The aim of the study was to evaluate the adhesive forces for removing iatrogenically fractured endodontic nickel-titanium instruments using a modified tube technique with various pre-treatment agents in combination with a light-curing composite. 120 Nickel-Titanium-Mtwo instruments were cut at its parallel shaft and fixed in a vise with an overlap of 2 mm. The surfaces were treated with different agents: A) GC Metalprimer; B) Prime and Bond active; C) NaOCl (3%); D) citric acid (15%); E) phosphoric acid (37%) and group (F) was not pretreated (control). One end of a matching microtube, filled with light-curing composite, was placed over the instrument and a transmitting glass fiber inserted from the opposite side guaranteed polymerization. Pull-out tests (1 mm/min) were performed and failure load was measured digitally. Data were statistically analyzed using the ANOVA and Student-Newman-Keuls tests. Interfaces were subjected to SEM analysis. Prime and Bond active created significant higher pull-out values (mean 30.5 N) compared to all other groups (p < 0.001) and Metalprimer (18.5 N) was significantly superior to the untreated (12.6 N) and NaOCl (11.7 N) group (p < 0.05). No significant differences were obtained between the other groups (p > 0.05). Thus, adhesives improved bonding to fractured NiTi instruments.

INTRODUCTION:The aim of this in vitro study was to assess an alternative method using light-curing composite for removing fractured endodontic instruments with a tube technique. METHODS:Two different stainless steel endodontic instruments (ISO 20: Hedstrom files, K-files; VDW, Munich, Germany) were cut at the diameter of 0.4 mm. These fragments were fixed in a vise leaving a free end of 1 or 2 mm. Cyanoacrylate (Instant Fix; Henry Schein Dental, Melville, NY), dual-curing Rebilda DC (VOCO, Cuxhaven, Germany), and light-curing SureFil SDR (Dentsply, York, PA) were placed into microtubes (N'Durance Syringe Tips; Septodont, Saint-Maur, France) and shifted over the instruments (n = 20 in each group). After polymerization, pull-out tests were performed with a constant speed of 2 mm/min; failure load was measured digitally. Data were analyzed using the Kruskal-Wallis test followed by the Dunn test for pairwise comparison. RESULTS:The median failure load was up to 62.5 N for SDR, 35.8 N for Rebilda, and 14.7 N for cyanoacrylate, respectively. Both tested composites yielded significantly higher values in pull-out tests than cyanoacrylate. The disconnecting force was highest when light-cured composite SDR was used for fixation. Removing Hedstrom files resulted in higher values than removing K-files. The median force when using SDR was 79.7 N (interquartile range, 66.0-86.8 N) in Hedstrom files and 53.3 N (interquartile range, 47.1-58.5 N) in K-files. CONCLUSIONS:Within the limitations of this study, the use of light-curing composite inside of the microtube was superior compared with the use of cyanoacrylate or chemically cured composite, which are being used presently.

Sodium hypochlorite (NaOCl) in various concentrations is the most widely used root canal irrigant, but it can be an irritant to vital tissue. There are several reports about complications of root canal irrigation with NaOCl. Most of them are the result of accidental extrusion beyond the apex. The inadvertent injection of NaOCl instead of local anaesthetic solution is an extremely rare misuse and results in severe problems. The consequences of the inadvertent injection of sodium hypochlorite, precautions to avoid such accidents and also treatment options are discussed. Sodium hypochlorite is highly irritating when introduced into oral tissues. To avoid inadvertent injection of sodium hypochlorite during root canal treatment, NaOCl solutions should be prepared in special syringes, which are clearly distinguishable from syringes used for other solutions or anaesthetics. Lower concentration NaOCl solutions should be preferred to higher or full-strength solutions.