title: HyFlex nickel-titanium rotary instruments after clinical use: metallurgical properties.
abstract: OBJECTIVE
  To analyse the type and location of defects in HyFlex CM instruments after clinical use in a graduate endodontic programme and to examine the impact of clinical use on their metallurgical properties.
  
  
  METHODS
  A total of 468 HyFlex CM instruments discarded from a graduate endodontic programme were collected after use in three teeth. The incidence and type of instrument defects were analysed. The lateral surfaces of the defect instruments were examined by scanning electron microscopy. New and clinically used instruments were examined by differential scanning calorimetry (DSC) and x-ray diffraction (XRD). Vickers hardness was measured with a 200-g load near the flutes for new and clinically used axially sectioned instruments. Data were analysed using one-way anova or Tukey's multiple comparison test.
  
  
  RESULTS
  Of the 468 HyFlex instruments collected, no fractures were observed and 16 (3.4%) revealed deformation. Of all the unwound instruments, size 20, .04 taper unwound the most often (n = 5) followed by size 25, .08 taper (n = 4). The trend of DSC plots of new instruments and clinically used (with and without defects) instruments groups were very similar. The DSC analyses showed that HyFlex instruments had an austenite transformation completion or austenite-finish (Af ) temperature exceeding 37 °C. The Af temperatures of HyFlex instruments (with or without defects) after multiple clinical use were much lower than in new instruments (P < 0.05). The enthalpy values for the transformation from martensitic to austenitic on deformed instruments were smaller than in the new instruments at the tip region (P < 0.05). XRD results showed that NiTi instruments had austenite and martensite structure on both new and used HyFlex instruments at room temperature. No significant difference in microhardness was detected amongst new and used instruments (with and without defects).
  
  
  CONCLUSIONS
  The risk of HyFlex instruments fracture in the canal is very low when instruments are discarded after three cases of clinical use. New HyFlex instruments were a mixture of martensite and austenite structure at body temperature. Multiple clinical use caused significant changes in the microstructural properties of HyFlex instruments. Smaller instruments should be considered as single-use.
authors: Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, The University of British Columbia, Vancouver, BC, Canada.
authors: Y
authors: Y
authors: Shen
authors: J M
authors: JM
authors: Coil
authors: H
authors: H
authors: Zhou
authors: Y
authors: Y
authors: Zheng
authors: M
authors: M
authors: Haapasalo
mesh_terms: D002152:Calorimetry, Differential Scanning; D003080:Cold Temperature; D003722:Dental Alloys / Q000737:chemistry*; D004868:Equipment Failure; D006244:Hardness; D006358:Hot Temperature; D006801:Humans; D008422:Materials Testing; D008669:Metallurgy; D008855:Microscopy, Electron, Scanning; D009532:Nickel / Q000737:chemistry*; D018915:Root Canal Preparation / Q000295:instrumentation*; D013314:Stress, Mechanical; D013499:Surface Properties; D014025:Titanium / Q000737:chemistry*; D014961:X-Ray Diffraction
chemical_list: D003722:Dental Alloys; C040654:titanium nickelide; C093824:Martensite; C093826:Austenite; D009532:Nickel; D014025:Titanium
keywords: HyFlex CM; clinical; defect; instrument; metallurgical property; nickel-titanium