Comparative Evaluation of Three Endodontic File Systems for Pericervical Dentin Preservation and Canal Transportation Using Cone-Beam Computed Tomography: An In Vivo Study.

INTRODUCTION

The preservation of pericervical dentin (PCD) and maintenance of the original root canal anatomy are fundamental objectives of contemporary minimally invasive endodontics. Advances in nickel-titanium (NiTi) rotary instrumentation have led to the development of file systems designed to improve shaping efficiency while minimizing dentin removal and canal transportation. Therefore, our aim was to compare the effects of GenEndo (Coltene Holding AG, Altstätten, Switzerland), ProTaper Ultimate (Dentsply Sirona, Ballaigues, Switzerland), and TruNatomy (Dentsply Sirona, Ballaigues, Switzerland) rotary file systems on PCD preservation and canal transportation using cone-beam computed tomography (CBCT).

MATERIALS AND

METHODS

This prospective in vivo comparative clinical study included 30 mandibular first molars requiring primary root canal treatment. The teeth were categorized into three groups (n = 10 each) according to the rotary file system used: GenEndo, ProTaper Ultimate, and TruNatomy. Preoperative and postoperative CBCT scans were obtained to evaluate PCD thickness and canal transportation. PCD was measured 4 mm apical to the cemento-enamel junction at the buccal, lingual, mesial, and distal aspects. Canal transportation was calculated by comparing pre- and post-instrumentation CBCT measurements. Data were analyzed using one-way analysis of variance followed by Tukey's post hoc test, with statistical significance set at p < 0.05.

RESULTS

Significant intergroup differences were observed in PCD preservation at all evaluated surfaces (p < 0.05). TruNatomy demonstrated the greatest preservation of PCD, followed by GenEndo, whereas ProTaper Ultimate exhibited the greatest dentin removal. Canal transportation also differed significantly among the groups (P = 0.009). TruNatomy produced the lowest mean canal transportation (0.0160 ± 0.0158 mm), significantly lower than both GenEndo (P = 0.043) and ProTaper Ultimate (P = 0.007). No significant difference in canal transportation was observed between GenEndo and ProTaper Ultimate (P = 0.951).

CONCLUSIONS

Within the limitations of this prospective in vivo clinical study, TruNatomy demonstrated superior preservation of PCD and significantly reduced canal transportation compared with GenEndo and ProTaper Ultimate. These findings support the use of heat-treated NiTi rotary systems to maintain root canal anatomy while preserving critical dentin during endodontic treatment.