Journal of endodontics · 2026
Planning protocol for apical preparation maximizing root canal wall instrumentation and preserving root dentin structural integrity.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Carvalho de Sousa Bruno, Cunha D'Assunção Fabio Luiz, Caldeira Celso Luiz, Dantas Hugo Victor, Barbosa de Sousa Frederico
Аннотация
INTRODUCTION: This study developed a personalized root canal instrumentation planning protocol designed to minimize uninstrumented canal walls while preserving a remaining dentin thickness (RDT) of at least 0.5 mm and compared it with the best available planning protocol.
METHODS: One hundred maxillary lateral incisors were scanned by micro-CT, and 400 cross-sections were analyzed at 1, 2, 3, and 4 mm from the apical foramen. Canal diameters, aspect ratio, and minimum RDT were measured. Virtual preparation was planned using 5 NiTi systems (ProTaper Ultimate, Reciproc Blue, SRF Sequence MKLife, HyFlex EDM, and WaveOne Gold) individually and a new hybrid protocol allowing instruments from multiple systems and hand K-files when necessary. The primary outcomes were uninstrumented canal surfaces and RDT <0.5 mm. Paired risk ratios (RRs), exact McNemar tests, and Bayes factors (BF10) were calculated.
RESULTS: The mean canal taper was 0.08 mm/mm, and the mean aspect ratio was 1.40 ± 0.59. Among single-system protocols, ProTaper Ultimate produced the lowest frequency of uninstrumented surfaces (215/400; 53.8%). The new protocol reduced this frequency to 52/400 (13.0%), corresponding to a 76% reduction versus ProTaper Ultimate (RR of 4.13; 95% CI, 3.20-5.34; p <.001). The hybrid protocol was also the only strategy with no sections presenting RDT <0.5 mm (0/400), whereas single-system protocols ranged from 1.8% to 4.5%. The protocol significantly outperformed every tested single-system strategy for both primary outcomes.
CONCLUSIONS: The new personalized hybrid instrumentation planning substantially reduced uninstrumented canal surfaces while preventing critical dentin thinning compared with existing customized single-system protocols.
METHODS: One hundred maxillary lateral incisors were scanned by micro-CT, and 400 cross-sections were analyzed at 1, 2, 3, and 4 mm from the apical foramen. Canal diameters, aspect ratio, and minimum RDT were measured. Virtual preparation was planned using 5 NiTi systems (ProTaper Ultimate, Reciproc Blue, SRF Sequence MKLife, HyFlex EDM, and WaveOne Gold) individually and a new hybrid protocol allowing instruments from multiple systems and hand K-files when necessary. The primary outcomes were uninstrumented canal surfaces and RDT <0.5 mm. Paired risk ratios (RRs), exact McNemar tests, and Bayes factors (BF10) were calculated.
RESULTS: The mean canal taper was 0.08 mm/mm, and the mean aspect ratio was 1.40 ± 0.59. Among single-system protocols, ProTaper Ultimate produced the lowest frequency of uninstrumented surfaces (215/400; 53.8%). The new protocol reduced this frequency to 52/400 (13.0%), corresponding to a 76% reduction versus ProTaper Ultimate (RR of 4.13; 95% CI, 3.20-5.34; p <.001). The hybrid protocol was also the only strategy with no sections presenting RDT <0.5 mm (0/400), whereas single-system protocols ranged from 1.8% to 4.5%. The protocol significantly outperformed every tested single-system strategy for both primary outcomes.
CONCLUSIONS: The new personalized hybrid instrumentation planning substantially reduced uninstrumented canal surfaces while preventing critical dentin thinning compared with existing customized single-system protocols.