Evaluation of Contact Friction in Fracture of Rotationally Bent Nitinol Endodontic Files.

摘要

The high flexibility of rotary Nitinol (Ni-Ti) files has helped clinicians perform root canal treatments with fewer technical errors than seen with stainless steel files. However, intracanal file fracture can occur, compromising the outcome of the treatment. Ni-Ti file fracture incidence is roughly around 4% amongst specialists and higher amongst general practitioners. Therefore, eliminating or reducing this problem should improve patient care. The aim of this project was to isolate and examine the role of friction between files and the canal walls of the glass tube model, and bending-related maximum strain amplitudes, on Ni-Ti file lifetimes-tofracture in the presence of different irrigant solutions and file coatings.;A specifically designed device was used to test over 300 electropolished EndoSequenceRTM Ni-Ti files for number of cycles to failure (NCF) in smooth, bent glass tube models at 45 and 60 degrees during dry, coated and liquid-lubricated rotation at 600rpm. Fractured files were examined under Scanning Electron Microscopy (SEM) afterwards. Four different file sizes 25.04, 25.06, 35.04, 35.06 (diameter in mm/taper %) and six surface modification conditions were used independently. These conditions included, three solutions; (1) a surfactant-based solution, Surface-Active-Displacement-Solution (SADS), (2) a mouth wash proven to remove biofilms, Delmopinol 1%(DEL), and (3) Bleach 6% (vol.%), the most common antibacterial endodontic irrigant solution. The conditions also included two low-friction silane-based coating groups, 3-Hepta-fluoroisopropyl-propoxymethyl-dichlorosilane (3-HEPT) and Octadecyltrichlorosilane (ODS), in addition to an as-received file control group (Dry). The coefficient of friction (CF) between the file and the canal walls for each condition was measured as well as the surface tension of the irrigant solutions and the critical surface tension of the coated and uncoated files by contact angle measurements. The radius of curvature and maximum strain amplitude (MSA) for each file size were determined based on images of the files inside the glass tubes. The force of insertion for each file type under each condition was also measured inside 45 and 60 degree glass tube paths, static and while dynamic.;The results showed that NCF of Ni-Ti files is strongly inversely related to the CF which ranged from 0.15 for ODS and 3-HEPT coated files to 0.43 for irrigant bleach. High CF (in the presence of bleach) significantly reduced the NCF. Conversely, lower CF (in the presence of other solutions and file coatings) resulted in significantly higher NCF. CF was found to be directly related to the surface tension of the media used. Similarly, high MSA typical of low radius of curvature and high bending angle significantly diminished the fatigue life of Ni-Ti files. The integral of the force of insertion versus time curve was the highest for bleach irrigation which also showed the highest CF.;Scanning electron microscope inspection of file fracture surfaces illustrated a 2-step progressive failure mode characterized by creation of a smooth initial fatigue area (striation marks) followed by catastrophic ductile fracture (dimple area) when the intact file shaft area was sufficiently reduced. The bleach-lubricated files failed earlier and with a smaller fatigue area (23%) than all other groups (31-35%) indicating premature fracture in the presence of higher frictional forces.;The acquired data demonstrate that the combination of low MSA and low CF (by using coatings or solutions with low surface tension), related to the magnitude of the superficial drag force, can lead to statistically longer rotational bending lifetimes for Ni-Ti files. Based on the data of this study, lubricant solutions with low surface tension could significantly improve the fracture life of Ni-Ti files in root canal glass model. Laboratory testing using natural teeth should be performed to evaluate the effect of using such solutions on the fatigue life of Ni-Ti files.