Comparison of Glide Path and Pathfiles in Canal Preparation by Cone-beam Computed Tomography: An Original Research.

Introduction: Endodontics has become a routine practice in the recent times and many recent advanced rotary systems are available commercially. Hence, in our study, we describe the canal transportation of the different file systems in various combinations of the "Glide path (Gp)" by cone-beam computed tomography (CBCT). Materials and
Methods: In vitro study was with 40 single-rooted extracted human teeth that were grouped as "Group 1: Pathfiles (PF) and Group 2: V Gp 2 (V2)." Measurement of Centric ability, canal transportation, root canal curvature of the CBCT images was compared of the pre and the postpreperation of the canals with the two systems.
Results: PF showed greater curvatures, working time, canal transportations, compared to the V2. PF showed lesser centric ratio, removed greater dentine compared to the V2 and also the cross-sectional area was also greater for the PF than V2.
Conclusion: V2 performed superiorly than PF showing lesser canal transportation. Copyright:

INTRODUCTION

Endodontics has become a vital part aspect of the routine clinical practice. The outcome of the dental endodontics is a factor of the preperation and the dental radicular anatomy. The best result is obtained in the preparations of the root canal that can be easily filled with the restorative materials and have a shape that favors such.[123] In this context, the “Glide Path (Gp)” was introduced. West defined Gp as “a smooth radicular tunnel from the canal orifice to the physiologic terminus of the root canal.” In the Gp preparation, different file systems have been put forward.[456] Hence, in our study, we aim to evaluate the canal transportation of these different file systems in the various combinations of the Gp using the cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

We conducted an in vitro study with 40 extracted human single canal teeth. They were assigned equally in number to different groups as “Group 1: Pathfiles (PF) (Dentsply Maillefer, Ballaigues, Switzerland); Group 2: V Gp 2 (V2) (SS White Technologies UK, Inc.).” The root canal access cavities were established with the patency checked with a 10 number k-file, keeping half millimeter short of the apex (radiographic). Later, CBCT imaging was taken from the most apical part of the tooth at 7, 5, 3, 2, 1, and 0 mm preoperatively. The preperation of the root canal was done with both the systems as per the manufacturer's guidelines. Postoperative CBCT images were taken later. The images that were obtained using the “CS3D (Carestream Dental, US)” and they were superimposed for the comparison of the pre and postoperative changes in the canal using the “On Demand Software (Cybermed Inc., Korea Version 1.0)” Figure 1. The following parameters were compared between the two file systems-Measurement of Centric ability, canal transportation, Root canal curvature, and the working length.

Figure 1

The superimposed images of the cone-beam computed tomography

RESULTS

We observed that PF showed greater curvatures compared to the V2 with 1.69° and 1.29°, respectively. PF took greater working time compared to the V2 with 69.6 and 38.7 s, respectively. PF showed greater canal transportations for all the levels of the canal at 7, 5, 3, 2, 1, and 0 mm, compared to the V2. PF showed lesser centric ratio compared to the V2. PF removed greater dentine compared to the V2 and also the cross-sectional area was also greater for the PF than V2 Table 1.

Table 1

Comparison of the different parameters for the pathfiles and V Glide Path 2

Variable	PF	V2
Measurement of centric ability (mean)	0.63	0.85
Canal transportation (mean at all 5 cross sections)	2.3	1.5
Curvature of the root canal	1.69	1.29
Working length (s)	69.6	38.7
Change in area (mean at all 5 cross sections)	0.81	0.42
Remaining dentin thickness (mean at all 5 cross sections)	1.57	2.56

PF: Pathfiles, V2: V Glide Path 2

DISCUSSION

The preperation of the root canal is inherent to human errors. One main among these is the canal transportation.,[4567] This is even more for the curved canals. This curved canals that are often encountered may present a challenge to the dentist. Precaution has to be taken to prevent the instrument fracture, perforations, etc. The GP has been proposed to enhance the success of the randomized controlled trials (RCTs). In this context, the concept of the Gp has been put forward. After the advent of the rotary systems, the RCT has become more sophisticated and less time consuming. These systems are continuous evolving and many commercially available file systems are available in the market.[45] Hence, in our study, we compared two such systems of various GP executing the CBCT image superimpositions. In our study, we observed that V2 caused less canal transportation than the PF. The V2 showed better centric ability compared to PF. The aggressiveness of the instrument is measured by the removal of the dentine. The Nickel-titanium is known for their efficiency. In our study, we found that PF removed more dentin than the V2. PF showed greater curvatures, working time, compared to the V2. The safety of the file can be measured by its cutting efficiency but not restricted to this feature or the degree of the transportation alone. The best file system should maintain the optimal dentin while planning the entire canal.[567] Lesser working time in the preperation will allow for the operator more time for cleaning and irrigation that will impact the success of the RCT. The other advantages seen with both the systems have been previously described individually comparing with the manual RCT.[7] Our study is one of the few comparing the PF and V2. The limitation of the study was that there were few curved canals and the study may have been biased as a single observer conducted the study.

CONCLUSION

To conclude, the V2 exhibited efficiency in the Gp preperation compared to the PF. Further clinical studies with different teeth are suggested to understand the outcomes of these systems.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.