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Background:
Review

In Vitro Research Methods Used to Evaluate Shaping Ability of Rotary Endodontic Files—A Literature Review

by
Ranya F. Elemam
1,*,
Ana Mano Azul
2,3,
João Dias
2,3,
Khaled El Sahli
4 and
Renato de Toledo Leonardo
5
1
Restorative Dental Science Department, College of Dentistry, Gulf Medical University, Ajman P.O. Box 4184, United Arab Emirates
2
Egas Moniz School of Health and Science, Monte da Caparica, 2829-511 Almada, Portugal
3
Egas Moniz Center for Interdisciplinary Research, Monte de Caparica, 2829-511 Almada, Portugal
4
The Libyan Authority for Scientific Research, Tripoli P.O. Box 80045, Libya
5
Department of Restorative Dentistry, School of Dentistry, São Paulo State University (Unesp), Araraquara 14801-903, SP, Brazil
*
Author to whom correspondence should be addressed.
Dent. J. 2024, 12(10), 334; https://doi.org/10.3390/dj12100334
Submission received: 20 August 2024 / Revised: 4 October 2024 / Accepted: 12 October 2024 / Published: 21 October 2024
(This article belongs to the Section Restorative Dentistry and Traumatology)
Browse Figures
Versions Notes

Abstract

:
Background/Objectives: In this article, we present a literature review of methods used to measure the shaping ability of endodontic rotary files, including the selection of endodontic sample type (extracted teeth versus simulated blocks) and an imaging evaluation method. This review was conducted as background research to identify concerns that arise when designing research studies in this domain and propose how the field can plan more systematic studies going forward. Methods: A literature search was conducted using PubMed, MEDLINE, Embase, ScienceDirect, Scopus, and e B-on databases, including studies published in English from January 2010 to June 2024. Only studies that specified in vitro or ex vivo methods for evaluating the endodontic performance of NiTi rotary files on canal transportation and centering ability were considered. Results: A total of 86 studies met the inclusion criteria from an initial pool of 651. Of these, 67 studies used extracted teeth, while 20 utilized simulated root canals in resin blocks. For evaluation methods, 55 studies employed Micro-Computed Tomography and Cone-Beam Computed Tomography (MCT + CBCT), 30 used Double Digital Images/Radiographs/Photographs (DDIR + DDIP) with software analysis, 1 used both DDIR and MCT, 1 used high-precision nano-CT, and 1 used a digital single-lens reflex (DSLR) camera. Conclusions: The findings indicate that the MCT method and its advanced variations appear superior in many cases for evaluating the quality of root canal instrumentation due to their ability to provide detailed three-dimensional images. We also discuss the pros and cons of other evaluation methods, including CBCT and DDIR. Finally, we identify important factors to consider for optimizing future cross-study comparisons. This work highlights the importance of being familiar with shaping ability assessment methods as new instruments are introduced to the market.

1. Introduction

NiTi rotary instruments show significant improvement in the technical quality of endodontic therapy due to their unique flexibility and time-saving properties [1]. In addition, the wide range of their designs and cross-sectional patterns have led to many experimental studies being performed by scientists to evaluate their clinical performance, mainly by studying the instruments’ cleaning ability, shaping ability, and safety concerns [2]. The shaping ability of endodontic nickel–titanium rotary instruments is still a major concern of endodontics researchers. It indicates the potential of the endodontic files to shape the root canal—specially curved canals—without causing any aberrations. This is attained by assessing whether the file is straightening the curvature of the canal, its ability to be centered, and its ability to maintain the centering of the canal with minimal transportation.
Schilder [3] proposed clear design objectives when operators are shaping the root canal; when the objectives are followed, cleaning will be easily facilitated, and obturation will produce an optimal seal. These objective areas, briefly, are as follows:
Taper—A continuously tapered preparation shape should be formed.
Canal axis—The position of the canal axis should be sustained in the center of the root with no deviation.
Foramen—The original position of the foramen should be maintained, and it should not be enlarged.
The shaping ability of endodontic files should reflect those clear objectives to obtain an ideal-shaped canal, with a preparation that involves negligible canal transportation with optimally centered preparations [4].
There are many evaluation parameters used in the literature to investigate the shaping ability of instruments. They include the change in the root canal cross-sectional area, degree of canal transportation, centering ability, minimum remaining dentine thickness in the mesial and furcal directions, taper and flow of “the prepared root”, smoothening of the canal walls, change in curvature angulation, centering ratio, working time, fracture of instruments, canal aberrations, and working length [5]. However, transportation and centering ability are used most frequently in the majority of studies; as a result, these factors were considered in this review.
Canal Transportation is defined as the removal of canal wall structure on the outside curve in the apical half of the canal due to the tendency of files to restore them to their original linear shape during canal preparation; this may lead to ledge formation and possible perforation [6]. Centering ability is the ability to keep the instruments centered to provide an accurate enlargement without excessive weakening of the root structure [7]. The canal-centering ratio is the difference between the instrumented and non-instrumented canals, which measures the ability of an instrument to stay centered [8].
Numerous devices and methods are used in the shaping ability evaluation process, which includes silicon impression, muffle system, and radiograph superimposition techniques. These techniques are effectively documented in endodontic research. Yet, limitations are well-recognized, encouraging a search for new evaluation methods with advanced capacities that permit both quantitative and qualitative three-dimensional (3D) assessments of the root canal [9]. Such evaluations are important to clinicians and researchers because their consideration is valued in the selection of a particular rotary NiTi instrument for clinical practice [10].
The purpose of this review article is to investigate and analyze the literature that examined the shaping ability of endodontic rotary files to weigh the pros and cons of different methods used for this assessment based on canal transportation and centering ability parameters. Importantly, this review covers in vitro or ex vivo samples only, and thus, the search was conducted to explore the research methods literature rather than to test a clinical question or hypothesis. The review was conducted to identify the issues and challenges that come into play when designing studies evaluating rotary files and was not designed to be a systematic clinical review to objectively compare methods or file performance. In particular, we focused on the heterogeneity of endodontic sample type in the literature (extracted tooth versus simulated tooth, as well as which type of tooth) to identify that this presents challenges in making objective comparisons of evaluation methods. This approach was intended to guide future study design and harmonization of clinical evaluations.

2. Materials and Methods

The first author of this paper reviewed the literature for relevant published studies on methods used in the evaluation of the shaping ability of rotary files in the context of endodontics. Six databases were searched: PubMed, MEDLINE, Embase, ScienceDirect, Scopus, and e B-on database. In the initial search phase, studies were identified using the following pair of search term strings in each database: “evaluating shaping ability of NiTi rotary endodontic files canal transportation” and “evaluating shaping ability of NiTi rotary endodontic files centering ability”. The First Author included temporal filters (publication date) in each search for the years covered (2010–2024). Upon collection, they were fully reviewed to ensure that they met the inclusion/exclusion criteria.
Inclusion criteria were in vitro and ex vivo studies that described, in the abstract and/or Materials and Methods section, use of either extracted teeth or simulated teeth and evaluation method to evaluate endodontic rotary file performance on the following parameters: transportation or centering ability parameters and evaluating preparation quality based on shaping ability of rotary files. Searches were limited to studies written in English with human-extracted teeth or experimental blocks and published between January 2010 and June 2024. The decision to begin the search in 2010 was based on this study being conducted as a literature search for a Master’s thesis that used a 10-year retroactive literature search approach. For the current publication, we updated references through the gap between the initial thesis and submission for publication.
The exclusion criteria consisted of studies that failed to meet the inclusion criteria. If a study did not define transportation/centering ability as parameters or report shaping ability to evaluate rotary files, it was excluded. All systematic reviews, literature reviews, case series, study reports, and studies that expressed opinions were read but not included in the analysis since they did not contribute new data points on the topic of this review, which was asking the question, which methods are used in vitro/ex vivo to evaluate rotary file performance? Studies that allocated cleaning rather than shaping and/or dealing with the identification of bacterial species, material science, or clinical settings were also excluded because they did not evaluate the topic of this review. Lastly, studies in which publication keywords did not match the subject of the search, as well as non-English language studies, were excluded as they did not evaluate the topic of this review.
Because this was part of an independent Master’s thesis project, only the student conducting the thesis and screened the initial pool of studies identified in the search. Information from included studies was tabulated as shown in Table 1 and Table 2. The First author then worked in collaboration with the other authors to validate, analyze, review and edit, visualize, and administer the project.

3. Results

The search of the selected databases yielded 651 studies. After the exclusion criteria were applied, duplicates across databases, case reports, and non-English language studies were excluded. After these exclusions, 389 published studies relevant to the instrumentation of root canals were identified. Titles and abstracts were additionally evaluated, and full texts of the selected studies were then obtained. Articles were further evaluated through a detailed reading of the methods to confirm their inclusion. After these screening procedures, only 87 were kept, as shown in Figure 1.
From the selected studies, the following data were extracted from the Abstract and Materials and Methods sections: endodontic sample type, methods used to evaluate transportation or centering ability (Micro-Computed Tomography (MCT)-NRecon v.1.6.4; Bruker micro-CT, Cone-Beam Computed Tomography (CBCT) -KaVo OP 3D Vision (Kavo Dental, Biberach, Germany), Digital Single-Lens Reflex Camera (version 1.0 (build 1.0.10.7462), × 64 Edition, copyright 2004–2017 Cybermed, Korea and license key 670,094,709.), High-Precision Nano-Computed Tomography (nano-CT), (ver. 2.1.0.2, SkyScan, Kontich, Belgium), Double Digital Images Photographs (DDIP) with either Adobe Photoshop (Adobe Photoshop CS6, Adobe Systems Inc. San Jose. CA. USA), Fiji ImageJ software v.1.49n, Image-Pro Plus software Image-Pro Plus 6.0 (Media Cybernetics, Warrendale, PA, USA), or AutoCAD software (version 23.0, 2018), Double Digital Image Radiographs (DDIR) with either MCT (Skyscan 1172; SkyScan b.v.b.a, Aartselaar, Belgium), Adobe Photoshop CS6 version 13.0 (Adobe Systems, San Jose, CA) or AutoCAD software 2006 and 2008 software (Autodesk Inc., San Francisco, CA, USA), as shown in Table 1.
The distribution of studies according to the types of samples, the evaluation methods used, and the evaluated parameters are shown in Table 2.
Table 2 reveals that mandibular molars and simulated block types of samples constituted about 85% of the selected studies. For mandibular molars, more than 92% of the studies used Micro-Computed Tomography (MCT), Cone-Beam Computed Tomography (CBCT), or Double Digital Image Radiographs (DDIR) with the AutoCAD software. For simulated blocks, about 77% of the studies used Double Digital Image Photographs (DDIP) with either Adobe Photoshop or AutoCAD software.
Reviewing all the selected study articles in detail resulted in the ranking of the evaluation methods used to assess shaping ability in terms of their frequency of use across all sample types, as shown in Figure 2.

4. Discussion

4.1. Types of Endodontic Samples

A strong majority (77%) of studies on post-operative root canal shape or changes in root canal morphology were performed in extracted teeth rather than in simulated samples. Molar teeth were the most selected type, and the highest percentage was found on mandibular molars [9,14,16,18,20,21,22,24,25,26,27,32,33,34,35,38,39,43,46,47,48,50,52,53,55,58,63,65,67,68,72,74,76,79,80,82,85,86,88,90,92,93,95,96,97]. Few experiments were performed on maxillary molars [13,15,40,42,54,60,71,77], and only three studies were performed on both maxillary and mandibular molars [22,31,56].
Researchers were interested in evaluating the quality of shaping ability of endodontic files in molar teeth because these teeth are the most treated within the general dental practice [34,98,99]. The mesial root was the preferred root for this type of experiment, usually because they are curved, with the greatest curvature in the mesio-buccal canal. This anatomical feature of the curved mesio-buccal canals often induces a greater challenge [32,100] and generates greater canal transportation by instrumentation than most other root canals [76].
Studies that used simulated canals in resin blocks were few [10,17,28,30,45,49,51,57,59,62,66,69,70,75,81,83,89,91,94,101]; in the cases they were chosen, it was due to these samples being reliable, valid, and credited models for testing canal preparation techniques and instrument ability [16,18]. One study used simulated blocks in the shape of molars [51]; this artificial molar tooth model is made of a material that is closely equal to natural dentin so that each step of the treatment is comparable to real clinical practice. The studies that used resin blocks confirmed that those blocks can give better standardization and are able to reduce the variability that exists in the human root canal anatomy [17,19,28,30,66,69,70,81,89,94], providing strictly controlled laboratory conditions [83]. They also allow a direct comparison of the shapes obtained with different movements [91] and with different instruments [70,81]. However, those simulated canals in resin block models may neither match the various anatomical configurations in actual tooth structure nor match the clinical setup; the patient factor for this clinical outcome might not be considered [70].

4.2. Main Evaluation Methods

Three main methods were cited in our reviewed literature to evaluate the performance of root canal instrumentation. These are Double Digital Images, MCT, and CBCT.

4.2.1. Double Digital Images Evaluation Method

The Double Digital Images or Standardized Images technique has traditionally been one of the most used methods in endodontic research studies and was widely mentioned in this review [9,10,19,23,29,45,49,51,56,57,58,59,60,62,66,69,70,73,75,78,80,81,83,84,86,89,90,92,93,94].
This technique allows a direct analysis of post-instrumentation changes in the root canal system and evaluates the tendency of instruments to maintain the original canal anatomy under standardized conditions in a simple approach [78,102]. The assessment of anatomic parameters like transportation, centering ability, and centering ratio was easily achieved when this technique was selected [19,23,29,102]. In addition, residual dentin and cutting efficiency of different instruments could be evaluated [103,104,105].
The Double Digital Radiographs/Photographs Images (DDIR/DDIP) method was named double because of the double time exposure—one before and one after instrumentation. It is also called standardized because the technique has to maintain the same image exposure position each time [106]. It is relatively simple to perform, starting by digitizing the radiographs or photographs so that the operators would have the advantage of controlling contrast and brightness [107], then superimposing post- and pre-instrumentation images using computer software to evaluate the degree of canal transportation or other parameters.
When the Double Digital Images method uses the muffle system, it is called the Bramante technique or a modification of the muffle block technique [108], where a plaster block is placed around a resin or indexed experimental tooth [108]. The block can be custom machined and sectioned in various planes to allow exact repositioning of the complete block or sectioned parts of the tooth in the same position [109]. In our review, one study applied the Bramante technique [73] due to its low cost, simplicity, and adequacy, and it was considered sufficient for the assessment of the quality of root canal preparation [73].
Photographs and radiographs cannot be observed in a cross-sectional view [110]. All images received from this method are two-dimensional (2D) views. Deolivera et al. [46] defined the two dimensions as area and perimeter and the three dimensions as volume, surface area, and structure model index. In clinical radiographs, the 2D images are the clinical (mesiodistal) and proximal (buccolingual), which did not display the real transportation because teeth do not always show their maximum curvatures in the mesiodistal or buccolingual planes [111,112]. Accordingly, different adjustments were suggested to overcome this by implementing some modifications. A recommendation to take another angulated radiograph, commonly perpendicular to the first one, to provide an understanding of the third dimension was proposed; however, this still drops short of generating 3D data for quantitative analysis [113]. Another suggestion was to inspect the tooth, locate the position of maximum curvature, and set it perpendicular to the X-ray beam [114]. This modification was first suggested by Maggiore [114], allowing an exact evaluation of the angle and radius of the curvature [104]; however, it is still not indicated in cases of root canals with double curvatures because maximum curvatures in these canals normally occur in multiple planes [104].
Comparing DDIR to MCT for evaluating canal transportation showed similar statistical results. Although this outcome lacked clinical relevance, radiography is still a reliable and precise tool [60].
Double Digital Image Radiography (DDIR) illustrates a nondestructive approach, demonstrating slow exposure to radiation [110], ease of use, and low cost compared to MCT, and is preferable to the investigators [9]. All images were taken in two perpendicular directions, providing 2D estimates of 3D structures. This does not give an adequate and complete description of an object, leading to reduced accuracy in quantitative studies [89]. Interpretation of radiographs and images remains subjective [115] and lacks the ability to reveal volumetric information of the 3D view [89], making CT superior [9].

4.2.2. MCT (Micro-Computed Tomography) Evaluation Method

MCT was the most-selected evaluation method within this review [14,18,20,24,26,27,32,33,34,35,37,38,39,40,41,42,43,46,47,48,53,54,55,60,61,63,64,65,67,68,71,76,77,82,87,88,89]. Authors specified the reason for this selection as the tool’s advantages, mainly the ability to obtain a 3D assessment of the root canal preparation [14,33,37,40,41,47,68,82]. One study used this method to anatomically match the sample to generate a calibration by having a reliable baseline and ensuring comparability of the groups by standardization [68]. However, Stern et al. chose this method for its accurate images, owing to the higher spatial resolution compared to conventional clinical scanners [87] and for the ability to overcome previous technique limitations [82].
MCT was described as a state-of-the-art method for examining the internal anatomy of teeth [102,116]. MCT can investigate root canal geometry based on a wide range of parameters, including apical transportation, centering ratio, volume changes, cross-sectional shape, taper, and anatomical structure of the root canal before and after instrumentation [2,18,20,24,26,27,95,117]. Its 3D capability works by collecting the 2D projections of X-rays through a specimen, which are then used to reconstruct a 3D image [118]. It has been shown that an initial scan that was used for comparison after the shaping procedure was enough to test the volume change of the canal [119].
Other advantages of the MCT method include its ability to detect anatomical complexities, such as accessory canals [120], C-shaped canals, and isthmuses [121,122]. MCT has emerged as a powerful tool for ex-vivo evaluation of root canal morphology due to its accuracy, noninvasive procedure [33,95], and 3D performance at both apical levels and point of maximum curvature [71].
The images provided through this method are induced at a resolution of 11.84 mm, proving to be an excellent method for the precise evaluation of the apical millimeters of instrumented root canals [90]. All transferred errors encountered by using radiographic or photographic methods are avoided [123]. This ability to image a very small structure made using MCT within this context is very demanding due to its higher magnification and significantly higher resolution compared to conventional tomography [119]. MCT has higher resolution due to lower voxel size. The importance of the resolution and quality of the image in scientific research outweigh the time required for the analysis [119].
Previous literature that used MCT analysis was hindered either by insufficient resolution [102] or projection errors [124]. Modern machines now offer better resolution and more accurate measurement software with the capability of matching multi-dimensional data from specimens before and after preparation [125]. For these reasons, the current generation of MCT is considered a superior method for evaluating the quality of root canal preparation techniques [126]. In spite of its high cost in requiring a well-trained operator and long scanning and reconstruction time [119], MCT is becoming a substantial educational tool for preclinical teaching in endodontics [127]. As technology continues to develop even further, higher resolution methods, such as nano-CT used in one recent study, may overtake MCT. Nano-CT currently has a resolution of <400 nanometers [128] and can image features at the cellular level, in addition to more macroscopic structural levels [129].

4.2.3. CBCT (Cone-Beam Computed Tomography) Evaluation Method

CBCT is an extra-oral imaging method able to produce 3D scans of the orofacial skeleton [130]. This technique was selected by a number of studies in our review [11,15,16,17,21,22,25,28,30,31,36,44,46,50,52,72,74,79,85,95] along with its advanced type, including spiral [95] and ICAT [79,85]. One study used CBCT only for the sample selection process [46]. The authors declared that CBCT enabled the collection of homogeneous and balanced experimental groups to analyze 2D and 3D values of the sample to precisely interpret endodontic instrument behavior during root canal preparation.
The rationale behind CBCT selection as an evaluation method includes having noninvasive tool characteristics [36,85], an accurate reproduction of 3D evaluation [44,46,74,85,95,130], and the ability to detect alterations in canal curvature, dentin thickness, and root canal volume accurately [36,44,85,95,102,131,132].
CBCT could overcome the limitations of conventional radiography [133], such as compression of a 3D object into a 2D image, image distortion, and anatomic superimposition [73]. These are the main advantages of the CBCT method [134], in addition to the fast data acquisition of CBCT when compared to MCT [50,135]. It is used in clinical endodontic practice and more frequently in endodontic research to evaluate root canal morphology, fractures, and changes in prepared root canal [136] volume change, surface area, 3D root canal axis, thickness, surface convexity, and structure model index [32].
CBCT produces pure, clear images with the ability to record all the anatomic details of the teeth [32]; however, it has lower resolution compared to MCT, which may cause problems when enhancing data during imaging for research purposes [137].
The method name is due to the X-ray beam shape and the area the detector captures is a cylinder-shaped volume of data in one gain [138]. This makes CBCT very convenient both clinically and in the research lab [50], whilst MCT is better recommended for laboratory research only [119]. The main shortcomings of using the CBCT method are reduced sensitivity to minor anatomical changes, possibly due to reduced resolution compared to MCT [139]. Voxel size in MCT ranges from 19.6 μm to 39.2 μm isotropic voxel size compared with CBCT, which is larger [140,141]. The larger voxel size in CBCT imaging led to a partial volume effect, making it impossible to perform accurate measurements [142].

4.2.4. Comparison of Evaluation Methods

This detailed discussion of the reviewed studies aimed to enhance understanding of the parameters to consider for selecting the most reliable method for evaluating the shaping ability of endodontic files, enabling the researchers to have a standard for testing the shaping ability of NiTi rotary instruments on a strong evidence base. This would further serve as a reference to clinical practitioners to promote better harmonization of tool assessment approaches across sites and studies.
The measurement of apical transportation can be particularly challenging because of the fact that there is no gold standard method for its assessment, as all methods chosen by researchers have limitations [113]. Additionally, apical transportation itself is difficult to measure because no standard exists for this measurement [9,84]. Lastly, we have determined that it is challenging to compare studies that assessed root canal transportation and centering ability due to a lack of standardized evaluation methods among the reviewed studies. Studies on canal shaping affected by instrumentation need to be homogeneous with respect to multiple factors such as canal shape and size, sample model nature, proper superimposition of before and after instrumentation images, the selected method, and the study design to objectively evaluate and compare the tools used for evaluation and achieve the optimal recommendation for any given evaluation.
In summary, the Double Digital Images (DDIR + DDIP) technique is a simple method offering 2D photographs of the sample, while MCT and CBCT present a 3D image. Both CT and CBCT are preferred due to their ability to capture images in three dimensions with accurate measurements, providing an opportunity for various slices of the same images. They also have a high efficiency in detecting anatomical complexities in the root canal system. They are both superior methods in evaluating and assessing canal preparation quality and could help in sample selection; however, they have a larger radiation exposure, longer time, and complex procedure compared with the Double Digital methods.

4.2.5. Study Limitations

Although this study used specific search keywords and screened a dense body of literature, it was intended as a discussion of the pros and cons of different rotary file performance evaluation methods and not as a systematic review. Moreover, the review covered only in vitro/ex vivo methods assessment and was not intended to be used as a clinical tool for direct in vivo evaluation. Because this was a literature review rather than a systematic review, certain constraints in the study could be removed in future systematic reviews. For example, searches could be conducted spanning more objectively defined time periods (i.e., longer to explore history of methods or shorter to focus on the most modern technologies), and more combinations of keywords might be used to conduct a systematic review of this topic. In the current analysis, we excluded other review articles because they do not present original research data points, and the goal of the project was to focus on original research and data collection methods. However, future systematic reviews on this topic might make use of existing review articles for faster and more thorough identification of original research studies. Finally, we limited our search to articles written in English; future studies could remove this constraint to minimize any geographic bias that English-language-only studies may have imparted.

5. Conclusions

This review conducted searches and analyses on canal transportation and centering ability evaluation parameters. Here, 651 publications were identified and screened, resulting in 87 studies being selected and analyzed. Some conclusions and recommendations are the following:
Evaluating the shaping ability of root canal files becomes essential with the gradual introduction of new instruments to the market.
MCT is an outstanding method for evaluating transportation and centering ability, with the highest resolution and ability to assess in 3D. CBCT followed closely behind MCT in our literature review, with similar assessment performance to MCT but with lower resolution and lower ability to resolve small anatomical changes. The Double Digital Images (DDI) technique is also an excellent, low-cost, and simple method, particularly for evaluating whether canal anatomy remains the same after instrumentation use. However, photographs cannot be reconstructed in 3D, which reduces the ease of volumetric assessment and the ability to detect anatomic features that change out of the plane of measurement.
Future studies evaluating rotary file performance should be based on the use of 3D evaluation methods and more homogeneous endodontic sample materials so that the results offer a more consistent understanding of instrument performance and its effects on the internal anatomy of the root canal system.
This literature review has identified important factors to consider when selecting evaluation methods to evaluate rotary endodontic files; these factors are critical, not only for assessing methods selection depending on the research question, but for informing future study design to promote the harmonization of research design going forward. The factors to consider include endodontic sample type (extracted tooth versus simulated block), parameters being assessed (e.g., canal transportation versus centering ability), and the pros and cons of each evaluation method. A possible extension of this work is that future reviews could be carried out on an individual parameter to test evaluation methods by specific parameters rather than as a whole since different parameters may be optimized by different evaluation methods. In addition, a systematic review would be advised for obtaining evidence-based recommendations for establishing formal clinical guidelines for evaluation methods testing.

Author Contributions

Conceptualization, R.F.E.; methodology, R.F.E.; software, R.F.E. and K.E.S.; validation, A.M.A., J.D., K.E.S. and R.d.T.L.; formal analysis, R.F.E., J.D. and K.E.S.; investigation, R.F.E.; resources, R.F.E.; data curation, R.F.E. and K.E.S.; writing—original draft preparation, R.F.E., A.M.A., J.D., K.E.S. and R.d.T.L.; writing—review & editing, R.F.E., A.M.A., J.D., K.E.S. and R.d.T.L.; visualization, J.D. and K.E.S.; supervision, A.M.A., J.D. and K.E.S.; project administration, A.M.A. and J.D. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

The original contributions presented in the study are included in the article; further inquiries can be directed to the corresponding author.

Acknowledgments

The authors would like to express their gratitude to Azza El Sahli for her valuable technical support in editing and formatting the manuscript.

Conflicts of Interest

The authors declare no conflicts of interest.

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Dentistry 12 00334 g001
Figure 1. Literature search and selection process.
Figure 1. Literature search and selection process.
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Figure 2. Percentage of evaluation methods used in descending order.
Figure 2. Percentage of evaluation methods used in descending order.
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Table 1. Studies included in reverse chronological order.
Table 1. Studies included in reverse chronological order.
No.YearAuthor/Reference Endodontic Sample Type(s)Evaluation MethodEvaluation Parameters
12024Shaimaa S
El-Desouky [11]		Upper primary anterior teethCBCTCanal transportation and centering ability
22024S Swathi [12]PremolarsHigh-Precision Nano-CTCanal centering
32024Bollineni A Swetha [13]Mandibular molarsDSLR CameraCentering capability
42024Qi Zhu [14]Maxillary first molarsMCT Canal transportation and centering ability
52023Anbarasu Subramanian [15]Mandibular first molarsCBCT Canal transportation and centering ability
62023Tanisha Singh [16]Mandibular molarsCone-Beam Computed TomographyCanal transportation and centering ability
72023Simar Kaur Manocha [17]Mandibular molarsCone-Beam Computed TomographyCanal transportation and centering ability
82023Nadine Hawi [18]Mandibular molarsMicro-Computed TomographyCanal transportation and centering ability
92022Vincenzo Biasillo [19]Simulated resin blocksDouble Digital Images (Photographs) and AutoCADCentering ability
102022Wania Christina Figueiredo Dantas [20] Mandibular molarsMicro-Computed TomographyCanal transportation and centering ability
112022Eduardo Hideki Suzuki [21]Mandibular molarsCone-Beam Computed TomographyCanal transportation and centering ability
122022Selvakumar Haridoss [22]Mandibular molarsCone-Beam Computed TomographyCanal transportation and centering ability
132022Lu Shi [23]Simulated resin blocksDouble Digital Images (Photographs) and Adobe PhotoshopCanal transportation and centering ability
142021Thamires C de Medeiros [24]Mandibular molarsMicro-Computed TomographyCanal transportation and centering ability
152021Mohammed Mustafa [25]Mandibular molarsCone-Beam Computed TomographyCanal transportation and centering ability
162021Shiva Shojaeian [26]Mandibular molarsMicro-Computed TomographyCanal transportation and centering ratio
172021Ibrahim Faisal [27]Mandibular molarsMicro-Computed TomographyCanal transportation and centering ability
182021A S Waly [28]Mandibular molarsCone-Beam Computed TomographyCanal transportation and centering ability
192021Kamil Zafar [29]Simulated resin blocksDouble Digital Images (Photographs) and Adobe PhotoshopCanal transportation and centering ability
202021Hamed Karkehabadi [30]Mandibular molarsCone-Beam Computed TomographyCanal transportation and centering ratio
212021Maryam Kuzekanani [31]Maxillary and Mandibular MolarsCone-Beam Computed TomographyCanal transportation
222021María de las Nieves Pérez Morales [32]Mandibular molarsMicro-Computed TomographyCanal transportation and centering ability
232020Swapnil Kolhe [33]Mandibular first molarsMicro-Compute TomographyCanal transportation and centering ability
242020Christina Razcha [34]Mandibular molarsMicro-Computed TomographyCanal transportation and centering ability
252020P. O. F. Fernandes [35]Mandibular molarsMicro-Computed TomographyCanal transportation
262020Burçin Arıcan Öztürk [36]Single rootedCone-Beam Computed TomographyCanal transportation and centering ability
272020P. H. Htun [37]Mandibular premolarsMicro-Computed TomographyCanal transportation
282020Mariana Mena Barreto Pivoto-João [38]Mandibular molarsMicro-Computed TomographyCentering ability
292020Franziska Haupt [39]Mandibular molarsMicro-Computed TomographyCanal transportation and centering ability
302020Emina Kabil [40]Maxillary molarsMicro-Computed TomographyCanal transportation and centering ability
312020Maria de las Nieves Perez Morales [41]Maxillary premolarsMicro-Computed TomographyCanal transportation and centering ratio
322019Peet J. van der Vyver [42]Maxillary molarsMicro-Computed TomographyCanal transportation and centering ratio
332019Zeliha Uğur Aydın [43]Mandibular molarsMicro-Computed TomographyCanal transportation and centering ability
342019Yousif Iqbal Nathani [44]Mandibular premolarsCone-Beam Computed TomographyCanal transportation and centering ability
352019Keiichiro Maki [45]Simulated resin blocksDouble Digital Images (Photographs) and Adobe PhotoshopCentering ability
362019Daniel José Filizola de Oliveira [46]Mandibular molarsMicro-Computed TomographyCanal transportation
372018Martin Vorster [47]Mandibular molarsMicro-Computed TomographyCanal transportation and centering ability
382018M. M. Kyaw Moe [48]Mandibular molarsMicro-Computed TomographyCanal transportation and centering ratio
392018Mohamed Medhat Kataia [49]Simulated resin blocksDouble Digital Images (Photographs) and Adobe PhotoshopCanal transportation
402018Seyed Mohsen Hasheminia [50]Mandibular molarsCone-Beam Computed TomographyCanal transportation and centering ability
412018Simone Staffoli [51]Simulated blocksDouble Digital Images (Photographs) and Adobe PhotoshopCentering ability
422018E. A. Saberi [52]Mandibular molarsCone-Beam Computed TomographyCanal transportation
432018Guohua Yuan [53]Mandibular molarsMicro-Computed TomographyCanal transportation
442018Pedro Marks Duarte [54]Maxillary molarsMicro-Computed TomographyCanal transportation and centering ability
452018Felipe Gonçalves Belladonna [55]Mandibular molarsMicro-Computed TomographyCanal transportation
462017Giulia Ferrara [56]Mandibular and maxillary molarsDouble Digital Images (Radiographs) and Adobe PhotoshopCanal transportation
472017Amin A. H. Alemam [57]Simulated resin blocksDouble Digital Images (Photographs) and Image-Pro Plus Canal transportation
482017Maurizio D’Amario [58]Mandibular molarsDouble Digital Images (Radiographs) and AutoCadCanal transportation
492017Taha Özyürek [59]Simulated resin blocksDouble Digital Images (Photographs) and AutoCadCanal transportation
502017Caroline Zanesco [60]Maxillary molarsMicro-Computed Tomography and Digital RadiographCanal transportation and centering ratio
512017Pier Matteo Venino [61]Max./Mand. molars, premolars and canineMicro-Computed TomographyCanal transportation and centering ratio
522017Lu Shi [62]Simulated resin blocksDouble Digital Images (Photographs) and Adobe PhotoshopCentering ability
532016Ana Grasiela da Silva Limoeiro [63]Mandibular molarsMicro-Computed TomographyCanal transportation and centering ability
542016Zhaohui Liu [64]PremolarsMicro-Computed TomographyCanal transportation
552016Farzana Paleker [65]Mandibular molarsMicro-Computed TomographyCanal transportation and centering ability
562016Ranya Faraj Elemam [10]Simulated resin blocksDouble Digital Images (Photographs) and AutoCadCanal transportation
572016Filipa Neto [66]Simulated resin blocksDouble Digital Images (Photographs) and Adobe PhotoshopCanal transportation
582015Ove A. Peters [67]Mandibular molarsMicro-Computed TomographyCanal transportation
592015Jason Gagliardi [68]Mandibular molarsMicro-Computed TomographyCanal transportation and centering ability
602015Emmanuel João Nogueira Leal Silva [69]Simulated resin blocksDouble Digital Images (Photographs) and Fiji Canal transportation
612015Abdulrahman Mohammed Saleh [70]Simulated resin blocksDouble Digital Images (Photographs) and Adobe PhotoshopCanal transportation
622015Damiano Pasqualini [71]Mandibular molarsMicro-Computed TomographyCanal transportation and centering ability
632015Guilherme Moreira de Carvalho [72]Mandibular molarsCone-Beam Computed TomographyCanal transportation and centering ability
642014K. K. Al-Manei [73]Mandibular molarsDouble Digital Images (Photographs) and AutoCadCanal transportation
652014Amr M. Elnaghy [74]Mandibular molarsCone-Beam Computed TomographyCanal transportation and centering ability
662014Matthew Thompson [75]Simulated resin blocksDouble Digital Images (Photographs) and Adobe PhotoshopCentering ability
672014Dan Zhao [76]Mandibular molarsMicro-Computed TomographyCanal transportation
682014Young-Hye Hwang [77]Maxillary molarsMicro-Computed TomographyCanal transportation
692014Nazarimoghadam K [78]Simulated resin blocksDouble Digital Images (Photographs) and AutoCadCanal transportation
702013Abeer M. Marzouk [79]Mandibular molarsCone-Beam Computed TomographyCanal transportation
712013Mina Zarei [80]Mandibular molarsDouble Digital Images (Photographs) and Adobe PhotoshopCanal transportation and centering ability
722012Jeffrey R Burroughs [81]Simulated resin blocksDouble Digital Images (Photographs) and Adobe PhotoshopCanal transportation
732012Brandon Yamamura [82]Mandibular molarsMicro-Computed TomographyCanal transportation and centering ability
742012Cumhur Aydin [83]Simulated resin blocksDouble Digital Images (Photographs) and Adobe PhotoshopCanal transportation
752012Fernando Duran-Sindreu [84]Mandibular molarsDouble Digital Images (Radiographs) and AutoCadCanal transportation
762012Ahmed Abdel Rahman Hashem [85]Mandibular molarsCone-Beam Computed TomographyCanal transportation and centering ability
772012Marc García [86]Mandibular molarsDouble Digital Images (Radiographs) and AutoCadCanal transportation
782012Stern S [87]Mandibular molarsMicro-Computed TomographyCanal transportation and centering ratio
792011Guobin Yang [88]Mandibular molarsMicro-Computed TomographyCanal transportation and centering ability
802011Hani F. Ounsi [89]Simulated resin blocksDouble Digital Images (Photographs) and AutoCadCanal transportation
812011Laila Gonzales Freire [90]Mandibular molarsMicro-Computed Tomographycanal transportation and centering ability
822011Vittorio Franco [91]Simulated resin blocksDouble Digital Images (Photographs) and Adobe PhotoshopCanal transportation
832010Frank C. Setzer [92]Mandibular molarsDouble Digital Images (Radiographs) and AutoCadCanal transportation
842010Bekir Karabucak [93]Mandibular molarsDouble Digital Images (Radiographs) and AutoCadCanal transportation
852010Rui Gonçalves Madureira [94]Simulated resin blocksDouble Digital Images (Radiographs) and Adobe PhotoshopCanal transportation
862010Richard Gergi [95]Mandibular molarsCone-Beam Computed TomographyCanal transportation and centering ratio
872010Mian K. Iqbal [9]Mandibular molarsDouble Digital Images (Radiographs) and AutoCadCanal transportation
Table 2. Distributions of studies per endodontic sample type, evaluation methods, and evaluation parameters.
Table 2. Distributions of studies per endodontic sample type, evaluation methods, and evaluation parameters.
Parameters:
Endodontic Sample Type
Evaluation Method		Canal TransportationCanal Transportation and Centering AbilityCanal Transportation and Centering RatioCentering AbilityTotal
Mandibular and maxillary molars2 2
Cone-Beam Computed Tomography1 1
Double Digital Images (Radiographs) and Adobe Photoshop1 1
Mandibular molars16304151
Cone-Beam Computed Tomography2122 16
Double Digital Images (Photographs) and Adobe Photoshop 1 1
Double Digital Images (Photographs) and AutoCad1 1
Double Digital Images (Radiographs) and AutoCad6 6
Micro-Computed Tomography6182127
Digital single-lens reflex camera1 1
Mandibular premolars11 2
Cone-Beam Computed Tomography 1 1
Micro-Computed Tomography1 1
Max./Mand. molars, premolars and canine 1 1
Micro-Computed Tomography 1 1
Maxillary molars132 6
Micro-Computed Tomography121 4
Micro-Computed Tomography and Digital Radiograph 1 1
Cone-Beam Computed Tomography 1 1
Maxillary premolars 1 1
Micro-Computed Tomography 1 1
Premolars2 2
Micro-Computed Tomography1 1
High-Precision Nano-CT1 1
Upper primary anterior teeth 1 1
Cone-Beam Computed Tomography 1 1
Simulated blocks 11
Double Digital Images (Photographs) and Adobe Photoshop 11
Simulated resin blocks132 419
Double Digital Images (Photographs) and Adobe Photoshop62 311
Double Digital Images (Photographs) and AutoCad3 14
Double Digital Images (Photographs) and Fiji 1 1
Double Digital Images (Photographs) and Image-Pro Plus 1 1
Double Digital Images (Photographs), Matlab, and Adobe Photoshop1 1
Double Digital Images (Radiographs) and Adobe Photoshop1 1
Single rooted 1 1
Cone-Beam Computed Tomography 1 1
TOTAL35397687
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Elemam, R.F.; Azul, A.M.; Dias, J.; El Sahli, K.; de Toledo Leonardo, R. In Vitro Research Methods Used to Evaluate Shaping Ability of Rotary Endodontic Files—A Literature Review. Dent. J. 2024, 12, 334. https://doi.org/10.3390/dj12100334

AMA Style

Elemam RF, Azul AM, Dias J, El Sahli K, de Toledo Leonardo R. In Vitro Research Methods Used to Evaluate Shaping Ability of Rotary Endodontic Files—A Literature Review. Dentistry Journal. 2024; 12(10):334. https://doi.org/10.3390/dj12100334

Chicago/Turabian Style

Elemam, Ranya F., Ana Mano Azul, João Dias, Khaled El Sahli, and Renato de Toledo Leonardo. 2024. "In Vitro Research Methods Used to Evaluate Shaping Ability of Rotary Endodontic Files—A Literature Review" Dentistry Journal 12, no. 10: 334. https://doi.org/10.3390/dj12100334

APA Style

Elemam, R. F., Azul, A. M., Dias, J., El Sahli, K., & de Toledo Leonardo, R. (2024). In Vitro Research Methods Used to Evaluate Shaping Ability of Rotary Endodontic Files—A Literature Review. Dentistry Journal, 12(10), 334. https://doi.org/10.3390/dj12100334

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