International Journal of Applied Dental Sciences 2016; 2(2): 19-23

ISSN Print: 2394-7489

ISSN Online: 2394-7497
IJADS 2016; 2(2): 19-23
2016 IJADS
www.oraljournal.com
Received: 05-02-2016
Accepted: 05-03-2016
Dr. Vamshi Krishna V
Post Graduate Student, Department
of Conservative Dentistry and
Endodontics, Krishnadevaraya
College of Dental Sciences and
Hospital, Bangalore, India.
Dr. Sujatha I
MDS Professor, Department of
Conservative Dentistry and
Endodontics, Krishnadevaraya
College of Dental Sciences and
Hospital, Bangalore, India.
Dr. Jayalakshmi KB
MDS Professor, Department of
Conservative Dentistry and
Endodontics, Krishnadevaraya
College of Dental Sciences and
Hospital, Bangalore, India.
Dr. Prasanna Latha Nadig
MDS Professor Department of
Conservative Dentistry and
Endodontics, Krishnadevaraya
College of Dental Sciences and
Hospital, Bangalore, India.
Dr. Sharath Chandra SM
MDS Professor Department of
Conservative Dentistry and
Endodontics, Krishnadevaraya
College of Dental Sciences and
Hospital, Bangalore, India.
Dr. Mayur GN
BDS Department of Conservative
Dentistry and Endodontics,
Krishnadevaraya College of Dental
Sciences and Hospital, Bangalore,
India.
Dr. Sivaji K
Post Graduate Student, Department
of Conservative Dentistry and
Endodontics, Krishnadevaraya
College of Dental Sciences and
Hospital, Bangalore, India.
Dr. Gyanendra Pratap Singh
Post Graduate Student, Department
of Conservative Dentistry and
Endodontics, Krishnadevaraya
College of Dental Sciences and
Hospital, Bangalore, India.
Correspondence
Dr. Vamshi Krishna V
Post Graduate Student, Department
of Conservative Dentistry and
Endodontics, Krishnadevaraya
College of Dental Sciences and
Hospital, Bangalore, India.
Comparison of the cleaning effectiveness of Mtwo &
protaper next rotary systems in permanent molar root
canals: An in vitro study
Dr. Vamshi Krishna V, Dr. Sujatha I, Dr. Jayalakshmi KB, Dr. Prasanna
Latha Nadig, Dr. Sharath Chandra SM, Dr. Mayur GN, Dr. Sivaji K,
Dr. Gyanendra Pratap Singh
Abstract
Aim: The aim of this in vitro study was to evaluate the presence of debris on the dentinal wall of palatal
root of maxillary molars and distal root of mandibular molars after instrumentation with rotary Mtwo and
Protaper Next files under stereomicroscope.
Materials and Methods: Forty freshly extracted human maxillary /mandibular molar teeth were selected
for this study. Teeth were divided into two groups of 20 teeth each (group A and B).Teeth were
decoronated at the CEJ, palatal and distal roots were taken. In group A, all the 20 canals were subjected
to cleaning and shaping with rotary Mtwo files and rotary Protaper Next files in group B. After splitting
the roots longitudinally, the dentinal debris of each root canal was evaluated at three areas (coronal,
middle and apical thirds of the root) by means of numerical evaluation scale, under a stereomicroscope.
The data obtained were analysed statistically using Mann-Whitney Test.
Results: There was no significant difference in the debris scores between the Mtwo group and Protaper
Next group in the total canal area.
Conclusions: Under the condition of the present study, both the instruments Mtwo and Protaper Next
rotary systems can be used to complete the preparation of canals. The use of Protaper Next instruments
resulted in better canal cleanliness in the middle part compared with Mtwo.
Keywords: Dentinal debris; rotary Mtwo; rotary Protaper Next; and Stereomicroscope
Introduction
The elimination of intracanal microorganisms is the major goal of root canal treatment. This
can be achieved with a proper chemo-mechanical preparation and is thus essential for
successful endodontic treatment [1, 2]. However, currently no instrument can predictably clean
the entire root canal system, especially in the apical portion of the root canals [3, 4]. Canals
prepared with stainless steel instruments were only superficially cleaned and much of the pulp
tissue was not removed. Stainless steel files have also been shown to create canal aberrations,
such as ledges, perforations, zips and elbows [5, 6]. To eliminate some of the short comings of
these traditional endodontic instruments, nickel-titanium (Ni-Ti) instruments have been
developed. Most of the new systems incorporate instruments with a taper greater than ISO
standard.02 design [6, 7]. Besides variation in taper, nickel-titanium instruments are
characterized by different cross-sections and blade design [6] Studies have shown that Ni-Ti
instruments can effectively produce a well-tapered root canal form sufficient for obturation,
with minimal risk of transporting the original canal [7-11]. Moreover, these investigations have
shown that the different Ni-Ti instruments produce inconsistent results and this variation in the
debri removal efficiency of these instruments may be due to variation in flute designs.
Mtwo (VDW, Munich, Germany) instruments have an S-shaped cross sectional design with a
non-cutting tip. The two cutting edges have positive rake angle to cut dentine effectively.
Moreover, the pitch length increases from the tip to the shaft. This design is claimed to
eliminate threading and binding in continuous rotation, and to reduce transportation of debris
towards the apex. The manufacturers claim that crown down instrumentation sequence is no
longer required, since each instrument creates a glide path to the apex for the following
instrument, and is used to the full working length to shape the entire length of the canal [12].
~19~
International Journal of Applied Dental Sciences
The ProTaper Next (Dentsply Maillefer, Ballaigues,
Switzerland) is the successor of the Pro Taper Universal
system (Dentsply Maillefer). It has an innovative off-centred
rectangular cross section that gives the file a snake-like
swaggering movement as it advances into the root canal. The
manufacturer claims that the rotation of this cross section
generates enlarged space for debris removal. These
instruments are manufactured from M-wire alloy that is
claimed to improve file flexibility and resistance to cyclic
fatigue whilst retaining cutting efficiency [13, 14].
The ability of rotary NiTi instruments to remove dentine and
pulpal debris during shaping is related to design features of the
instrument, particularly the cross-sectional profile and the
flutes [15]. The purpose of this study was to compare the
cleaning effectiveness of the Mtwo and ProTaper Next
systems, in the palatal canal of maxillary molar and distal
canal of mandibular molars in human permanent molar teeth.
Materials and Methods:
A total of 40 extracted human mandibular and maxillary molar
teeth with single distal and palatal root canal were used. Teeth
were decoronated at CEJ and the canals were assessed for
apical patency using an ISO 15 file. Teeth with intact root
apices and root canal width of ISO 15 size in the apical third
region were used [Fig 1]. The selected teeth were then divided
randomly into two experimental groups of 20 each. In group
A, the Mtwo system was used in the selected distal/palatal
canal, according to the manufacturer's instructions. The
instrumentation sequence employed five files, as follows: 0.04
taper ISO 10, 0.05 taper ISO 15, 0.06 taper ISO 20, 0.06 taper
ISO 25, 0.06 taper ISO 30. All five instruments were used to
the full working length of the canals, employing a cyclical in-
out motion. Irrigation was performed after each instrument
change, with 2 ml of 2.5% NaOCl and finally at the end of
instrumentation with 5 ml of Nacl using syringe. Each
instrument was used to prepare only four root canals in group
B, the selected distal/palatal root canal was instrumented using
the ProTaper Next system to the full length of the canals in the
following sequence: X1 instrument. Taper 0.04, Size 17; X2
instrument. Taper 0.06, Size 25; X3 instrument. Taper 0.07,
Size 30.
The same cyclical in-out motion and irrigation protocol was
used as with Mtwo instruments. Each instrument was used to
prepare only four root canals.
After preparation, all the root canals were flushed with 5ml
Nacl and dried with absorbent paper points and roots were
split longitudinally [Fig 2] with water-cooled double-faced
diamond disk operated at low speed and then examined under
a stereomicroscope with 20x magnification. [Fig 3]
Presence of debris was evaluated with the 5-score index [16].
The cleanliness of each root canal was evaluated at three
different areas {apical, middle, coronal third of root}. [Table
1]
Score 1: clean canal wall, only very few debris particles. [Fig
4]
Score 2: few small conglomerations. [Fig 5]
Score 3: many conglomerations; less debris than 50 % of the
canal wall covered. [Fig 6]
Score 4: more than 50% of the canal wall covered. [Fig 7]
Score 5: complete or nearly complete covering of the canal
wall by debris [Fig 8]
The data were recorded and analysed statistically using Mann-
Whitney Test for comparison of the two groups. The level of
statistical significance was set at P<0.05.
~20~
Results
There was no significant difference in the scores between the
coronal third and apical third between group A and group B.
However there was statistical difference in the scores at the
middle third level between the groups [Table 2]. There was no
significant difference in scores between Mtwo group and the
Protaper Next group in the total canal area [Table 3].
Discussion
The removal of vital and/or necrotic pulp tissue, infected
dentine and dentine debris to eliminate most of the micro-
organisms from the root canal system is still one of the most
important objectives during root canal instrumentation [17].
Debris have been used as criteria in this study to assess the
cleaning efficiency of the different instruments, because debris
comprises dentine chips, residual vital or necrotic pulp tissue
attached to the root canal wall that is considered to be infected
in many cases [18].
Considering the major objective of the present study (to
compare the cleaning effectiveness of the different
instruments), a simple irrigation protocol with only NaOCl
was used, avoiding any influence of different irrigation
solutions, as justified in detail in several previous studies [19, 20,
21]
. Thus, it should be accentuated that the cleaning efficiency
of the instruments evaluated in the present investigation might
be enhanced using a combination of NaOCl and EDTA as a
chelating agent. In the present study, the cleaning efficiency
was examined on the basis of a numerical evaluation scheme
for debris, by means of an Stereomicroscope -evaluation of the
coronal, the middle and the apical parts of the canals [22]. The
present results confirm previous observations that cleanliness
decreased from the coronal to the apical part of the root canal.
[23-25]
Therefore, sufficient disinfection and copious irrigation
are essential to improve root canal cleanliness [23, 25].
In the coronal third and middle third of the canals,
instrumentation with Protaper Next resulted in significantly
less remaining debris compared with Mtwo. A possible reason
for this could be their cross sectional design. ProTaper Next
files have a unique swaggering motion which is attributed to
unique patented off-centred rectangular cross section. This
swaggering motion means that at all times the file is only
contacting with the canal in two places which allows a greater
space for removal of debris, optimises canal tracking and
reduces binding [26].
In the apical third of the canals, Mtwo resulted in less
remaining debris compared with Protaper Next but there is no
significant difference. The greater taper of ProTaper next (size
30, taper.07) compared with Mtwo (size 30, taper.06) might be
reason for the increased amounts of residual debris especially
in the apical portion of the canals because it might be assumed
that ProTaper Next instruments are less flexible at their tip
region compared to the less tapered Mtwo files [27, 28].
A comparison of the results obtained in previous studies under
similar experimental conditions with those of the present study
reveals that all instruments used displayed a relatively good
cleaning ability. The mean overall score for debris was in the
range from 2.03 for protaper next to 2.36 for Mtwo. Thus,
according to the average score for debris obtained in the
present study, it can be concluded that both the instruments
can be used to complete the preparation of canals.
Conclusion
Under the condition of the present study, both the instruments
Mtwo and Protaper Next rotary systems can be used to
complete the preparation of canals. The use of Protaper Next
instruments resulted in better canal cleanliness in the middle
part compared with Mtwo.
International Journal of Applied Dental Sciences

Fig 1: Armamentarium Fig 5: SCORE 2

Fig 2: Sectioned samples after preparation Fig 6: SCORE 3

Fig 3: Stereomicroscope with mounted sample Fig 7: SCORE 4

Fig 4: Score 1 Fig 8: SCORE 5

Table 1: Summary of scores for debris

~21~
International Journal of Applied Dental Sciences
Table 2: Mean and Std. Deviation values
N Minimum
Coronal [Group A] 20 1 3
Coronal [Group B] 20 1 2
Middle [Group A] 20 1 4
Middle [Group B] 20 1 3
Apical [Group A] 20 1 5
Apical [Group B] 20 1 5
P<0.05
Table 3: Over all mean value
Instrument N Mean value p-value
Mtwo 60 2.36
0.09
Protaper Next 60 2.03
P<0.05
References
1. Hulsmann M, Peters OA, Dummer PMH. Mechanical
preparation of root canals: shaping goals, techniques and
means. Endodontic Topics 2005; 10:30-76.
2. Averbach RE, Kleier DJ. Clinical update on root canal
disinfection. Compendium of Continuous Education in
Dentistry 2006; 27:284, 286-9.
3. Usman N, Baumgartner JC, Marshall JG. Influence of
instrument size on root canal debridement. Journal of
Endodontics. 2004; 30:110-2.
4. Wu MK, Wesselink PR. Efficacy of three techniques in
cleaning the apical portion of curved root canals. Oral
SurgeryOral Medicine Oral Pathology Oral Radiology &
Endodontology 1995, 79:492-6.
5. Schafer E, Tepel J, Hoppe W. Properties of endodontic
hand instruments used in rotary motion: Part 2-
Instrumentation of curved canals. J Endod. 1995; 21:493-
7.
6. Bergmans E, Van Clenynenbreugel J, Wevers M,
Lambrechts P. Mechanical root canal preparation with
NiTi rotary instruments: rationale, performance and
safety- Status report for the American journal of
Dentistry. Am J Dent. 2001; 14:324-33.
7. Thompson SA, Dummer PM. Shaping ability of NT
engine and McXim rotary nickel-titanium instruments in
stimulated root canals: Part 1. Int Endod J. 1997; 30:262-
9.
8. Bertrand MF, Lupi-Pegurier L, Medioni E, Mullar M,
Bolla M. Curved molar root canal preparations using Hero
642 rotary nickel-titanium instruments. Int Endod J. 2001;
34:631-6.
9. Hulsmann M, Schade M, Schafers F. A comparative study
of root canal preparation with HERO 642 and Quantac SC
rotary Ni-Ti instruments. Int Endod J. 2001; 34:538-66.
10. 10. Hulsmann M, Gressmann G, Schafers F. A
comparative study of root canal preparation using
Flexmaster and HERO 642 rotary Ni-Ti instruments. Int
Endod J. 2003; 36:358-66.
11. Schafer E, Lohmann D. Efficiency of rotary nickel-
titanium Flexmaster instruments compared with stainless
steel hand K-flexofile: Part 2- Cleaning effectiveness and
instrumentation results in severely curved root canals of
extracted teeth. Int Endod J. 2002; 35:514-21.
12. Kuzekanani M, Walsh LJ, Yousefi MA. Cleaning and
shaping curved root canals: Mtwo vs ProTaper
instruments, a lab comparison. Indian J Dent Res. 2009;
20:268-70.
13. Alapati SB, Brantley WA, Iijma M. Metallurgical
characterization of a new nickel-titanium wire for rotary
Maximum Mean Std. Deviation p-value
1.75 .716
0.422
1.55 .510
2.65 1.089
0.010
1.80 .616
2.70 1.218
0.742
2.75 1.020
endodontic instruments. Journal of Endodontics 2009;
35:1589-93.
14. Zhou H, Peng B, Zheng YF. An overview of the
mechanical properties of nickel-titanium endodontic
instruments. Endodontic Topics 2013; 29:42-54.
15. Gambarini G, Lasakiewics J. A scanning electron
microscopic study of debris and smear layer remaining
following GT rotary instruments. Int Endod J. 2002;
35:422-7.
16. Hulsmann M, Rummelin C, Schafers F. Root canal
cleanliness after preparation with different endodontic
handpieces and hand instruments: a comparative SEM
investigation. J Endod. 1997; 33:150.
17. European Society of Endodontology. Quality guidelines
for endodontic treatment: consensus report of the
European Society of Endodontology. International
Endodontic Journal 2006; 39:921-30.
18. Hulsmann M, Rummelin C, Schafers F. Root canal
cleanliness after preparation with different endodontic
handpieces and hand instruments: a comparative SEM
investigation. Journal of Endodontics. 1997; 23:301-6.
19. Schafer E, Vlassis M. Comparative investigation of two
rotary nickel-titanium instruments: ProTaper versus RaCe.
Part 2. Cleaning effectiveness and instrumentation results
in severely curved root canals of extracted teeth.
International Endodontic Journal. 2004; 37:239-48.
20. Bu rklein S, Schafer E. The influence of various
automated devices on the shaping ability of Mtwo rotary
nickel-titanium instruments. International Endodontic
Journal 2006; 39:945-51.
21. Bu rklein S, Hiller C, Huda M, Schafer E. Shaping
ability and cleaning effectiveness of Mtwo versus coated
and uncoated EasyShape instruments in severely curved
root canals of extracted teeth. International Endodontic
Journal. 2011; 44:447-57.
22. Singh S, Nigam N. Comparative evaluation of surface
characteristics of dentinal walls with and without using
plastic finishing file. J Conserv Dent. 2010; 13:89-93.
23. Hulsmann M, Gressmann G, Schafers F. A comparative
study of root canal preparation using Flex Master and
HERO 642 rotary Ni-Ti instruments. International
Endodontic Journal. 2003; 36:358-66.
24. Haapasalo M, Endal U, Zandi H, Coil JM. Eradication of
endodontic infection by instrumentation and irrigation
solutions. Endodontic 2005; 10:77-102.
25. Paque F, Musch U, Hulsmann M. Comparison of root
canal preparation using RaCe and ProTaper rotary Ni-Ti
instruments. International Endodontic Journal. 2005; 38:8-
16.
26. Macmillan publishers limited: An endodontic file with
swagger. British dental journal. 2013; 214:11.
27. Dobo-Nagy C, Serban T, Szabo J. A comparison of the
shaping characteristics of two nickel-titanium endodontic
hand instruments. International Endodontic Journal. 2002;
35:283-8.
~22~
International Journal of Applied Dental Sciences

28. Schafer E, Erler M, Dammaschke T. Comparative study

on the shaping ability and cleaning efficiency of rotary
Mtwo instruments. Part 2. Cleaning effectiveness and
shaping ability in severely curved root canals of extracted
teeth. International Endodontic Journal. 2006; 39:203-12.

~23~