Oshida Y. Bioscience and Bioengineering of Titanium Materials

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The shape transformation behavior in three commercial NiTi orthodontic wires

having different transformation temperatures was studied by micro X-ray diffrac-

tion by Iijima et al. [9-94]. MicroXRD spectra were obtained at three different

NiTi wires included bending angles (135

, 146

and 157

) and three different tem-

peratures (25, 37, and 60

C). The regions analyzed by microXRD were within the

separate areas of a given wire specimen that experienced only tensile or compres-

sive strain. The diffraction intensity ratio (M002/A110) between the plane (002)

peak in martensite phase and the plane (110) peak in austenite phase of NiTi was

used as the index to the proportional of the martensite and austenite phases. It was

reported that the ratio of martensite to austenite increased in all three Ni-Ti wires

with decreasing included bending angle (greater permanent bending deformation),

and was lower within the compression area for all wires at all bending angles than

within the tension area [9-94].

Orthodontic brackets made of CpTi have been proposed [9-95], which can be

fabricated through the metal injection mold (MIM) technique, as will be described

in Chapter 10 [9-96].

9.9. ENDODONTIC FILES AND REAMERS

During the instrumentation of curved canals, inadvertent procedural errors, such as

ledging, zip formation, and separation of instruments, occasionally occur [9-97].

When such problems occur, the root canal morphology is adversely altered. This vio-

lates a basic endodontic principle, which is that endodontic preparation should con-

form as closely as possible to the general configuration of the original canal [9-98,

9-99]. The American National Standards Institute/American Dental Association

(ANSI/ADA) specification No.28 lists certain torsional property requirements for

endodontic files and reamers [9-100]. Instrument separation is a serious concern in

endodontics. Because stainless-steel instruments usually deform before they separate,

dentists can inspect them for visible signs of instrument deformation. A deformed

instrument usually shows severe bending or unwinding of the flutes, indicating that

the elastic limit of the metal has been exceeded, and that the instrument should be dis-

carded. NiTi endodontic instruments were introduced to facilitate instrumentation of

curved canals. NiTi instruments are superelastic and will flex far more than stainless-

steel instruments before exceeding their elastic limit. This flexibility is an important

property that allows preparation of curved canals while minimizing transportation.

Despite this increased flexibility, separation is still a concern with NiTi instruments,

and they have been reported to undergo unexpected fracture [9-101, 9-102].

Separation can occur without any visible signs of previous permanent deformation,

apparently within the elastic limit of the instrument [9-102]. This indicates that the

NiTi instruments could be deteriorated by low-cycle (or high-stress) fatigue damage.

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The torsional properties of stainless-steel endodontic files and NiTi superelas-

tic endodontic files were compared by Rowan et al. [9-97]. File sizes 15, 25, 35,

45, and 55 were subjected to torsional loads in both the clockwise (CW) and

counterclockwise (CCW) directions independently. Results showed that stainless

steel files had a significantly greater rotation to failure in the CW direction,

whereas the NiTi files had a significantly greater rotation to failure in the CCW

direction. Despite these differences in rotation to fracture, it was reported that

there was essentially no difference between the stainless steel and NiTi instru-

ments in the torque that it took to cause failure in both the CW and CCW direc-

tions. Therefore, it was concluded that whereas the number of CW and CCW

rotations to failure differed for the two instruments, the actual force that it took

to cause that failure was the same [9-97]. Pruett et al. [9-102] studied cyclic

fatigue of NiTi engine-driven instruments by determining the effect of canal cur-

vature and operating speed on the breakage of light-speed instruments. A new

method of canal curvature evaluation that addressed both angle and abruptness of

curvature was introduced. Canal curvature was simulated by constructing six

curved stainless-steel guide tubes with angles of curvature of 30, 45, or 60

, and

radii of curvature of 2 or 5 mm. A simulated operating load of 10 g cm was

applied. Instruments were able to rotate freely in the test apparatus at speeds of

750, 1300, and 2000 rpm until separation occurred. It was found that (i) cycles to

failure were not affected by rotation speeds, (ii) instruments did not separate at

the head, but rather at the point of maximum flexure of the shaft, corresponding

to the midpoint of curvature within the guide tube, and (iii) cycles to failure sig-

nificantly decreased as the radius of curvature decreased from 5 to 2 mm, and as

the angle of curvature increased greater than 30

. On the basis of these findings,

it was concluded that, for NiTi engine-drive rotary instruments, the radius of cur-

vature, angle of curvature, and instrument size are more important than operating

speed for predicting separation [9-102].

Instrumentation of the curved canal remains a challenging task to maintain the

curvature while avoiding apical transportation and strip perforation. Tucker et al.

[9-103] quantified the canal wall planning achieved by hand instrumentation

using stainless steel files, compared with engine-driven NiTi files in curved

canals. Twenty-two mesial roots of extracted human mandibular molars were

divided into two groups based on root curvature and length. The mesiolingual

canals were instrumented using either stainless steel files in a step-back anticur-

vature filing method, or they were instrumented with engine-driven 0.02 taper

NiTi files. Ground sections were prepared at 1-, 2.5-, and 5-mm levels from the

working length. The mesiobuccal canal was used as an uninstrumented control

for predentin character. It was found that there was no significant difference in

overall canal wall planning between the two groups and no significant difference

272 Bioscience and Bioengineering of Titanium Materials

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at each of the three levels [9-103]. Coleman et al. [9-104] compared step-back

preparations in curved canals of resin blocks using NiTi K-files and stainless-

steel K-files [9-104]. Forty canals in resin blocks were cross-sectioned at 3 lev-

els; 12 mm from the apical foramen, middle of the curve, and coronal. Direct

digital computer images were recorded before and after instrumentation, and

superimposition of the images combined with digital subtraction computer soft-

ware allowed direct measurement of area instrumented, distance of transporta-

tion, and shape analysis. It was found that (i) area removed by instrumentation

was significantly greater for stainless-steel files at the middle level and (ii) it took

significantly longer to prepare a canal with NiTi files in resin blocks compared

to stainless steel.

There are various methods to assess the progressive damage due to fatigue

cycling by either destructive method or non-destructive method. They might

include subsequent measurements on hardness, ductility, electrical resistance,

density, modulus of elasticity [9-105], and dislocation density measurements by

X-ray diffraction technique [9-106]. Files are the most efficient instruments in

endodontics for the removal of hard tissue and canal enlargement. If the file is

evaluated as non-damaged, it will be sterilized and re-used (or recycled) on the

next patient. Although the breakage and abandonment of a portion of the

endodontic file in the root canal may be considered an option, it may cause many

problems to certain type of patients. If the patient is hypersensitive to nickel, an

allergic reaction may occur. In a more serious case, the dissolved nickel element

will act. Accordingly, it can be speculated that the dissolution of nickel out of

broken NiTi is likely to be much greater than in the intraoral environment. Even

with the materials containing potentially harmful elements, there are no scien-

tific standards to assess the cumulative damage on NiTi before mechanical fail-

ure occurs. Oshida et al. [9-107] investigated progressive fatigue damage on two

NiTi files (0.25 and 0.35 mm in diameter) under fatigue cycling in a push-pull

mode inside the root canal having three different canal curvatures (25, 40,

and 55

). Changes in DC electrical resistance was monitored with the

Wheatstone’s bridge type galvanometer (4.5 DCV) to an accuracy of 0.001  at

room temperature. It was concluded that (i) normalized cycle-to-failure is lin-

early related to the normalized damage parameter (change in resistance), and (ii)

all the fatigue-fractured files demonstrated an electric resistance ranging

between 35 and 40 m  [9-107].

9.10. CLAMPS AND STAPLES

The forming and clinical tests of osteosynthesis clamps in NiTi alloy were

described. It was reported that (i) by application of localized heating a defined

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change in shape is induced after implantation, which compresses the osteotomy

gap, and (ii) histological evaluation of the tissue surrounding the clamp shows

that the alloy satisfies tissue compatibility needs [9-108]. The SME NiTi staple

with an oval part joining the two prongs provides not only a double-compression

permanent effect in the prongs and in the oval part, but also provides better sta-

bility of the osteosynthesis [9-109]. Its application in the foot has been studied in

1850 cases since 1986 with few (5%) of the contra-indications. It was reported

that (i) they are associated to the compression strength of the staple in very osteo-

porotic bones and in the arthrodesis with important resection of the subchandral

and cancellous bones, (ii) they have been used successfully for shaft osteotomies

of the first phalanx, but also for first joint arthrodesis, and for middle or hind foot

arthrodesis, and (iii) in each of these indications, the use of SME staples results

in a great improvement not only concerning the reliability of the osteosynthesis,

but also in healing time due to the double compression effect [9-109].

Coronary stents made out of NiTi should not be omitted here. NiTi stents have

excellent mechanical properties to provide strength to artery walls. The perfect stent

does not exist, and it will probably never exist. However, several approaches have

been or are currently under investigation to increase their clinical performance. One

of these is the implanting of biodegradable stents made of non-toxic materials. The

major clinical complication with stents is restenosis, defined as the blockage of blood

flow by the coagulation of blood inside the stent [9-110]. The Homer Mannalok wire

needle localizer was also developed using NiTi’s superelastic characteristics [9-80].

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