Which techniques preserve pericervical dentin, prevent fracture?

Removing too much pericervical dentin can compromise the integrity of teeth that have undergone endodontic therapy.

In an in vitro study published in Cureus, researchers sought to understand which instrumentation systems and taper types may best preserve pericervical dentin and minimize the risk of fracture among 40 newly extracted, intact, single-rooted mandibular first premolars following root canal treatment. They randomly assigned the teeth to undergo one of four instrumentation types: stainless steel hand files with a 2% taper, rotary files with a 4% taper, files up to F2 and rotary files with a 6% taper — using cone-beam computed tomography to measure pericervical dentin thickness at the cementoenamel junction prior to and following instrumentation. The investigators then obturated and restored the teeth with composite resin and subsequently assessed their fracture resistance.

While all four instrumentation groups demonstrated significant reductions in pericervical dentin after the procedure, rotary files with a 6% taper showed 0.42 ± 0.09 millimeters of pericervical dentin loss, followed by hand files with a 2% taper at 0.35 ± 0.10 millimeters, files up to F2 at 0.28 ± 0.11 millimeters and rotary files with a 4% taper at 0.23 ± 0.08 millimeters.

Further, files up to F2 exhibited the greatest levels of fracture resistance at 724.91 ± 149.39 Newtons, followed by rotary files with a 4% taper at 706.73 ± 134.52 Newtons, rotary files with a 6% taper at 654.68 ± 139.76 Newtons and hand files with a 2% taper at 635.42 ± 59.87 Newtons.

Because of the findings, the researchers argued that instrumentation type alone may not be responsible for pericervical dentin loss and fracture risk. They warned against interpreting the results of their study as demonstrating superiority among instrumentation types.

Read more: Cureus

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