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Laslami K, Khaldoune S, Sy A, Drouri S, Benkiran I. Apical Extrusion: Is It an Inherent Occurrence During Every Endodontic Treatment? Cureus 2023; 15:e45211. [PMID: 37720124 PMCID: PMC10504573 DOI: 10.7759/cureus.45211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 09/19/2023] Open
Abstract
The aim of this literature review was to analyze all available scientific data on apical extrusion and to identify and associate the possible factors influencing the occurrence of apical extrusion, ranging from the choice of the canal shaping system, the irrigation technique, to the choice of diameter and the apical limit of preparation. A bibliographic search for relevant articles on apical extrusion of debris, irrigants, and bacteria was performed using the following databases: PubMed, Cochrane Library, and ScienceDirect. This search identified articles published between 2010 and 2023 in two languages (French and English). After selective sorting, 25 relevant documents were included. All the studies retained clearly agree on the inherent nature of apical extrusion during endodontic treatment. At the same time, we also understand that the amount of extrusion can be influenced by a number of parameters throughout endodontic therapy. According to this review, despite the undeniable nature of apical extrusion during endodontic therapy, studies with relatable experimental models that approach in vivo conditions are required to establish exploitable conclusions regarding apical extrusion and its prevention.
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Affiliation(s)
- Kaoutar Laslami
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Medicine, University Hassan II, Casablanca, MAR
| | - Salma Khaldoune
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Medicine, University Hassan II, Casablanca, MAR
| | - Aly Sy
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Medicine, University Hassan II, Casablanca, MAR
| | - Sofia Drouri
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Medicine, University Hassan II, Casablanca, MAR
| | - Imane Benkiran
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Medicine, University Hassan II, Casablanca, MAR
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Neelakantan P, Vishwanath V, Taschieri S, Corbella S. Present status and future directions ‐ Minimally invasive root canal preparation and periradicular surgery. Int Endod J 2022; 55 Suppl 4:845-871. [DOI: 10.1111/iej.13750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Affiliation(s)
- P. Neelakantan
- Faculty of Dentistry The University of Hong Kong Hong Kong SAR
| | - V. Vishwanath
- Faculty of Dentistry The University of Hong Kong Hong Kong SAR
| | - S. Taschieri
- Department of Biomedical Surgical and Dental Sciences Università degli Studi di Milano Milan Italy
- IRCCS Istituto Ortopedico Galeazzi Milan Italy
- Department of Oral Surgery Institute of Dentistry I. M. Sechenov First Moscow State Medical University Moscow Russia
| | - S. Corbella
- Department of Biomedical Surgical and Dental Sciences Università degli Studi di Milano Milan Italy
- IRCCS Istituto Ortopedico Galeazzi Milan Italy
- Department of Oral Surgery Institute of Dentistry I. M. Sechenov First Moscow State Medical University Moscow Russia
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Fornari VJ, Hartmann MSM, Vanni JR, Rodriguez R, Langaro MC, Pelepenko LE, Zaia AA. Apical root canal cleaning after preparation with endodontic instruments: a randomized trial in vivo analysis. Restor Dent Endod 2020; 45:e38. [PMID: 32839719 PMCID: PMC7431928 DOI: 10.5395/rde.2020.45.e38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives This study aimed to evaluate vital pulp tissue removal from different endodontic instrumentation systems from root canal apical third in vivo. Materials and Methods Thirty mandibular molars were selected and randomly divided into 2 test groups and one control group. Inclusion criteria were a positive response to cold sensibility test, curvature angle between 10 and 20 degrees, and curvature radius lower than 10 mm. Root canals prepared with Hero 642 system (size 45/0.02) (n = 10) and Reciproc R40 (size 40/0.06) (n = 10) and control (n = 10) without instrumentation. Canals were irrigated only with saline solution during root canal preparation. The apical third was evaluated considering the touched/untouched perimeter and area to evaluate the efficacy of root canal wall debridement. Statistical analysis used t-test for comparisons. Results Untouched root canal at cross-section perimeter, the Hero 642 system showed 41.44% ± 5.62% and Reciproc R40 58.67% ± 12.39% without contact with instruments. Regarding the untouched area, Hero 642 system showed 22.78% ± 6.42% and Reciproc R40 34.35% ± 8.52%. Neither instrument achieved complete cross-sectional root canal debridement. Hero 642 system rotary taper 0.02 instruments achieved significant greater wall contact perimeter and area compared to reciprocate the Reciproc R40 taper 0.06 instrument. Conclusions Hero 642 achieved higher wall contact perimeter and area but, regardless of instrument size and taper, vital pulp during in vivo instrumentation is not entirely removed.
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Affiliation(s)
- Volmir João Fornari
- Endodontic Division, Department of Restorative Dentistry, Piracicaba Dental School, Campinas State University (UNICAMP), Piracicaba, SP, Brazil
| | - Mateus Silveira Martins Hartmann
- Endodontic Division, Department of Restorative Dentistry, Piracicaba Dental School, Campinas State University (UNICAMP), Piracicaba, SP, Brazil
| | | | | | | | - Lauter Eston Pelepenko
- Endodontic Division, Department of Restorative Dentistry, Piracicaba Dental School, Campinas State University (UNICAMP), Piracicaba, SP, Brazil
| | - Alexandre Augusto Zaia
- Endodontic Division, Department of Restorative Dentistry, Piracicaba Dental School, Campinas State University (UNICAMP), Piracicaba, SP, Brazil
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Influence of Apical Preparation Size on Effective Conventional Irrigation in the Apical Third: A Scanning Electron Microscopic Study. Eur Endod J 2020; 4:9-14. [PMID: 32161880 PMCID: PMC7006559 DOI: 10.14744/eej.2018.06078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 12/18/2018] [Accepted: 12/18/2018] [Indexed: 11/20/2022] Open
Abstract
Objective This study aimed to investigate the relationship between final apical preparation size and smear layer removal in the apical third using conventional irrigation in mandibular bicuspids. Methods A total of 66 extracted human mandibular bicuspids with comparable root canal morphology were equally divided into five experimental groups and a control group (n=11). Based on their experimental group, samples were instrumented up to size 25, 30, 35, 40, or 45 with 0.04 taper using 2.5% sodium hypochlorite (NaOCl) as the irrigant. Final irrigation was performed with 17% EDTA followed by 2.5% NaOCl. The control group was instrumented up to size 45/.04, and was irrigated with distilled water. Samples were sectioned buc-colingually, and they were qualitatively evaluated under scanning electron microscope for efficacy in smear layer removal. The Kruskal-Wallis and Mann-Whitney U tests were employed for statistical analysis. Results Statistical analysis revealed comparable removal of smear layer in the coronal and middle thirds of all experimental samples regardless of grouping. When using file size larger than 35, removal of smear layer in the apical third significantly improved (p<0.05). No significant difference was observed between 40/.04 and 45/.04. Conclusion Under the conditions of this study, using conventional irrigation, apical enlargement more than size 35/.04 is essential to enhance removal of smear layer at the apical third.
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Lee OYS, Khan K, Li KY, Shetty H, Abiad RS, Cheung GSP, Neelakantan P. Influence of apical preparation size and irrigation technique on root canal debridement: a histological analysis of round and oval root canals. Int Endod J 2019; 52:1366-1376. [DOI: 10.1111/iej.13127] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/10/2019] [Indexed: 12/22/2022]
Affiliation(s)
- O. Y. S. Lee
- Faculty of Dentistry The University of Hong Kong Hong Kong
| | - K. Khan
- Faculty of Dentistry The University of Hong Kong Hong Kong
| | - K. Y. Li
- Centralized Research Laboratories Faculty of Dentistry The University of Hong Kong Hong Kong
| | - H. Shetty
- Department of Conservative Dentistry and Endodontics Nair Hospital Dental College Mumbai India
| | - R. S. Abiad
- Endodontic Division Faculty of Dentistry Beirut Arab University Beirut Lebanon
| | | | - P. Neelakantan
- Faculty of Dentistry The University of Hong Kong Hong Kong
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Keskin C, Sarıyılmaz E. Apically extruded debris and irrigants during root canal filling material removal using Reciproc Blue, WaveOne Gold, R-Endo and ProTaper Next systems. J Dent Res Dent Clin Dent Prospects 2019; 12:272-276. [PMID: 30774793 PMCID: PMC6368952 DOI: 10.15171/joddd.2018.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 11/18/2018] [Indexed: 11/13/2022] Open
Abstract
Background. The present study aimed to compare the amount of apically extruded debris and irrigants produced by various nickel-titanium instruments.
Methods. A total of 100 single-rooted mandibular premolar teeth were root canal treated and prepared for agar gel model. The root canal fillings were removed using Reciproc Blue, ProTaper Next, R-Endo, WaveOne Gold systems or hand instrumentation. The mean weights of apically extruded materials were calculated. Data were statistically analyzed using one-way ANOVA and post hoc Bonferroni tests.
Results. Hand instrumentation resulted in significantly more debris and irrigants than other systems (P<0.05). The mean amount of apically extruded debris and irrigants produced by Reciproc Blue system was significantly greater than motordriven instruments (P<0.05). No significant difference was detected between ProTaper Next and WaveOne Gold systems (P>0.05), while they both produced significantly less apically extruded material than R-Endo system (P<0.05).
Conclusion. All the instruments caused apical extrusion. ProTaper Next and WaveOne Gold systems were associated with significantly less apical extrusion.
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Affiliation(s)
- Cangul Keskin
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | - Evren Sarıyılmaz
- Department of Endodontics, Faculty of Dentistry, Ordu University Ordu, Turkey
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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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Caviedes-Bucheli J, Castellanos F, Vasquez N, Ulate E, Munoz HR. The influence of two reciprocating single-file and two rotary-file systems on the apical extrusion of debris and its biological relationship with symptomatic apical periodontitis. A systematic review and meta-analysis. Int Endod J 2015; 49:255-70. [DOI: 10.1111/iej.12452] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 03/23/2015] [Indexed: 12/23/2022]
Affiliation(s)
- J. Caviedes-Bucheli
- Postgraduate Endodontics Department; School of Dentistry; Pontificia Universidad Javeriana; Bogota Colombia
| | - F. Castellanos
- Postgraduate Endodontics Department; School of Dentistry; Pontificia Universidad Javeriana; Bogota Colombia
| | - N. Vasquez
- Postgraduate Endodontics Department; School of Dentistry; Pontificia Universidad Javeriana; Bogota Colombia
| | - E. Ulate
- Postgraduate Endodontics Department; School of Dentistry; Pontificia Universidad Javeriana; Bogota Colombia
| | - H. R. Munoz
- Postgraduate Endodontics Department; School of Dentistry; Universidad de San Carlos de Guatemala; Guatemala
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Aminoshariae A, Kulild J. Master apical file size - smaller or larger: a systematic review of microbial reduction. Int Endod J 2014; 48:1007-22. [PMID: 25387434 DOI: 10.1111/iej.12410] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/07/2014] [Indexed: 01/21/2023]
Abstract
The purpose of this systematic review was to determine, in patients undergoing root canal treatment, whether apical enlargement of canals affected microbial reduction. A PICO (population, intervention, comparison and outcome) strategy was developed to identify previously published studies dealing with apical size of canal and microbial reduction. The MEDLINE, Embase, Cochrane and PubMed databases were searched. Additionally, the bibliographies of all relevant articles and textbooks were manually searched. Based on inclusion and exclusion criteria, two reviewers independently selected the relevant articles. Due to the variety of methodologies and different techniques used to measure outcome for master apical file enlargement, it was not possible to standardize the research data and to apply a meta-analysis. Seven articles were identified that met the inclusion criteria. Five of the seven articles generally concluded that canal enlargement reduced bioburden in the root canal system. Two articles reported no difference in canals enlarged to size 25 or 40. The results of the systematic review confirmed that more evidence-based research in this area is needed. With the limited information currently available, the best current available clinical evidence suggests that contemporary chemomechanical debridement techniques with canal enlargement techniques do not eliminate bacteria during root canal treatment at any size.
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Affiliation(s)
- A Aminoshariae
- Department of Endodontics, Case School of Dental Medicine, Cleveland, OH, USA
| | - J Kulild
- Dental School, UMKC, Kansas City, MO, USA
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Minimally invasive endodontics: challenging prevailing paradigms. Br Dent J 2014; 216:347-53. [DOI: 10.1038/sj.bdj.2014.201] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2013] [Indexed: 11/08/2022]
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