Apically-Extruded Debris Using The ProTaper System

Evaluation of Apically Extruded Debris and Cleaning Efficiency of the Pediatric Rotary File System and the Manual Nickel-Titanium File System

Background This study aimed to assess and compare the Kidzo pediatric rotary file system with the manual nickel-titanium (NiTi) K-file system used for preparing the root canal of primary mandibular second molars by measuring the total apically extruded debris utilizing a sensitive microbalance and assessing cleaning efficiency using a scanning electron microscope. Methodology A total of 46 mandibular second primary molars were instrumented using a pediatric rotary system (Elephant Kidzo, India) and a manual NiTi K-file system (Endostar, Poldent, Poland). The debris released from the apex was retrieved and dried in Eppendorf tubes that were weighed beforehand. The total extruded debris was determined using a digital electronic scale, following which the molar roots were vertically sectioned, and the canal walls were investigated at the apical, middle, and coronal levels by a scanning electron microscope for debris and smear layer. Results The Kidzo pediatric rotary file system extruded a lesser amount of debris than the manual Endostar file system, but the difference was statistically not significant. Regarding cleaning efficiency, the debris originating in the apical and middle regions by employing the rotary filing technique was significantly less (p < 0.05); however, at the coronal level, there were no notable differences. Conclusions The Kidzo pediatric rotary system produced less apically extruded debris than the manual system and demonstrated better cleaning efficiency.

COMPARATIVE EVALUATION OF THE EFFECT OF DIFFERENT ROTARY INSTRUMENT SYSTEMS ON THE AMOUNT OF APICALLY EXTRUDED DEBRIS

Objectives: The purpose of our study is to examine in vitro the amount of debris extrusion from the apical after root canal preparation with different rotary instruments. Materials and Methods: In present study, 60 single root single-canal lower premolar human teeth were used. The teeth were randomly selected and divided into 4 main groups (n=15). Root canals are shaped by using 2Shape, One Curve and XP-3DEndo Shaper working in rotational motion and WaveOne Gold working reciprocal motion. Later, the weight of each eppendorf tube was weighed on a precision scale and the amount of debris extrusion from the apical was determined with 10ˉ4 precision by subtracting the empty weight of the tube. Since the parametric test assumptions were fulfilled in the evaluation of the data obtained regarding the amount of debris extrusion from the apical of file systems by loading them into the SPSS 22.0 program, One-Way Variance analysis was used and the level of error was taken as 0.05. Results: When the amount of debris extrusion from the apical is ordered from high to low, it was seen that there are 2Shape, One Curve, XP-Endo Shaper, WaveOne Gold. However, the difference between study groups was not statistically significant (p> 0.05). Conclusions: Considering the results obtained in terms of debris extrusion from the apical about the new generation files with different metallurgy, kinematics, structural features, designs and different configurations that we used ın present study, it was seen that these systems would not show any difference in terms of the effect of debris on the success of endodontic treatment.

Apically Extruded Debris during Instrumentation using Different Engine Driven File Systems: A Comparative In Vitro Study

AIM: The aim of the present study was to evaluate and compare the amount of apically extruded debris using three engine driven systems. METHODS: Sixty mandibular premolars with single root were used. The samples were divided into three groups with 20 teeth for each group: group 1 Neolix Neoniti A1 (25, 0.08), group 2 WaveOne GOLD Primary (25.07, red), and group 3 Protaper Next (PTN), using X1 (017/0.04), X2 (025/0.06) files. All files were used to prepare the root canals according to manufacturer instruction. Root canal preparation for each group was done according to manufacturer instructions using 16:1 gear reduction hand piece powered by a torque controlled electric motor. Debris collection was made using apparatus described by Myers and Montgomery. The extruded debris weight was measured by subtracting the weight of the empty Eppendorf tubes from the weight of the debris containing tubes results were statistically analyzed. RESULTS: One-way analysis of variance test revealed that there was statistically significant differences between all the three groups being tested (p < 0.001) showed that apical extrusion of the debris of WaveOne Gold was the least followed by Neolix Neoniti and finally PTN which showed the most apical extrusion of debris with a significant difference between all groups. CONCLUSIONS: WaveOne Gold was found to be the least apical extruded debris system among all groups.

A Comparison of the Apical Extrusion of Debris during the Preparation of Root Canal with Medin, RaCe, and ProTaper Rotary Systems

Statement of the Problem:

The extrusion of intracanal debris is one of the challenging problems related to almost all root canal preparation systems, which may cause flare-ups and impairment in the healing process.

Purpose:

This study was conducted to evaluate the amount of apically-extruded debris during root canal preparation using Medin (MEDIN Co., Czech Republic) rotary system compared with two common rotary systems, including ProTaper (Dentsply Maillefer., Switzerland) and RaCe (FKG Dentaire, Switzerland).

Materials and Method:

In this in vitro study, Sixty mandibular premolars with single canal were randomly assigned to three groups (n=20). The root canals were prepared with Medin, ProTaper, and RaCe rotary instruments based on their manufacturers’ instructions. The debris were collected into pre-weighted Eppendorf tubes. The weight of the extruded debris was calculated by subtracting the pretreatment weight of the vials. Data were analyzed using the Kruskal-Wallis test at a 5% significance level.

Results:

Medin instrument caused significantly less debris extrusion in comparison with ProTaper and RaCe (p< 0.05). The differences between the ProTaper and RaCe rotary systems were not statistically significant (p= 0.752).

Conclusion:

Within the limitations of this in vitro study, Medin rotary system produced less apical extrusion than ProTaper and RaCe.

Apically extruded debris associated with ProTaper Next, ProTaper Gold and TruNatomy systems: An in vitro study

Background. This research aimed to investigate and compare the amount of apically extruded debris after root canal preparation using ProTaper Next, ProTaper Gold, and TruNatomy systems. Methods. Forty-five extracted mandibular premolar teeth with single canals with similar lengths were used. The root canals were prepared using ProTaper Next (Dentsply Maillefer, Ballaigues, Switzerland), ProTaper Gold (Dentsply Maillefer, Ballaigues, Switzerland), or TruNatomy (Dentsply Maillefer, Ballaigues, Switzerland) files. Apically extruded debris during preparation was gathered into preweighed Eppendorf tubes. Then the Eppendorf tubes were incubated at 70°C for five days. The Eppendorf tubes were weighed again to determine their final weight plus the extruded debris. Results. The TRN system resulted in significantly less debris extrusion than the PTN system (P <0.05). There was no significant difference between the PTN and PTG groups and between the PTG and TRN groups (P >0.05). Conclusion. All the instrumentation systems caused apical extrusion of debris. However, the TRN system resulted in significantly less debris extrusion than the other systems.

Post-treatment Flare-up Incidence after Using Nano Zinc Oxide Eugenol Sealer in Mandibular First Molars with Irreversible Pulpitis

Statement of the Problem:

Some patients may report moderate-to-severe pain and/or swelling following root canal treatment, which is undesirable for both the patient and dentist and may require an unscheduled emergency visit by patients to relieve their symptoms.

Purpose:

The aim of this study was to evaluate the post-treatment flare-up incidence following application of nano zinc oxide-eugenol (NZOE) sealer in mandibular first molars with irreversible pulpitis.

Materials and Method:

This single-blinded study was performed on 60 patients having mandibular first molars with irreversible pulpitis. After signing the written consent form, the patients were randomly divided into two groups considering their age range (20-34 and 35-50 years). Individuals without systemic diseases and with a first mandibular molar diagnosed with irreversible pulpitis due to caries, no sinus track and abscess, normal periapical radiographic appearance, no spontaneous pre-treatment pain, not taken any medication for at least 8 hours before the treatment visit were included in this study. Patients of both sexes with age range of 20 to 50 years were selected. In order to obturate the root canal space, AH26 sealer was used in the one group and the synthesized NZOE was applied in another group. The patients were then given questionnaires to report the severity of pain and presence of swelling during 6, 18, 24, and 48 hours of follow-up. The data was analyzed using SPSS v.19 software applying repeated measures ANOVA. The significance level was set at 0.05.

Results:

The severity of pain was significantly lower in NZOE group at 24 hours post-treatment (p= 0.003). Patients reported no symptoms of swelling in any group.

Conclusion:

NZOE sealer manifested satisfactory results and could be regarded as a promising substitute to routine sealers since patients may experience less pain during the first hours after receiving root canal therapy.

Assessment of various endodontic instrumentation systems on the amount of apically extruded bacteria - An in vitro study

Aim:

The objective of this in vitro study was to assess the effect of different endodontic instrumentation systems on the amount of apically extruded bacteria.

Materials and Methods:

One hundred and twenty freshly extracted human mandibular premolars with single canal were collected. Endodontic access cavities were prepared and then contaminated with an Enterococcus faecalis suspension (ATCC 29212). After incubation at 37°C for 24 h, the root canals were instrumented with K flare files, F360 Single file system, K3XF files, Heroshaper files, Protaper Next files, and Hyflex EDM Single file system. During instrumentation, apically extruded bacteria were collected in the vials containing 0.9% NaCl. Samples were taken from the vials and incubated in brain–heart infusion agar medium for 24 h.

Statistical Analysis:

The number of colony-forming units was determined, and data were statistically analyzed using one-way analysis of variance and post hoc Tukey test.

Conclusions:

Both rotary and hand instrumentation systems extruded intracanal bacteria through the apical foramen, Group 1 (Hand K Flare files) showed maximum, whereas, Group 5 (Protaper Next) and Group 6 (Hyflex EDM) showed the least extrusion.

Apically extruded debris during the removal of canal filling material from root canals using three techniques

AIM

In the present study, we evaluated the effect of the single-cone technique (SCT), cold lateral compaction (CLC), and wave vertical compaction (WVC) technique performed using two different sealers on the amount of apically extruded debris (AED) produced during the removal of canal filling material.

METHODS

Ninety extracted mandibular premolars were prepared with ProTaper instruments. The teeth were then randomly assigned to six groups (N = 15) for root canal filling: (a) group 1, CLC+AH Plus; (b) group 2, SCT+AH Plus; (c) group 3, WVC+AH Plus; (d) group 4, CLC+MTA Fillapex; (e) group 5, SCT+MTA Fillapex; and (f) group 6, WVC+MTA Fillapex. In all groups, the removal of canal filling material was performed with ProTaper retreatment instruments. The mean weight of the AED was assessed with an analytical balance.

RESULTS

The amount of AED was lowest in groups 2 and 5 (P < .05), with no difference between these groups (P > .05). Groups 3 and 6 produced the greatest amount of extruded debris (P < .05); there was no difference between these groups (P > .05). Additionally, there was no difference between groups 1 and 4 (P > .05). There was no significant difference among the groups regarding sealer type (P > .05).

CONCLUSIONS

The canal filling technique used affected the amount of AED produced during the removal of canal filling material, but not sealer type.

Comparison of apical extrusion of intracanal bacteria by various glide-path establishing systems: an in vitro study

OBJECTIVES

This study compared the amount of apically extruded bacteria during the glide-path preparation by using multi-file and single-file glide-path establishing nickel-titanium (NiTi) rotary systems.

MATERIALS AND METHODS

Sixty mandibular first molar teeth were used to prepare the test apparatus. They were decoronated, blocked into glass vials, sterilized in ethylene oxide gas, infected with a pure culture of Enterococcus faecalis, randomly assigned to 5 experimental groups, and then prepared using manual stainless-steel files (group KF) and glide-path establishing NiTi rotary files (group PF with PathFiles, group GF with G-Files, group PG with ProGlider, and group OG with One G). At the end of canal preparation, 0.01 mL NaCl solution was taken from the experimental vials. The suspension was plated on brain heart infusion agar and colonies of bacteria were counted, and the results were given as number of colony-forming units (CFU).

RESULTS

The manual instrumentation technique tested in group KF extruded the highest number of bacteria compared to the other 4 groups (p < 0.05). The 4 groups using rotary glide-path establishing instruments extruded similar amounts of bacteria.

CONCLUSIONS

All glide-path establishment instrument systems tested caused a measurable apical extrusion of bacteria. The manual glide-path preparation showed the highest number of bacteria extruded compared to the other NiTi glide-path establishing instruments.

Apical Extrusion of Intracanal Bacteria with Single File and Multifile Rotary Instrumentation Systems

Aims and Objectives:

Instrumentation techniques may cause extrusion of microorganisms and their products into the periapical region resulting inflammation and treatment failure. The aim of this ex vivo study was comparing the apical bacterial extrusion in canals prepared with single file versus multiple file rotary systems.

Materials and Methods:

Ninety-two human single-rooted mandibular first premolars were used. Endodontic access cavities were prepared, and root canals were contaminated with an Enterococcus faecalis (E. faecalis) suspension. The samples were incubated at 37°C for 30 days; the contaminated teeth were divided into four groups of 20 specimens each (1: Reciproc, 2: Mtwo, 3: Neoniti A1, 4: Safesider). Six teeth were not infected and each were prepared with one of the above instruments were considered as negative and six teeth which had been previously infected, were used as positive control groups. Extruded bacteria from the apical foramen during instrumentation were collected into vials containing 0.9% NaCl. The microbial samples were taken from the vials and incubated in brain heart agar medium for 24 h. The resulting bacterial titer, in colony-forming units per mL, was determined. The data entered into SPSS 18 software and were analyzed by Kruskal–Wallis and Mann–Whitney U-tests at 0.05 significance level.

Results:

Mtwo multifile system showed significantly less bacterial extrusion than Safesider (P = 0.015) and Neoniti A1 (P = 0.042) but did not show significant difference with Reciproc system (P = 0.25).

Conclusions:

All instrumentation systems extruded bacteria beyond the apical foramen. However, this study showed that Mtwo multifile rotary system extruded fewer bacteria.

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

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.

In vitro Comparison of Apical Debris Extrusion Using Rotary and Reciprocating Systems in Severely Curved Root Canals

Introduction:

The aim of this in vitro study was to compare the amount of apically extruded debris after root canal preparation using rotary and reciprocating systems in severely curved root canals.

Methods and Materials:

Thirty six extracted human mandibular first molars with 25-35^° curvature in their mesiobuccal (MB) canal (according to Schneider’s method) were cleaned and shaped with ProTaper and WaveOne systems. The extruded debris was collected and their net weight was calculated. To compare the efficiency of the two systems, the operation time was also measured. The data were analyzed with t-test.

Results:

The amount of extruded debris in WaveOne group was significantly greater in comparison with ProTaper group (26%). The operating time for ProTaper was however, significantly longer than WaveOne.

Conclusion:

Both root preparation systems caused some degree of debris extrusion through the apical foramen. However, this amount was greater in WaveOne instruments.

Evaluation of conventional, protaper hand and protaper rotary instrumentation system for apical extrusion of debris, irrigants and bacteria- An in vitro randomized trial

BACKGROUND

Endodontic instrumentation carries the risk of over extrusion of debris and bacteria. The technique used and the type of instrumentation influences this risk.

AIM

The purpose of this study was to evaluate and compare the K-file, ProTaper hand and ProTaper rotary instrumentation systems for the amount of apically extruded debris, irrigant solution and intracanal bacteria.

DESIGN

Experimental single blinded randomized type of in vitro study with sample of 30 single rooted teeth. Endodontic access cavities were prepared and the root canals were filled with the suspension of E. faecalis. Myers and Montogomery Model was used to collect apically extruded debris and irrigant. Canals were prepared using K files, Hand protapers and Protaper rotary files.

STATISTICAL ANALYSIS

Non Parametric test like Kruskal-Wallis and Mann-Whitney U test were applied to determine the significant differences among the group.

RESULTS

Tests revealed statistically significant difference between the amount of debris and number of bacteria extruded by the ProTaper hand and the K-files. No statistically significant difference was observed between the amounts of irrigant extruded by the ProTaper hand and the K-file system. Statistically significant differences were observed between the amounts of bacteria and irrigant extruded by the ProTaper rotary and the Protaper hand. No statistically significant difference was observed between the amounts of debris extruded by the ProTaper hand and the K-file system.

CONCLUSIONS

Amount of apical extrusion of irrigant solution, bacteria and debris are significantly greater with K File instruments and least with Protaper rotary instruments. Key words:Protaper, rotary, periapical extrusion.

Comparative evaluation of apically extruded debris during root canal instrumentation using two Ni-Ti single file rotary systems: An in vitro study

BACKGROUND

Apical extrusion of debris during instrumentation is detrimental to the patient.

AIM

The aim of this study was to evaluate the apical extrusion of debris during root canal instrumentation using two single file rotary Ni-Ti systems.

MATERIALS AND METHODS

Thirty freshly extracted mandibular premolars with straight roots were sterilized and divided into two groups instrumented using: One Shape rotary Ni-Ti system with Endoflare orifice shaper (Group 1) and Neo-Niti rotary Ni-Ti system with C1 orifice shaper (Group 2). Preweighed Eppendorf tubes fitted for each tooth before instrumentation. During instrumentation, 1 mL of distilled water with a 30-gauge needle was used to irrigate after every instrument. Tips of the tooth were irrigated with 2 ml distilled water after removal from Eppendorf tubes. The total volume of irrigant in each group was the same 8 ml. All tubes were incubated at 68°C for 15 days and subsequently weighed. The difference between pre- and post-debris weights was calculated, and statistical analysis was performed using independent t-test and level of significance was set at 0.05.

RESULTS

The difference between pre- and post-weights was significantly greater for the One Shape system.

CONCLUSIONS

The Neolix Niti single file was associated with less extrusion compared to One Shape single file system.

Comparison of apical debris extrusion of two rotary systems and one reciprocating system

BACKGROUND

Postoperative inflammation and endodontic failure occur due to apical extrusion of debris.

AIM

To evaluate the amount of apically extruded debris after preparation of straight root canals in extracted human teeth using three rotary systems.

MATERIALS AND METHODS

Sixty single-rooted human teeth with single root canal and apical foramen were selected and randomly divided into three experimental groups (n = 20) according to the rotary system used: Group 1 - ProTaper, Group 2 - Revo-S, Group 3 - WaveOne. Apical enlargement was done up to size 40/0.06 for Groups 1 and 2 and 40/0.08 for Group 3. For debris collection, each tooth was held in a preweighed Eppendorf tube fixed inside a glass vial through rubber plug. After instrumentation, each tooth was separated from the Eppendorf tube and the debris adhering to the root surface was collected by washing the root with 1 mL of bi-distilled water and incubated at 70°C for 5 days. The dry weight of extruded debris was weighed in an electronic balance.

STATISTICAL ANALYSIS

The mean weights of extruded debris were statistically analyzed using GraphPad prism version 6 and the intergroup comparison was done using unpaired t-test.

RESULTS

There was a statistically significant difference in the mean debris score among all the three groups - ProTaper (0.00065 g), Revo-S (0.00045 g) and WaveOne (0.00089 g).

CONCLUSION

Revo-S system was associated with significantly less debris extrusion compared with ProTaper or WaveOne.

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.

Postoperative Pain after Endodontic Treatment of Asymptomatic Teeth Using Rotary Instruments: A Randomized Clinical Trial

INTRODUCTION

The aim of the present study was to compare the effect of two different rotary instruments on postoperative pain in teeth with asymptomatic irreversible pulpitis.

METHODS AND MATERIALS

A total of 78 mandibular first and second molars were divided into two groups (n=39) and their root canal preparation was carried out with either RaCe or ProTaper rotary instruments. All the subjects underwent one-visit root canal treatment and the severity of postoperative pain was evaluated using visual analog scale (VAS) at 4-, 12-, 24-, 48- and 72-h and 1-week intervals. In addition, the need for taking analgesics was recorded. Data were analyzed with the repeated-measures ANOVA and the Mann-Whitney U test was used for two-by-two comparison. Statistical significance was set at 0.05.

RESULTS

Comparison of mean pain severity between the two groups at various postoperative intervals did not reveal any significant differences (P=0.10). The difference in amount of analgesics taken by each groups was not statistically significant (P=0.25).

CONCLUSION

There were no significant differences in the postoperative pain reported between the two groups; which indicates the clinical acceptability of both systems.

A Comparison of Apical Bacterial Extrusion in Manual, ProTaper Rotary, and One Shape Rotary Instrumentation Techniques

INTRODUCTION

Apical extrusion of irrigants and debris is an inherent limitation associated with cleaning and shaping of root canals and has been studied extensively because of its clinical relevance as a cause of flare-ups. Many factors affect the amount of extruded intracanal materials. The purpose of this study was to assess the bacterial extrusion by using manual, multiple-file continuous rotary system (ProTaper) and single-file continuous rotary system (One Shape).

METHODS

Forty-two human mandibular premolars were inoculated with Enterococcus faecalis by using a bacterial extrusion model. The teeth were divided into 3 experimental groups (n = 12) and 1 control group (n = 6). The root canals of experimental groups were instrumented according to the manufacturers' instructions by using manual technique, ProTaper rotary system, or One Shape rotary system. Sterilized saline was used as an irrigant, and bacterial extrusion was quantified as colony-forming units/milliliter. The results obtained were statistically analyzed by using one-way analysis of variance for intergroup comparison and post hoc Tukey test for pair-wise comparison. The level for accepting statistical significance was set at P < .05.

RESULTS

All the instrumentation techniques resulted in bacterial extrusion, with manual step-back technique exhibiting significantly more bacterial extrusion than the engine-driven systems. Of the 2 engine-driven systems, ProTaper rotary extruded significantly more bacteria than One Shape rotary system (P < .05).

CONCLUSIONS

The engine-driven nickel-titanium systems were associated with less apical extrusion. The instrument design may play a role in amount of extrusion.

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 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.

Postoperative pain after manual and mechanical glide path: a randomized clinical trial

INTRODUCTION

This prospective randomized clinical trial evaluated the incidence of postoperative pain after glide path performed with PathFile (PF) (Dentsply Maillefer, Ballaigues, Switzerland) versus stainless-steel K-file (KF).

METHODS

In 149 subjects, the mechanical glide path was performed with nickel-titanium (NiTi) rotary PF; in 146 subjects, the manual glide path was performed with stainless-steel KFs. Postoperative pain, analgesics consumption, and the number of days to complete pain resolution were evaluated in the following 7 days. An analysis of variance model for repeated measures was used to compare the variation of pain-scale values (P < .05). The Student's t test for continuous variables normally distributed, the nonparametric Mann-Whitney U test for the nonnormally distributed variables, and the chi-square test for dichotomous variables were used (P < .05). Despite homogeneous baseline conditions at diagnosis, tooth type, pain prevalence, and scores, the postoperative pain prevalence curves in PF group evidenced a more favorable trend in terms of time to pain resolution compared with the KF group (P = .004). The difference was also evident in the model adjusted for analgesics consumption in both groups (P = .012). The mean analgesics intake per subject was significantly higher in the KF group (3.7 ± 2.2) compared with the PF group (2 ± 1.7) (P < .001). Mean pain stop values were also significantly higher in the KF group (2.7) compared with the PF group (1.7) (P = .001).

CONCLUSIONS

The glide path with NiTi Rotary PF leads to less postoperative pain and faster symptom resolution.

Apical extrusion of intracanal bacteria following use of two engine-driven instrumentation techniques

AIM

To evaluate the number of bacteria extruded apically from extracted teeth ex vivo after canal instrumentation using the two engine-driven techniques utilizing nickel-titanium instruments (ProTaper and System GT).

METHODOLOGY

Forty extracted single-rooted human mandibular premolar teeth were used. Access cavities were prepared and root canals were then contaminated with a suspension of Enterococcus faecalis and dried. The contaminated roots were divided into two experimental groups of 15 teeth each and one control group of 10 teeth. Group 1, ProTaper group: the root canals were instrumented using ProTaper instruments. Group 2, System GT group: the root canals were instrumented using System GT instruments. Group 3, control group: no instrumentation was attempted. Bacteria extruded from the apical foramen during instrumentation were collected into vials. The microbiological samples from the vials were incubated in culture media for 24 h. Colonies of bacteria were counted and the results were given as number of colony-forming units. The data obtained were analysed using the Kruskal-Wallis one-way analysis of variance and Mann-Whitney U-tests, with alpha = 0.05 as the level for statistical significance.

RESULTS

There was no significant difference as to the number of extruded bacteria between the ProTaper and System GT engine-driven systems (P > 0.05).

CONCLUSIONS

Both engine-driven nickel-titanium systems extruded bacteria through the apical foramen.