinal defects; hand files; NiTi instruments; ProTaper nextTM rotary system; root canal preparations

INTRODUCTION
The irrevocable aim of endodontics is a three-dimensional
unblemished seal of the root canal system which is achieved
by perfect designing of the canal diameter and canal form.
The biomechanical preparation is one of the major steps
for removal of bacteria and debris in the root canal so as
to achieve a successful endodontic treatment.[1,2] During
root canal instrumentation there are complications such
as perforations, ledge formation, transportation of canal,
and formation of cracks in the root dentin.[3,4] At times,
in the zeal of biomechanical preparation of the canal we
inevitably end up damaging the root dentin, which becomes
a gateway to dentinal cracks and minute intricate fractures;
thereby, causing failure of treatment.[1,5-7]
As a result of craze lines or microcracks, there might
be occurrence of root fracture that propagates due to
repeated application of stress by the occlusal forces.[7,8,11]
Shemesh et al.,[12] observed more dentinal defects in teeth
which were obturated with spreader than teeth obturated
Address for correspondence:

Dr. Arshia R Baig, Department of Conservative Dentistry and

Endodontics, Vidya Shikshan Prasarak Mandals Dental College
and Research Centre, Nagpur - 440 019, Maharashtra, India.
E-mail: arshia.baig@yahoo.in

without spreader. In different degrees, dentinal damage can

occur due to procedures like biomechanical preparation,
obturation, and retreatment.[9-11]
Complexities in the preparation of root canal may be
attributed to variation in the design of the cutting instrument,
taper, or composition of the material from which it is made.[2]
Hand instrumentation the milestone of endodontic
practice in the past though have lost popularity, still
remain the integral part of canal preparation.[3]
Rotary instrument by its innate behavior in the canal
may result in more friction, which may increase dentinal
defects and microcracks formation in comparison to hand
instruments.[13,14] Possible relationship between the design
of NiTi rotary instruments and the incidence of the vertical
root fractures was found by Kim et al.,[14] and it was concluded
that the design of the file affects strain concentration and
the apical stress during instrumentation of root canal.
Recently, the ProTaper next (PTN, Dentsply, Maillefer) files
were introduced in the family of NiTi rotary instruments
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Date of submission : 06.12.2014

Review completed : 15.01.2015
Date of acceptance : 12.02.2015

210

Journal of Conservative Dentistry | May-Jun 2015 | Vol 18 | Issue 3

Website:
www.jcd.org.in

DOI:
10.4103/0972-0707.154045

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Shori, et al.: Stereomicroscopic evauation of dentinal defects induced by new rotary system: ProTaper NEXT

with a completely new design comprising of unique

swaggering movement, greater flexibility, the M-wire
technology, the5th generation of continuous improvement,
and its offset design.[9,10,15]

recommended to be used mechanically (manually in very

severe curvatures) in a clockwise continuous motion with
a brushing motion, away from external root concavities, to
facilitate flute unloading and apical file progression.[16,18]

Whether it is rotary or hand files (HFs), they are assumed

to cause limited frictional forces within the canal, hence
creating dentinal defects. So there is need to study the
behavior of different NiTi rotary instruments and the newly
developed rotary system, PTN, on root dentin.

In all the experimental groups, irrigation of each specimen

was done with sodium hypochlorite solution.[11]

MATERIALS AND METHODS

Sixty single-rooted premolars were selected and stored in
purified water. Teeth with curved roots, calcified canals,
extracanals, and teeth with developmental anomaly or
resorption were excluded from the study. The teeth were
decoronated at coronal portions by using a diamond disc,
leaving roots approximately of 10mm in length. All the
roots were inspected with transmitted light for detecting
any preexisting cracks or any craze-lines by using a
stereomicroscope under 12, to exclude teeth with such
findings from this study.
Patency of the canal was established using a #10 K-File
(Mani, Japan) in the canal. The specimens were then divided
into four groups; each group containing 15 specimens each.
Group I:
Group II:
Group III:
Group IV:

HFs.
Protaper Universal (PT).
Hero Shaper (HS).
PTN.

In the HF group, HFs upto file #40 were used for canal
preparation. In the PT (Dentsply, Maillefer), HS (Micromega, Besancon, France), and PTN (Dentsply, Maillefer)
groups; preparation of the canals was done using speed and
torque controlled motor (X-SMART; Dentsply, Maillefer).
In the Hand Files Group, step-back technique was used
upto file #40. In the PT group, the following sequence of
PT rotary NiTi files were used for preparation of canals at
300 rpm: The shaping file X for coronal enlargement, and
S1, S2, F1, F2, and F3 files, corresponding to apical size 30,
used at the working length. In the HS group, the HS NiTi
files were used upto file #30 at 300 rpm in crown-down
sequence. In PTN group, the PTN rotary system files were
used at 300 rpm in the following sequence: X1, X2 and X3,
corresponding to apical size #30. The PTN rotary files were
used in a constant rotation at a speed of 300 rpm with light
apical pressure (recommended torque is 2.0 Ncm, adjustable
up to 5.2 Ncm according to practitioner experience).
Flutes of the instruments were cleaned frequently to check
any signs of distortion or wear. The PTN instruments are

Sectioning and Microscopic Evaluation

Sectioning of all the roots was done perpendicular to the
long axis at 9, 6, and 3 mm using a diamond disc under
water cooling.[5,7,11] Digital images of each sectioned root
was captured using a 40 stereomicroscope by using a
digital camera (Olympus, Tokyo, Japan). Two operators
checked each specimen for the presence of dentinal
defects. Roots were classified as no defect, fracture,
and other defects as described in Table 1.

Statistical Analysis
The results were expressed as the number and percentage
of defects in each group. Chi-square test was used for the
statistical analysis of the groups. The level of significance
was set at P = 0.05 using Statistical Package for Social
Sciences (SPSS) 20.0.

RESULTS
Figure 1 is a bar chart representing the number of root
defects in each group. HFs group showed lowest defect
(1/15) followed by PT (6/15), HS (10/15), and PTN (4/15).
Statistical significant difference was seen between HFs and
HS group and between HS and PTN groups (P < 0 .05). No
significant difference was found between the PT and HS
(P > 0.05).
The Stereomicroscopic images of Group I, II, III and IV are
shown in Figure 2.

DISCUSSION
In the present study; in HFs, PT, HS, and PTN, the number
and incidence of defects observed in the root dentin was
found to be 1/15 (6.67%), 6/15 (40%), 10/15 (66.67%), and
Table 1: Classification for identification of defects
in the specimens
No defect
Fracture
Other defects

Root dentin devoid of any lines or cracks where both the

external surface of the root and the internal root canal
wall will not present any evident defects
A line extending from the root canal space all the way to
the outer surface of the root
All other lines observed that will not extend from the
root canal to the outer root surface (e.g.,a craze line, a
line extending from the outer surface into the dentin but
will not reach the canal lumen, or a partial crack, a line
extending from the canal walls into the dentin without
reaching the outer surface)

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Figure 1: Bar chart representing number of root defects in each group

4/15 (26.7%), respectively. Group I (HFs) showed the lowest

incidence of defects (6.67%); whereas, HS group showed
the maximum incidence of defects (66.67%) as compared
to other groups. The results of our study are in accordance
with Imam,[7] who reported lowest number of defects (1/20)
by HFs; and Yold as et al.,[11] observed highest incidence
of defects (12/20) by HSs rotary files. Similar to results
by Capar et al.,[19] in the present study the number and
percentage of defects shown by the PTN rotary files were
4/15, that is, 26.7%. The results of the present study are not
in accordance with the results by Bier et al.,[5] where the
HFs showed no defect and PT rotary files showed highest
incidence of dentinal damage (16%).
Excess removal of root dentin during root canal preparation
and obturation of the canal with spreader may create
fracture in the teeth. The important goal in endodontics is
resistance to tooth fracture because such fractures might
cause decrease in the long-term survival rate.[11,12] In the
presents study, only one dentinal defect was seen in the
HF group. The number of rotations required for complete
root canal preparation is more with NiTi rotary instruments
than with the HFs.[7,17]
Kim et al.,[14] stated that taper of the files is the responsible for
increase of stress on the walls of the root canal; whereas, Bier
et al.,[5] stated taper of the files as one of the contributing factor
for crack formation in root dentin. PT have more taper (0.07,
0.08, and 0.09, respectively) than the HSs (0.04 and 0.06) and
the PTN (X1, X2, and X3; 0.04, 0.06, and 0.07, respectively).
This explains that there can be formation of cracks in the PT
group, as reported earlier by Bier et al.,[5] Liu et al.,[20] Barreto
et al.,[21] and Liu et al.[22] Furthermore, relatively low flexibility
of the HS may have contributed to the maximum number of
defects in HS group in the present study.[7]
Rotational force is applied to the canals of the root by NiTi
rotary instruments, thus creating craze line or microcracks
in root dentin. Formation of such defects may be associated

212

Figure 2: Stereomicroscopic images showing dentinal defects

seen in Groups I, II, III, and IV, showing craze lines seen in
Group I. Fracture and other defects in Group II craze lines
and partial crack in Group III and craze lines in Group IV

with the design of tip, cross-sectional geometry, taper type

(constant or progressive), flute form, and pitch (constant or
variable).[7,12]
The PT files have a triangular cross-sectional geometry, HS
having a triple helix cross-sectional geometry; whereas, the
PTN is rectangular. There is variable pitch in both PT and PTN
files. Thus, it can be stated that design of the rotary files is not
the only factor for defect formation in root dentin. Lam et al.,[23]
stated that forces shaping the root dentin can be affected by
the file design. Risk of root fracture is increased due to the
forces generated during the root canal preparation.[14] PTN files
have M-wire technology with off-centered rectangular crosssection, giving the file a snake-like swaggering movement as
it moves along the root canal, thus reducing the screw effect,
the unwanted taper lock, and torque on any of the given file;
thus decreasing the file-root dentin contact.[24,25]
M-wire alloy NiTi material with controlled memory NiTi
wire are flexible than those made from conventional NiTi
wire.[19] Thus, such flexibility of PTN rotary files may have
contributed in less number of dentinal defects formation as
compared to PT and HS. Capar et al.,[19] concluded that the
swaggering motion and less taper of the PTN instruments
could change the root canal volume to an extent as that of
the higher tapered instruments.

Limitations
1. Use of different speed and torque settings for each
rotary system could be the limitation of our study.
Increase in the rotational speed is associated with
increased cutting efficiency.[19]
2. Simulation of periodontal ligament was not done in the
present study. Capar ID et al.[19] stated that simulation of
the periodontal ligament is necessary for investigating
the influence of forces on formation of crack or fracture

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strength. Moreover, the periodontal ligament has

viscoelastic property. It plays an important role in stress
dissipation created by application of load to the teeth.

Within the limitations of this in vitro study, PTN rotary

system can induce less dentinal defects than PT and HS.

ACKNOWLEDGMENTS

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The authors thank Mr. Ashok Bhagat (Praj Laboratories, Pune,

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Professor, Department of Community Medicine, NKPSIMS,
Nagpur, India ) for statistical analysis, and Mr. Nandakumar C from
Dentsply (Key Account Manager, Karnataka State India) for
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How to cite this article: Shori DD, Shenoi PR, Baig AR, Kubde
R, Makade C, Pandey S. Stereomicroscopic evaluation of dentinal
defects induced by new rotary system: ProTaper NEXT. J
Conserv Dent 2015;18:210-3.
Source of Support: Nil, Conflict of Interest: None declared.

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