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Influence of sodium hypochlorite on cyclic fatigue resistance of nickel–titanium instruments: A systematic review and meta-analysis of in vitro studies

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Abstract

Objective

This systematic review/meta-analysis investigated the influence of NaOCl on cyclic fatigue resistance of endodontic NiTi instruments.

Materials and methods

A systematic search until July 2022 in PubMed/MEDLINE, Embase, Scopus, Web of Science, SciELO, Cochrane Library, and grey literature was conducted. According to the PECOS strategy, only in vitro studies evaluating the effects of NaOCl on the cyclic fatigue resistance of NiTi instruments were eligible. Cyclic fatigue resistance was the primary outcome. A modified Joanna Briggs Institute’s Checklist was used for risk of bias assessment.

Results

Of the 2,445 records screened, 37 studies were included. Most studies used simulated canals made of stainless-steel block with severe to moderate curvatures. NaOCl concentration varied from 1–6%, mainly at 37 °C. Regarding fatigue resistance, 23 studies using 1.2% to 6% NaOCl showed a reduction in the resistance compared to the control groups, especially when pre-heated. Four meta-analyses were performed according to the tested NiTi systems. The meta-analyses indicated that the PTU F2 files had higher reduction of fatigue resistance after exposure to 5.25% NaOCl; no differences between NaOCl and no immersion were observed for Reciproc R25, WaveOne 25.08, and WaveOne Gold Primary files. Included studies had low risk of bias.

Conclusion

NaOCl appears to reduce cyclic fatigue resistance of certain NiTi files, especially when they are pre-heated, particularly in conventional NiTi files compared to some heat-treated instruments. It is possible that the temperature of the solution may have a greater influence on resistance than NaOCl itself. Important to note that an overall tendency toward no significant influence was observed among various systems.

Clinical relevance

Precautions are necessary when a pre-heated high-concentration NaOCl is used to enhance its properties during root canal preparation, mainly using conventional wire.

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Data Availability

The data that support the findings of this study are available from the corresponding authors upon reasonable request.

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Funding

This study was financed in part by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES) – 88887.649870/2021–00.

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Authors and Affiliations

  1. Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil

    Alexandre Henrique dos Reis-Prado, Lara Cancella de Arantes, Kiani dos Santos de Paula, Sabrina de Castro Oliveira, Ana Cecília Diniz Viana & Francine Benetti

  2. Department of Child’s and Adolescent’s Oral Health, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil

    Lucas Guimarães Abreu

  3. Department of Restorative Dentistry, School of Dentistry, São Paulo State University (Unesp), Araçatuba, SP, Brazil

    Juliana Goto

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  1. Alexandre Henrique dos Reis-Prado
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Contributions

Conceptualization: Francine Benetti, Lucas Guimarães Abreu, and Alexandre Henrique dos Reis-Prado; study selection: Lara Cancella de Arantes, Sabrina de Castro Oliveira, and Alexandre Henrique dos Reis-Prado; data collection: Lara Cancella de Arantes, Kiani dos Santos De Paula, and Alexandre Henrique dos Reis-Prado; quality assessment: Alexandre Henrique dos Reis-Prado, Sabrina de Castro Oliveira, and Lucas Guimarães Abreu; methodology: Francine Benetti, Alexandre Henrique dos Reis-Prado, Kiani dos Santos De Paula, and Juliana Goto; project administration: Francine Benetti, Alexandre Henrique dos Reis-Prado, Kiani dos Santos De Paula, and Juliana Goto; resources: Francine Benetti and Ana Cecília Diniz Viana; supervision: Francine Benetti, Lucas Guimarães Abreu, and Ana Cecília Diniz Viana; validation: Francine Benetti and Ana Cecília Diniz Viana; visualization: Francine Benetti, Lucas Guimarães Abreu, and Ana Cecília Diniz Viana; writing—original draft: Alexandre Henrique dos Reis-Prado, Lara Cancella de Arantes, Sabrina de Castro Oliveira, and Juliana Goto; writing—review and editing: Francine Benetti, Lucas Guimarães Abreu, and Ana Cecília Diniz Viana. All authors read and approved the final manuscript.

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Correspondence to Alexandre Henrique dos Reis-Prado.

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dos Reis-Prado, A.H., Abreu, L.G., de Arantes, L.C. et al. Influence of sodium hypochlorite on cyclic fatigue resistance of nickel–titanium instruments: A systematic review and meta-analysis of in vitro studies. Clin Oral Invest 27, 6291–6319 (2023). https://doi.org/10.1007/s00784-023-05243-4

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  • DOI: https://doi.org/10.1007/s00784-023-05243-4

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