10.59987/ads/2017.1.18-22
Aim. The aim of the present study was to evaluate radiographically the technical quality of root canal filling performed by postgraduate students with a new single-file Nickel-Titanium System (F6 Skytaper Komet) in clinical practice.
Methods. Records of 74 patients who had received endodontic treatment by postgraduate students at the School of Dentistry, Faculty of Medicine, University of Pavia in the period between September 2015 and April 2016 were collected and examined: the final sample consisted 114 teeth and 204 root canals. The quality of endodontic treatment was evaluated by examining the length of the filling in relation to the radiographic apex, the density of the obturation according to the presence of voids and the taper of root canal filling. Chi-squared analysis was used to determine statistically significant differences between the technical quality of root fillings according to tooth’s type, position and curvature.
Results. The results showed that 75,49%, 82,84% and 90,69% of root filled canals had adequate length, density and taper respectively.
Conclusions. Overall, the technical quality of root canal fillings performed by postgraduates students was acceptable in 60,78% of the cases.
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Annali di stomatologia
root filling
Radiographic technical quality of root canal treatment performed by a new rotary single-file system
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Original Article
2022-08-10
2022-08-10
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2023-12-04
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Ann Stomatol (Roma)
C. Poggio 
2017
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root filling
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Radiographic technical quality of root canal treatment performed by a new rotary single-file system
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                                                                                                    Original article


    Radiographic technical quality of root canal
    treatment performed by a new rotary single-file
    system




                                                                                                                 i
                                                                                                n              al
    Marco Colombo DMD, PhD                                  dents was acceptable in 60,78% of the cases.
    Cristina Bassi DMD
    Riccardo Beltrami DMD, PhD                              Key words: apical periodontitis, nickel-titanium




                                                                                             io
    Paolo Vigorelli DMD                                     files, quality of root canal treatment, root filling.
    Antonio Spinelli DMD
    Andrea Cavada DMD




                                                                az
    Alberto Dagna DMD                                       Introduction

                                                            The aim of root canal treatment is to prevent and
    Marco Chiesa DMD

                                                            treat apical periodontitis (1), with the objective of
    Claudio Poggio MD, DDS

                                                            eliminating microorganisms and necrotic pulp through




                                                              rn
    Department of Clinical-Surgical, Diagnostic and Pedi-   chemomechanical debridement, and providing an ad-
    atric Sciences, Section of Dentistry, University of     equate root filling (2) in order to seal the canals and
    Pavia, Pavia, Italy                                     prevent reinfection (3).
                                                            Several Authors reported a lower incidence of peri-




                                                            te
                                                            apical periodontitis in teeth with adequate root fillings,
                                                            so this variable should be taken into consideration
    Claudio Poggio                                          when evaluating root canal treatment success (4). In
    Corresponding author:                            In
    Department of Clinica-Surgical, Diagnostic and          the study performed by Azim et al. (1), they reported
    Pediatric Sciences                                      that poor root filling density, short root filling length
    Section of Dentistry, Policlinico “San Matteo”          (> 2mm short form the radiographic apex) are associ-
    Piazzale Golgi 3                                        ated with unfavorable outcome, and in teeth with
    27100 Pavia, Italy                                      overextended filling a delayed healing could be ex-
                                          ni

    E-mail: claudio.poggio@unipv.it                         pected.
                                                            The quality of root canal treatment undertaken in dif-
                                                            ferent populations by students (5) and general practi-
                                  io


                                                            tioners (6, 7) has been extensively investigated, and
                                                            it was observed that the technical quality of root fill-
    Summary

                                                            ings was poor and unsatisfactory in most cases.
                          iz



                                                            Treatment success can be related to lots of reasons
    Aim. The aim of the present study was to evaluate

                                                            such as patient age or immune conditions, but proba-
    radiographically the technical quality of root

                                                            bly also to poor canal cleansing and shaping, use of
    canal filling performed by postgraduate students
             Ed




                                                            inadequate aseptic techniques and lack of rubber
    with a new single-file Nickel-Titanium System (F6

                                                            dam, which could contribute to the persistence or in-
    Skytaper Komet) in clinical practice.

                                                            troduction of microbes into the canal system (8).
    Methods. Records of 74 patients who had re-

                                                            Shaping of the root canal was achieved by using
    ceived endodontic treatment by postgraduate stu-

                                                            stainless steel hand files, but the introduction of nick-
    dents at the School of Dentistry, Faculty of Medi-

                                                            el-titanium instruments in the last decades has led to
    cine, University of Pavia in the period between
 IC




                                                            a significant improvement of quality of root canal
    September 2015 and April 2016 were collected

                                                            shaping and less iatrogenic damage, even in severely
    and examined: the final sample consisted 114

                                                            curved canals (9, 10). Over the years, several gener-
    teeth and 204 root canals. The quality of en-

                                                            ations of file systems have been introduced, instru-
    dodontic treatment was evaluated by examining
C




                                                            ment design has changed considerably intending to
    the length of the filling in relation to the radi-

                                                            improve on previous generations.
    ographic apex, the density of the obturation ac-

                                                            The fifth generation of shaping files is the last that
    cording to the presence of voids and the taper of

                                                            has been introduced, with instruments characterized
    root canal filling. Chi-squared analysis was used
@




                                                            by having the centre of mass and/or rotation offset,
    to determine statistically significant differences

                                                            with a design, which should minimize the engage-
    between the technical quality of root fillings ac-

                                                            ment between the file and the dentin (11). F6 SkyTa-
    cording to tooth’s type, position and curvature.

                                                            per system (Komet, Brasseler GmbH & Co., Lemgo,
    Results. The results showed that 75,49%, 82,84%

                                                            Germany) belongs to fifth generation, is a single-file
    and 90,69% of root filled canals had adequate

                                                            endodontic systems, which are used in continuous ro-
    length, density and taper respectively.

                                                            tation, with two sharp cutting edges in a double-S
    Conclusions. Overall, the technical quality of root
    canal fillings performed by postgraduates stu-

    18                                                                          Annali di Stomatologia 2017;VIII (1):18-22
    Radiographic technical quality of root canal treatment


    cross-section design, and it is made up of 5 different      different sizes and three lengths with 6% taper; the
    instruments (12).                                           rotational speed advised for these instruments, which
    The purpose of this study is to evaluate, analyzing         is 300 rpm, and a torque of 2,2 Ncm for 020-030 files
    periapical radiographs, the technical quality of root       and 2,8 Ncm for 035-040 files, are controlled by an
    canal treatment performed by postgraduate students          endodontic motor (EndoPilot, Komet Brasseler GmbH
    at the School of Dentistry, Faculty of Medicine, Uni-       & Co., Lemgo, Germany) (14). For each tooth, a new
    versity of Pavia.                                           F6 was used and canal preparation was accom-




                                                                                                                  i
                                                                                                                al
                                                                plished with continuous irrigation with 5,25% sodium
                                                                hypoclorite and 17% EDTA solution; afterwards teeth
                                                                were filled with a carrier-based filling system (F360
                                                                Fill Obturators, Komet Brasseler GmbH & Co., Lem-




                                                                                                   n
    Materials and methods

                                                                go, Germany) with a root filling material based on
    Records of 74 patients who had received endodontic          epoxy resin (EasySeal, Komet Brasseler GmbH &




                                                                                                io
    Patient selection

    treatment by postgraduate students at the School of         Co., Lemgo, Germany).
    Dentistry, Faculty of Medicine, University of Pavia in
    the period between September 2015 and April 2016




                                                                    az
    were collected and examined. The final sample con-          Digital periapical radiographs were taken using a par-
                                                                Radiographic examination

    sisted of periapical radiographs of 204 root canals,        alleling device (XCP, Dentsply Rinn, Elgin, IL, USA)
    for a total of 114 teeth. All endodontic treatment was      with an intraoral X-ray equipment set on 7mA, 70kVp,
    performed by postgraduate students, with the super-         50/60 Hz (BlueX IntraOs 70, BIOTEX S.A., Athens,




                                                                  rn
    vision of teaching assistants. First, every patient was     Greece) and examined using the equipment own soft-
    required to give informed consent together with med-        ware (Digora Soredex-Finndent Medical Systems,
    ical and dental history, then the teeth and soft tissues    Helsinki, Finland), which provides the options for




                                                                te
    were clinically examined for tenderness, swelling,          measuring root lengths and also the distance be-
    crown fracture, and finally, if necessary, they have        tween the end of the filling and the root apex. The ra-
    been treated and information about root canal fillings      diographs were evaluated independently by two dif-
    was acquired.                                               ferent operators and the results were compared, then
                                                             In
    Preoperative and postoperative periapical radi-             a final evaluation was agreed.
    ographs were taken for every tooth and, when neces-         The quality of endodontic treatment was determined
    sary, also the intraoperative radiograph was taken.         by the length of the root filling in relation to the radi-
    Radiographs with over-projection of anatomical struc-       ographic apex, the density of the obturation according
                                                 ni
    tures, poor quality and not visible apex were excluded      to presence of voids and the taper of root canal fill-
    from the study to eliminate the possibility of radi-        ings (consistent taper from coronal to apical aspect of
    ographic misinterpretation.                                 the root), according to the criteria of Barrieshi-Nusair
                                        io


                                                                et al. (15). The root canal obturation ending more
                                                                than 2 mm from the radiographic apex was consid-
    All patients were treated with the following protocol:      ered under filling while extending beyond the radi-
    Canal preparation
                              iz



    local anesthesia was administrated (if needed) and          ographic apex was considered over filling. Presence
    then an aseptic isolation with rubber dam technique         of voids, no homogenous root canal fillings were con-
    was applied in all the cases. After the access prepa-       sidered as poor filling, moreover not consistent taper
               Ed




    ration, to eliminate coronal interferences and for a        from the coronal to the apical part of the filling was
    quick enlargement of the canal entrance, an Opener          considered as poor taper (Tab. 1).
    OP10 (Komet Brasseler GmbH & Co., Lemgo, Ger-               The relation of root canal length, density and taper
    many) was used, then working length was acquired            adequacy to canal curvature, arch and tooth position
    using 0,10 K-file with an apex locator (Endopilot,          (mandibular/maxillar) was assessed. The teeth were
    Komet Brasseler GmbH & Co., Lemgo, Germany). In             classified according to their location in the arch.
 IC




    every root canal a glide path was created first using a     Canal curvature was recorded as straight or curved.
    K-file and then with the PathGlider PG03 of 0.03 ta-        A straight line parallel to the long axis of the canal
    per (Komet Brasseler GmbH & Co., Lemgo, Ger-                was drawn using an endodontic ruler along the coro-
    many), whose rotational speed was set on 300 rpm            nal straight portion of the root canal space. If this line
C




    and torque of 0,5 Ncm. A mechanical preflaring helps        passed through and intersected the apical foramen,
    to create a safe and easy glide path and maintain the       the canal was considered straight. If the line deviated
    original canal anatomy even when used by inexpert           and did not pass through the apical foramen, the
    clinician (13).                                             canal was considered curved, according to Barrieshi-
@




    Then, a suitable F6 SkyTaper file was chosen ac-            Nusair (15).
    cording to the size of the previously used manual file,
    and finally the root canal was instrumented with a
    crown down technique in continuous clockwise rota-          The analysis of the data was performed using SPSS
                                                                Statistical analysis

    tion with gentle in- and out-motion for quick and safe      14.0 for Windows (SPSS Inc., Chicago, IL, USA).
    root canal preparation. The F6 SkyTaper System is           Sample means and their standard errors were used
    composed of highly flexible nickel-titanium files in five   to describe every item listed on the evaluation form.

    Annali di Stomatologia 2017;VIII (1):18-22                                                                         19
    M. Colombo et al.


    Table 1. Criteria for the standard of the examined root canal treatment.

    Variable                                  Criteria                          Definition
    Lenght of root canal filling              Acceptable                        Root filling end 0-2 of radiographic apex
                                              Overfilled                        Root filling ending beyond the apex




                                                                                                                                         i
                                              Underfilled                       Root filling ending > 2 mm short of radiographic apex




                                                                                                                                       al
    Density of root filling                   Acceptable                        Uniform density of root filling without voids
                                              Poor                              No uniform density of root filling with clear space is visible




                                                                                                                       n
    Taper of root filling                     Acceptable                        Consistent taper from the coronal to the apical part
                                              Poor                              No consistence taper from coronal to apical part




                                                                                                                    io
                                                                                    az
    The chi-square test of independence was used to                             to the tooth type, more than half of the canals
    compare obturation quality of root filling in term of                       (56,86%) belonged to molars teeth, while canals of
    length, density and taper in relation to canal prepara-                     anteriors and premolars were respectively 42
    tion technique. Because of the low relative frequen-                        (20,59%) and 46 (22,55%). Only 18,6% of the canals




                                                                                  rn
    cies Fisher’s exact test was alternatively used. A P-                       treated were considered curved.
    value <0,05 was considered statistically significant.                       Tables 2 and 3 show relative and percentage fre-
                                                                                quencies for length, density and taper according to
                                                                                canal curvature and position (anterior, premolars, mo-




                                                                                te
                                                                                lars). No relation was established between tooth posi-
                                                                                tion (anterior/posterior) and the involved parameters
    Results

    A sample of 74 patients, 20 females and 54 males,                           (P >0,05). Similarly, the shape of the canals did not
                                                                    In
    aged 56,5 on average, was included in the study, for                        show any relation with the adequacy of length, densi-
    a total number of 114 teeth and 204 canals, with the                        ty and taper of the root fillings (P >0,05).
    predominance of maxillary teeth (56,86%). According                         Table 4 shows the length, density and tapering of the
                                                     ni

    Table 2. Lenght, density and taper of canal filling in relation to canal curvature.
                                         io


         Root        Total                       Lenght                                      Density                          Taper
         canal
                                acceptable       overfilled       underfilled      acceptable          poor        acceptable          poor
                                iz



     Straight          166            125           19               22               138             28               152               14
                    (81,37%)       (75,30%)      (11,45%)         (13,25%)         (83,13%)        (16,87%)         (91,57%)          (8,43%)
                  Ed




     Curved            38             29             5                4               31               7               33               5
                    (18,63%)       (76,32%)      (13,16%)         (10,53%)         (81,58%)        (18,42%)         (86,84%)        (13,16%)
     Total            204             154           24               26               169             35               185               19
                    (100%)         (75,49%)      (11,76%)         (12,75%)         (82,84%)        (17,16%)         (90,69%)          (9,31%)
 IC




    Table 3. Lenght, density and taper of canal filling in relation to teeth position.
C




          Root        Total                           Lenght                                 Density                        Taper
          canal                     acceptable       overfilled      underfilled      acceptable   poor             acceptable      poor
         Anterior       42              27              10               5                38            4               39            3
@




                     (20,59%)        (64,29%)        (23,81%)        (11,90%)          (90,48%)     (9,52%)          (92,86%)     (7,14%)
      Premolar          46              35               4                7               38               8            44                2
                     (22,55%)        (76,09%)        (8,70%)          (15,22%)         (82,61%)        (17,39%)      (95,65%)         (4,35%)
          Molar         116             92              10               14               93              23            102              14
                     (56,86%)        (79,31%)        (8,62%)          (12,07%)         (80,17%)        (19,83%)      (87,93%)         (12,07%)
          Total         204             154             24               26               169             35            185              19
                      (100%)         (75,49%)        (11,76%)         (2,75%)          (82,84%)        (17,16%)      (90,69%)         (9,31%)



    20                                                                                                 Annali di Stomatologia 2017;VIII (1):18-22
    Radiographic technical quality of root canal treatment


    Table 4. Lenght, density and taper of canal filling in relation to the teeth location.

                                                       Lenght                              Density                   Taper
       Root canal          Total
                                       acceptable      overfilled    underfilled    acceptable     poor       acceptable   poor
                            116            96             14              6             94          22            105            11
        Maxillary




                                                                                                                                i
                         (56,86%)       (82,76%)      (12,07%)        (5,17%)        (81,03%)    (18,97%)      (90,52%)       (9,48%)




                                                                                                                              al
                            88             58             12             18             75          13            80              8
       Mandibular
                         (43,14%)       (65,91%)       (13,64%)       (20,45%)       (85,23%)    (14,77%)      (90,91%)       (9,09%)




                                                                                                               n
                            204            154            24             26             169         35            185            19
          Total
                          (100%)        (75,49%)       (11,76%)       (12,75%)       (82,84%)    (17,16%)      (90,69%)       (9,31%)




                                                                                                            io
                                                                                                           Figure 1. Length of the
                                                                                                           root canal filling in relation




                                                                              az
                                                                                                           to the arch.




                                                                            rn
                                                                          te
                                                               In
                                                 ni
                                        io
                              iz



    root canal filling in the maxilla or mandible; tests of
    independence between the root canal location and
    adequacy of the canal filling length showed that tooth
               Ed




    location is related to length adequacy. There were
    significantly more mandibular canals (20,45%) with
    short fillings compared to maxillary canals (5,17%) (P
    <0,05) (Fig. 1).
    Considering the overall adequacy, adequate density
 IC




    was found in 82,84% of the cases, and adequate ta-
    per in 90,69% of the cases.
    A good quality root canal filling (defined as adequate
    length, density and taper) was found in 60,8% (124
C




    canals) of all evaluated teeth (Fig. 2).
@




    Discussion

    This study aimed to evaluate the quality of root canal
    treatment carried out by postgraduate students with a
    new rotary single-file system (F6 SkyTaper Komet) at
    the School of Dentistry, Faculty of Medicine, University
    of Pavia. Periapical radiographs were used for assess-
    ment. The quality of root canal obturation was evaluat-              Figure 2. Overall quality of root canal treatment.


    Annali di Stomatologia 2017;VIII (1):18-22                                                                                        21
    M. Colombo et al.


    ed according to the criteria of Barrieshi-Nusai et al.                4.    Vukadinov T, Blažić L, Kantardžić I, Lainović T. Technical
    (15). To increase the objectivity of the study, two differ-                 quality of root fillings performed by undergraduate students:
    ent examiners evaluated the periapical radiographs.                         a radiographic study. ScientificWorldJournal. 2014;28:751274.
    Quality of root canal treatment has been investigated                 5.    Khabbaz MG, Protogerou E, Douka E. Radiographic qual-
                                                                                ity of root fillings performed by undergraduate students. Int
    in many countries and often resulted to be inade-
                                                                                Endod J. 2010;43:499-508.
    quate. In this study the density resulted to be ade-                  6.    Peak JD, Hayes SJ, Bryant ST, Dummer PM. The outcome
    quate in 82,84% of the cases, more than the study of




                                                                                                                                       i
                                                                                of root canal treatment. A retrospective study within the armed
    Khabbaz (33,5%) (5) and Moradi (34,1%) (16) and al-




                                                                                                                                     al
                                                                                forces (Royal Air Force). Br Dent J. 2001;190:140-144.
    so the taper, acceptable in 90,69%, of the cases, is                  7.    Ertas ET, Ertas H, Sisman Y, Sagsen B, Er O. Radiographic
    better than other studies such as Rafeek (72,2%) (17)                       assessment of the technical quality and periapical health
    and Barrieshi (85,3%) (15), showing that the Ni-Ti                          of root-filled teeth performed by general practitioners in a




                                                                                                                     n
    files and the new system perform well even when                             Turkish subpopulation. ScientificWorldJournal. 2013;2013:
    used by recently graduated students without great ex-                       514841.




                                                                                                                  io
                                                                          8.    Loftus JJ, Keating AP, McCartan BE. Periapical status and
    perience.
                                                                                quality of endodontic treatment in an adult Irish population.
    It was observed that the mandibular molars had a
                                                                                Int Endod J. 2005;38:81-86.
    higher percentage of short fillings, similar to the re-               9.    Yared G. Canal preparation using only one Ni-Ti rotary in-




                                                                              az
    sults of the studies of Khabbaz (5), Vukadinov (4) and                      strument: preliminary observations. Int Endod J. 2008;41:339-
    Barrieshi (15). This may be explained partly by the                         344.
    anatomy of such teeth, especially the presence of                     10.   Peters OA. Current challenges and concepts in the prepa-
    more than one canal in a root, and curvature of such                        ration of root canal systems: a review. J Endod. 2004;30:559-




                                                                            rn
    roots, which makes root canal treatment more chal-                          567.
    lenging (15), or because of difficulty in isolation (18).             11.   Ruddle CJ, Matchou P, West JD. The shaping movement:
    The results of the present study demonstrated ade-                          fifth generation technology. Dent Today. 2014;33:118-123.
                                                                          12.   Kaval ME, Capar ID, Ertas H, Sen BH. Comparative evalu-
    quate quality of root fillings in 60,78% of root canals,




                                                                          te
                                                                                ation of cyclic fatigue resistance of four different nickel-tita-
    more than the study of Barrieshi (47,4%) (15), Khab-                        nium rotary files with different cross-sectional designs and
    baz (33,5%) (5) and Elsayed (24%) (18) but lower                            alloy properties. Clin Oral Investig. 2016. Jul 26. [Epub ahead
    than the frequency reported by Benenati (91,05%)                            of print]
    (19) and Al-Yahya (20), even if it’s difficult to make
                                                                  In      13.   Berutti E, Cantatore G, Castellucci A, Chiandussi G, Pera
    comparison between different studies.                                       F, Migliaretti G, Pasqualini D. Use of nickel-titanium rotary
    Within the limitations of the presented study, it can be                    PathFile to create the Glide Path: comparison with manual
    concluded that 60,78% of root canal fillings per-                           preflaring in simulated root canals. J Endod. 2009;35:408-
    formed by postgraduate students resulted radi-                              412.
                                                    ni
                                                                          14.   Dagna A, Gastaldo G, Beltrami R, Chiesa M, Poggio C. F360
    ographically adequate, which is quite satisfactory and
                                                                                and F6 Skytaper: SEM evaluation of cleaning efficiency. Ann
    the new endodontic system F6 SkyTaper Komet is re-
                                                                                Stomatol (Roma). 2016;12:3-4.
    ally effective.
                                         io


                                                                          15.   Barrieshi-Nusair KM, Al-Omari MA, Al-Hiyasat AS. Radio-
                                                                                graphic technical quality of root canal treatment performed
                                                                                by dental students at the Dental Teaching Center in Jordan.
                                                                                Dent J. 2004;32:301-307.
                               iz


    Conflict of interest statement
                                                                          16.   Moradi S, Gharechahi M. Quality of root canal obturation per-
    The Authors of this study have no conflict of interest                      formed by senior undergraduate dental students. Iran Endod
    to disclose.                                                                J. 2014;9:66-70.
               Ed




                                                                          17.   Rafeek RN, Smith WA, Mankee MS, Coldero LG. Radio-
                                                                                graphic evaluation of the technical quality of root canal fill-
                                                                                ings performed by dental students. Aust Endod J. 2012;38:64-
                                                                                69.
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@




    22                                                                                            Annali di Stomatologia 2017;VIII (1):18-22
