Factors affecting apically extrusion debris during root canal treatment -A literature review: Factors affecting apically extrusion debris

Murtada Qadir Muhaibes; Shatha A. Alwakeel

doi:10.36320/ajb/v15.i2.12433

Authors

Murtada Qadir Muhaibes Aesthetic and restorative dentistry department, College of Dentistry, University of Baghdad, Baghdad, Iraq.
Shatha A. Alwakeel College of Dentistry, University of Baghdad/Iraq

DOI:

https://doi.org/10.36320/ajb/v15.i2.12433

Keywords:

Debris extrusion, flare up, Ni–Ti file, postoperative pain

Abstract

The extrusion of intracanal debris as well as irrigants is a regular occurrence during root canal therapy; nevertheless, this issue has not been satisfactorily resolved by any instrument or method to date. Even if it's not always possible, a shaping or irrigation method should reduce the likelihood of apical extrusion as much as possible. This is because flare-ups may result from any irritation that is directed towards the periapical tissues. During the course of the previous decade, there was a rapid development of root canal instruments and irrigation systems; several of these instruments and systems have been evaluated for their propensity to extrude debris. This research was conducted with the intention of locating literature that discusses the assessment of debris, bacteria, and irrigant extrusion during root canal therapy. The terms "apical extrusion," "debris extrusion," and "endodontic treatment" were entered into the search engines PubMed, Ovid, and MEDLINE, respectively. The search through the relevant literature spanned more than 30 years, all the way up to 2012. The scope of this review was restricted to the apical extrusion of debris and irrigants, the extrusion of fluids by irrigation systems, and the extrusion of bacteria. In the publications that were retrieved, further searching in the reference sections provided information on issues that were relevant to apical extrusion. This study offers an update on the most recent developments concerning apical extrusion.

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References

Möller AJR, Fabricius L, Dahlén G, Öhman AE, et al. (1981). Influenceon periapical tissues of indigenous oral bacteria and necrotic pulp tissue in monkeys. Eur J Oral Sci. 89(6): 475-84.

Berutti E, Negro AR, Lendini M, Pasqualini D. (2004). Influence of manual preflaring and torque on the failure rate of ProTaper rotary instruments. J Endod. 30(4): 228.

Ng YL, Mann V, Rahbaran S, Lewsey J, et al. (2008). Outcome of primary root canal treatment: systematic review of the literature - Part 2. Influence of clinical factors. Int Endod J. 41(1): 6-31.

Peters OA. (2004). Current challenges and concepts in the preparation of root canal systems: A review. J Endod. 30(8): 559-67.

Wang J, Jiang Y, Chen W, Zhu C, et al. (2012). Bacterial flora and extraradicular biofilm associated with the apical segment of teeth with post-treatment apical periodontitis. J Endod. 38(7): 954-9.

Kustarcı A, Akpınar KE, Er K. (2008). Apical extrusion of intracanal debris and irrigant following use of various instrumentation techniques. Oral Surg, Oral Med, Oral Pathol, Oral Radiol, Endodontol. 105(2): 257-62.

Shalan, L. A., Al-Huwaizi, H. F. & Fatalla, A. A. (2018).Apical extrusion of debris and Irrigants after using different irrigation needles and systems with different depth of penetration (a comparative study). Biomed Pharmacol J . 11:519-523.

Tanalp J, Güngör T. (2014).Apical extrusion of debris: a literature review of an inherent occurrence during root canal treatment. Int Endod J. 47(3): 211-21

Yusuf H. (1982).The significance of the presence of foreign material periapically as a cause of failure of root treatment. Oral Surg Oral Med Oral Pathol. 54(5): 566-74.

Sjogren U, Hagglund B, Sundqvist G, Wing K. (1990). Factors affecting the long-term results of endodontic treatment. J Endod. 16(10): 498-504.

Kirchhoff AL, Fariniuk LF, Mello I. (2015). Apical extrusion of debris in flat-oval root canals after using different instrumentation systems. J Endod.; 41(2): 237-41.

Beeson TJ, Hartwell GR, Thornton JD, Gunsolley JC. (1998). Comparison of debris extruded apically in straight canals: Conventional filing versus profile .04 Taper series 29. J Endod. 24(1): 18-22.

Buldur B, Hascizmeci C, Aksoy S, Nur Aydin M, et al. (2018). Apical extrusion of debris in primary molar root canals using mechanical and manual systems. Eur J Paediatr Dent. 19(1): 16-20.

Nair PNR, Henry SP, Cano V, Vera J. (2005). Microbial status of apical root canal system of human mandibular first molars with primary apical periodontitis after “one-visit” endodontic treatment. Oral Surg, Oral Med, Oral Pathol, Oral Radiol Endodontol. 99(2): 231-52.

Ruiz-Hubard EE, Gutmann JL, Wagner MJ. (1987). A quantitative assessment of canal debris forced periapically during root canal instrumentation using two different techniques. J Endod. 13(12): 554-8.

McKendry DJ. (1990). Comparison of balanced forces, endosonic, and step-back filing instrumentation techniques: quantification of extruded apical debris. J Endod. 16(1): 24-7.

Al-Omari MAO, Dummer PMH. (1995).Canal blockage and debris extrusion with eight preparation techniques. J Endod. 21(3): 154.

Reddy SA, Hicks ML. (1998). Apical extrusion of debris using two hand and two rotary instrumentation techniques. J Endod.;24(3): 180-3.

Del Fabbro M, Afrashtehfar KI, Corbella S, El-Kabbaney A, et al. (2018). In vivo and in vitro effectiveness of rotary nickel-titanium vs manual stainless steel instruments for root canal therapy: Systematic review and meta-analysis. J Evid Based Dent Pract. 18(1): 59-69.

Al-Doory, Z. K. & Al-Hashimi, M. K. (2012). The influence of instrument application frequency on the apical extrusion of debris using rotary ProTaper, hand ProTaper and hybrid technique (An in vitro study). J Bagh Coll Dent. 24:34-39.

Çiçek E, Koçak MM, Koçak S, Sag-lam BC, et al. (2017). Postoperative pain intensity after using different instrumentation techniques: a randomized clinical study. J Appl Oral Sci: revista FOB. 25(1): 20-6.

Kashefinejad M, Harandi A, Eram S, Bijani A. (2016). Comparison of single visit post endodontic pain using Mtwo rotary and hand K-file instruments: A Randomized Clinical Trial. J Dent (Tehran). 13(1): 10-7.

Relvas JBF, Bastos MMB, Marques AAF, Garrido ADB, et al. (2016) Assessment of postoperative pain after reciprocating or rotary NiTi instrumentation of root canals: A randomized, controlled clinical trial. Clin Oral Investig. 20(8): 1987-93.

Jain N, Pawar A, Gupta A. (2016). Incidence and severity of postoperative pain after canal instrumentation with reciprocating system, continuous rotary single file system, versus SAF system. Endod practice. 10: 153-60.

Mollashahi NF, Saberi EA, Havaei SR, Sabeti M. (2017). Comparison of postoperative pain after root canal preparation with two reciprocating and rotary single-file systems: A randomized clinical trial. Ir Endod J. 12(1): 15-9.

Neelakantan P, Sharma S. (2015). Pain after single-visit root canal treatment with two single-file systems based on different kinematics - a prospective randomized multicenter clinical study. Clin Oral Investig. 19(9): 2211-7.

Sun C, Sun J, Tan M, Hu B, et al. (2018). Pain after root canal treatment with different instruments: A systematic review and meta-analysis. Oral Dis. 24(6): 908-19.

Robinson JP, Lumley PJ, Cooper PR, Grover LM, et al. (2013). Reciprocating root canal technique induces greater debris accumulation than a continuous rotary technique as assessed by 3-dimensional micro-computed tomography. J Endod. 39(8): 1067-70.

Berman, L. H., & Hargreaves, K. M. (2015). Cohen's pathways of the pulp expert consult. Elsevier Health Sciences..

Webber J. (2015). Shaping canals with confidence: WaveOne GOLD single-file reciprocating system. Roots.(1): 34-40.

Sattapan B, Nervo GJ, Palamara JEA, Messer HH. (2000). Defects in rotary nickel-titanium files after clinical use. J Endod. 26(3): 161-5.

Sattapan B, Palamara JEA, Messer HH. (2000). Torque during canal instrumentation using rotary nickel-titanium files. J Endod. 26(3): 156-60.

Gabel WP, Hoen M, Steiman HR, Pink FE, et al. (1999). Effect of rotational speed on nickel-titanium file distortion. J Endod. 25(11): 752-4

Plotino G, Grande NM, Melo MC, Bahia MG, et al. (2010). Cyclic fatigue of NiTi rotary instruments in a simulated apical abrupt curvature. Int Endod J. 43(3): 226-30.

Parashos P, Messer HH. (2006). Rotary NiTi instrument fracture and its consequences. J Endod. 32(11): 1031-43.

Gambarini G, Grande NM, Plotino G, Somma F, et al. (2008). Fatigue resistance of engine-driven rotary nickel-titanium instruments produced by new manufacturing methods. J Endod. 34(8): 1003-5.

De-Deus G, Moreira EJL, Lopes HP, Elias CN. (2010). Extended cyclic fatigue life of F2 ProTaper instruments used in reciprocating movement. Int Endod J. 43(12): 1063-8.

Webber J. (2015). Shaping canals with confidence: WaveOne GOLD single-file reciprocating system. Roots.(1): 34-40.

Gupta R, Tomer A, Rohilla S. (2016). Single file endodontics: Boon or myth? Asian Pacific J Health Sci. 3(2): 102-5

Fidler A. (2016). Kinematics of 2 reciprocating endodontic motors: The difference between actual and set values. J Endod. 40(7): 990-4.

Bürklein S, Benten S, Schäfer E. (2014). Quantitative evaluation of apically extruded debris with different single-file systems: Reciproc, F360 and OneShape versus Mtwo. Int Endod J. 47(5): 405-9.

Bürklein S, Schäfer E. (2012). Apically extruded debris with reciprocating single-file and full-sequence rotary instrumentation systems. J Endod. 38(6): 850

Alani, M. A. & Al-Huwaizi, H. (2019). Evaluation of apically extruded debris and irrigants during root canal preparation using different rotary instrumentation systems: An In-vitro comparative study. Int J of Medical Research & Health Sci. 8:21-26.

Surakanti J, Venkata RC, Vemisetty H, Dandolu R, et al. (2014). Comparative evaluation of apically extruded debris during root canal preparation using ProTaper, Hyflex and Waveone rotary systems. J Conserv Dent. 17(2): 129

Arslan H, Dog-anay E, Alsancak M, Çapar ID, et al. (2016). Comparison of apically extruded debris after root canal instrumentation using Reciproc instruments with various kinematics. Int Endod J. 49(3): 307-10.

Flanders D. Endodontic patency. How to get it. How to keep it. Why it is so important. N Y State Dent J. 2002; 68: 30-2.

Paleker F, van der Vyver PJ. (2017). Glide path enlargement of mandibular molar canals by using K-files, the ProGlider File, and G-Files: A comparative study of the preparation times. J Endod. 43(4): 609-12

Tinaz AC, Alacam T, Uzun O, Maden M, et al. (2005). The effect of disruption of apical constriction on periapical extrusion. J Endod31(7): 533-5.

Lambrianidis T, Tosounidou E, Tzoanopoulou M. (2001). The effect of maintaining apical patency on periapical extrusion. J Endod. 27(11): 696-8.

Izu KH, Thomas SJ, Zhang P, Izu AE, et al. (2004). Effectiveness of sodium hypochlorite in preventing inoculation of periapical tissues with contaminated patency files. J Endod. 30(2): 92-4.

Hartmann RC, Peters OA, de Figueiredo JAP, Rossi-Fedele G. (2018). Association of manual or engine-driven glide path preparation with canal centring and apical transportation: a systematic review. Int Endod J. 51(11): 1239-52

West, J. D. (2010). The endodontic Glidepath:" Secret to rotary safety". Dentistry today, 29(9), 86-88.

Elnaghy AM, Elsaka SE. (2014). Evaluation of root canal transportation, centering ratio, and remaining dentin thickness associated with ProTaper Next instruments with and without glide path. J Endod. 40(12): 2053-6

Rodrigues E, De-Deus G, Souza E, Silva EJ. (2016). Safe mechanical preparation with reciprocation movement without glide path creation: result from a pool of 673 root canals. Braz Dent J. 27(1): 22-7.

Patiño PV, Biedma BM, Liébana CR, Cantatore G, et al. (2005). The influence of a manual glide path on the separation rate of NiTi rotary instruments. J Endod. 31(2): 114-6.

Gunes B, Yeter Y. (2018). Effects of different glide path files on apical debris extrusion in curved root canals. J Endod. 44(7): 1191-4.

Basmadjian-Charles CL, Farge P, Bourgeois DM, Lebrun T. (2002). Factors influencing the long-term results of endodontic treatment: a review of the literature. Int Dent J. 52(2): 81-6.

Tinoco JM, De-Deus G, Tinoco EM, Saavedra F, et al. (2014). Apical extrusion of bacteria when using reciprocating single-file and rotary multifile instrumentation systems. Int Endod J. 47(6): 560-6.

Zupanc J, Vahdat-Pajouh N, Schäfer E. (2018). New thermomechanically treated NiTi alloys - a review. Int Endod J. 51(10): 1088-103.

Goo H-J, Kwak SW, Ha J-H, Pedullà E, et al. (2017). Mechanical properties of various heat-treated nickel-titanium rotary instruments. J Endod. 43(11): 1872-7.

You S-Y, Kim H-C, Bae K-S, Baek S-H, et al. (2011). Shaping ability of reciprocating motion in curved root canals: A comparative study with micro-computed tomography. J Endod. 37(9): 1296-300.

Varela-Patino P, Ibanez-Parraga A, Rivas-Mundina B, Cantatore G, et al. (2011). Alternating versus continuous rotation: A comparative study of the effect on instrument life. J Endod. 36(1): 157-9.

Espir CG, Nascimento-Mendes CA, Guerreiro-Tanomaru JM, Freire LG, et al. (2018). Counterclockwise or clockwise reciprocating motion for oval root canal preparation: A micro-CT analysis. Int Endod J. 51(5): 541-8

Siddique R, Nivedhitha MS. (2019). Effectiveness of rotary and reciprocating systems on microbial reduction: A systematic review. J Conserv Dent. 22(2): 114-22.

Karatas E, Arslan H, Kırıcı D, Alsancak M, Çapar ID. (2016). Quantitative evaluation of apically extruded debris with Twisted File Adaptive instruments in straight root canals: Reciprocation with different angles, adaptive motion and continuous rotation. Int Endod J. 49(4): 382-5

Paqué F, Boessler C, Zehnder M. (2011). Accumulated hard tissue debris levels in mesial roots of mandibular molars after sequential irrigation steps. Int Endod J. 44(2

Gizem Demiray K, Ahmet G, Bülent A, Güven K. (2016). Comparison of the smear layer- and debris-removal abilities and the effects on dentinal microhardness of 5% and 17% EDTA solutions used as final irrigants: In vitro study. Acta Odontol Turc. 33(2): 63-8.

Siqueira JF. (2003). Microbial causes of endodontic flare-ups. Int E ndod J. 36(7): 453-63.

Kim H-J, Park S-J, Park S-H, Hwang Y-C, et al. (2013). Efficacy of flowable gel-type EDTA at removing the smear layer and inorganic debris under manual dynamic activation. J Endod. 39(7): 910-4.

Gupta, J., Nikhil, V., & Jha, P. (2014). Corelation between machines assisted endodontic irrigant agitation and apical extrusion of debris and irrigant: a laboratory study. The scientific world journal, 2014.

Baker NA, Eleazer PD, Averbach RE, Seltzer SP. (1975). Scanning electron microscopic study of the efficacy of various irrigating solutions. J Endod. 1(4): 127-35.

Myers GL, Montgomery S. (1991). A comparison of weights of debris extruded apically by conventional filing and canal master techniques. J Endod. 17(6): 275-9

Tinaz AC, Alacam T, Uzun O, Maden M, et al. (2005). The effect of disruption of apical constriction on periapical extrusion. J Endod. 31(7): 533-5.

Hinrichs RE, Walker WA, 3rd, Schindler WG. (1998). A comparison of amounts of apically extruded debris using handpiece-driven nickel-titanium instrument systems. J Endod. 24(2): 102-6.

Ferraz CCR, Gomes NV, Gomes BPFA, Zaia AA, et al. (2001). Apical extrusion of debris and irrigants using two hand and three engine-driven instrumentation techniques. Int Endod J. 34(5): 354-8

Johnson BR, Remeikis NA. (1993). Effective shelf-life of prepared sodium hypochlorite solution. J Endod. 19(1): 40-3

Naenni N, Thoma K, Zehnder M. (2004). Soft tissue dissolution capacity of currently used and potential endodontic irrigants. Journal of endodontics. 30(11):785-7.

Zehnder M. (2006). Root canal irrigants. J Endod. 32(5): 389- 98.

Putzer P, Hoy L, Günay H. (2008). Highly concentrated EDTA gel improves cleaning efficiency of root canal preparation in vitro. Clin Oral Investig12(4): 319-24.

Cruz A, Vera J, Gascón G, Palafox-Sánchez CA, et al. (2014). Debris remaining in the apical third of root canals after chemomechanical preparation by using sodium hypochlorite and glyde: An in vivo study. J Endod. 40(9): 1419-23.

Altundasar, E., Nagas, E., Uyanik, O., & Serper, A. (2011). Debris and irrigant extrusion potential of 2 rotary systems and irrigation needles. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 112(4), e3

Factors affecting apically extrusion debris during root canal treatment -A literature review