Evaluation of apically extruded debris during root canal preparation in primary molar teeth using three different rotary systems and hand files

In vitro apical extrusion of debris and instrumentation time following root canal instrumentation with Reciproc and Reciproc Blue instruments and a novel stainless steel rotary system (Gentlefile) versus manual instrumentation

Background

This study compared apical extrusion of debris and instrumentation time following root canal instrumentation with Reciproc, Reciproc Blue, and Gentlefile (GF) rotary instruments versus the manual step-back technique.

Methods

This in vitro study was conducted on 80 extracted mandibular premolars with mature apices and a root curvature of<10°. The teeth were randomly assigned to 4 groups (n=20), standardized regarding working length, and placed in pre-weighed vials. The root canals were instrumented with Reciproc, Reciproc Blue, and GF systems and the manual step-back technique in the four groups. The vials containing the collected debris were then dried and weighed. The instrumentation time was also recorded for each group. Data were analyzed with one-way ANOVA and post hoc Games-Howell test (α=0.05).

Results

Minimum apical debris extrusion was noted in Reciproc, followed by Reciproc Blue, GF, and manual technique (P<0.05). Pairwise comparisons showed significantly lower apical extrusion of debris in the Reciproc compared with GF (P=0.015) and manual instrumentation (P=0.011) groups. The Reciproc system also had the shortest instrumentation time, followed by Reciproc Blue, GF, and manual instrumentation (P<0.05). Pairwise comparisons showed significant differences between all the systems (P<0.05) except between Reciproc and Reciproc Blue (P>0.05) in this respect.

Conclusion

Although all systems caused apical extrusion of debris, manual instrumentation caused maximum extrusion of debris. In contrast, the Reciproc system was superior to others regarding minimal apical extrusion of debris and the shortest instrumentation time.

Assessment of clinical and radiographic efficiency of manual and pediatric rotary file systems in primary root canal preparation: a randomized controlled clinical trial

INTRODUCTION

The success of primary teeth pulpectomy is strongly reliant on instrumentation techniques and their impact on obturation quality & postoperative pain. Recently, pediatric rotary file systems have been implemented.

AIM

to compare two pediatric rotary file systems (Kedo-S-Square & Fanta AF™ Baby) with manual K-files concerning obturation quality, instrumentation time, and postoperative pain in root canal preparation of primary molars using cone beam computed tomography (CBCT).

METHODS

A randomized clinical trial was conducted with the trial registration number (TRN: NCT05619796 and date of registration: (17/11/2022) on sixty primary lower 2nd molars in healthy children aged 4-7 years. Molars were assigned randomly to three groups (n = 20). Group-I and -II were prepared with Kedo-S-Square & Fanta AF™Baby rotary systems respectively while group-III was prepared with a manual K-file. Instrumentation time was recorded using a stopwatch. CBCT was used to assess obturation quality immediately & recorded as optimal, underfilled, or overfilled. Postoperative pain was evaluated at 6, 12, 24, 48 h-time intervals using a four-point pain intensity scale. Statistical analysis was performed for the collected data.

RESULTS

Among the three groups, group-I revealed a greater number of optimally filled teeth (85%) & less instrumentation time (74.75 s) followed by group-II & manual-K file group (p < 0.05). The hand K-file group had significantly more postoperative pain than the two rotary groups (p < 0.05).

CONCLUSION

the tested rotary file systems resulted in better obturation quality, less instrumentation time, and less postoperative pain compared to manual-K files during primary teeth pulpectomy.

Comparative Evaluation of Extrusion of Apical Debris in Primary Maxillary Anterior Teeth Using Two Different Rotary Systems and Hand Files: An In Vitro Study

Successful outcome of pulp therapy depends on good chemomechanical preparation of the canals. This is completed with the help of various upcoming rotary and hand files. However, during this preparation, there might be an apical extrusion of the debris which may result in postoperative complications. The aim of this study was to evaluate and compare the number of debris apically extruded during canal preparation using two different pediatric rotary file systems and conventional hand file systems in primary teeth. 60 primary maxillary central incisors that were extracted due to trauma or untreated dental caries with no signs of resorption were taken. Canal preparation was executed using three different file systems: Group A: Group A hand K file system, Group B Kedo S Plus, Group C Kedo SG Blue. For each of these files using the Myers and Montgomery model, the pre- and post-weight of the eppendorf tube was assessed to quantify the number of apical debris. The maximum extrusion of apical debris was noticed with the Hand K-file system. The least debris was noticed in the Kedo S Plus file system. Statistical analysis revealed that there were highly significant differences in apical extrusion and debris when comparing hand files and rotary files and also between the two rotary files used. Apical debris collection is an unavoidable outcome of canal instrumentation. Among the file systems compared, rotary files had lesser extrusion when compared to hand files. Among the rotary files, Kedo S plus showed normal extrusion compared to SG Blue.

Comparison of apical debris extrusion during root canal preparation in primary molars using different file systems: an in vitro study

This study aimed to compare the amount of debris extrusion of four endodontic systems made of Nickle-Titanium alloy. This in vitro study was done on 80 extracted primary molars. They were selected by cone-beam computed tomography and randomly divided into four groups (n = 20) to be prepared to the apical size of 25 by one of the systems: Reciproc, Protaper Universal, Neolix, or Hyflex CM. Debris was collected into Eppendorf microtubes and placed in an incubator to evaporate the washing solution. Debris was weighed by a digital scale of 0.01 g precision. Data were statistically analysed using SPSS software. Tukey's comparison was used to determine the difference between the four file systems (α = 0.05). Debris extrusion after Reciproc preparation (0.00320) was significantly higher than the other (P < 0.05), with no significant difference having been observed among the other systems (P > 0.05). It can be concluded that all systems under investigation exhibited debris extrusion.

Comparative Evaluation of Apically Extruded Debris during Pulpectomy Procedure in Primary Molar Teeth Using Two Different Rotary Systems and Hand Files: An In Vitro Study

Background

Successful outcome of endodontic treatment depends on chemomechanical preparation of the tooth. However, during canal preparation, debris may extrude through the apical foramen causing postoperative complications. The aim of this study is to evaluate and compare the amount of apically extruded debris during the pulpectomy procedure in primary molar teeth using two different rotary files and hand files.

Materials and Methods

Distal roots of sixty extracted primary molars were divided into three groups: group A: Prime Pedo™ pediatric rotary files, group B: DXL-Pro Pedo™ pediatric rotary files, and group C: hand files. Myers and Montgomery experimental model was used. Preweighed Eppendorf tubes were used to collect apically extruded debris. The tubes were then placed in an incubator at 70°C for 5 days. The weight of the debris attained was determined. The data were analyzed using ANOVA and post hoc Bonferroni test.

Results

Hand files produced more apical debris extrusion (P < 0.05). Prime Pedo™ pediatric rotary files produced the least debris (P < 0.05).

Conclusion

Prime Pedo™ and DXL-Pro Pedo™ pediatric rotary files extruded significantly lower amount of debris apically during pulpectomy as compared to hand files. Rotary files can be considered an alternative to hand files in pediatric endodontics.

Comparative Evaluation of Cleaning Efficiency and Apical Extrusion of Debris Using Two Pediatric Rotary Endodontic Files: An In Vitro Study

Aim and objective

Apical extrusion of debris and cleaning efficacy in primary root canal treatment has not been well elucidated by using specialized pediatric rotary endodontic files. The purpose of this study is to compare the amount of apically extruded debris and cleaning efficacy during the preparation of primary molar root canals using Pro AF Baby Gold and Kedo-S pediatric rotary files.

Materials and methods

Twenty extracted primary molar teeth were assigned randomly to two groups (n = 10 teeth for each group), injected with Indian Ink and instrumented using Kedo-S and Pro AF Baby Gold pediatric rotary files, respectively. The apically extruded debris was collected and dried in pre-weighed using Eppendorf tubes. The dry weight was calculated by subtracting the preoperative weight from the postoperative weight. The cleaning efficacy was evaluated after the diaphanization process. Statistics: Data were analyzed statistically using the independent sample t-test.

Results

The amount of apically extruded debris was significantly less for the Pro AF Baby rotary files group compared to the Kedo-S rotary files group (p < 0.05). Cleaning efficacy was significantly better with Pro AF Baby Gold when compared to Kedo-S rotary files in the apical region of the tooth.

Conclusion

All instruments caused apically extruded debris in primary teeth. Pro AF baby Gold files can be used with less apical extrusion of debris. Cleaning efficacy was shown to be better with the Pro AF Baby Gold pediatric rotary endodontic file.

How to cite this article

Rathi N, Jain SA, Thosar N, et al. Comparative Evaluation of Cleaning Efficiency and Apical Extrusion of Debris Using Two Pediatric Rotary Endodontic Files: An In Vitro Study. Int J Clin Pediatr Dent 2021;14(2):196–200.

Apical debris extrusion during instrumentation of oval root canals in primary teeth using manual versus motorized files: an ex vivo study

This study aimed to assess the apical extrusion of debris during instrumentation of primary canines using three endodontic file types. Forty-five extracted primary canines were randomly assigned to three instrumentation groups (n = 15): Hand K-files; and the motorized Kedo-S files and XP-endo Shaper files. The apically extruded debris produced during the procedure was collected and dried in pre-weighed Eppendorf tubes, and the mass of debris was calculated. The time required for the endodontic procedure was also recorded. Analysis of variance (ANOVA) and Tukey’s post hoc test were used with a significance level set at 5%. XP-endo Shaper and Kedo-S files extruded significantly less debris compared with hand K-files with means of 0.84 ± 0.31 and 1.20 ± 0.67 mg respectively, compared to 2.13 ± 0.31 mg (p < 0.0001). No significant difference was found between the two motorized files. Less time was required to complete the procedure with the XP-endo Shaper compared to the hand K-files (p < 0.0001) and Kedo-S files (p < 0.0001). Within the limitations of the present study, it may be concluded that motorized files extruded less debris and required less instrumentation time compared to traditional K-files, which could benefit paediatric patients with root canal treatment needs.

Evaluation of Postoperative Pain after Pulpectomy using Different File Systems in Primary Teeth: A Systematic Review

OBJECTIVE

The purpose of this systematic review was to compare the incidence and intensity of postoperative pain after pulpectomy using different instrumentations in primary teeth.

MATERIALS AND METHODS

An extensive literature search in PubMed, Cochrane Library, Science Direct, LILAC, SIGLE, and Google Scholar was performed to identify English language articles with human subjects that evaluated the effects of different instruments on postoperative pain after pulpectomy.

RESULTS

The search retrieved 187 references. After screening of the abstracts and articles, based on the inclusion and exclusion criteria, a total of three articles were included in the systematic review. Of the three included studies, two of them had a moderate risk of bias and one showed a high risk of bias.

CONCLUSION

The use of rotary instruments contributed to a lower incidence and intensity of postoperative pain than did the hand instruments in all the three studies. More high-quality randomized clinical trials are needed in this field in future studies to support the evidence.

The effect of sonic activation of irrigant on postoperative pain after root canal treatment in primary molar teeth: a randomized, clinical study

PURPOSE

Postoperative pain following root canal treatment is a concern for pediatric patients and pediatric dentists. The purpose of this study was to evaluate the effect of using sonic activation (SA) on postoperative pain levels after root canal therapy of primary molars.

METHODS

A total of 110 patients aged 5-9 years with symptomatic irreversible pulpitis involving primary molars were included in the study and were randomly divided into two groups according to agitation methods: SA and no sonic activation (NSA). Root canal treatments were completed, and the teeth were restored permanently. Postoperative pain levels were evaluated using the five-face scale at 8, 24, 48, and 72 h and 1 week after treatment. Pain levels and frequency of analgesic intake were recorded and analyzed.

RESULTS

Postoperative pain values were lower in the SA group than in the NSA group at 8, 24, and 48 h after treatment (p < 0.05). No significant difference was observed between the groups in terms of postoperative pain values at 72 h and 1 week after treatment (p > 0.05).

CONCLUSIONS

It was determined that the use of SA reduces postoperative pain level significantly after root canal treatment in primary molar teeth.

CLINICAL RELEVANCE

The use of SA can be recommended to clinicians since it is effective in the successful management of postoperative pain of root canal treatment in primary molar teeth.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT04197531.

The effect of two different irrigation needles on post-operative pain after pulpectomy in primary molar teeth: A randomized clinical study

BACKGROUND

Post-operative pain (PP) following pulpectomy is of concern for endodontic patients and dentists.

AIM

This study evaluated the intensity of PP following pulpectomy in primary maxillary molars, using two irrigation needles.

DESIGN

One hundred patients in ages ranging from 6-9 years requiring pulpectomy for asymptomatic primary teeth with non-vital pulp were included in the study. The participants were randomly assigned to two groups of 50 patients each, according to the type of irrigation needle used, that is, a conventional open-ended needle and a double side-vented needle. The teeth were obturated and then permanently restored. The presence of PP was assessed after six, 12, 24, 48, and 72 hours, and finally after one week, using a four-point pain intensity scale. The PP scores were then statistically analysed.

RESULTS

In 6, 12, and 24 hours time intervals, patients who had their teeth irrigated with the open-ended needle exhibited more intense PP than those who had their teeth irrigated with a double side-vented needle (P < .05). After 48 hours, 72 hours, and 1 week, however there was no significant difference between the groups (P > .05).

CONCLUSIONS

Side-vented needles may be preferred in order to decrease PP at the first 24 hours after pulpectomy in primary molars.

[Advanced research on root canal therapy for primary teeth]

Primary tooth root canal therapy is a treatment performed on primary teeth diagnosed with pulpitis or periapical periodontitis. This procedure requires perfect instrumentation, disinfection, and filling of root canals to eliminate infection, control inflammation, relieve pain, prevent pathological effects on inherited permanent tooth, and prolong primary tooth preservation. This paper reviews the research history on primary tooth root canal treatment and summarizes the progress on primary tooth root canal treatment, including anatomical morphology, root canal preparation, root canal disinfection, root canal filling, and application of antibiotics.

Bactericidal effect of a diode laser on Enterococcus faecalis in human primary teeth-an in vitro study

Background

In recent years, the diode laser (810 nm) has been used for root canal disinfection, which plays an important role in endodontic therapy. This study was undertaken to evaluate the disinfecting ability of a diode laser in experimentally infected root canals of primary teeth.

Methods

Human retained mandibular primary anterior teeth without apical foramen resorption were selected and contaminated with Enterococcus faecalis for 21 days. The specimens were randomly divided into four groups: the negative group (no treatment), positive group (5.25% NaOCl), diode laser group (diode laser), and diode-NaOCl group (diode laser combined with NaOCl). The disinfecting abilities of the treatments were measured by the numbers of bacteria, scanning electron microscopy and confocal laser microscopy (live-dead staining).

Results

Eighty teeth were selected. After irradiation and irrigation, the elimination of bacteria and the smear layer in the laser groups and positive group were significantly superior, compared with the negative group (p < 0.01). In the diode-NaOCl group, bacterial reduction reached nearly 100% on the surfaces of root canals; live bacteria were rarely observed, even in deeper dentinal tubules.

Conclusion

Use of a diode laser, especially in combination with NaOCl, was effective for disinfecting infected root canals of primary teeth.

Influence of File Motion on Shaping, Apical Debris Extrusion and Dentinal Defects: A Critical Review

Advances in endodontics have enabled the evolution of file manufacturing processes, improving performance beyond that of conventional files. In the present study, systems manufactured using state of the art methods and possessing special properties related to NiTi alloys (i.e., CM-Wire, M-Wire and R-Phase) were selected. The aim of this review was to provide a detailed analysis of the literature about the relationship between recently introduced NiTi files with different movement kinematics and shaping ability, apical extrusion of debris and dentin defects in root canal preparations. From March 2016 to January 2017, electronic searches were conducted in the PubMed and SCOPUS databases for articles published since January 2010. In vitro studies performed on extracted human teeth and published in English were considered for this review. Based on the inclusion criteria, 71 papers were selected for the analysis of full-text copies. Specific analysis was performed on 45 articles describing the effects of reciprocating, continuous and adaptive movements on the WaveOne Gold, Reciproc, HyFlex CM and Twisted File Adaptive systems. A wide range of testing conditions and methodologies have been used to compare the systems. Due the controversies among the results, the characteristics of the files used, such as their design and alloys, appear to be inconsistent to determine the best approach.

Extrusion of Debris from Primary Molar Root Canals following Instrumentation with Traditional and New File Systems

INTRODUCTION

To assess the amount of debris extruded apically during instrumentation of distal canals of extracted primary molars by three instrument systems [ProTaper Universal (PTU), ProTaper NEXT (PTN), and self-adjusting file (SAF)] compared with conventional stainless steel hand K-files (HF, control).

MATERIALS AND METHODS

Primary mandibular molars (n = 120) with a single distal canal were selected and randomly divided into four groups (n = 30) for root canal instrumentation using group I, HF (to size 0.30/0.02 taper), group II, PTU (to size F3), group III, PTN (to size X3), and group IV, SAF. Debris extruded during instrumentation was collected in preweighed Eppendorf tubes, stored in an incubator at 70°C for 5 days and then weighed. Statistical analysis was performed by one-way analysis of variance (ANOVA), followed by Turkey's post hoc test (p = 0.05).

RESULTS

All the groups resulted in extrusion of debris. There was statistically significant difference (p < 0.001) in the debris extrusion between the three groups: HF (0.00133 ± 0.00012), PTU (0.00109 ± 0.00005), PTN (0.00052 ± 0.00008), and SAF (0.00026 ± 0.00004).

CONCLUSION

Instrumentation with SAF resulted in the least debris extrusion when used for shaping root canals of primary molar teeth.

CLINICAL SIGNIFICANCE

Debris extrusion in primary teeth poses an adverse effect on the stem cells and may also alter the permanent dental germ. Debris extrusion is rarely reported for primary teeth and it is important for the clinician to know which endodontic instrumentation leads to less extrusion of debris.