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Ahmad MZ, Sadaf D, MacBain MM, Merdad KA. Effect of mode of rotation on apical extrusion of debris with four different single-file endodontic instrumentation systems: Systematic review and meta-analysis. AUST ENDOD J 2022; 48:202-218. [PMID: 35255170 DOI: 10.1111/aej.12612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/20/2021] [Accepted: 02/13/2022] [Indexed: 01/19/2023]
Abstract
This systematic review and meta-analysis evaluated whether single-file endodontic instrumentation systems with the reciprocating type of motion are responsible for more debris extrusion than single-file endodontic instrumentation systems with the full rotational type of motion. Electronic and manual searches were performed following the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analysis - PRISMA. We included studies comparing rotary (Neoniti and/ OneShape) versus reciprocating (WaveOne and/ Reciproc) systems. We evaluated the quality of studies and performed statistical analysis using R-Project software. Eight studies of high quality were included to perform the meta-analysis. Subgroup analysis was also done. The overall risk of bias was too low. In conclusion, single-file reciprocating systems tend to generate more extrusion of debris than single-file rotary systems.
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Affiliation(s)
- Muhammad Zubair Ahmad
- Restorative Dentistry Department, College of Dentistry in Ar Rass, Qassim University, Ar Rass, Saudi Arabia.,Nuffield Department of Primary Care Health Sciences, Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK
| | - Durre Sadaf
- Nuffield Department of Primary Care Health Sciences, Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK
| | - Marcy McCall MacBain
- Nuffield Department of Primary Care Health Sciences, Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK
| | - Khalid A Merdad
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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Keskin C, Sivas Yilmaz Ö, Inan U. Apically extruded debris produced during glide path preparation using R-Pilot, WaveOne Gold Glider and ProGlider in curved root canals. AUST ENDOD J 2020; 46:439-444. [PMID: 32820600 DOI: 10.1111/aej.12428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/26/2020] [Indexed: 11/29/2022]
Abstract
The present study aimed to compare the apically extruded debris produced during glide path preparation using R-Pilot (RP), WaveOne Gold Glider (WGG) and ProGlider (PG) with the subsequent preparation using Reciproc Blue in curved root canals. Mesial roots of mandibular molars with angle of curvature between 25° and 35° were selected (n = 20). The Myers and Montgomery method was used to collect and assess apically extruded debris. The glide path was prepared either manually with K-file, ProGlider, R-Pilot or WaveOne Gold Glider. Manual preparation group produced the highest amount of apically extruded debris (P < 0.05), while all groups caused debris extrusion. There were no significant differences among the extruded debris caused by RP, PG and WGG groups (P > 0.05). Apically extruded debris produced by engine-driven reciprocational or continuous rotational single file glide path instruments was similar, whereas manual glide path preparation was associated with the greatest amount of extruded debris.
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Affiliation(s)
- Cangül Keskin
- Faculty of Dentistry, Department of Endodontics, Ondokuz Mayis University, Samsun, Turkey
| | - Özlem Sivas Yilmaz
- Faculty of Dentistry, Department of Endodontics, Ondokuz Mayis University, Samsun, Turkey
| | - Uğur Inan
- Faculty of Dentistry, Department of Endodontics, Ondokuz Mayis University, Samsun, Turkey
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ALTUNBAŞ D, TOYOĞLU M. THE INFLUENCE OF DIFFERENT TORQUE SETTINGS ON THE AMOUNT OF APICALLY EXTRUDED DEBRIS DURING ROTARY INSTRUMENTATION. CUMHURIYET DENTAL JOURNAL 2020. [DOI: 10.7126/cumudj.691090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Gokturk H, Ozkocak I, Aydin U, Serefli ED. Effect of different chelating agents and their surface tension on the amount of apically extruded debris. J Dent Sci 2020; 16:195-200. [PMID: 33384797 PMCID: PMC7770288 DOI: 10.1016/j.jds.2020.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/14/2020] [Indexed: 12/01/2022] Open
Abstract
Background/purpose During root canal preparation apical extrusion is an undesirable situation that can cause postoperative complications. The aim of the present study is to evaluate the effect of the presence of different chelators in root canals during preparation on the amount of apically extruded debris and to investigate the effect of surface tension of irrigant on the apical extrusion. Materials and methods Ninety extracted mandibular incisor teeth were included. Prior to canal preparation, the teeth were mounted to Eppendorf tubes. Root canals of the samples were prepared with Reciproc instruments in the presence of different chelating agents (17% EDTA-liquid, 17% EDTA-gel, 7% maleic acid, 2.25% peracetic acid, 10% citric acid) and 5% NaOCl. Apically extruded debris was collected in Eppendorf tubes and weighted with an electronic balance. The surface tension of solutions was calculated with the ring method using a du Noüy ring digital tensiometer. The statistical analysis was performed with Tamhane's T2 test for apical extrusion and the Tukey for surface tension. The correlation between apical extrusion and surface tension was compared using Pearson's coefficient. Results The least amount of apically extruded debris was with EDTA-gel, peracetic acid and citric acid which were similar to each other. NaOCl had the highest surface tension whereas peracetic acid and EDTA-liquid had the lowest. There was no significant correlation exists between apical extrusion and surface tension. Conclusion The presence of EDTA-gel, citric acid and peracetic acid in root canals during preparation decreased the amount of apically extruded debris compared to other solutions. The investigated irrigation solutions have no significant effect on the amount of apical debris extrusion.
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Affiliation(s)
- Hakan Gokturk
- Department of Endodontics, Bolu Abant İzzet Baysal University, Bolu, Turkey
| | - Ismail Ozkocak
- Department of Endodontics, Bolu Abant İzzet Baysal University, Bolu, Turkey
| | - Ugur Aydin
- Department of Endodontics, Gaziantep University, Gaziantep, Turkey
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Bordagaray T, Steinfort K, Pendola M, Monardes H, Abarca J. Evaluation of apical debris extrusion and patency file in continuous and reciprocating rotary endodontic systems. JOURNAL OF ORAL RESEARCH 2019. [DOI: 10.17126/joralres.2019.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of the study was to quantify and compare apical debris extrusion in two systems of continuous and reciprocating rotary instrumentation with, and without, the use of a patency file. An experimental study was carried out in 120 mesial roots of lower first molars, which were randomized in the following 4 groups: Group A. Reciproc (VDW) R25 without a patency file, Group B Mtwo (VDW) without a patency file, Group C Reciproc (VDW) R25 with a patency file and Group D Mtwo with a patency file. Groups A, B and C presented statistically significant differences in comparison to group D, Mtwo with the use of a patency file (p<0.008 to 95% reliability). In conclusion, the greater amount of debris extruded through the apex occurred in roots instrumented with the reciprocating rotary system; this difference was statistically significant in relation to teeth treated with the Mtwo continuous rotary system with the use of a patency file.
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Arruda-Vasconcelos R, Barbosa-Ribeiro M, Louzada LM, Mantovani GD, Gomes BPFA. Apically Extruded Debris Using Passive Ultrasonic Irrigation Associated with Different Root Canal Irrigants. Braz Dent J 2019; 30:363-367. [DOI: 10.1590/0103-6440201902674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 02/21/2019] [Indexed: 11/21/2022] Open
Abstract
Abstract The present study evaluated the amount of apically extruded debris after chemo-mechanical preparation (CMP) associated with passive ultrasonic irrigation (PUI) using four different root canal irrigants, namely, 6% sodium hypochlorite (NaOCl), 2% chlorhexidine gel + saline solution (2% CHXg+SS), 2% chlorhexidine solution (2% CHXs) and SS alone. Sixty mandibular premolars with single straight root canals were selected and randomly assigned into 4 groups (n=15) according to the root canal irrigant used as follows: G1 (PUI + NaOCl), G2 (PUI + CHXg+SS), G3 (PUI+CHXs) and G4 (PUI+SS). Reciproc® R25 files (25/.08) were used during CMP and the debris extruded from each tooth were collected in pre-weighted Eppendorf tubes and dried. The average weight of debris was assessed by using an analytical microbalance. Data were statistically analysed by using ANOVA and post-hoc Tukey’s test (a=0.05). Debris extrusion was observed in all groups, irrespective of the root canal irrigating, with 2% CHXg + SS being associated with lower debris extrusion compared to other irrigants (p<0.05). No significant differences were observed between 6% NaOCl, 2% CHXs and SS. In conclusion, passive ultrasonic irrigation did not completely prevent apically extrusion of debris. PUI performed with 2% chlorhexidine gel + saline solution significantly minimized debris extrusion compared to 6% sodium hypochlorite, chlorhexidine solution and saline solution.
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Barbosa-Ribeiro M, Arruda-Vasconcelos R, Fabretti FL, Silva EJNL, De-Deus G, Gomes BPFA. Evaluation of Apically Extruded Debris Using Positive and Negative Pressure Irrigation Systems in Association with Different Irrigants. Braz Dent J 2018; 29:184-188. [PMID: 29898066 DOI: 10.1590/0103-6440201801750] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/11/2017] [Indexed: 11/21/2022] Open
Abstract
This study evaluated the amount of apically extruded debris after chemo-mechanical preparation (CMP) using positive and negative pressure irrigation systems [Conventional irrigation (CI) and EndoVac (EV)] in association with different irrigants [6% Sodium Hypochlorite (NaOCl), 2% Chlorhexidine gel + saline solution (CHXg + SS), 2% Chlorhexidine solution (CHXs) or Saline solution (SS)]. Eighty mandibular premolars with single root canals were selected and randomly assigned into 8 groups (n = 10) according to the irrigation system and the irrigant used during CMP: G1 (EV + NaOCl), G2 (EV + CHXg + SS), G3 (EV + CHXs), G4 (EV + SS), G5 (CI + NaOCl), G6 (CI + CHXg + SS), G7 (CI + CHXs) and G8 (CI + SS). Reciproc® R25 files (25/.08) were used during the CMP and the extruded debris from each tooth was collected in pre-weighted Eppendorf tubes and dried. The average weight of debris was assessed using a microbalance, and the data were statistically analyzed using ANOVA and the post hoc Tukey's test (a = 0.05). All groups were associated with debris extrusion. EV was the irrigation system with less extruded debris (p < 0.05). No differences were observed regarding the irrigant when EV was used. When CI was used, CHXg + SS were associated with lower debris extrusion (p < 0.05). It was concluded that no irrigation protocol succeeded in preventing debris extrusion. EV resulted in lower levels of debris extrusion than CI. The use of CHXg + SS resulted in lower debris extrusion.
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Affiliation(s)
- Marlos Barbosa-Ribeiro
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State UNICAMP - Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | - Rodrigo Arruda-Vasconcelos
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State UNICAMP - Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | - Fabio L Fabretti
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State UNICAMP - Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | - Emmanuel J N L Silva
- Department of Integrated Clinical Procedures, Division of Endodontics, UERJ - Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Department of Endodontics, School of Dentistry, UNIGRANRIO - Universidade Grande Rio, Rio de Janeiro, RJ, Brazil
| | - Gustavo De-Deus
- Department of Endodontics, School of Dentistry, UNIGRANRIO - Universidade Grande Rio, Rio de Janeiro, RJ, Brazil.,Department of Endodontics, UFF - Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
| | - Brenda P F A Gomes
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State UNICAMP - Universidade Estadual de Campinas, Piracicaba, SP, Brazil
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Effects of Different Glide Path Files on Apical Debris Extrusion in Curved Root Canals. J Endod 2018; 44:1191-1194. [DOI: 10.1016/j.joen.2018.04.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 11/20/2022]
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Espir CG, Nascimento-Mendes CA, Guerreiro-Tanomaru JM, Freire LG, Gavini G, Tanomaru-Filho M. Counterclockwise or clockwise reciprocating motion for oval root canal preparation: a micro-CT analysis. Int Endod J 2018; 51:541-548. [PMID: 28375575 DOI: 10.1111/iej.12776] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/29/2017] [Indexed: 11/28/2022]
Abstract
AIM To evaluate oval root canal preparation using one or two instruments in counterclockwise or clockwise reciprocating motion. METHODOLOGY The radiographic diameter of mandibular human incisors was evaluated, and oval canals were selected (2 ≤ Diameter Ratio ≤ 4). Fifty-seven teeth were assigned to root canal preparation (n = 19): Reciproc 40 (R40) in a counterclockwise reciprocating motion; Mtwo size 40, .06 taper (M 40.06) in a clockwise reciprocating motion or Mtwo size 20, .06 taper and size 40, .06 taper (M 20/40.06) in a clockwise reciprocating motion. Mtwo instruments were coupled to an ENDO DUAL motor, turning 150° clockwise and 30° counterclockwise. Scanning was performed before and after root canal preparation using a SkyScan 1176 micro-computed tomography. Volume, percentage of debris and percentage of uninstrumented surface were analysed in the entire root canal and in each third of the canal. Data were compared using anova and Tukey's tests or Kruskal-Wallis and Dunn tests. RESULTS The Reciproc and Mtwo systems using different kinematics were associated with a similar increase in root canal volume. Additionally, both system had similar percentage of uninstrumented surface (P > 0.05). Mtwo size 20, .06 taper and size 40, .06 taper was associated with significantly lower debris (P < 0.05) in the middle third (0.56%) when compared to R40 (1.31%) and M size 40, .06 taper (1.54%). CONCLUSIONS The conventional reciprocation motion for R40 and the clockwise reciprocation motion for Mtwo resulted in similar root canal preparations. Less remaining debris was present in the middle third when two instruments with different diameters were used.
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Affiliation(s)
- C G Espir
- Department of Restorative Dentistry, Araraquara Dental School, São Paulo State University, Araraquara, São Paulo, Brazil
| | - C A Nascimento-Mendes
- Department of Restorative Dentistry, Araraquara Dental School, São Paulo State University, Araraquara, São Paulo, Brazil
| | - J M Guerreiro-Tanomaru
- Department of Restorative Dentistry, Araraquara Dental School, São Paulo State University, Araraquara, São Paulo, Brazil
| | - L G Freire
- Department of Dentistry, São Paulo Dental School, University of São Paulo, São Paulo, São Paulo, Brazil
| | - G Gavini
- Department of Dentistry, São Paulo Dental School, University of São Paulo, São Paulo, São Paulo, Brazil
| | - M Tanomaru-Filho
- Department of Restorative Dentistry, Araraquara Dental School, São Paulo State University, Araraquara, São Paulo, Brazil
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Espir CG, Nascimento-Mendes CA, Guerreiro-Tanomaru JM, Cavenago BC, Hungaro Duarte MA, Tanomaru-Filho M. Shaping ability of rotary or reciprocating systems for oval root canal preparation: a micro-computed tomography study. Clin Oral Investig 2018. [DOI: 10.1007/s00784-018-2411-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kfir A, Moza-Levi R, Herteanu M, Weissman A, Wigler R. Apical extrusion of debris during the preparation of oval root canals: a comparative study between a full-sequence SAF system and a rotary file system supplemented by XP-endo finisher file. Clin Oral Investig 2017; 22:707-713. [PMID: 28608053 DOI: 10.1007/s00784-017-2144-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the amount of apically extruded debris during the preparation of oval canals with either a rotary file system supplemented by the XP-endo Finisher file or a full-sequence self-adjusting file (SAF) system. MATERIALS AND METHODS Sixty mandibular incisors were randomly assigned to two groups: group A: stage 1-glide path preparation with Pre-SAF instruments. Stage 2-cleaning and shaping with SAF. Group B: stage 1-glide path preparation with ProGlider file. Stage 2-cleaning and shaping with ProTaper Next system. Stage 3-Final cleaning with XP-endo Finisher file. The debris extruded during each of the stages was collected, and the debris weights were compared between the groups and between the stages within the groups using t tests with a significance level set at P < 0.05. RESULTS The complete procedure for group B resulted in significantly more extruded debris compared to group A. There was no significant difference between the stages in group A, while there was a significant difference between stage 2 and stages 1 and 3 in group B, but no significant difference between stages 1 and 3. CONCLUSIONS Both instrumentation protocols resulted in extruded debris. Rotary file followed by XP-endo Finisher file extruded significantly more debris than a full-sequence SAF system. Each stage, in either procedure, had its own contribution to the extrusion of debris. CLINICAL RELEVANCE Final preparation with XP-endo Finisher file contributes to the total amount of extruded debris, but the clinical relevance of the relative difference in the amount of apically extruded debris remains unclear.
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Affiliation(s)
- Anda Kfir
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rotem Moza-Levi
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moran Herteanu
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Weissman
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronald Wigler
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
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Silva PB, Krolow AM, Pilownic KJ, Casarin RP, Lima RKP, Leonardo RDT, Pappen FG. Apical Extrusion of Debris and Irrigants Using Different Irrigation Needles. Braz Dent J 2017; 27:192-5. [PMID: 27058383 DOI: 10.1590/0103-6440201600382] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 02/16/2016] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Paula Barcellos Silva
- Department of Semiology and Clinics, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Angélica Mohnsam Krolow
- Department of Semiology and Clinics, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Katerine Jahnecke Pilownic
- Department of Semiology and Clinics, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Renata Picanço Casarin
- Department of Semiology and Clinics, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Regina Karla Pontes Lima
- Department of Restorative Dentistry, Araraquara Dental School, Universidade Estadual Paulista, Araraquara, SP, Brazil
| | - Renato de Toledo Leonardo
- Department of Restorative Dentistry, Araraquara Dental School, Universidade Estadual Paulista, Araraquara, SP, Brazil
| | - Fernanda Geraldo Pappen
- Department of Semiology and Clinics, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
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Western JS, Dicksit DD. Apical extrusion of debris in four different endodontic instrumentation systems: A meta-analysis. J Conserv Dent 2017; 20:30-36. [PMID: 28761250 PMCID: PMC5514807 DOI: 10.4103/0972-0707.209066] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND All endodontic instrumentation systems tested so far, promote apical extrusion of debris, which is one of the main causes of postoperative pain, flare ups, and delayed healing. OBJECTIVES Of this meta-analysis was to collect and analyze in vitro studies quantifying apically extruded debris while using Hand ProTaper (manual), ProTaper Universal (rotary), Wave One (reciprocating), and self-adjusting file (SAF; vibratory) endodontic instrumentation systems and to determine methods which produced lesser extrusion of debris apically. METHODOLOGY An extensive electronic database search was done in PubMed, Scopus, Cochrane, LILACS, and Google Scholar from inception until February 2016 using the key terms "Apical Debris Extrusion, extruded material, and manual/rotary/reciprocating/SAF systems." A systematic search strategy was followed to extract 12 potential articles from a total of 1352 articles. The overall effect size was calculated from the raw mean difference of weight of apically extruded debris. RESULTS Statistically significant difference was seen in the following comparisons: SAF < Wave One, SAF < Rotary ProTaper. CONCLUSIONS Apical extrusion of debris was invariably present in all the instrumentation systems analyzed. SAF system seemed to be periapical tissue friendly as it caused reduced apical extrusion compared to Rotary ProTaper and Wave One.
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Affiliation(s)
- J Sylvia Western
- Faculty of Dentistry, SEGi University, No. 9, Jalan Teknologi, Kota Damansara, PJU5, Selangor, Malaysia
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