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Article

Micro-Computed Tomographic Evaluation of the Shaping Ability of Vortex Blue and TruNatomyTM Ni-Ti Rotary Systems

by
Batool Alghamdi
1,2,
Mey Al-Habib
1,
Mona Alsulaiman
1,
Lina Bahanan
3,
Ali Alrahlah
4,
Leonel S. J. Bautista
5,
Sarah Bukhari
1,
Mohammed Howait
1 and
Loai Alsofi
1,*
1
Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia
2
Department of Endodontics, King Fahad Hospital, Ministry of Health, Almadinah 42351, Saudi Arabia
3
Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah 22252, Saudi Arabia
4
Restorative Dental Sciences Department, Engineer Abdullah Bugshan Research Chair for Dental and Oral Rehabilitation, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia
5
Engineer Abdullah Bugshan Research Chair for Dental and Oral Rehabilitation, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia
*
Author to whom correspondence should be addressed.
Crystals 2024, 14(11), 980; https://doi.org/10.3390/cryst14110980
Submission received: 1 November 2024 / Revised: 9 November 2024 / Accepted: 11 November 2024 / Published: 14 November 2024
(This article belongs to the Special Issue Shape Memory Alloys: Recent Advances and Future Perspectives)
Browse Figures
Versions Notes

Abstract

:
This study aimed to assess and evaluate the canal shaping ability of two different Ni-Ti rotary systems, Vortex Blue (VB) and TruNatomy (TN), using micro-computed tomography in extracted premolars. A total of 20 extracted bifurcated maxillary first premolars with two separate canals were randomly divided into two groups and prepared with either VB 35/0.04 (Dentsply Maillefer, Ballaigues, Switzerland) or TN Medium 36/0.03 (Dentsply Sirona). Pre- and post-instrumentation micro-CT scans were analyzed to measure the following parameters: percentage of untouched canal surface area, changes in canal surface area, changes in canal volume, structural model index (SMI), changes in canal angulation, changes in dentin thickness, transportation, and centering ability. Statistical analysis was performed with a significance level set at p-value < 0.05. Both VB and TN files showed a significant increase in the basic canal geometry parameters including canal surface area and canal volume. Both file systems showed no significant changes in SMI or dentin thickness after canal instrumentation (p > 0.05). Some degree of canal transportation and a similar centering ability ratio with no significant difference were observed in both file systems (p > 0.05). TN files showed less pre-cervical dentin removal when compared to VB files. A significant difference was found in the TN group regarding the dentin removal between coronal and apical thirds (p = 0.03). Both VB and TN files produced comparable root canal preparation with no considerable shaping mishaps and errors. Both files showed minimum canal transportation and minimum straightening of the canal curvature. TN files removed less pre-cervical dentin than apical dentin.

1. Introduction

Continuous developments are being made in nickel–titanium (NiTi) rotary systems to achieve optimal root canal preparation while reducing procedural errors. The rotary files’ design has been significantly improved to enhance fatigue resistance. This can be achieved through modifications in the instrument design or alterations in the metallurgical and thermal properties of NiTi wire [1,2,3,4].
Special thermomechanical treatment during the manufacturing of Vortex Blue (VB) and TruNatomy (TN) file systems results in super-elastic NiTi alloys with shape-memory properties. Both systems lack radial land; show non-active tips, asymmetrical blades, and symmetrical cross-sections; and have similar equi-atomic nickel–titanium ratios [5]. However, differences were found in their number of blades, helical angles, taper, apical tip size, cross-section design, and geometry [5].
Vortex Blue files are available in two tapers (0.04 and 0.06) and multiple tip sizes (ISO 15-50). They are manufactured with a 1 mm maximum flute diameter and convex triangular cross-section.
TN files are made with a slim NiTi wire design, featuring a maximum flute diameter of 0.8 mm and a regressive taper. The TN file set includes an orifice modifier with a tip size of ISO 20 and a fixed 0.08 taper, along with a glider that has a centered parallelogram cross-section, an ISO 17 tip size, and a 0.02 taper. Additionally, there are three shaping files: SMALL with an ISO 20 tip size and a 0.04 taper, PRIME with an ISO 26 tip size and a 0.04 taper, and MEDIUM with an ISO 36 tip size and a 0.03 taper. Each shaping file has a 16 mm cutting length and an off-centered parallelogram cross-section. No significant differences were found in a study that evaluated the shaping ability of TN, and VDW.ROTATE, and ProTaper Gold systems in preparing resin-printed mandibular molar mesial root canals using CBCT before and after preparation in terms of changes in the canal area, volume, untouched canal surface area, and minimum dentin wall wear. However, the ProTaper Gold system has shown significantly less maximum dentin wall wear compared to the other two systems [6]. In another study that evaluated the same parameters of XP-endo Shaper (XPS; FKG Dentaire), TN (TRN; DentsplySirona), and EdgeFile X3 (EF; EdgeEndo), the XP-endo Shaper instruments showed improved shaping ability with lower untouched root canal surface and better preservation of root canal anatomy during the preparation of resin-printed mandibular mesial root canals compared with TN and EdgeFile X3 systems [7].
VB and TN have been compared in many studies [8,9]. Regarding their cyclic and torsional fatigue resistance, one study by Elnaghy et al. showed no significant difference between both files in the mean numbers of cycles to fracture (523.9 and 436.8 cycles to fracture for VB and TN, respectively) [8]. Two other studies showed significant statistical differences between both files. In the first study, the mean number of cycles to fracture was 666.7 for VB and 341.7 for TN [5]. In the other study, TN had a higher mean number of cycles to fracture compared to VB, which was 1238.8 and 529.5, respectively [9]. However, the differences in the results in each study are explained by the differences in the conducted testing methods [5,8,9].
Regarding the shaping ability of VB and TN files [5]. A study with a sample size of only n= four lower molar teeth per group with no specific inclusion criteria performed micro-CT analysis to assess three key parameters: changes in canal volume following instrumentation, accumulation of hard tissue debris, and percentage of untouched canal walls. In another study, the design, metallurgy, mechanical performance, and shaping ability of three endodontic rotary systems, Genius Proflex, VB, and TN, were compared. Differences were noted in the number of blades, helical angles, cross-sectional design, and tip geometry. TN had the highest flexibility and the lowest fracture resistance. No significant differences were observed between Genius Proflex and VB regarding flexibility. Additionally, all instruments demonstrated similar shaping abilities, removing similar volumes of dentin and leaving untouched canal walls without clinically significant errors. Despite their differences in mechanical properties and design, all three systems performed comparably regarding shaping ability [5].
Micro-CT analysis has recently become a valuable imaging and assessment tool in endodontics. This high-resolution, non-invasive, and non-destructive technology enables detailed 3D visualization and examination of the root canal system. It is considered the most precise research tool for studying root canal anatomy and observing morphological changes in the root canal system after chemomechanical instrumentation [10,11,12].
To our knowledge, only one study in the literature has conducted a comprehensive assessment of VB with TN files using micro-CT, in which, a multimethod evaluation was performed to compare Genius Proflex (25/0.04), VB (25/0.04), and TN (26/0.04v) files. All files had the same taper with differences in file size (TruNatomoy) [5].
This study aimed to evaluate and compare the shaping performance of TN and VB rotary systems in an ex vivo model using micro-CT analysis. Key parameters include the percentage of untouched canal surface, changes in canal surface area and volume, structural model index (SMI), canal angulation, dentin thickness, canal transportation, and centering ability. This study also examined how differences in tip size and taper affect the shaping abilities of these two NiTi rotary systems, both of which have similar features such as thermomechanical treatment, super-elasticity, shape-memory properties, symmetrical cross-sections, no radial land, asymmetrical blades, non-active tips, and comparable nickel–titanium ratios.

2. Materials and Methods

Ethical approval (number 108-10-20) was granted by the Research Ethics Committee of the Faculty of Dentistry at King Abdulaziz University. Forty canals were randomly assigned to two groups: the TN group (n = 20) and the VB group (n = 20). All teeth were extracted for orthodontic purposes and met specific inclusion criteria. The selected teeth were healthy maxillary first and second double-rooted premolars with two distinct canals, fully developed apices, and canal curvatures ranging from 10 to 40 degrees, measured using the Schneider technique [13]. The teeth were cleaned and soaked in full-strength NaOCl for 5 min, and then autoclaved for 40 min at 121 °C and 15 psi. After sterilization, the teeth were stored in normal saline until further use [14]. Simple randomization was used to assign both buccal and palatal canals to either the TN or VB groups.
After access cavity preparation, the canals were located and negotiated to achieve apical patency. A glide path was created using a K-file of size #15. Instrumentation in both groups was performed according to the manufacturer’s guidelines, stopping 0.05 mm short of the full working length. Three pecking motions were used per advancement, with 17% EDTA gel (Meta-Biomed Co. Ltd., Chungcheongbuk-do, Republic of Korea) applied for lubrication. After each instrumentation cycle, the canals were thoroughly irrigated with 3% NaOCl to remove debris. All procedures were conducted by the same operator under dental operating microscopy (DOM) and followed the same chemomechanical protocols.
In the VB group, canals were instrumented using the crown-down technique up to file size 35 with a 0.04 taper. In the TN group, the coronal third was first enlarged with the orifice modifier, followed by glide path refinement with the glider. Root canal preparation was then completed using a medium TN file (size 36 and 0.03 taper).
The irrigation was administered using a 30-gauge side-vented needle and activated with an Ultra-X cordless ultrasonic activator (Eighteeth, Changzhou City, China). The canals were then flushed with a 3% sodium hypochlorite (NaOCl) solution, followed by 1 mL of 17% EDTA solution. Afterward, the canals were irrigated with 2 mL of saline and dried using paper points.
Before instrumentation, the clinical crowns of each sample were embedded in a polypropylene tube filled with PVS impression material (3M™, St. Paul, MN, USA), leaving the anatomical root area exposed. A reference point was established during the pre- and post-scanning phases by positioning the samples in the micro-stage, ensuring reproducibility of the datasets. Scanning was performed using the Bruker SkyScan 1172 high-resolution micro-CT (Bruker SkyScan, Kontich, Belgium) with the following standardized parameters: 96 kV voltage, 102 µA anode current, 316 ms exposure time, 19.70 µm pixel size, 0.4° rotation step for a 360° angle, frame averaging of 4 for improved signal-to-noise ratio, random movement of 8 to reduce ring artifacts, and the use of a Cu + Al filter to minimize beam hardening. After scanning, the projected images were reconstructed using the N-Recon© program version 1.6.9.4 (Bruker SkyScan, Kontich, Belgium) to generate cross-sectional images.
A co-registration dataset was saved and imported into the CTAn© version 1.20.8.0 software for the imaging, analysis, and quantification of the root canal scans before and after instrumentation. The CTVol 2.3.2.0© (Bruker Skyscan, Kontich, Belgium) software was utilized for 3D visualization and the creation of color-coded images of the samples for analysis. The images were then loaded into IC Measure version 2.00286 software for angle measurement evaluation.
The following parameters were calculated and assessed to compare the shaping ability of the two file systems: the percentage of untouched canal walls, changes in surface area, alterations in canal volume, modifications in dentin thickness, variations in canal angulation, transportation, centering ability, and structural model index (SMI) [15].
The dentin thickness of the canal was calculated along its length using distance transformation techniques [16]. The structure model index (SMI) was calculated to determine the flatness of the root canal [15]. The centers of gravity of the canal were calculated for each slice and then connected by fitting a line. This line was subsequently used to calculate the curvature of the root canal [16]. Straightening was measured as the percentage difference between the canal’s post-instrumentation curvature (fitted line) and its initial curvature. The un-instrumented surface area was determined by comparing the canal’s surface areas before and after preparation, using superimposed images to match surface areas from both stages. This calculation assumed that surface voxels retained the same positions before and after preparation.

3. Statistical Analysis

The data were expressed as mean and standard deviation (SD). The Shapiro–Wilk test was used to assess the normality of the distribution. The independent sample t-test or Mann–Whitney U test was applied to compare parameters between the two file systems. The paired sample t-test or Wilcoxon’s Signed-Rank test were used to evaluate differences between pre- and post-instrumentation. One-way ANOVA, followed by post hoc Tukey’s test, was employed to compare the different levels of the root canals within each instrumentation system. All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS), Version 20. A significance level of p < 0.05 was considered statistically significant.

4. Results

Qualitative analysis revealed that no procedural errors occurred after instrumentation in either group, including issues such as instrument separation, perforations, zipping, canal blockage, or ledges.
The percentage of untouched surface area and changes in canal surface area are presented in (Table 1). The mean untouched surface area did not show a statistically significant difference between the two groups; however, TN tends to leave less untouched surface area than VB. Three-dimensional rendered images of the touched and untouched root canal surfaces are displayed in Figure 1.
Cross-sectional images showing touched and untouched areas of the canals after instrumentation are shown in Figure 2. The pre-instrumentation and post-instrumentation canal volume, SMI, and changes in these parameters are shown in Table 2. Both files show a statistically significant increase in canal volume after instrumentation with no statistically significant difference in the changes in both canal volume and SMI between both file systems after instrumentation.
Changes in canal angulation indicates that the VB file tends to straighten the root canal curvature, while the TN file preserves the original curvature with minimal changes. However, no statistically significant difference was observed in the changes in canal angulation between the two groups (Table 3). Changes in canal angulation produced by TN and VB files are shown in Figure 3.
The changes in dentin thickness measurements are presented in Table 4. The overall changes in dentin thickness were 0.07 ± 0.012 mm for the VB group and 0.06 ± 0.016 mm for the TN group, with TN producing less change in dentin thickness in coronal and middle thirds than VB. However, these differences were not statistically significant. In the TN group, dentin wear was significantly lower (p = 0.03) in the coronal, 7 mm compared to the apical 3 mm. However, no significant difference was observed between the different root canal levels in the VB group.
Canal transportation produced by TN and VB files at 1 mm, 3 mm, 5 mm, and 7 mm root canal levels are shown in Table 5. The overall canal transportation of the VB group was −0.003 ± 0.01 mm and 0.01 ± 0.03 mm for the TN group. VB files tend to deviate from the canal into the distal side. However, no significant difference was found between both file systems at the same root level and the overall canal transportation results.
The centering ability ratio after canal instrumentation was assessed, as presented in Table 6. Both files showed a similar centering ability ratio with no statistically significant differences. Additionally, no significant difference was found in the same group at different root levels.

5. Discussion

Recent advancements in imaging technology like micro-CT allow for the non-invasive assessment of canal surface preparation. However, small alignment errors can significantly affect surface treatment assessments, and changes in a single voxel may not ensure sufficient antimicrobial action [18]. The use of this technology allows for the assessment of the shaping ability of different rotary NiTi systems in the preparation of root canal systems [19].
Minimally invasive endodontic treatment approaches prioritize the preservation of radicular structures and pericervical dentin to improve the fracture resistance and mechanical integrity of endodontically treated teeth. This approach has led to the development of endodontic systems aimed at optimizing tooth preservation, as demonstrated by TN rotary files. The biomechanical preparation of root canals aims to remove inner dentin layers that may harbor tissue and biofilm, contributing to persistent apical periodontitis [20,21,22]. The effectiveness of different instruments is linked to their ability to achieve this.
This study evaluated the claim that TN enhances mechanical preparation in oval-shaped canals, using double-rooted teeth as a model. VB is used for comparison due to its similar design and properties, as both instruments are made from super-elastic, shape-memory NiTi alloys [5,8,9,23,24,25].
Oval-shaped canals present anatomical and morphological irregularities that complicate treatment using conventional preparation techniques [26]. Micro-CT investigations have indicated that 5% to 80% of the canal surface remains unprepared after various preparation methods [15,18,27,28,29,30,31,32,33]. The literature suggests that TN files leave approximately 50–52% of the canal surface untouched, showing no significant difference compared to VB files [5], but a significantly higher percentage when compared to files such as XP-Shaper and WaveOne Gold [7,12,34]. Conversely, VB files resulted in 55–58% of the canal surface remaining unprepared, significantly more than XP-Shaper and TRUShape [35,36,37]. In the present study, the mean percentage of untouched surface area for VB and TN groups was 27.81 ± 17.46% and 22.74 ± 16.28%, respectively, with no statistically significant difference between the two groups. Although the percentage of untouched surface area was lower than reported in previous studies, it is evident that no shaping protocol was able to adequately prepare all canal walls, a limitation likely attributable to the anatomical complexities of oval canals in premolar teeth. The TN system’s off-centered cross-sectional design allows for shaping a larger canal surface than concentric instruments with the same cross-section, promoting better stress distribution during instrumentation [38]. This design also permits the use of smaller diameter instruments, enhancing canal shaping and preserving pericervical dentin [39].
Evaluating dentin thickness is crucial, as excessive removal can increase the risk of root fracture. Maintaining a centered position of instruments within the canal is expected to preserve more dentin [40]. In this study, the changes in root canal surface area and volume after preparation with both the VB and TN groups were comparable, showing no significant differences. Previous studies have also demonstrated that TN exhibits no significant differences in canal area changes after instrumentation compared to VB [5], ProTaper Next [41,42], and XP-Shaper [34]. However, TN shows significantly fewer changes in canal surface area when compared to WaveOne Gold, Reciproc Blue, TRUShape, and iRace [34].
Previous studies have found that TN rotary files exhibit the lowest volume variation after instrumentation, followed by ProTaper Ultimate (PU), with WaveOne Gold (WOG) showing significantly higher variation [43]. This trend also applies to dentin preservation near the cementoenamel junction (CEJ). These findings align with earlier comparisons between TN and WaveOne Gold (WOG), which demonstrated that TN possesses superior shaping ability, enhanced capacity to preserve the original canal morphology, and reduced canal transportation [44,45] and maintained a high-level centering ability [41].
Our results show similar changes in dentin thickness between both groups in the apical third, while less dentin wear was noticed in the middle and coronal thirds in the TN group compared to the VB group, which supports the minimum invasive endodontics concept in preserving the pre-cervical dentin [46]. The heat-treated TN rotary instruments feature a variable taper and an off-centered parallelogram cross-sectional design. Studies have demonstrated their effectiveness in preserving radicular dentin during the mechanical preparation of root canals [39].
Canal transportation is usually considered a procedural error. Our study shows that both files create minimal canal transportation. Both files had a similar overall centering ability ratio between 0.47 and 0.45 for the VB and TN groups, respectively.
The SMI is a morphometric evaluation parameter that helps determine whether the root canal maintains a plate-like or cylinder-like shape. In this study, both file systems preserved the original SMI of the instrumented canals. Canal angulation changes were minimal in both groups, likely due to the flexibility of the heat-treated files, which make them effective for preparing curved canals [47,48].
Nickel–titanium (NiTi) alloys used in endodontic instruments typically consist of an equiatomic ratio of nickel and titanium and can exhibit three microstructural phases: austenite, R-phase, and martensite, which influence their mechanical properties [49,50,51]. Conventional superelastic NiTi alloys primarily maintain an austenite structure at room (20 °C) and body (37 °C) temperatures, resulting in increased stiffness and limited flexibility. To address this limitation, innovative heat treatment processes have been developed to enhance the proportion of stable martensite in endodontic instruments [51]. In its martensitic state, NiTi is softer and more ductile, allowing for easier deformation [49,51], while the R-phase often appears as an intermediate phase in commercially available NiTi wires [52]. Heat-treated NiTi instruments have shown improved cyclic fatigue resistance, strength, and flexibility compared to austenitic instruments [53,54,55], requiring lower bending loads in testing [54,55,56]. The mechanical behavior of the instruments evaluated in this study, made from nearly equiatomic NiTi alloys, can be attributed to variations in design and crystallographic arrangement [49,51], which are reflected in their unique phase transformation temperatures. Overall, both groups demonstrated minimal canal transportation, likely due to the high flexibility of the tested instruments and the low curvature of the selected roots, consistent with previous studies highlighting the effectiveness of heat-treated instruments in preparing curved canals with minimal transportation.
The results indicate that TN files removed significantly less dentin in the cervical third compared to the apical third. In contrast, VB files showed no significant differences in dentin removal across the different root levels. However, other evaluation parameters, including the percentage of untouched canal surface area, changes in canal area, canal volume, SMI, canal angulation, and overall dentin thickness, showed no significant differences between the two file systems.
In the current study, significant effort was devoted to ensuring the homogeneity of specimens in terms of the configuration, volume, and surface area of root canals in both the coronal and apical thirds, as determined by preoperative scans. Proper sample pairing enhances the validity of this study by substantially reducing anatomical bias, which could potentially lead to inaccurate results. Limitations of this investigation include its in vitro design, which did not correlate mechanical preparation with bacterial load reduction, and the evaluation of only two file systems. Additionally, while the behavior of heat-treated files may be influenced by body temperature, this study was conducted at room temperature, approximately 20–25 °C. Furthermore, there was a notable difference in the taper between the two selected file systems, as no other rotary files with a 0.3 taper comparable to TN are available.

6. Conclusions

Within the limitations of this ex vivo study, it can be concluded that both VB (35, 0.040) and TN (36, 0.03) files produced similar root canal preparations without significant shaping errors or mishaps. Both files caused minimal canal straightening after preparation. TN files removed less dentin in the cervical region than in the apical region, which may be attributed to the 0.03 taper of the file. Overall, both file systems align with the concept of minimally invasive endodontics by preserving the original canal shape and removing minimal dentin.

Author Contributions

Conceptualization, M.A.-H. and L.A.; methodology, B.A.; software, L.S.J.B.; validation, B.A., M.A.-H. and L.A.; formal analysis, B.A., M.A.-H. and L.A.; investigation, B.A. and L.A.; resources, A.A.; data curation, B.A. and L.B.; writing—original draft preparation, B.A. and L.A.; writing—review and editing, M.A.-H., M.A. and L.A.; visualization, S.B.; supervision, L.A.; project administration, L.A.; funding acquisition, M.H. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Data Availability Statement

The datasets generated and/or analyzed during the current study are not publicly available because the research is under consideration for publication but are available from the corresponding author upon reasonable request.

Acknowledgments

The authors are grateful to the Deanship of Scientific Research, King Saud University for their support through the Vice Deanship of Scientific Research Chairs and Engineer Abdullah Bugshan research chair for dental and oral rehabilitation.

Conflicts of Interest

The authors declare no conflicts of interest.

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Crystals 14 00980 g001
Figure 1. Three-dimensional rendered images of teeth before instrumentation (left column) and after instrumentation (right column). In the right columns, touched root canal surface is presented with a gray color, and untouched root canal surface is presented with an orange color. B indicates buccal canal and palatal indicates palatal canal.
Figure 1. Three-dimensional rendered images of teeth before instrumentation (left column) and after instrumentation (right column). In the right columns, touched root canal surface is presented with a gray color, and untouched root canal surface is presented with an orange color. B indicates buccal canal and palatal indicates palatal canal.
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Figure 2. Cross-sectional images of the buccal and palatal canals after instrumentation at 3 mm, 5 mm, and 7 mm root areas. The buccal canal was treated with the TN file, and the palatal canal was treated with the VB file. The touched root canal surface is presented with a gray color, and the untouched root canal surface is presented with an orange color. B indicates buccal canal and palatal indicates palatal canal.
Figure 2. Cross-sectional images of the buccal and palatal canals after instrumentation at 3 mm, 5 mm, and 7 mm root areas. The buccal canal was treated with the TN file, and the palatal canal was treated with the VB file. The touched root canal surface is presented with a gray color, and the untouched root canal surface is presented with an orange color. B indicates buccal canal and palatal indicates palatal canal.
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Figure 3. Three-dimensional images of the root canal showing canal angulation before instrumentation (left column) and after instrumentation (right column). (A,C) show root canal instrumented with TN files and canal angulation changed 1.43 degrees from 30.44° to 29.01°. (B,D) show canal instrumented with VB files and canal angulation changed 2.42 degrees from 26.28° to 23.86°. Root canal angulation is calculated by drawing two lines, one parallel with the long axis of the tooth and the other one extending from the apical foramen to intersect with the first line at the point where the canal starts to leave the long axis of the tooth [13].
Figure 3. Three-dimensional images of the root canal showing canal angulation before instrumentation (left column) and after instrumentation (right column). (A,C) show root canal instrumented with TN files and canal angulation changed 1.43 degrees from 30.44° to 29.01°. (B,D) show canal instrumented with VB files and canal angulation changed 2.42 degrees from 26.28° to 23.86°. Root canal angulation is calculated by drawing two lines, one parallel with the long axis of the tooth and the other one extending from the apical foramen to intersect with the first line at the point where the canal starts to leave the long axis of the tooth [13].
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Table 1. Comparison of percentage of untouched surface area and changes in canal surface area before and after instrumentation between the two instrumentation systems.
Table 1. Comparison of percentage of untouched surface area and changes in canal surface area before and after instrumentation between the two instrumentation systems.
ParameterVB
Mean ± SD		TN
Mean ± SD		p-Value
Untouched surface area [17]27.81 ± 17.4622.74 ± 16.280.2 †
Changes in surface area (mm2)3.68 ± 2.633.27 ± 1.870.6 ‡
† Mann–Whitney U test, ‡ independent sample t-test.
Table 2. Comparison of pre-and post-instrumentation canal volume and SMI.
Table 2. Comparison of pre-and post-instrumentation canal volume and SMI.
ParameterVB Mean ± SDTN Mean ± SDp-Value
Pre Vol (mm3)2.39 ± 0.872.41 ± 0.740.9 †
Post Vol (mm3)3.36 ± 0.893.17 ± 0.920.3 †
p-value<0.001 ¶*<0.001 ¶*
Changes in canal volume0.97 ± 0.640.76 ± 0.460.2 †
Pre SMI2.89 ± 0.442.92 ± 0.150.7 ‡
Post SMI3.0 ± 0.242.93 ± 0.150.6 ‡
p-value0.4 §1.0 §
Changes in SMI0.11 ± 0.360.0008 ± 0.150.3 ‡
† Mann–Whitney U test, ¶ Wilcoxon’s Signed-Rank test, ‡ independent sample t-test, § paired sample t-test, * statistically significant p < 0.05.
Table 3. Comparison of changes in canal angulation produced by TN and VB files.
Table 3. Comparison of changes in canal angulation produced by TN and VB files.
ParameterPre Instrumentation
Mean ± SD		Post Instrumentation
Mean ± SD		p-Value †
TN162.25 ± 8.7162.60 ± 9.40.7
VB165.60 ± 8.2163.90 ± 7.50.3
p-value ‡0.30.2
† Paired sample t-test, ‡ independent sample t-test.
Table 4. Comparison of the dentin thickness changes after canal instrumentation.
Table 4. Comparison of the dentin thickness changes after canal instrumentation.
ParameterLevelVB
Mean ± SD		TN
Mean ± SD		p-Value
Changes in
dentin thickness 		Apical 3 mm0.08 ± 0.08 a0.08 ± 0.06 ab0.7 †
Middle 5 mm0.07 ± 0.05 a0.06 ± 0.04 a0.7 †
Coronal 7 mm0.06 ± 0.05 a0.04 ± 0.02 c0.2 †
p-value 0.70.03 *
Overall changes in dentin thickness0.07 ± 0.0120.06 ± 0.0160.4 †
† Independent sample t-test, ¶ one-way ANOVA test, * significant p < 0.05. Different lowercase letters indicate a significant difference within the same group (column). ab indicates statistical significance compared to c but not to a.
Table 5. Canal transportation produced by TN and VB files at 1 mm, 3 mm, 5 mm, and 7 mm root canal levels.
Table 5. Canal transportation produced by TN and VB files at 1 mm, 3 mm, 5 mm, and 7 mm root canal levels.
ParameterLevelVB
Mean ± SD		TN
Mean ± SD		p-Value
Canal transportation 1 mm 0.01 ± 0.10.02 ± 0.120.7 ‡
3 mm −0.005 ± 0.10.03 ± 0.130.3 ‡
5 mm −0.01 ± 0.10.03 ± 0.080.1 ‡
7 mm −0.008 ± 0.1−0.03 ± 0.090.5 ‡
p-value 0.9 0.2
Overall canal transportation−0.003 ± 0.010.01 ± 0.030.4 ‡
‡ Mann–Whitney U test, Kruskal–Wallis test.
Table 6. Comparison of centering ability ratio after canal instrumentation.
Table 6. Comparison of centering ability ratio after canal instrumentation.
ParameterLevelVB
Mean ± SD		TN
Mean ± SD		p-Value
Centering ability ratioApical 1 mm0.51 ± 0.31 a0.48 ± 0.28 a0.9 ‡
Apical 3 mm0.50 ± 0.33 a0.42 ± 0.31 a0.4 ‡
Middle 5 mm0.40 ± 0.28 a0.46 ± 0.39 a0.7 ‡
Coronal 7 mm0.46 ± 0.35 a0.45 ± 0.33 a0.9 ‡
p-value 0.7 0.9
Overall centering ability ratio0.47 ± 0.050.45 ± 0.0240.6 ‡
‡ Mann–Whitney U test, Kruskal–Wallis test. Different lowercase letters indicate a significant difference within the same group (column). a indicates no statistical significance between the thirds within the same group.
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Alghamdi, B.; Al-Habib, M.; Alsulaiman, M.; Bahanan, L.; Alrahlah, A.; Bautista, L.S.J.; Bukhari, S.; Howait, M.; Alsofi, L. Micro-Computed Tomographic Evaluation of the Shaping Ability of Vortex Blue and TruNatomyTM Ni-Ti Rotary Systems. Crystals 2024, 14, 980. https://doi.org/10.3390/cryst14110980

AMA Style

Alghamdi B, Al-Habib M, Alsulaiman M, Bahanan L, Alrahlah A, Bautista LSJ, Bukhari S, Howait M, Alsofi L. Micro-Computed Tomographic Evaluation of the Shaping Ability of Vortex Blue and TruNatomyTM Ni-Ti Rotary Systems. Crystals. 2024; 14(11):980. https://doi.org/10.3390/cryst14110980

Chicago/Turabian Style

Alghamdi, Batool, Mey Al-Habib, Mona Alsulaiman, Lina Bahanan, Ali Alrahlah, Leonel S. J. Bautista, Sarah Bukhari, Mohammed Howait, and Loai Alsofi. 2024. "Micro-Computed Tomographic Evaluation of the Shaping Ability of Vortex Blue and TruNatomyTM Ni-Ti Rotary Systems" Crystals 14, no. 11: 980. https://doi.org/10.3390/cryst14110980

APA Style

Alghamdi, B., Al-Habib, M., Alsulaiman, M., Bahanan, L., Alrahlah, A., Bautista, L. S. J., Bukhari, S., Howait, M., & Alsofi, L. (2024). Micro-Computed Tomographic Evaluation of the Shaping Ability of Vortex Blue and TruNatomyTM Ni-Ti Rotary Systems. Crystals, 14(11), 980. https://doi.org/10.3390/cryst14110980

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