Evaluation of Apically Extruded Debris using Two Niti Systems Associated with Two İrrigation Techniques in Primary Teeth

Evaluation of various root canal irrigation methods in primary teeth: a systematic review

BACKGROUND AND OBJECTIVES

Although effective irrigation methods are crucial for pulpectomy in primary teeth (PT), no consensus exists on the best technique. This study guides clinicians in making evidence-based choices for irrigation techniques in PT.

DESIGN

This study reviewed in vitro and in vivo research on PT using an extensive electronic search up to April 2024. The QUIN and RoB 2 tools were used to assess bias, and no meta-analysis was conducted in this study.

RESULTS

Eleven in vitro studies evaluated outcomes such as microorganism reduction, smear layer (SL) removal, and apical extrusion of debris. Some methods significantly reduced bacteria and improved SL removal compared to conventional techniques. Six in vivo studies on primary root canal treatment reported that certain methods reduced postoperative pain (PP), improved obturation quality, and enhanced antibacterial effects. The risk assessment tools identified most studies with low risk of bias.

CONCLUSION

In vitro studies suggest that activating irrigants in PT canals, especially with laser activation, effectively reduces Enterococcus faecalis and removes SLs, particularly in the apical third. Endovac caused less debris extrusion. Clinical studies indicated that sonic activation and side-vent syringes reduce PP, but more data is needed on the antibacterial effects of these techniques.

Comparative Evaluation of Apical Debris Extrusion in Primary Molars Using Three Different Pediatric Rotary Systems: An In Vitro Study

Aims and background

Failure of the endodontic treatment might be due to various reasons like zipping, apical blockade, ledging, debris extrusion, etc. Apical debris extrusion in primary teeth is of major concern as it does not have a proper well-developed apex, that is, mature apex. This study aims to compare and evaluate the apical debris extrusion in primary molars using three different pediatric rotary file system.

Materials and methods

Thirty freshly extracted teeth primary molars were divided into three experimental groups according to the used file systems as group I-NT Pedo Gold, group II-Pedo Flex, and group III-Kedo-S. Debris extruded during canal shaping were collected in preweighed vials. Each canal was irrigated with 6 mL of saline and 2 mL of sodium hypochlorite. The amount of debris extruded from each tooth was calculated by subtracting the preinstrumentation from the postinstrumentation measurement. Data were analyzed using analysis of variance (ANOVA) and post hoc Tukey tests with α = 0.05.

Results

Kedo-S showed statistically significant lesser apical debris extrusion than Pedo Flex and NT Pedo Gold (p-value < 0.001) while comparing Pedo Flex and NT Pedo Gold insignificant difference.

Conclusion

All three pediatric rotary file systems extruded debris apically; while Kedo-S can be safely used as a rotary file in pediatric dentistry with minimal apical debris extrusion.

Clinical significance

An ideal rotary instrument should not extrude debris apically, the lesser the extrusion greater the endodontic treatment success. Kedo-S can be securely used as a rotary file with less apical debris extrusion than the other two rotary systems.

How to cite this article

Manoharan M, Kowsalya S, Mathian VM, et al. Comparative Evaluation of Apical Debris Extrusion in Primary Molars Using Three Different Pediatric Rotary Systems: An In Vitro Study. Int J Clin Pediatr Dent 2024;17(11):1224-1228.

To Evaluate Different Endodontic Instrumentation Systems Regarding Post-Operative Pain After Endodontic Therapy: A Clinical Study

BACKGROUND

Despite substantial breakthroughs in instrumentation systems and pharmaceutical interventions, pain following endodontic therapy remains a serious concern. The effect of the type of endodontic instrumentation system in post-operative pain after endodontic therapy has been a matter of debate.

AIM

To evaluate different endodontic instrumentation systems, namely Reciproc (GmbH, Munich), OneShape® (MicroMega, France), Protaper Gold (Dentsply Sirona, USA), and Hyflex® EDM (Coltène/Whaledent Inc., USA) file systems, regarding post-operative pain after endodontic therapy Methods and materials: The endodontic department treated healthy patients aged 20 to 50 years who were experiencing symptoms of irreparable pulpitis in one or more maxillary molars or mandibular molars. Five hundred was the determined size of the sample. The study participants were divided into five categories, each comprising 100 participants. These categories were: Category 1: Reciproc instrumentation system. Category 2: OneShape® instrumentation system. Category 3: ProtaperGold instrumentation system. Category 4: HyFlex® EDM instrumentation system. Category 5: Control (stainless steel K-files). Following endodontic therapy, these scores were recorded at 6 hours, 12 hours, 24 hours, 48 hours, and 72 hours using the VAS scale.

RESULTS

The visual analog scale (VAS) score (mean±SD) in the control group was 0.73± 0.40 (<0.001). The VAS score in the Reciproc group was 0.43± 0.05 (<0.001). The VAS score in the OneShape® group was 0.36±0.09 (<0.001). The VAS score in the Protaper Gold group was 0.41 ±0.08 (<0.001). The VAS score in the HyFlex® EDM group was 0.55 ±0.02 (<0.001). The VAS score in all instrumentation techniques at 72 hours follow-up was lesser in comparison to a control group with meaningful statistical significance (<0.001). However, the post-operative pain among the Reciproc, OneShape®, Protaper Gold, and HyFlex® EDM instrumentation systems was not different clinically when compared among themselves. However, VAS values were greater in OneShape® and HyFlex® EDM compared to Reciproc and Protaper Gold, showing increased post-operative pain in OneShape and HyFlex® EDM compared to Reciproc and Protaper Gold. It was also observed that there was a decline in the VAS score in all instrumentation systems as the follow-up period increased from 6 hours to 72 hours, with maximum post-operative pain at 6 hours of follow-up and minimum post-operative pain at 72 hours of follow-up. However, the decline was lesser in OneShape® and HyFlex® EDM in comparison to Reciproc and Protaper Gold, with increased post-operative pain in OneShape® and HyFlex® EDM in comparison to Reciproc and Protaper Gold.

CONCLUSION

Post-operative pain at all follow-ups of endodontic procedures was less in Reciproc, OneShape®, Protaper Gold, and HyFlex® EDM than in the control group. VAS scores were higher in the OneShape® and HyFlex® EDM groups compared to the Reciproc and Protaper Gold groups, indicating increased post-operative pain with OneShape® and HyFlex® EDM instruments in comparison to Reciproc and Protaper Gold.

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.

Shaping Properties and Outcomes of Nickel-Titanium Reciprocation Systems in Primary Teeth: A Systematic Review and Meta-Analysis of In Vitro Studies

The aim of this systematic review was to investigate the shaping properties and outcomes of reciprocating instruments in primary teeth. A search was conducted across various electronic databases such as PubMed, Scopus, EBSCO (dentistry and oral health sciences), LILACS, Cochrane, Google Scholar (first 100 hits), Open Grey, Ovid, and Shodhganga. Two authors independently performed data extraction and quality assessment of the selected articles using Rayyan software. A total of 12 studies were included. All 12 included studies qualified for qualitative analysis and five for meta-analysis. The meta-analysis revealed there was no statistical significance between rotary and reciprocating instruments concerning instrumentation time and canal transportation. The rotary and reciprocating instruments showed better shaping outcomes than hand instruments. Randomized controlled trials are required with adequate quality to perform a meta-analysis to provide better and more substantial evidence to use reciprocating instruments.

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.

Influence of glide path kinematics during endodontic treatment on the occurrence and intensity of intraoperative and postoperative pain: a systematic review of randomized clinical trials

BACKGROUND

Preliminary canal enlargement (glide path preparation) may play a significant role in the development of pain. The aim of this systematic review of randomized clinical trials was to assess the influence of glide path kinematics during endodontic treatment on the occurrence and intensity of intraoperative and postoperative pain.

METHODS

A search was performed in June 2019 in six electronic databases (PubMed, Scopus, LILACS, SciELO, Embase and Web of Science) and two grey literature databases (OpenGrey and OpenThesis). The bibliographic references of the eligible articles were also hand-searched. The included clinical studies assessed the occurrence and intensity of intraoperative and/or postoperative pain after root canal preparation without glide path preparation (WGP) or with glide path preparation using manual (M-GP), continuous rotary (CR-GP), or reciprocating (R-GP) instruments. The primary outcome was the occurrence and intensity of intraoperative and postoperative pain, while analgesic consumption was the secondary outcome. The full texts of the eligible studies were analyzed by two reviewers who performed calibration exercises to verify the risk of bias and quality of the individual studies using the Joanna Briggs Institute Critical Appraisal tool.

RESULTS

From 1283 identified articles, only six studies were included in the qualitative analysis of the results, with a total sample of 884 patients/teeth. Three studies presented a high risk of bias, while three studies presented a moderate risk. Two studies reported that CR-GP causes lower pain levels than M-GP and WGP, and three studies showed no differences between CR-GP and R-GP. Regarding analgesic consumption, two studies found no differences among glide path kinematics, and one study reported lower consumption for CR-GP than for M-GP. Because of the limited number of studies and methodological differences, no statistical analyses were performed for the glide path kinematics comparisons.

CONCLUSIONS

Compelling evidence indicating a significantly different occurrence and intensity of pain among glide path kinematics is lacking. The systematic review protocol was registered in the PROSPERO database [CRD42020139989].

Comparison of postoperative pain intensity after using reciprocating and continuous rotary glide path systems: a randomized clinical trial

Objectives

The aim of this study was to compare postoperative pain intensity after root canal treatment with One G (OG) vs. R-Pilot (RP) files used for glide path preparation.

Materials and Methods

Ninety-three single-canaled mandibular premolar teeth with asymptomatic non-vital pulp were randomly assigned into 3 groups (n = 31): OG, RP, or without glide path (WGP). After creating the glide path, the root canals were prepared using sequential Mtwo rotary files to size 30/0.05. One endodontic specialist carried out single-visit endodontic treatment. The patients were asked to rate the severity of postoperative pain on a visual analogue scale at 24, 48, and 72 hours after the visit. They were also asked to record their intake of prescribed analgesics taken. The data were analyzed using the χ², Friedman, Kruskal-Wallis, and Mann-Whitney U tests.

Results

In all 3 groups, postoperative pain decreased significantly at each time interval (p < 0.05). At 24 hours, the OG group had less postoperative pain than the WGP group (p < 0.05). However, no significant difference was found between the RP group and the others. No statistically significant difference was found among the WGP, OG, and RP groups in postoperative pain intensity at 48 or 72 hours or in analgesic tablet intake at the 3 assessed time intervals.

Conclusions

The OG group had less postoperative pain than the WGP group in the first 24 hours. The OG and RP systems were similar regarding postoperative pain intensity and analgesic intake.

Reciprocating instrumentation in a maxillary primary central incisor: A protocol tested in a 3D printed prototype

BACKGROUND

Efficient endodontic instrumentation of primary teeth is a challenge for paediatric dentists.

AIM

To evaluate biomechanical outcomes of endodontic instrumentation with a reciprocating system in a polymer-prototyped primary maxillary central incisor.

DESIGN

The specimen was systematically instrumented and micro-CT scanned before and after each file. The amount of debris, percentage of non-instrumented areas, removed dentin volume, and lower dentin thickness at specific points along the root canal were analyzed.

RESULTS

A 10% increase in removed dentin volume was observed when R40 was compared to R25 (14.5% vs 4.2%). When comparing R50 with R40, this increase was only 3.4% (17.9% vs 14.5%). In the root cervical third, there was substantial reduction in dentin thickness with R50 (48.8%), followed by R40 (39.5%) and R25 (18.6%). There was no difference between R25 and R40 in the removal of dentin at the apical third (15.8%), while R50 resulted in 39.8% reduction in dentin thickness. Percentage of non-instrumented areas were the same for all files. Accumulated debris with R40 and R50 was the same (0.19 mm³) while for R25 was 0.11 mm³.

CONCLUSIONS

The Reciproc^® system was effective for instrumentation of a prototyped primary maxillary central incisor. The most suitable file for apical preparation was R40.

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.