{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T05:27:04Z","timestamp":1786685224546,"version":"build-2736575974"},"reference-count":75,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009687","name":"Wroclaw Medical University","doi-asserted-by":"crossref","award":["SUBD.B180.26.003"],"award-info":[{"award-number":["SUBD.B180.26.003"]}],"id":[{"id":"10.13039\/501100009687","id-type":"DOI","asserted-by":"crossref"}]},{"award":["SUBD.B180.26.003"],"award-info":[{"award-number":["SUBD.B180.26.003"]}],"id":[{"id":"https:\/\/ror.org\/01qpw1b93","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Funct. Biomater.","JFB"],"abstract":"<jats:p>This systematic review aimed to evaluate whether cross-sectional geometry is associated with cyclic fatigue resistance of nickel\u2013titanium (NiTi) endodontic instruments and to identify the geometric and materials-related features most frequently associated with improved fatigue performance. The protocol was prospectively registered on the Open Science Framework (OSF). PubMed, Scopus, Embase, Web of Science, and WorldCat were searched in April 2026 in accordance with PRISMA 2020. Eligible studies were comparative in vitro investigations that explicitly evaluated cross-sectional geometry or a related geometric parameter as a prespecified study factor and reported quantitative cyclic fatigue outcomes. Of 107 screened records, 66 full-text reports were assessed and 23 studies were included in the qualitative synthesis. Twenty-two studies had a medium risk of bias and one had a low risk of bias according to the Quality Assessment Tool for In Vitro Studies (QUIN). Cyclic fatigue resistance was most often reported as time to fracture or number of cycles to failure. Instruments with reduced metal mass, smaller core volume, lower cross-sectional area, and greater flexibility tended to demonstrate higher fatigue resistance in curved canals. S-shaped and double-S-shaped cross-sections were most consistently associated with favorable outcomes; however, this association is more plausibly related to reduced bending stiffness and canal-wall contact forces than to increased intrinsic material fatigue strength. Flat-side designs did not show a consistent advantage. The evidence was limited by heterogeneous testing protocols and residual confounding by alloy, heat treatment, taper, manufacturing, surface condition, and kinematics. No meta-analysis or quantitative dimensional correlation was feasible because testing conditions and detailed geometric parameters were inconsistently reported.<\/jats:p>","DOI":"10.3390\/jfb17080399","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T12:53:48Z","timestamp":1786539228000},"page":"399","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Cross-Sectional Geometry and Cyclic Fatigue Resistance of Nickel\u2013Titanium Endodontic Instruments: A Systematic Review"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9875-0337","authenticated-orcid":false,"given":"Mariya","family":"Kubatska","sequence":"first","affiliation":[{"name":"Kera Dental Clinic, Lilleakerveien 23b, 0283 Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1680-793X","authenticated-orcid":false,"given":"Julia","family":"Kensy","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry and Preclinical Dentistry, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Cygankiewicz","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry and Preclinical Dentistry, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0093-9164","authenticated-orcid":false,"given":"Maja","family":"Gajewska","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry and Preclinical Dentistry, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8783-2365","authenticated-orcid":false,"given":"Anna","family":"B\u0142aszczyk-Po\u015bpiech","sequence":"additional","affiliation":[{"name":"Pre-Clinical Research Center, Wroc\u0142aw Medical University, Karola Marcinkowskiego 1, 50-368 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamil","family":"Weso\u0142ek","sequence":"additional","affiliation":[{"name":"J\u00f3zef Stru\u015b Multi-Specialty Municipal Hospital with a Care and Treatment Facility, Independent Public Health Care Facility, Szwajcarska 3, 61-285 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5187-5324","authenticated-orcid":false,"given":"Agata","family":"Ma\u0142yszek","sequence":"additional","affiliation":[{"name":"Department of Biostructure and Animal Physiology, Wroc\u0142aw University of Environmental and Life Sciences, Ko\u017cuchowska 1, 51-631 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3801-0218","authenticated-orcid":false,"given":"Jacek","family":"Matys","sequence":"additional","affiliation":[{"name":"Dental Surgery Department, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2368-1534","authenticated-orcid":false,"given":"Maciej","family":"Dobrzy\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry and Preclinical Dentistry, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1111\/j.1365-2591.2009.01671.x","article-title":"Tooth Survival Following Non-Surgical Root Canal Treatment: A Systematic Review of the Literature","volume":"43","author":"Ng","year":"2010","journal-title":"Int. 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