Apical extrusion of debris and irrigants using ProTaper hand, M-two rotary and WaveOne single file reciprocating system: An ex vivo study

An Evaluation of Biomechanical Preparation of Root Canals using Protaper Hand File, Mtwo NiTi Rotary File and NeoNiTi Single File Systems with Cone Beam Computed Tomography - An in Vitro Study

Background

Root canal therapy is the most widely accepted treatment modality for pulpally involved teeth. Rotary NiTi instruments improve the root canal preparation because of the unique properties of the alloy. Cone beam computed tomography (CBCT) permits non-destructive and metrically exact analyses of variable such as volume, surface area, cross sectional shape, and taper. Thus the present study was conducted to evaluate the effect of biomechanical preparation of root canals using different file systems on cervical dentinal thickness at coronal level; canal transportation, and surface area at coronal, middle and apical levels using CBCT.

Methodology

Forty-five single rooted premolars were randomly divided into three groups (n=15), (Protaper hand file, MtwoNiTi rotary file and NeoNiTi single file). CBCT scans were taken before and after the preparation. Dentinal thickness was measured in all four directions to assess cervical dentin thickness and canal transportation. Surface area was evaluated in Adobe Photoshop both before and after preparation.

Results

The data obtained was subjected to statistical analysis. The total mean change in cervical dentin thickness and total mean canal transportation at coronal and apical was found to be maximum in Group III. The maximum increase of surface area was observed in Group I at coronal level whereas in Group III at middle and apical levels.

Conclusion

It was concluded that the change in cervical dentin thickness was maximum in Group III. The canal transportation at coronal level and apical level was found to be maximum in Group III; at middle level it was maximum in Group II. The maximum increase of surface area at coronal level was observed in Group I, at middle and apical levels it was seen in Group III.

Effect of mode of rotation on apical extrusion of debris with four different single-file endodontic instrumentation systems: Systematic review and meta-analysis

This systematic review and meta-analysis evaluated whether single-file endodontic instrumentation systems with the reciprocating type of motion are responsible for more debris extrusion than single-file endodontic instrumentation systems with the full rotational type of motion. Electronic and manual searches were performed following the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analysis - PRISMA. We included studies comparing rotary (Neoniti and/ OneShape) versus reciprocating (WaveOne and/ Reciproc) systems. We evaluated the quality of studies and performed statistical analysis using R-Project software. Eight studies of high quality were included to perform the meta-analysis. Subgroup analysis was also done. The overall risk of bias was too low. In conclusion, single-file reciprocating systems tend to generate more extrusion of debris than single-file rotary systems.

Factors affecting the periapical healing process of endodontically treated teeth

Tissue repair is an essential process that reestablishes tissue integrity and regular function. Nevertheless, different therapeutic factors and clinical conditions may interfere in this process of periapical healing. This review aims to discuss the important therapeutic factors associated with the clinical protocol used during root canal treatment and to highlight the systemic conditions associated with the periapical healing process of endodontically treated teeth. The antibacterial strategies indicated in the conventional treatment of an inflamed and infected pulp and the modulation of the host's immune response may assist in tissue repair, if wound healing has been hindered by infection. Systemic conditions, such as diabetes mellitus and hypertension, can also inhibit wound healing. The success of root canal treatment is affected by the correct choice of clinical protocol. These factors are dependent on the sanitization process (instrumentation, irrigant solution, irrigating strategies, and intracanal dressing), the apical limit of the root canal preparation and obturation, and the quality of the sealer. The challenges affecting the healing process of endodontically treated teeth include control of the inflammation of pulp or infectious processes and simultaneous neutralization of unpredictable provocations to the periapical tissue. Along with these factors, one must understand the local and general clinical conditions (systemic health of the patient) that affect the outcome of root canal treatment prediction.

Apical extrusion of debris in four different endodontic instrumentation systems: A meta-analysis

BACKGROUND

All endodontic instrumentation systems tested so far, promote apical extrusion of debris, which is one of the main causes of postoperative pain, flare ups, and delayed healing.

OBJECTIVES

Of this meta-analysis was to collect and analyze in vitro studies quantifying apically extruded debris while using Hand ProTaper (manual), ProTaper Universal (rotary), Wave One (reciprocating), and self-adjusting file (SAF; vibratory) endodontic instrumentation systems and to determine methods which produced lesser extrusion of debris apically.

METHODOLOGY

An extensive electronic database search was done in PubMed, Scopus, Cochrane, LILACS, and Google Scholar from inception until February 2016 using the key terms "Apical Debris Extrusion, extruded material, and manual/rotary/reciprocating/SAF systems." A systematic search strategy was followed to extract 12 potential articles from a total of 1352 articles. The overall effect size was calculated from the raw mean difference of weight of apically extruded debris.

RESULTS

Statistically significant difference was seen in the following comparisons: SAF < Wave One, SAF < Rotary ProTaper.

CONCLUSIONS

Apical extrusion of debris was invariably present in all the instrumentation systems analyzed. SAF system seemed to be periapical tissue friendly as it caused reduced apical extrusion compared to Rotary ProTaper and Wave One.