Debris and irrigant extrusion potential of 2 rotary systems and irrigation needles

Apical Extrusion of Debris and Irrigants Using Different Irrigation Needles

This study evaluated the influence of irrigation tip, root canal curvature and final apical diameter on periapical debris and irrigant extrusion during root canal instrumentation. After being classified as mildly or moderately curved, the mesiobuccal root canals of 90 human molars were instrumented. The teeth were allocated into three groups according to the used needle type: a flat open-end needle (Group 1), a side-vented needle (Group 2) or a double side-vented needle (Group 3). The amount of extruded material after instrumentation was calculated for each group. The differences in irrigant and debris extrusion between the experimental groups were analyzed with the Mann-Whitney U test. Irrigation tips and final instrument diameter differences were analyzed with the Kruskal-Wallis test. Multiple groups were compared using the Mann-Whitney U-test with a Bonferroni correction at α=0.05. The amount of extruded material from the double side-vented needle was significantly less than the open-ended flat needle (p=0.008), but there was no difference compared to the side-vented needle (p=0.929). The results showed no effect of root curvature and final apical diameter on the amount of irrigant and debris extrusion (p>0.05). The double side-vented needles generated the least material extrusion to the periapical tissues. Irrigation needle type had the greatest influence on periapical irrigant and debris extrusion and the double side-vented needles may be safely used during endodontic therapy.

Effect of three different rotary instrumentation systems on postinstrumentation pain: A randomized clinical trial

Background:

Endodontic instrumentation is liable to cause some postinstrumentation pain (PIP). Rotary endodontic instruments differ in their design, metallurgy, surface treatment, etc.

Aim:

This randomized clinical trial aimed to assess the incidence of PIP after root canal instrumentation with three different rotary endodontic systems which differ in their design, namely, ProTaper, Mtwo, and K3.

Materials and Methods:

A total of 150 patients between the ages of 25 and 50 were chosen for the study. Teeth with asymptomatic irreversible pulpitis due to carious exposure were selected. The patients received local anesthesia by inferior alveolar nerve block. After preparing the access cavity, root canal instrumentation was done with one of the three instruments (n = 50) and closed dressing was given. PIP was assessed every 12 h for 5 days, and tenderness to percussion was analyzed at the end of 1, 3, and 7 days.

Statistical Analysis:

Mann–Whitney U-test to determine significant differences at P < 0.01.

Results:

The PIP and tenderness were less in Mtwo group when compared to ProTaper and K3 groups up to 84 h and 72 h respectively and statistically significant (P < 0.05). There was no statistically significant difference between ProTaper and K3 both in PIP and tenderness.

Conclusion:

Rotary endodontic instrumentation causes some degree of PIP and tenderness to percussion. Among the instruments used, Mtwo causes less PIP and tenderness when compared to ProTaper and K3, and there was no difference between ProTaper and K3.

Clinical Relevance:

PIP is highly subjective and may vary among different subjects. The apical (3 mm) taper of ProTaper was 0.08 followed by a smaller taper, whereas, the other two files were of a constant 0.06 taper, which means there could have been a greater apical extrusion and therefore more PIP. Despite, the mean of the age was similar, there could have been a difference in the size of the canal and therefore a difference in apical extrusion and PIP.

Debris extrusion by glide-path establishing endodontic instruments with different geometries

BACKGROUND/PURPOSE

Glide-path preparation is an important step during initial endodontic procedure to reduce shaping-instrument fracture. The aim of this study was to evaluate the amount of apically extruded debris produced by glide-path preparation instruments with different geometric designs.

MATERIALS AND METHODS

Forty teeth extracted for periodontal reasons were randomly divided into four groups (n = 10). The working length was standardized at 17 mm from the apical foramen by a flattening reference point. The glide-path was created using repetitive up-and-down movement three times with one of following four selected instruments: One G, ProGlider, a size 15 ScoutRace, and a size 15 stainless-steel K-file. To collect the apically extruded debris, the customized apparatus was used, and the collected debris was stored in an incubator. The weight of the debris was measured using an analytical balance with an accuracy of 0.00001 g. The data were analyzed by one-way analysis of variance and Duncan's multiple comparison test at a significance level of 95%.

RESULTS

The ProGlider group produced significantly less debris extrusion relative to the other groups (P < 0.05). The One G and ScoutRace groups showed no significant difference, but debris production was lower than that observed for the stainless-steel group (P < 0.05).

CONCLUSION

Creating the glide-path using nickel-titanium rotary files produced lower amounts of debris extrusion than using manual stainless-steel files. The progressive taper design of ProGlider, the center-off cross-section of One G, and the alternative-pitch design of ScoutRace may have increased the efficiencies of debris removal with minimal extrusion during glide-path preparation. Glide-path preparation using NiTi rotary files have better clinical efficiency than the manual stainless-steel file.

Influence of Apical Preparation Size and Working Length on Debris Extrusion

The aim of this study was to quantitatively evaluate the amount of apically extruded debris by single-file reciprocating instruments with different working lengths and apical preparation sizes. Eighty human single-rooted mandibular incisors were used and conventional access cavities were prepared. Then, the specimens were divided into four groups (n=20), according to root canal instrumentation: Reciproc size 25, .08 taper and Reciproc size 40, .06 taper instruments were used at the foramen; Reciproc size 25, .08 taper and Reciproc size 40, .06 taper instruments were used 1 mm short of the foramen. Distilled water was used as an irrigant and the apically extruded debris were collected in pre-weighted glass vials and dried afterwards. The mean weight of debris was weighed with a microbalance and statistically analyzed using one-way analysis of variance and the post hoc Tukey multiple comparison test (p<0.05). The results showed that all experimental groups were associated with debris extrusion. No significant difference was found in the amount of apically extruded debris among all experimental groups (p>0.05). The present study demonstrated that the working length and the apical preparation size did not have a significant effect on debris extrusion when performing single-file reciprocating instrumentation.

Evaluation of Apically Extruded Debris during Root Canal Retreatment with Two Different Rotary Systems Followed by a Self-Adjusting File

Purpose

To compare the amount of apically extruded debris during root canal retreatment using ProTaper retreatment system (Dentsply Maillefer, Ballaigues, Switzerland), ProTaper retreatment system with Self-Adjusting File (SAF) system (ReDent-Nova, Ra'anana, Israel), Mtwo retreatment system (VDW, Munich, Germany), Mtwo retreatment system with SAF instruments.

Methods

In total, 72 extracted human mandibular incisor teeth were used. All root canals were prepared with ProTaper universal (Dentsply Maillefer) up to F2 file and filled with gutta percha and AH plus sealer using cold lateral condensation before being assembled randomly into 4 groups (n = 18 each). Root canal filling materials were removed using the ProTaper retreatment system, the ProTaper retreatment system followed by SAF system, Mtwo retreatment system and Mtwo retreatment system followed by SAF system. Debris extruded apically during the removal of canal filling material was collected into preweighed Eppendorf tubes. The tubes were then stored in an incubator at 70°C for 5 days. The weight of the dry extruded debris was established by subtracting the preretreatment and postretreatment weight of the Eppendorf tubes for each group. The data obtained were analyzed using Kruskal-Wallis test.

Results

All retreatment techniques caused the apical extrusion of debris. There was no significant difference between the groups statistically (p>0.05).

Conclusions

The results of this study showed that SAF system after Mtwo retreatment system and ProTaper retreatment system for improving retreatment has no significant effect on the amount of debris extruded apically.

Apical Extrusion of Debris Produced during Continuous Rotating and Reciprocating Motion

This study aimed to analyse and compare apical extrusion of debris in canals instrumented with systems used in reciprocating and continuous motion. Sixty mandibular premolars were randomly divided into 3 groups (n = 20): the Reciproc (REC), WaveOne (WO), and HyFlex CM (HYF) groups. One Eppendorf tube per tooth was weighed in advance on an analytical balance. The root canals were instrumented according to the manufacturer's instructions, and standardised irrigation with 2.5% sodium hypochlorite was performed to a total volume of 9 mL. After instrumentation, the teeth were removed from the Eppendorf tubes and incubated at 37°C for 15 days to evaporate the liquid. The tubes were weighed again, and the difference between the initial and final weight was calculated to determine the weight of the debris. The data were statistically analysed using the Shapiro-Wilk, Wilcoxon, and Mann-Whitney tests (α = 5%). All systems resulted in the apical extrusion of debris. Reciproc produced significantly more debris than WaveOne (p < 0.05), and both systems produced a greater apical extrusion of debris than HyFlex CM (p < 0.001). Cross section and motion influenced the results, despite tip standardization.

Comparison of apical and coronal extrusions using reciprocating and rotary instrumentation systems

Background

The aim of this study was to compare the apical and coronal extrusions by using two reciprocating and two rotary instrumentation systems.

Methods

Eighty extracted human single-rooted anterior teeth were randomly assigned to four groups. Four different root canal instrumentation systems were used according to the manufacturers instructions, including two reciprocating single-file systems, Reciproc and WaveOne, and two full-sequence rotary BLX and ProTaper instruments. Debris collected from the coronal by the instruments and apical extrusions were quantified respectively. After drying the collections, the mean weight of debris collected from apical and coronal extrusions was assessed using an electronic balance and analyzed using the Kruskal–Wallis H and Mann–Whitney U tests.

Results

Statistically significant differences in the apical extrusion were observed among the four groups. Reciproc and WaveOne instruments produced significantly less debris than BLX and ProTaper instruments (P < 0.05).

Conclusions

All of the systems produced apical extrusion of debris. However, reciprocating single-file systems produced less apical extrusion than full-sequence rotary systems. No relationship was observed between apical and coronal extrusions.

Effects of Different Rotary Files Combined with Different Irrigation Needles on Apically Extruded Debris

<p>The aim of this study was to compare the apically extruded debris associated with ProTaper Next and OneShape Apical files using two different irrigation needles, open-ended and closed-ended (Max-I-Probe). Forty-eight mandibular premolars were assigned to four groups (n=12) as follows: Group PTN-SN: Root canal was prepared with ProTaper Next (PTN) and irrigated with open-ended standard needle; Group PTN-MP: Root canal was prepared with PTN and irrigated with Max-I-Probe; Group OSA-SN: Root canal was prepared with OneShape Apical (OSA) and irrigated with open-ended needle; Group OSA-MP: Root canal was prepared with OSA and irrigated with Max-I-Probe. Debris extruded during instrumentation was collected into pre-weighed Eppendorf tubes. After storage in an incubator at 70 °C for 5 days, the Eppendorf tubes were weighed to obtain the final weight with extruded debris. The difference between pre-and post-debris weights was calculated and statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U tests (p<0.05). No statistically significant difference was observed between files and needles regarding amount of apically extruded debris (p>0.05). OneShape Apical and ProTaper Next resulted in extrusion of debris beyond the apical foramen, regardless of needle tip.</p>

The self-adjusting file instrumentation results in less debris extrusion apically when compared to WaveOne and ProTaper NEXT

Aim:

The present ex vivo study aimed to evaluate the debris extrusion after instrumenting the root canals by three different files systems.

Materials and Methods:

Sixty extracted human mandibular premolars with single canals were selected and randomly divided into three groups (n = 20) for instrumentation with three different files. Group 1: WaveOne (primary) single reciprocating file (WO; Dentsply Maillefer, Ballaigues, Switzerland) (25/08), Group 2: Self-adjusting file (SAF; ReDent-Nova, Ra’anana, Israel) (1.5 mm), and Group 3: ProTaper NEXT X1 and X2 (PTN; Dentsply Tulsa Dental, Tulsa, OK) (25/06). Debris extruding by instrumentation were collected into pre-weighed Eppendorf tubes. These tubes were then stored in an incubator at 70°C for 5 days. The tubes were then weighed to obtain the final weight, with the extruded debris. Statistical analysis for the debris extruded apically was performed using one-way analysis of variance and post hoc Tukey's test.

Results:

The statistical analysis showed a significant difference between all the three groups tested (P < 0.01). The following post hoc Tukey's test confirmed that Group 2 (SAF) exhibited significantly least (P < 0.01) debris extrusion between the three groups tested.

Conclusions:

The SAF resulted in significantly less extrusion of debris when compared to reciprocating WO and rotary PTN.

A comparison of different irrigation systems and gravitational effect on final extrusion of the irrigant

BACKGROUND

The aim of this study was to compare manual needle irrigation (MNI), RinsEndo (RE), and passive ultrasonic irrigation (PUI), and assess the effect of gravity on extrusion from the apex in vitro.

MATERIAL AND METHODS

The distobuccal roots of molars were used and the canals were instrumented up to F2. Teeth were mounted on models, which permitted visualization and manipulation of the apices for necessary procedures. The models were placed in articulator to simulate the jaw. Six groups (G) were formed as: G1, G2 and G3 represented mandibular positioning of teeth and were irrigated with MNI, RE, and PUI, respectively, while G4, G5, and G6 represented maxillary positioning of teeth and were also irrigated in same sequence. Prior to the final irrigation, 72 cube-shaped foam pieces covered with aluminum foil were weighed and the values were recorded as the initial weights. The cubes were then placed on the apical part of each sample. Final irrigation was performed with distilled water and the cubes were weighed again to determine their final weight. Data were analyzed using Kruskal-Wallis and Mann-Whitney U post-hoc test (p<0.05).

RESULTS

Irrespective of the irrigation technique used, the amount of irrigant extruded from the apex showed a statistically significant difference related to the effect of gravity (p<0.05). There was no statistically significant difference between irrigation methods (p>0.05). When the irrigation systems were compared to examine the effect of gravity, the significant difference was found between G2 and G5 (p<0.05).

CONCLUSIONS

Within the limitations of this study, MNI and PUI were found to be reliable irrigation systems. Caution should be exercised when using RinsEndo. Key words:Final irrigation, manual needle irrigation, passive ultrasonic irrigation, RinsEndo.

Assessment of apically extruded debris and irrigant produced by different nickel-titanium instrument systems

The aim of this study was to evaluate the preparation time and the amounts of apically extruded debris and irrigant using different nickel-titanium instrumentation systems. Forty-five extracted single-rooted mandibular premolar teeth were selected and divided into three groups. The root canals were instrumented according to the manufacturers' instructions, using a reciprocating single-file system, a single-file rotary system and a multiple-file rotary system. Bidistilled water was used as the irrigant solution. The apically extruded debris and irrigant were collected into preweighed Eppendorf tubes. The amounts of extruded debris and irrigant were assessed with a precision micro-balance. The Eppendorf tubes were incubated at 37°C for 15 days. After the incubation period, they were weighed again to assess the debris extrusion. The time required to prepare the canals was also recorded. The results were statistically analyzed using MANOVA and Bonferroni's adjustment. Considering the apically extruded debris and irrigant, there were no statistically significant differences among the groups (p > 0.05). The Reciproc group produced the highest debris (0.000632 ± 0.000162 gr) and irrigant (0.844587 ± 0.437814 ml) extrusion values. While the least extruded debris was observed with OneShape (0,000431 ± 0,000171 gr), the least extruded irrigant was observed with ProTaper system (0.564147 ± 0.370596 ml). Instrumentation was faster using the Reciproc than the other two instruments (70.27 ± 13.38 s) (p < 0.05). All of the instrumentation systems used in this study produced apical debris and irrigant extrusion. The reciprocating single-file system tended to produce more debris and irrigant extrusion, compared with the rotary systems. Considering the preparation time, the single-file systems appeared to be advantageous due to their working time.

Comparative evaluation of postoperative pain after using endodontic needle and EndoActivator during root canal irrigation: A randomised controlled trial

The purpose of this study was to evaluate and compare the postoperative level of pain after activation of irrigants using EndoActivator with conventional needle irrigation during root canal therapy. In this prospective randomised clinical trial, 72 symptomatic irreversible pulpitis patients were selected. Based on block randomisation after routine root canal preparation, patients were assigned to two groups. In group EN, procedures were performed with endodontic irrigating needle (n = 36) while group EA received activation using EndoActivator (n = 36) in the final irrigation protocol. All the participants were called through phone at 8, 24 and 48 h to analyse pain score using visual analogue scale. Those patients who developed pain were prescribed ibuprofen 200 mg. Pain score and frequency of tablet intake were recorded and statistically analysed. Results showed that group EA resulted in significantly less postoperative pain and analgesics intake than group EN. In conclusion, within the limitations of this study, the activation of irrigants using EndoActivator can be considered an effective method for reducing postoperative pain.

Apical extrusion of debris and irrigant using novel preparation systems

AIM

The aim of this in vitro study was to assess the amount of apically extruded debris and irrigant using Reciproc vs self-adjusting fle (SAF) and to investigate the effect, if any, of gravitational force via mandibular and maxillary positioning of the teeth.

MATERIALS AND METHODS

Forty human mandibular premolars were randomly assigned to four groups of 10 teeth each. The root canals were instrumented according to the manufacturers' instructions using the Reciproc and SAF. Sodium hypochlorite was used as the irrigant. The apically extruded debris was collected in pre-weighted glass vials using the Myers and Montgomery method, and teeth were placed in vials both in downward and upward positions. After drying, the mean weight of debris was assessed with a microbalance and statistically analyzed using two-way ANOVA with Bonferroni correction.

RESULTS

All instrumentation techniques and positions caused measurable apical extrusion of debris. A significant difference was observed according to position and instrument used (p < 0.05). The Reciproc extruded significantly more debris than SAF and vial downward position extruded significantly more debris than upward position (p < 0.05).

CONCLUSION

Under the conditions of this study, all systems caused apical debris extrusion, especially in the downward position.

CLINICAL SIGNIFICANCE

According to results of this study, the SAF was associated with less debris extrusion compared to the Reciproc in both mandibular and maxillary positions.

Comparative evaluation of apically extruded debris during root canal preparation using ProTaper™, Hyflex™ and Waveone™ rotary systems

BACKGROUND AND AIMS

Extrusion of any debris during endodontic treatment may potentially cause post-operative complications such as flare-ups. The purpose of this in vitro study was to assess the amount of apically extruded debris during the root canal preparation using rotary and reciprocating nickel-titanium instrumentation systems.

MATERIALS AND METHODS

In this study, 60 human mandibular first premolars were randomly assigned to 3 groups (n = 20 teeth/group). The root canals were instrumented according to the manufacturers' instructions using the Reciprocating single-file system WaveOne™ (Dentsply Maillefer, Ballaigues, Switzerland) and full-sequence rotary Hyflex CM™ (Coltene Whaledent, Allstetten, Switzerland) and ProTaper™ (Dentsply Maillefer, Ballaigues, Switzerland) instruments. The canals were then irrigated using bidistilled water. The debris that was extruded apically was collected in preweighed eppendorf tubes and assessed with an electronic balance and compared.

STATISTICAL ANALYSIS USED

The debris extrusion was compared and statistically analyzed using analysis of variance and the post hoc Student-Newman-Keuls test.

RESULTS

The WaveOne™ and ProTaper™ rotary instruments produced significantly more debris compared with Hyflex CM™ rotary instruments (P < 0.05).

CONCLUSIONS

Under the conditions of this study, all systems that were used resulted in extrusion of apical debris. Full-sequence rotary instrumentation was associated with less debris extrusion compared with the use of reciprocating single-file systems.

Pregabalin in the treatment of inferior alveolar nerve paraesthesia following overfilling of endodontic sealer

A case of orofacial pain and inferior alveolar nerve (IAN) paraesthesia after extrusion of endodontic sealer within the mandibular canal treated with prednisone and pregabalin is described. A 36-year-old woman underwent root canal treatment of the mandibular second right premolar tooth. Post-operative panoramic radiograph revealed the presence of radiopaque canal sealer in the mandibular canal. Damage to IAN consecutive to extrusion of endodontic sealer was diagnosed. Non-surgical management was decided, including: 1 mg/kg/day prednisone 2 times/day, once-daily regimen, and 150 mg/day pregabalin, two doses per day, monitoring the progress with periodic follow-up visits. Six weeks after the incident the signs and symptoms were gone. The complete resolution of paraesthesia and the control of pain achieved suggest that a non-surgical approach, combining prednisone and the GABA analogue pregabalin, is a good option in the management of the IAN damage subsequent to endodontic sealer extrusion. Key words:Endodontics, inferior alveolar nerve, neuropathic pain, orofacial pain, paraesthesia, pregabalin.

Influência do diâmetro foraminal do canal radicular, do tipo e da penetração de agulha, e do fluxo da solução irrigadora na limpeza e na extrusão apical

Introdução: A irrigação do canal radicular visa a limpeza e desinfecção do sistema de canais radiculares, sem promover extrusão apical. Objetivo: Avaliar a influência do diâmetro foraminal do canal radicular, da penetração e do tipo de agulha, e do fluxo na limpeza e na extrusão apical da solução irrigadora. Material e método: Doze dentes incisivos inferiores humanos com canal único foram instrumentados e, após ampliação foraminal com diferentes diâmetros (LK #40 e 60), os canais radiculares foram preenchidos com solução de contraste radiológico espessada com propilenoglicol e óxido de zinco. Foram utilizados dois tipos de agulhas de irrigação 27G com diferentes designs (abertura apical ou lateral), dois fluxos correspondentes a 15 ou 25 mL/min, e com penetração das agulhas em duas profundidades (3 e 6 mm aquém do ápice). Antes e após irrigação, os dentes foram radiografados utilizando um sistema radiográfico digital. As áreas do canal radicular antes (preenchido pelo contraste) e após irrigação (remanescente do contraste) foram submetidas à subtração de imagens no programa Adobe Photoshop CS4 e mensuradas por meio do programa Image Tool 3.0, obtendo o percentual de limpeza e de extrusão. Os dados foram analisados por meio dos testes ANOVA e Tukey, com nível de significância de 5%. Resultado: Não houve diferença estatística entre o diâmetro foraminal, o tipo e a profundidade de penetração da agulha, e a velocidade do fluxo de irrigação nos parâmetros limpeza (acima de 97%) e extrusão apical (menor do que 0,38 mm2), com p>0,05. Conclusão: Todos os protocolos de irrigação avaliados proporcionaram limpeza do canal radicular e pequena extrusão apical da solução irrigadora.

Apically extruded debris and irrigant with two Ni-Ti systems and hand files when removing root fillings: a laboratory study

AIM

To compare the amount of apically extruded debris and irrigant produced by two Ni-Ti instruments and hand files when removing root fillings, and to compare two experimental models.

METHODOLOGY

Sixty single straight root canals in human mandibular premolars were prepared with K-files and filled with gutta-percha and AH Plus sealer. The teeth were randomly divided into three groups of 20 for removal of the root filling material with Reciproc files (Group 1, RP), Mtwo retreatment files (Group 2, MR) or hand files (Group 3, H). Each group was then equally divided into experimental subgroups: A, with 1.5% agar gel model (AG); B, with empty tube model (ET). Apically extruded debris and irrigant was quantified by subtracting the initial weight of the test apparatus without a tooth from its weight after the root canal retreatment. Comparative analysis of the amount of apically extruded debris and irrigant for each of the instruments and the experimental models was performed. Time for gutta-percha removal was recorded. Data were statistically analysed using one-way analysis of variance.

RESULTS

Removal of root fillings with two Ni-Ti instruments produced less apically extruded debris and irrigant than hand files in both experimental models (P < 0.05). More apically extruded debris and irrigant was produced with Reciproc files than Mtwo retreatment files using the 1.5% agar gel model (P > 0.05). Significantly more apically extruded debris and irrigant was produced with Reciproc files than Mtwo retreatment files using the empty tube model (P < 0.05). The time required to remove the root fillings followed Reciproc<Mtwo R<hand files (P < 0.05).

CONCLUSIONS

All the instruments produced apically extruded debris and irrigant. The two Ni-Ti instruments produced less apically extruded debris and irrigant than hand files. A 1.5% agar gel can provide resistance to apically extruded debris and irrigant and may represent the clinical situation better than the empty tube model.

Weight of apically extruded debris following use of two canal instrumentation techniques and two designs of irrigation needles

AIM

To compare the weight of apically extruded debris associated with canal shaping using K-files, and the Revo-S system using two different needle tips, open-ended and side-vented.

METHODOLOGY

Forty freshly extracted mandibular premolar teeth were divided into four groups as follows; Group 1a: Hand instrumentation of root canal with open-ended needle used to provide irrigation, Group 1b: Hand instrumentation with a two side-port needle, Group 2a: Revo-S preparation with open-ended needle, Group 2b: Revo-S preparation with a two side-port needle. One Eppendorf tube for each tooth was weighed with a 0.0001 electronic weighing machine before instrumentation procedures. During instrumentation, irrigation was performed after every instrument with 1 mL distilled water. On completion of the preparation, teeth were removed from the Eppendorf tubes. All of the tubes were incubated at 37 °C for 15 days, to evaporate the irrigant. After the incubation period, tubes were weighed again. The difference between pre-and post-debris weights was calculated, and statistical evaluation was performed using analysis of variance at 0.05 level of significance.

RESULTS

No statistically significant difference was observed between K-files and the RevoS system. A significant difference was observed between needles (P < 0.05). Open-ended needles were associated with significantly more debris than side-vented needles (P < 0.05).

CONCLUSIONS

Both hand and rotary canal instrumentation resulted in extrusion of debris beyond the apical foramen. No significant difference was observed between K-files and Revo-S system. Open-ended needles were associated with significantly more extruded debris than two side-port needles.