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BACKGROUND: Root canal retreatment is necessary when initial treatment fails. Nickel-titanium systems help remove filling materials; however, some methods can cause canal content extrusion, resulting in inflammation and delayed healing. This study aimed to examine the impact of different preparation techniques and endodontic file systems on apical debris volume to limit material dispersion to periradicular tissues. METHODS: Ninety extracted maxillary incisors were evaluated. Simulated apical root resorption was created by removing the apical 2 mm of the root. The teeth were divided into two groups: one filled with a single cone and the other with cold lateral compaction (CLC). Each group was further divided into three subgroups (n = 15 each): Subgroup 1 used Reciproc R25 for removal and R50 for final preparation; Subgroup 2 used ProTaper Universal Retreatment (PTUR) files D1, D2, and D3 for removal and ProTaper Next X5 for finalization; and Subgroup 3 used VDW.Rotate Retreatment (VDW.RotateR) for removal and VDW.Rotate 50.04 for completion. Debris from retreatment was collected in pre-weighed tubes to determine the amount. The apical extrusion data underwent a two-way analysis of variance. RESULTS: The Reciproc group had a mean extruded debris weight of 0.54 ± 0.24 mg, higher than the PTUR (0.28 ± 0.15 mg) and VDW.RotateR (0.39 ± 0.29 mg) groups (p < 0.05). The single-cone technique (SCT) resulted in a mean debris weight of 0.34 ± 0.23 mg, lower than the CLC technique, which had a mean of 0.46 ± 0.27 mg (p < 0.05). SCT had a shorter retreatment duration (111.12 ± 33.46 s) compared to CLC (176.26 ± 52.26 s) (p < 0.05). CONCLUSION: The Reciproc file system and the CLC obturation technique resulted in greater apical debris extrusion than the other methods. SCT was quicker than CLC. The Reciproc groups are more susceptible to apex extrusion during retreatment.

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This study aimed to compare apical debris extrusion and canal preparation time with ProTaper Gold (PTG) and ProTaper Ultimate (PTU) files at different temperatures. Mesio-buccal roots of 60 mandibular first molars were distributed into six groups depending on the file type (PTG, PTU) and irrigation solution temperature (20, 37, 45°C). During instrumentation, extruded debris were collected and weighed to measure the mass in milligrams. The canal preparation time was recorded in seconds. ANOVA followed by Bonferroni post-hoc tests were used for analysis. The amount of debris extrusion was significantly higher in PTU, which was affected by the irrigation solution temperature (p < 0.05). The difference in canal preparation time was not significant between the two file systems, however, it was significant between the different temperatures (p = 0.001). Both file systems had shorter canal preparation times at 20°C. The irrigation solution temperature could influence the debris extrusion and time of canal preparation.

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AIM: This study aimed to assess and compare debris quality expelled beyond the apex during re-treatment using two reciprocating and two re-treatment rotary files. MATERIALS AND METHODS: A total of 80 healthy human mandibular premolars excised for orthodontic therapy were selected. Distilled water was used to sterilize the teeth before they were preserved. The canals were widened and coronal access was created so that the F2 ProTaper universal system could be used. For the obturation, we utilized gutta-percha cones and AH plus sealant. All samples were cone-beam computed tomography (CBCT) recorded. Teeth were separated into four groups (n=20); Group 1: ProTaper re-treatment, Group 2: Mtwo re-treatment, Group 3: WaveOne gold, and Group 4: Reciproc. The re-instrumented process included collecting the extruded debris in Eppendorf tubes and then drying it off by evaporating the distilled water. The weight of the tube with debris was subtracted from the weight of the tube without debris to get the dry debris weight. Post-retreatment CBCT was recorded for all samples. Mean apical debris extrusion values were obtained, after which necessary statistical analysis was obtained using SPSS Statistics, version 21 (IBM Corp., Armonk, NY) to obtain the results. A one-way analysis of variance (ANOVA) and the student t-test were utilized for statistical analysis to compare the different experimental groups. Post-hoc Bonferroni tests were used to compare several groups. RESULT: No statistical difference (p>0.05) was identified in the filler material that was left over across all groups. The reciprocating files discharged more material compared with re-treatment file systems. CONCLUSION: The Reciproc files expelled more waste than WaveOne gold, ProTaper re-treatment, and Mtwo re-treatment file systems. Reciprocating file systems showed better cleaning efficiency compared to the re-treatment file systems.

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The aim of the study was to evaluate the impact of kinematics and irrigation protocols on the extrusion of apical debris during removal of different obturation techniques. A total of 144 single-rooted teeth were instrumented and obturated with Thermafil+AH Plus, Thermafil+AH Plus Bioceramic and single gutta-percha cone+AH Plus Bioceramic. Samples were divided according to the retreatment kinematics: continuous rotation or Jeni motion. Each sub-group was subjected to conventional irrigation or irrigation activated by EDDY. Extruded debris was collected in Eppendorf tubes, weighted and retreatment time was digitally recorded. Data were analysed with two-way ANOVA (p < 0.05). Debris extrusion was not significantly different between all groups. EDDY activation system and CanalPro Jeni required significantly longer time compared with other groups to remove Thermafil+AH Plus and single cone+AH Plus Bioceramic. Within current limitations, obturation technique, irrigation protocol and kinematics tested had no influence on apical extrusion debris, while they significantly impacted the retreatment time.

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The aim of this study was to compare four different instrument kinematics in oval canals. Distal root of sixty extracted first mandibular molars with single oval canal were allocated randomly to four groups (n = 15) namely protaper universal [PTU] (Rotary), self-adjusting file [SAF] (Adaptive), TruShape [TS] (Rotary) and WaveOne [WO] (Reciprocating). The percentage of untouched and touched surfaces of the root canal was evaluated using micro-computed tomography (MCT). Pre- and post-instrumentation weight was assessed using digital microbalance for determining the amount of dentin removed and apical extrusion of debris. The results were tabulated, and their mean difference was statistically analysed using one-way ANOVA and Tukey's HSD test. PTU and SAF exhibited significantly less mean percentage of untouched surface compared to TS. TS files removed less dentin and extruded less debris in long oval canals.

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It is essential to create a glide path before root canal preparation with nickel-titanium rotary files to avoid file breakage and preserve the original canal structure. The aim of this study was to compare the amount of apically extruded debris after using different glide path files. A total of 96 first mandibular molars with curved mesial roots were randomly divided into six groups (n = 16) which are K-files, Proglider, R-Pilot, TruNatomy Glider, WaveOne Gold Glider and group without a glide path. Apically extruded debris was measured after glide path and canal preparation. The highest amount of debris was found in the control group without a glide path and using a glide path file caused less debris and significant differences were observed between R-Pilot, TruNatomy Glider, ProGlider, WaveOne Gold Glider and K-file groups. It may be recommended to create a glide path before root canal shaping to reduce the amount of extrusion debris from the apical. Especially in curved and narrow root canals, it is recommended to use an R-Pilot file before root canal shaping in order to reduce the amount of apically extruded debris.

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This study aimed to evaluate the amount of apically extruded debris caused by different NiTi files. One hundred mandibular premolars were included in this study. The specimens were divided into five groups (n = 20): (i) TruNatomy, (ii) WaveOne Gold, (iii) 2Shape, (iv) ProTaper Next and (v) Reciproc Blue. The extruded debris was collected into preweighed Eppendorf tubes. These tubes were weighed again, and the net weight of debris was calculated. Data were statistically analysed, and the significance level was set at 5%. The least amount of extruded debris was observed in the TruNatomy group (p < 0.05). Statistically significant differences were not found among (iii), (iv) and (v) groups (p > 0.05). However, these groups resulted in significantly higher amounts of debris when compared to (i) and (ii) groups (p < 0.05). The results lead us to conclude that all instrumentation systems caused apical extrusion of debris at varying weights.

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Background: Guided conservative endodontic access is a novel technique and the influence of such access cavities on apical debris extrusion (ADE) can have a significant effect on postoperative pain. Objective: This study compared ADE and preparation time (PT) in the mesial canals of the mandibular first permanent molars in different access cavity designs and the amount of sodium hypochlorite in the extruded debris using attenuated total reflection-Fourier transform infrared spectrometer (ATR-FTIR). Materials and Methods: Human mandibular first permanent molars (N = 72) were selected and randomly divided into six groups (n = 12) based on type of cavity design and files used: Group 1, Conservative Access Cavity [ConsAC])-WaveOne Gold; Group 2, ConsAC-Mtwo; Group 3, ConsAC-XP-endo shaper; Group 4, Traditional Access Cavity [TradAC])-WaveOne; Group 5, TradAC-Mtwo; and Group 6, TradAC-XP-endo shaper. All the ConsAC were prepared with a customized template fabricated using cone beam computed tomography. ADE evaluation was done using the Myers and Montgomery set up. All the instruments were used according to the manufacturers' instructions, followed by a final irrigation using Endoactivator. The time taken for preparation was calculated using a digital watch. Five samples in each group was taken and subjected to ATR-FTIR analysis. Results: There was no significant difference between the groups with respect to ADE (P > 0.05). Whereas, a statistically significant difference was seen in PT between the TradAC and ConsAC (P < 0.05). Using ATR-FTIR, it was found that all the samples of extruded debris had the presence of sodium hypochlorite. Conclusions: All instrumentation systems produced ADE irrespective of access cavity design. The time taken for preparation of canals in ConsAC was significantly longer compared to TradAC. Clinical Relevance: ADE can translate clinically as postoperative pain. Assessing the ADE in ConsAC could shed light on the type of file systems that can be used in such cavities in order to minimize postoperative pain clinically.

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Aim: This study aimed to systematically review available literature of in vitro studies on apical extrusion of debris through rotary instrumentation in comparison to manual instrumentation in pediatric endodontics, and also to perform a comparison between various rotary instrumentation systems for assessment of debris extrusion. Materials and Methods: A comprehensive search was conducted on PubMed, Medline, Cochrane Library, Embase, Scopus, and Google Scholar without any language restriction and year of publication. A planned search strategy was made for PubMed and applied to other databases. After full-text reading, 7 articles were selected for quantitative synthesis. Modified CONSORT checklist of items for reporting in vitro studies of dental materials was used for quality assessment of included studies. Results: Root canal preparation with rotary instrumentation led to lesser apical debris extrusion than manual instrumentation. Self-adjusting file system was associated with the least debris extrusion among all included studies, followed by ProTaper Next, Kedo-S, ProTaper, K3, Mtwo, Revo-S, and Wave One. Conclusion: More apical debris extrusion was seen with manual instrumentation than rotary instrumentation. Furtrhermore, variance in debris extrusion was seen with different rotary file systems.

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The aim was to evaluate apical debris extrusion produced by a single-file system used in counter-clockwise reciprocation and compare it to rotary single-file systems used in clockwise rotation and clockwise reciprocation. A total of 100 first mandibular molars were divided into five groups (n = 20): (i) WaveOne Gold Glider and Primary instrument in counter-clockwise reciprocation; (ii) One G and One Curve file in clockwise rotation; (iii) One G and One Curve file in clockwise reciprocation; (iv) TruNatomy Glider and Prime instrument in clockwise rotation; and (v) TruNatomy Glider and Prime instrument in clockwise reciprocation. Apical debris extruded was measured after glide path preparation and canal preparation. WaveOne Gold displayed significantly higher amounts of apical debris extrusion in all the groups (P < 0.05). The lowest mean values were recorded by clockwise reciprocation groups: TruNatomy Glider, One Curve and TruNatomy Glider and Prime combined value, for glide path, canal preparation and combined mean values, respectively.

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AIM: The aim of the study is to quantify the amount of debris extrusion after instrumentation with single-file rotary and reciprocating systems used either with conventional irrigation (CI) or passive ultrasonic irrigation (PUI) systems. METHODOLOGY: Sixty extracted human mandibular incisors were randomly assigned to two groups (n = 30); rotary single-file system, One Shape (OS-Group 1) and reciprocating single-file system, WaveOne (WO-Group 2) instruments. The two groups were further subdivided into two subgroups (n = 15); (A) PUI and (B) CI. The apically extruded debris was collected in preweighed glass vials as per the Myers and Montgomery method. After drying, the mean weight of debris was assessed with a microbalance and statistically analyzed using analysis of variance and Student's t-test. RESULTS: The reciprocating file system produced significantly more debris compared to the rotary file system using either of the irrigation systems (P = 0.04). CI produced significantly more (P = 0.02) debris extrusion compared to PUI irrespective of the file system used. CONCLUSION: Under the conditions of this study, both systems caused apical debris extrusion. Rotary single-file system produced less debris extrusion compared to reciprocating single-file system. Use of PUI may be advocated as an alternative to CI, as it causes lesser apical debris extrusion.

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The aim of this study was to introduce a new three-dimensional curvature classification method to evaluate the canal curvature and analyse its effect on the amount of debris extrusion during reciprocating preparation. Freshly extracted mandibular molar teeth were collected. After performing access cavities, periapical radiographs were taken on both mesio-distal and bucco-lingual planes of each tooth using a digital sensor. The radii of the curvature were calculated and a new three-dimensional classification method was used to classify canal curvature, based on radius as follows: Three-dimensionally slight, moderate and severe curve root canal. Fifteen teeth for each curvature sort were randomly chosen for canal instrumentation. The extruded debris was collected in pre-weighed Eppendorf tubes and calculated. A significant difference was noted between root canals with slight and severe three-dimensional curvatures (P < 0.001). It can be concluded that root canal curvature plays a significant role in the amount of extruded debris.

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INTRODUCTION: The purpose of this study was to evaluate apical debris extrusion associated with different kinematics in curved root canals. METHODS: Forty-five extracted mandibular molars with root curvature angles ranging between 20° and 40° and curvature radii <10 mm were randomly assigned to 3 groups (n = 15) according to the kinematics used for root canal preparation: reciprocating motion with the WaveOne Gold system (Dentsply Tulsa Dental, Tulsa, OK), rotary/reciprocating motion with the Twisted File Adaptive system (SybronEndo, Orange, CA), and the manual technique. The debris apically extruded during preparation was collected into preweighed Eppendorf tubes. The tubes were then stored in an incubator at 70°C for 5 days. The extruded debris was quantified by subtracting the preinstrumentation from the postinstrumentation weight of the Eppendorf tubes. The time required for each instrumentation procedure was recorded. Data were analyzed using 1-way analysis of variance Tukey post hoc tests (∝ = 0.05). RESULTS: The WaveOne Gold reciprocating single-file system was associated with less extrusion of debris compared with hand files (P < .05) and the Twisted File Adaptive system (P > .05). The preparation time required by hand files was significantly longer than that required by the other techniques (P < .05). CONCLUSIONS: Under the conditions of this study, all of the instrumentation systems caused apical debris extrusion to some degree. The WaveOne Gold reciprocating system was associated with less debris extrusion in curved root canals compared with the manual technique and the Twisted File Adaptive system although the difference between the WaveOne Gold and Twisted File Adaptive systems was not significant.

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BACKGROUND: Complete cleaning of the root canal is the goal for ensuring success in endodontics. Removal of debris plays an important role in achieving this goal. In spite of advancements in instrument design, apical extrusion of debris remains a source of inflammation in the periradicular region. AIM: To comparatively evaluate the amount of apically extruded debris with V-Taper, ProTaper Next, and the self-adjusting File (SAF) system. MATERIALS AND METHODS: Sixty-four extracted human mandibular teeth with straight root canals were taken. Access openings were done and working length determined. The samples were randomly divided into three groups: Group I - V-Taper files (n = 20), Group II - ProTaper Next (n = 20), Group III - SAF (n = 20). Biomechanical preparation was completed and the debris collected in vials to be quantitatively determined. The data obtained was statistically analyzed using ANOVA and post hoc Tukey's test. RESULTS: All the specimens showed apical debris extrusion. SAF showed significantly less debris extrusion compared to V-Taper and ProTaper Next (P < 0.001). Among Groups I and II, ProTaper Next showed lesser debris extrusion as compared to V-Taper, but it was not significant (P = 0.124). CONCLUSION: The SAF showed least amount of apical debris extrusion when compared to newer rotary endodontic instruments. This indicates that the incidence of inter-treatment flare-ups due to debris extrusion would be less with the SAF.

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INTRODUCTION: This review aimed to compare the kinematic effect of nickel-titanium instruments with reciprocating and continuous rotation motion for cyclic fatigue resistance, shaping ability, apical debris extrusion, and dentinal defects or cracks. METHOD: Articles were selected for inclusion in this review if they fulfilled all of the following criteria: described in vitro studies performed on either extracted human teeth or an artificial canal model, assessed both reciprocating and rotary instruments, compared reciprocating files and rotary files for the kinematics of files, and evaluated reciprocating and rotary files regarding the aim of this study. The electronic search was undertaken in MEDLINE, Cochrane database, and manual searches, including journals, reference lists, and other reviews. RESULTS: Twelve studies were chosen for cyclic fatigue, 19 studies for shaping ability, 14 studies for apical debris extrusion, and 13 studies for dentinal defects or cracks. Most of the studies showed that reciprocating motion had a higher resistance to cyclic fatigue. Nine studies from the shaping studies reported less canal transportation by using the reciprocating motion than the continuous rotation. The reciprocating instruments tended to extrude more dentin debris than the continuous rotating instruments, but many of the studies showed conflicting results. In addition, 2 studies from the defects or cracks studies claimed the reciprocating motion produced more dentinal defects than the continuous rotating motion. CONCLUSIONS: Instruments with reciprocating motion seemed to have better resistance to cyclic fatigue with less canal transportation tendency than the instruments with continuous rotating motion.

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AIM: This study evaluated whether using supplementary files for removing root canal filling residues after ProTaper Universal Retreatment files (RFs) increased the debris extrusion apically. MATERIALS AND METHODS: Eighty mandibular premolars with single root and canal were instrumented with ProTaper Universal rotary system (SX-F3) and obturated. The samples were divided randomly into four groups (n = 20). Group 1 served as a control; only ProTaper Universal RFs D1-D3 were used, and the extruded debris was weighed. Groups 2, 3, and 4 were the experimental groups, receiving a twofold retreatment protocol: Removal of the bulk, followed by the use of supplementary files. The bulk was removed by RFs, followed by the use of ProTaper NEXT (PTN), WaveOne (WO), and Self-Adjusting File (SAF) for removal of the remaining root filling residues. Debris extruded apically were weighed and compared to the control group. Statistical analysis was performed using one-way analysis of variance (ANOVA) and post hoc Tukey's test. RESULTS: All the three experimental groups presented significant difference (P < .01). The post hoc Tukey's test confirmed that Group 4 (SAF) exhibited significantly less (P < .01) debris extrusion between the three groups tested. CONCLUSION: SAF results in less extrusion of debris when used as supplementary file to remove root-filling residues, compared to WO and PTN.

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OBJECTIVES: The aim was to evaluate ex vivo apical debris extrusion associated with WaveOne and Self-Adjusting File instruments when used in oval canals. METHODS: Twenty-four extracted human mandibular premolars with oval-shaped canals were assigned in two equal groups. Following coronal cavity preparation, a glide path was created. Group A was subjected to canal preparation using a WaveOne primary file, which was used along with syringe and needle irrigation and 10 mL of 2.4 % NaOCl solution, followed by flushing with 10 mL of 17 % EDTA solution, activation with EndoActivator for 1 min and final flushing with 10 mL of 2.4 % NaOCl solution, and activation for 30 s. Group B, the SAF system was used with continuous simultaneous irrigation, provided by the system's pump. The irrigant was supplied at 5 mL/min, alternating every minute between 2.4 % NaOCl solution and 17 % EDTA solution, over a total of 4 min followed by final flushing with 10 mL of 2.4 % NaOCl solution. Extruded apical debris from each root canal was collected into a preweighed glass vial and dried. The mean weight of the debris from each group was assessed and analyzed statistically. Both systems resulted in apical debris extrusion. RESULTS: The WaveOne system was associated with a statistically significant greater mean mass of apically extruded debris (2.18 ± 0.44 mg) than the SAF system (0.49 ± 0.33 mg, permutation-based Wilcoxon test, p < 0.001). CONCLUSION: Both WaveOne and the SAF systems were associated with apical debris extrusion. The amount of debris extruded by the WaveOne system was 4.4 times greater than that extruded by the SAF system. CLINICAL RELEVANCE: The results of the present ex vivo comparative study cannot be directly applied to the clinical situation. Difference between both groups remains completely unclear; maybe the amount of extrusion is harmless in both groups or similarly deleterious for the periradicular tissues in both groups or may be dose-related to the amount of the extruded material.

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AIM: To evaluate the amount of apically extruded debris after root canal instrumentation with ProTaper Next and HyFlex instruments in curved root canals. METHODOLOGY: Forty extracted mandibular first molar teeth with curved mesial roots and of similar lengths were instrumented using ProTaper Next or HyFlex instruments. The extruded debris was collected into pre-weighed Eppendorf tubes. The tubes were stored in an incubator at 68 °C for 5 days. The tubes were weighed to obtain the final dry weight of the extruded debris. The weight of the extruded debris was determined by subtracting the initial weight from the final weight. Distribution of data was determined by Shapiro-Wilk test. Continuous variables were compared with the Independent Sample t-test or Mann-Whitney U-test. The significance level was set at P = 0.05. RESULTS: Both instruments were associated with apical debris extrusion. The HyFlex group had significantly less debris extrusion than the ProTaper Next group (P = 0.014). CONCLUSION: HyFlex CM was associated with significantly less apical extrusion than ProTaper Next.

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This systematic review and meta-analysis investigated the influence of the number of files (full-sequence rotary-file versus reciprocating single-file systems) used during root canal preparation on the apical extrusion of debris and its biological relationship with the occurrence of symptomatic apical periodontitis. An extensive literature research was carried out in the Medline, ISI Web of Science and Cochrane databases, for relevant articles with the keyword search strategy. Based on inclusion and exclusion criteria, two reviewers independently rated the quality of each study determining the level of evidence of the articles selected. The primary outcome for the meta-analysis was determined by the amount of debris extruded into the periapical tissue during root canal preparation with multiple- or single-file systems in four laboratory studies. Analysis of in vivo release of neuropeptides (SP and CGRP) after root canal preparation with single- or multiple-file systems was also carried out. Amongst the 128 articles initially found, 113 were excluded for being nonrelevant or not fulfilling the selection criteria. Another four articles were excluded after methodology evaluation. Finally, nine laboratory studies and two in vivo studies were included in the systematic review. Four of the laboratory studies were further included for meta-analysis that revealed greater debris extrusion after the use of single-file techniques when compared to multiple-file systems. Analysis of in vivo neuropeptide expression in the periodontal ligament suggests that the design of the instrument is more important than the number of files used. Both rotary and reciprocating single-file systems generate apical extrusion of debris in laboratory studies, or expression of neuropeptides in vivo. Available evidence is limited, but supports the fact that this inflammatory reaction is not influenced by the number of files but the type of movement and the instrument design.

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