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Successful outcome of pulp therapy depends on good chemomechanical preparation of the canals. This is completed with the help of various upcoming rotary and hand files. However, during this preparation, there might be an apical extrusion of the debris which may result in postoperative complications. The aim of this study was to evaluate and compare the number of debris apically extruded during canal preparation using two different pediatric rotary file systems and conventional hand file systems in primary teeth. 60 primary maxillary central incisors that were extracted due to trauma or untreated dental caries with no signs of resorption were taken. Canal preparation was executed using three different file systems: Group A: Group A hand K file system, Group B Kedo S Plus, Group C Kedo SG Blue. For each of these files using the Myers and Montgomery model, the pre- and post-weight of the eppendorf tube was assessed to quantify the number of apical debris. The maximum extrusion of apical debris was noticed with the Hand K-file system. The least debris was noticed in the Kedo S Plus file system. Statistical analysis revealed that there were highly significant differences in apical extrusion and debris when comparing hand files and rotary files and also between the two rotary files used. Apical debris collection is an unavoidable outcome of canal instrumentation. Among the file systems compared, rotary files had lesser extrusion when compared to hand files. Among the rotary files, Kedo S plus showed normal extrusion compared to SG Blue.

Background: Recently several calcium silicate flowable sealers have been introduced as endodontic materials for the root canal. This clinical study tested the use of a new premixed calcium silicate bioceramic sealer in association with the Thermafil warm carrier-based technique (TF). Epoxy-resin-based sealer with the warm carrier-based technique was the control group. Methodology: Healthy consecutive patients (n = 85) requiring 94 root canal treatments were enrolled in this study and assigned to one filling group (Ceraseal-TF n = 47, AH Plus-TF n = 47) in accordance with operator training and best clinical practice. Periapical X-rays were taken preoperatively, after root canal filling and after 6, 12 and 24 months. Two evaluators blindly assessed the periapical index (PAI) and sealer extrusion in the groups (k = 0.90). Healing rate and survival rate were also evaluated. Chi-square tests was used to analyze significant differences between the groups. Multilevel analysis was performed to evaluate the factors associated with healing status. Results: A total of 89 root canal treatments in 82 patients were analyzed at the end-line (24 months). The total drop-out was 3.6% (3 patients; 5 teeth). A total of 91.1% of healed teeth (PAI 1-2) was observed in Ceraseal-TF, with 88.6% in AH Plus-TF. No significant difference was observed on healing outcome and survival among the two filling groups (p > 0.05). Apical extrusion of the sealers occurred in 17 cases (19.0%). Of these, 6 occurred in Ceraseal-TF (13.3%) and 11 in AH Plus-TF (25.0%). Three Ceraseal extrusions were radiographically undetectable after 24 months. All the AH Plus extrusions did not change during the evaluation time. Conclusions: The combined use of the carrier-based technique and premixed CaSi-based bioceramic sealer showed clinical results comparable with carrier-based technique and epoxy-resin-based sealer. The radiographical disappearance of apically extruded Ceraseal is a possible event in the first 24 months.

The purpose of this research was to compare apical debris extrusion and fracture resistance of teeth prepared with OneCurve, WaveOne Gold, or ProTaper Universal. Materials and Methods: Mandibular premolars were prepared with OneCurve, WaveOne Gold, or ProTaper Universal. In the experimental model, debris was recovered by apical section of the root washing with distilled water. The Eppendorf tubes were weighed after 15 days of storage to establish the overall weight of the tubes, including the extruded debris. The dry weight of the ejected material was then computed. After root canal obturation, the apical root ends were trapped in the acrylic up to 2 mm below the cementoenamel junction. The fracture force was calculated and given in Newtons. A one-way ANOVA test was used to compare more than two groups, followed by a Tukey post hoc test. The significance level was set at P≤ 0.05. Results: The results revealed a statistically significant difference in extruded debris between OneCurve, WaveOne Gold, and ProTaper Universal (P

Aim: To compare the amount of extruded debris with three endodontic NiTi engine driven systems, Protaper Next, Hyflex CM and EdgeFile X7. Material and Methods: A total number of 42 freshly extracted human premolars were selected. Teeth were divided randomly into three equal groups (14 teeth each group) according to type of Ni-Ti rotary file system; (A) Protaper Next, (B) Hyflex CM and (C) EdgeFile X7. Standard Access cavity prepared and checked for patency using K file #10 and #15. Root canal instrumentation on the single canal lower premolars was done. Debris was collected after root canal instrumentation in pre-weighed Eppendorf tubes. The Eppendorf tubes were weighed 2 times on the analytical balance. First weight: Before instrumentation. Second weight: After evaporation of moisture and irrigant and incubation. Welch test was used for comparison between the three groups. Results: There was no statistically significant difference between the amounts of debris extrusion of the three groups Conclusion: All endodontic rotary instruments tested produced apical extrusion of debris.

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.

Aim and objective Apical extrusion of debris and cleaning efficacy in primary root canal treatment has not been well elucidated by using specialized pediatric rotary endodontic files. The purpose of this study is to compare the amount of apically extruded debris and cleaning efficacy during the preparation of primary molar root canals using Pro AF Baby Gold and Kedo-S pediatric rotary files. Materials and methods Twenty extracted primary molar teeth were assigned randomly to two groups (n = 10 teeth for each group), injected with Indian Ink and instrumented using Kedo-S and Pro AF Baby Gold pediatric rotary files, respectively. The apically extruded debris was collected and dried in pre-weighed using Eppendorf tubes. The dry weight was calculated by subtracting the preoperative weight from the postoperative weight. The cleaning efficacy was evaluated after the diaphanization process. Statistics: Data were analyzed statistically using the independent sample t-test. Results The amount of apically extruded debris was significantly less for the Pro AF Baby rotary files group compared to the Kedo-S rotary files group (p < 0.05). Cleaning efficacy was significantly better with Pro AF Baby Gold when compared to Kedo-S rotary files in the apical region of the tooth. Conclusion All instruments caused apically extruded debris in primary teeth. Pro AF baby Gold files can be used with less apical extrusion of debris. Cleaning efficacy was shown to be better with the Pro AF Baby Gold pediatric rotary endodontic file. How to cite this article Rathi N, Jain SA, Thosar N, et al. Comparative Evaluation of Cleaning Efficiency and Apical Extrusion of Debris Using Two Pediatric Rotary Endodontic Files: An In Vitro Study. Int J Clin Pediatr Dent 2021;14(2):196–200.

AIM AND OBJECTIVE The aim of this study was to evaluate the apical extrusion of debris during root canal preparation with the use of different Nickel-Titanium (Ni-Ti) file systems. MATERIALS AND METHODS Totally 60 single-rooted human mandibular premolar teeth with fully formed roots were chosen for the study. The coronal access cavity and all other preparations were done with the use of an access cavity kit and then 60 samples were randomly separated into three investigational groups (n = 20); group I: self-adjusting file, group II: WaveOne Gold, and group III: Mtwo rotary system. After instrumentation, the teeth were taken out from the tube and the root surface-adherent debris was collected by washing off the apical area of the tooth with distilled water (1 ml) into a centrifuge tube. The centrifuge tube was kept for 5 days in an incubator at 70°C to permit evaporation of the moisture prior to weighing the dry debris with the aid of an electrical analytical balance. RESULTS The highest quantity of debris extruded was by the Mtwo rotary system (0.0394 ± 0.880) followed by WaveOne Gold (0.0247 ± 1.030) and self-adjusting file (0.0198 ± 0.102). A statistically significant difference (p < 0.001) was found between the various file systems. CONCLUSION After considering the drawbacks of this study, apical debris extrusion could be found with all three groups. However, the self-adjusting file demonstrated a significantly reduced quantity of apical debris extrusion compared to the Mtwo rotary system and WaveOne Gold. CLINICAL SIGNIFICANCE The chief step during the procedure of root canal treatment is the preparation of the infected root canals biomechanically. This preparation may lead to forcing the apical debris into the periapical space through the apical foramen, resulting in host-initiated immunological response which leads to postoperative discomfort and pain. This consequently leads to selection of a specific rotary system for endodontic treatment.

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 (P0.05). Conclusion. All the instrumentation systems caused apical extrusion of debris. However, the TRN system resulted in significantly less debris extrusion than the other systems.

When transformed cells emerge in an epithelium, their elevated class I MHC expression signals to normal neighboring epithelial cells, which respond by inducing their apical extrusion as a tumor-suppressive mechanism.

Laser-activated irrigation (LAI) is an activation method that is based on transferring pulsed energy to the irrigation solution by using different fiber tips and generating explosive vapor bubbles with a secondary cavitation effect, causing rapid solution movement through the root canal. This study aimed to compare different types of LAI and ultrasonically activated irrigation (UAI) in terms of cleaning efficacy by using scanning electron microscopy (SEM) images. Sixty straight and single-rooted mature mandibular premolars were prepared with ProTaper Ni-Ti rotary instruments up to F4. According to the final irrigation/agitation protocols, four experimental groups (n = 15) were generated as conventional laser–activated irrigation (group 1: C.LAI), photon-induced photoacoustic streaming (group 2: PIPS), shock wave–enhanced emission photoacoustic streaming (group 3: SWEEPS), and passive ultrasonic irrigation (group 4:UAI). The irrigation protocols were performed for 60 s with 2.5% NaOCl and 17% EDTA. Debridement was evaluated using SEM with a scoring system. Apical extrusion was calculated using cube-shaped flower arrangement foam by subtracting the initial weights from the final weights. All data were statistically analyzed. C.LAI and SWEEPS showed significantly lower debris scores than PIPS and UAI (p

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.

Aim: The aim of this study was to evaluate the number of intracanal bacteria extruded apically after instrumentation with three different nickel–titanium rotary instruments. Materials and Methodology: Forty freshly extracted mandibular premolars were selected, access cavities were prepared, and the teeth were mounted in the bacterial collection apparatus. Root canals were contaminated with a suspension of Enterococcus faecalis and incubated for 24 h at 37°C. The contaminated teeth were divided into four groups of 10 teeth each according to the rotary system used for instrumentation: Group 1: ProTaper universal files, Group 2: MTwo files, Group 3: ProTaper Next files, and Group 4: Control group (no instrumentation). Bacteria extruded after preparations were collected into vials. The number of colony-forming units (CFUs) was determined for each sample. Statistical Analysis: The data obtained were analyzed using the one-way analysis of variance followed by post hoc Tukey’s test with a P = 0.05 as the level for statistical significance. Results: The results suggested a statistically significant difference in the number of CFUs between four experimental groups (P < 0.001). Conclusion: Least amount of bacterial extrusion was seen in ProTaper Next Group while more bacterial extrusion was seen in MTwo Group.

Sodium hypochlorite is considered the most widely used irrigant in endodontics as it exhibits effective antimicrobial activity and has potent tissue-dissolving ability. Whilst it is considered safe when used within the confines of the root canal system, it can cause serious complications when inadvertent periradicular extrusion occurs. This article outlines the complications of sodium hypochlorite extrusion and reviews the appropriate management based on the contemporary evidence. Preventive measures are suggested and the relevant medico-legal considerations are outlined.

This study compared the amount of apically extruded debris associated with different heat-treated Ni-Ti rotary systems during the preparation of curved root canals of mandibular molars. Sixty extracted human mandibular molars were selected. EdgeFile, K3XF, OneCurve (OC) and ROTATE files were used to prepare both mesial canals of teeth. The initial weight of each Eppendorf tube to be used was calculated using an analytical balance prior to instrumentation. After instrumentation, the tubes were then stored for 5 days in an incubator at 70 degrees C. Each tube was reweighed, and the weight of the dry extruded debris was established by subtracting the pre-instrumentation and post-instrumentation weight of the Eppendorf tubes for each group. All files caused apical extrusion of debris. There was no statistical difference between the ROTATE, EdgeFile, OC and K3XF systems (P 0.05). All the heat-treated Ni-Ti rotary systems led to similar apical debris extrusion during the canal preparation.

Endodontic flare-up or post-operative pain occurs when debris such as necrotic pulp tissue, dentin chips, irrigants, and microorganisms are extruded from the apical foramen intraoperatively into the periradicular tissue during root canal instrumentation. This study compared the amount of apical debris extrusion of the root canal dentin layer after using reciprocating and rotary file systems (WaveOne, ProTaper Next and ProTaper Gold). Sixty extracted human maxillary central incisors with one canal and closed apex were included in the study. Samples were randomly and equally divided into three groups (n = 20) according to the file systems used for preparation of the root canal. Teeth in the WO group were instrumented by WaveOne, while the PTN group were instrumented by ProTaper Next, and teeth samples in the PTG group were cleaned and shaped by ProTaper Gold. The mean apically extruded debris weight in grams was estimated using the modified Myers and Montgomery experimental model. Analysis of variance (ANOVA) test was used for the comparison of debris weight in three groups. Post hoc LSD test was applied for pairwise comparison of debris weight. The α value of significance was 0.05. The WO group had significantly lower mean debris weight than the PTN and PTG groups (p = 0.001). Post hoc pairwise comparison revealed that there was a statistically significant difference in mean debris weight between the WO group and PTN group (0.0215 vs. 0.0341, p = 0.001); and the WO group and PTG group (0.0215 vs. 0.0324, p = 0.003). Root canal preparations with different file systems were associated with apical extrusion of the debris from the root canal dentin layer. However, the WaveOne system resulted in a comparatively lower amount of apical debris layer extrusion than the ProTaper Next and ProTaper Gold rotary file systems.

The present study aimed to compare the apically extruded debris produced during glide path preparation using R-Pilot (RP), WaveOne Gold Glider (WGG) and ProGlider (PG) with the subsequent preparation using Reciproc Blue in curved root canals. Mesial roots of mandibular molars with angle of curvature between 25° and 35° were selected (n = 20). The Myers and Montgomery method was used to collect and assess apically extruded debris. The glide path was prepared either manually with K-file, ProGlider, R-Pilot or WaveOne Gold Glider. Manual preparation group produced the highest amount of apically extruded debris (P 0.05), while all groups caused debris extrusion. There were no significant differences among the extruded debris caused by RP, PG and WGG groups (P 0.05). Apically extruded debris produced by engine-driven reciprocational or continuous rotational single file glide path instruments was similar, whereas manual glide path preparation was associated with the greatest amount of extruded debris.

Aim: This study aims to evaluate the amount of apical extrusion of bacteria during root canal instrumentation using K3XF, Protaper Gold, Edge taper platinum, and Hyflex CM Rotary systems. Materials and Methods: Sixty freshly extracted maxillary incisors teeth collected in saline. Access cavity prepared and canals were made free of bacterial and pulp. The teeth were mounted on the bacteria collecting apparatus. Root canals were contaminated with the Fusobacterium Nucleatum (ATCC25586) and dried at 37°C for 24 h. In Group 1 (Control group): No instrumentation was done and biomechanical preparation done in all other groups with Group 2: Hand K-files, Group 3: Protaper gold, Group 4: K3XF, Group 5: Edge taper platinum, and Group 6: Hyflex CM rotary file systems. Then, the extrude was collected, and it is incubated in Mueller-Hinton agar for 24 h and the number of colony forming units were counted and statistical comparison was done using Kruskal–Wallis test and Mann–Whitney U test. Results: Hand K-files extruded more bacteria when compared to other four rotary systems, K3XF file system extruded least number of bacteria. Conclusion: All instrumentation techniques extruded intracanal bacteria apically. However, engine-driven nickel-titanium instruments extruded less bacteria than the manual technique. The K3XF rotary file system comparatively extruded less bacteria than other rotary file systems.

Aim: To evaluate flow, filling ability, and apical extrusion of three calcium silicate-based sealers, Neo MTA Plus (Avalon, USA), Bio-C Sealer (Angelus, Brazil) and Sealer Plus BC (MK Life, Brazil), in comparation with the gold standard based on epoxy resin, AH Plus (Dentsply, Germany). Methodology: The flow was evaluated based on ISO 6876/2012 standard (mm) and in area (mm2 ). For assessment of filling ability and apical extrusion of the sealers, curved artificial canals were prepared up to size 25.06, and filled with the sealers by the single cone technique. The samples were scanned in microcomputed tomography (SkyScan 1272. Bruker, Belgium) after preparation and after filling of the root canals. The percentage of voids throughout the entire extension of the root canals and in the apical third, besides the volume of apical extrusion of each sealer were calculated. Data were statistically analyzed using ANOVA/Tukey tests (α = 0.05). Results: Bio-C Sealer showed the highest flow and NeoMTA Plus had the lowest value (p < 0.05). Bio-C Sealer had lower percentage of total voids than NeoMTA Plus (p < 0.05). AH Plus had greater percentage of voids in the apical third than Bio-C Sealer and Sealer Plus BC (p < 0.05). Bio-C Sealer showed higher volume of extrusion (p < 0.05) than AH Plus and NeoMTA Plus. Conclusion: Bio-C Sealer and Sealer Plus BC had greater flow and proper filling ability in the apical third. However, these sealers presented high volume of apical extrusion. NeoMTA Plus provided less sealer extrusion, low flow, and more presence of voids.

Objective: The Aim of this study was to evaluate the effect of instrument kinematics on the apical extrusion of debris. Materials & Methods: Fourteen single rooted mandibular premolars with single single canals were used in this study. The teeth were divided into to two groups: Group 1: WaveOne Group (Reciprocation Group) and Group 2: OneCurve group (Continuous Rotation Group). The teeth were then accessed and the buccal cusp was reduced so that the external tooth length of all the teeth was 18 mm. The teeth were secured using composite resin in pre-weighed Eppendorf tubes and instrumentation of the canals using the different instruments was done. The teeth were then removed from the tubes and the tubes were incubated for 15 days and then weighed to evaluate the amount of extruded debris. Results: No significant difference in the amount apical extruded debris was found between the WaveOne Gold and the OneCurve instrument. Conclusions: The kinematics of the instruments used in this study did not affect the amount of extruded debris.

The aim of this study was to compare the root canal instrumentation techniques that involve foraminal enlargement versus those not involving it, in regard to the apical extrusion of filling material, using micro-computed tomography (micro-CT). Twenty-two premolars with single canals were instrumented using the ProTaper Universal System and then randomly divided into two groups (n = 11): Group NFE, without foraminal enlargement, and Group FE, with foraminal enlargement. Instrumentation was performed up to 1 mm short of the apical foramen, and foraminal patency was maintained at each instrument change in both groups. Prior to obturation, the apical portion of the specimens was wrapped in adhesive paper to ensure complete separation between apex and extruded material. The canals were filled according to the continuous wave of condensation technique. The apically extruded material was collected and measured using micro-CT. Extrusion in Group FE was significantly higher than in Group NFE (0.928 mm3 vs. 0.148 mm3 ; P < 0.001).

Aim: To evaluate the various kinematic effects of WaveOne Gold reciprocating file system such as 150°° counterclockwise (CCW)–30°° clockwise (CW), 270°° CCW–30°° CW, 360°° CCW–30°° CW, and continuous rotation and the influence of reciprocating and continuous rotary motions of the same file system on the apical extrusion of debris. Materials and Methods: Sixty mandibular premolars were selected. Instrumentation of the canals was done using WaveOne Gold single-file reciprocating systems and grouped into four groups as follows: Group I – 150°° CCW–30°° CW; Group II – 270°° CCW–30°° CW; Group III – 360°° CCW–30°° CW; and Group IV – continuous rotation. The debris extruded through the apical foramen was collected, dried, and weighed, and the raw data thus obtained were subjected to statistical analysis using one-way analysis of variance and least significant difference post hoc tests (P = 0.05). Results: The mean value for the difference of debris extrusion for the four groups was as follows: Group I: 0.0023 ± 0.002 g, Group II: 0.0071 ± 0.0049 g, Group III: 0.0029 ± 0.002 g, and Group IV: 0.0019 ± 0.002 g. The mean value depicted that the manufacturer recommended reciprocation kinematics (Group I) and the continuous rotation (Group IV) extruded less debris than compared to the other two. The intergroup comparison showed that there were significant differences between Group II and III but no significant differences between Group I and IV. Conclusions: Debris extrusion is inevitable. However, the manufacturer prescribed kinematics 150°° CCW–30°° CW and 270°° CCW–30°° CW extruded less debris than compared with the other two groups.

Aim The objective of this study was to assess apical extrusion after filling material removal using two systems, one rotary and one reciprocating. Materials and methods A total of 34 extracted mandibular premolars with single roots were selected and, posteriorly, prepared and filled. Following material aging for 60 days, teeth were divided into two groups, according to the method used to remove root filling material: group I, ProTaper® Universal Retreatment instruments plus refining with the Hero 642® sequence and group II, WaveOne® instruments. The teeth were fixed in an apparatus designed to collect the extruded material during removal procedure. Data on the amount of debris extruded (mg/weight) were analyzed using the Student's t test with a significance level of 5%. Results No significant differences were found between the groups with regard to the amount of material extruded during root canal retreatment. Conclusion The present findings suggest that the extrusion of debris during apical root canal retreatment does not depend on the instrument design or the protocol employed. Clinical significance Regardless of root canal clearance techniques, debris extrusion eventually occurs during endodontic retreatment and may be related to postoperative pain.

Introduction Root canal filling material may be extruded during retreatment through the apical foramen and cause flare-up or chronic infection. The aim of this study was to compare the apical extrusion of gutta-percha and resilon filling materials during retreatment using hand and rotary instruments. Methods Sixty extracted single-rooted teeth with single, straight canal were selected. Canals were prepared with ProTaper Universal rotary system to a size F2. Two groups (30 teeth in each) were filled with gutta-percha or resilon points, respectively. In both groups teeth were randomly divided into the three subgroups (10 teeth in each), based on the instruments used for retreatment: Hedstrom hand files and two rotary groups-ProTaper and Twisted File instruments. Apical extrusion was detected visually, using a 4-degree scoring system. Mean scores were calculated and analyzed statistically (t-test and ANOVA). The level of significance was set at p < 0.05. Results Under tested experimental conditions, the type of canal filling material did not have significant effect on the results of apical extrusion during retreatment. Significantly more material was extruded in the resilon group when manual, Hedstrom file was used (1.80 ± 1.13) than rotary ProTaper (0.60 ± 0.70) and Twisted File (0.50 ± 0.71). Conclusions The use of a rotary technique is recomended to minimize apical extrusion, especially when resilon obturation material is removed during retreatment.

Introduction. Root canal filling material may be extruded during retreatment through the apical foramen and cause flare-up or chronic infection. The aim of this study was to compare the apical extrusion of gutta-percha and resilon filling materials during retreatment using hand and rotary instruments. Methods. Sixty extracted single-rooted teeth with single, straight canal were selected. Canals were prepared with ProTaper Universal rotary system to a size F2. Two groups (30 teeth in each) were filled with gutta-percha or resilon points, respectively. In both groups teeth were randomly divided into the three subgroups (10 teeth in each), based on the instruments used for retreatment: Hedstrom hand files and two rotary groups- ProTaper and Twisted File instruments. Apical extrusion was detected visually, using a 4-degree scoring system. Mean scores were calculated and analyzed statistically (t-test and ANOVA). The level of significance was set at p < 0.05. Results. Under tested experimental conditions, the type of canal filling material did not have significant effect on the results of apical extrusion during retreatment. Significantly more material was extruded in the resilon group when manual, Hedstrom file was used (1.80 ± 1.13) than rotary ProTaper (0.60 ± 0.70) and Twisted File (0.50 ± 0.71). Conclusions. The use of a rotary technique is recomended to minimize apical extrusion, especially when resilon obturation material is removed during retreatment.

Purpose: present study designed to evaluate the influence of coronal preflaring on the amount of debris extruded apically during preparation of the root canal using reciprocating systems,Reciproc and WaveOne Gold.Materials and Methods:Sixty mandibular first molars with canal curvature between 25°-35° used and divided into 2 groups(Ι and ΙΙ) according to the method of preparation of the root (30 samples each); Group I: were prepared with coronal preflaring , Group II: were prepared without coronal preflaring. The groups further subdivided into 2 subgroups (A, B) according to the reciprocating file system used (15 samples each); Subgroup A: instrumented using Reciproc , Subgroup B: instrumented by WaveOne Gold .samples mounted in a model used to measure the amount of debris extruded apically.Results: In Reciproc subgroup, no statistical difference in samples prepared with and without coronal preflaring in the median of debris extruded apically (P>0.05). WaveOne Gold subgroup, samples prepared with coronal preflaring showed lower value of apically extruded debris than samples prepared without coronal preflaring. However,there was no statistical difference between the samples in the median of debris extruded apically (P > 0.05).In group I and II: (with and without coronal preflaring respectively), no statistically significant difference between Reciproc and WaveOne Gold in the median of debris extruded apically (P> 0.05). Conclusions:Reciproc and WaveOne Gold presented similar behavior regarding the amount of debris extruded apically during preparation .Coronal preflaring has no effect on the amount of debris extruded apically during preparation using reciprocating single-file systems,Reciproc and Wave One Gold.

Epithelia can eliminate apoptotic cells by apical extrusion. This is a complex morphogenetic event where expulsion of the apoptotic cell is accompanied by rearrangement of its immediate neighbors to form a rosette. A key mechanism for extrusion is constriction of an actomyosin network that neighbor cells form at their interface with the apoptotic cell. Here we report a complementary process of cytoskeletal relaxation that occurs when cortical contractility is down-regulated at the junctions between those neighbor cells themselves. This reflects a mechanosensitive Src family kinase (SFK) signaling pathway that is activated in neighbor cells when the apoptotic cell relaxes shortly after injury. Inhibiting SFK signaling blocks both the expulsion of apoptotic cells and the rosette formation among their neighbor cells. This reveals the complex pattern of spatially distinct contraction and relaxation that must be established in the neighboring epithelium for apoptotic cells to be extruded. Refereed/Peer-reviewed

Background/Aim: The aim of this study was to compare the apical extrusion during endodontic retreatment using three different endodontic systems. Material and Methods: 120 extracted human teeth were ex vivo endodontically treated and retreatment was performed using three different endodontic systems. Samples were divided into 3 groups, A-retreatment with Hedstroem hand files, B-retreatment with Pro Taper Retreatment files and C-retreatment with Pro Taper Gold files. Apically extruded material was collected in pre-measured Eppendorfs on a laboratory scale (10-5g). The amount of the extruded material was measured after the retreatment. The data were analysed using the the statistical software: STATISTICA 7.1 and SPSS for Windows 20. Results: The statistical analysis of the data revealed significant differences between the three endodontic retreatment systems (P< 0.05). Apical extrusion in the A endodontic system is significantly greater than the rotary (B and C) endodontic systems. Conclusions: In ex vivo conditions the results of this study showed significant statistical difference between three investigated endodontic retreatment systems concerning the amount of apically exuded material. The largest amount of material suppressed periapically was proven for Hedstroem hand instruments.

Aim: The aim is to compare the apical extrusion of debris during endodontic instrumentation with continuous rotation and reciprocating motion. Materials and Methods: Sixty extracted single-rooted mandibular premolar human teeth were randomly assigned to four groups of 15 teeth each. The canals were then instrumented with the following instrument systems: ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), 2Shape (TS; MicroMega, Besancon, France), Reciproc Blue (RB; VDW, Munich, Germany) and WaveOne Gold (WOG; Dentsply Sirona, Ballaigues, Switzerland). Apically extruded debris during instrumentation was collected into pre-weighed Eppendorf tubes. The Eppendorf tubes were then stored in an incubator at 70°C for 5 days. The weight of the dry extruded debris was established by subtracting the pre-instrumentation weight from postinstrumentation weight of the Eppendorf tubes. The data were analyzed using one-way analysis of variance and Tukey's Post hoc tests. Results: Among the instruments tested in the present study, the least amount of extrusion of debris was seen with TS rotary file system (Group IA) followed by RB (Group IIA) and WOG (Group IIB) (P < 0.05), the results, however, were not found to be statistically significant between them. The maximum amount of debris extrusion was observed with PTN (Group IB) with a statistically significant difference when compared to TS, RB, and WOG file system (P > 0.05). Conclusion: All instruments were associated with apical extrusion of debris with TS rotary file system associated minimum extrusion and PTN, resulting in maximum extrusion of debris.

Abstract It is increasingly evident that cells in tissues and organs can communicate with one another using mechanical forces. Such mechanical signalling can serve as a basis for the assembly of cellular communities. For this to occur, there must be local instabilities in tissue mechanics that are the source of the signals, and mechanisms for changes in mechanical force to be transmitted and detected within tissues. In this review, we discuss these principles using the example of cell death by apoptosis, when it occurs in epithelia. This elicits the phenomenon of apical extrusion, which can rapidly eliminate apoptotic cells by expelling them from the epithelium. Apoptotic extrusion requires that epithelial cells detect the presence of nearby apoptotic cells, something which can be elicited by the mechanotransduction of tensile instabilities caused by the apoptotic cell. We discuss the central role that adherens junctions can play in the transmission and detection of mechanical signals from apoptotic cells. Graphical abstract

Objectives: This study evaluated alterations in neuronal conductivity related to calcium silicate cements (CSCs) by investigating compound action potentials (cAPs) in rat sciatic nerves. Materials and methods: Sciatic nerves were placed in a Tyrode bath and cAPs were recorded before, during, and after the application of test materials for 60-minute control, application, and recovery measurements, respectively. Freshly prepared ProRoot MTA, MTA Angelus, Biodentine, Endosequence RRM-Putty, BioAggregate, and RetroMTA were directly applied onto the nerves. Biopac LabPro version 3.7 was used to record and analyze cAPs. The data were statistically analyzed. Results: None of the CSCs totally blocked cAPs. RetroMTA, Biodentine, and MTA Angelus caused no significant alteration in cAPs (p > 0.05). Significantly lower cAPs were observed in recovery measurements for BioAggregate than in the control condition (p < 0.05). ProRoot MTA significantly but transiently reduced cAPs in the application period compared to the control period (p < 0.05). Endosequence RRM-Putty significantly reduced cAPs. Conclusions: Various CSCs may alter cAPs to some extent, but none of the CSCs irreversibly blocked them. The usage of fast-setting CSCs during apexification or regeneration of immature teeth seems safer than slow-setting CSCs due to their more favorable neuronal effects.

Objectives: This study compared the amount of apically extruded debris and irrigant using VDW.ROTATE instruments with different kinematics (continuous rotation and reciprocation motion) and the ProTaper Gold system. Methods: Sixty extracted mandibular premolar teeth were selected. The teeth were prepared for the agar gel model. The roots were randomly divided into three groups (n=20). In two groups, the root canals were instrumented using the following movement kinematics: VDW.ROTATE reciprocation motion and continuous rotation. In the other group, root canals were prepared with ProTaper Gold. Apically extruded debris and irrigant during instrumentation were collected into preweighed Eppendorf tubes and were assessed with an electronic balance. All procedures were performed in a 35o C hot water bath. The data were analyzed using the Shapiro–Wilk and Kruskal–Wallis tests at a 5% significance level. Results: ROTATE-Reciprocation extruded the least amount of debris, but this finding was not significant when compared with the amount of debris and irrigant extruded by the ProTaper Gold and ROTATE-Rotation (p>.05). Conclusion: All instrumentation kinematics were associated with apical debris and irrigant extrusion. Movement kinematics did not affect the amount of apically extruded debris and irrigants when using VDW.ROTATE instruments.

Introduction:The extrusion of apical detritus during the retracting procedure is very important, as, besides eliminating materials of radicular obturation, aggressive agents and products such as the remains of dentin taken out, and microorganisms are generally located in tissue around the roots, producing undesired effects, such as inflammation, acute pain, post-operatory pain and delays in the periapical treatment.Objective:To determine the amount of apically extruded detritus using rotary and reciprocating retreatment systems.Methodology:An experimental comparative study as conducted in which 40 single-rooted human first premolars were analyzed. The instruments used were ProTaper Universal files up to F3 and sodium hypochlorite, and the sealing was made through the hybrid technique Tager. They were then kept at 37ºC and 100% of humidity for 15 days so that the sealing material would seal. For the retracting procedure, experimental tubes previously weighted were used. The sample was divided randomly into two groups of 20 pieces. Group A: ProTaper R, and group B: Reciproc. Then, the irrigating material (distilled water) was evaporated from the tubes for 12 hours in a stove at 105ºC, and the experimental tubes were weighted in an analytical precision weighing scale 10-5g. The data was analyzed through the T Student with a significance level of 5%.Results:Results indicated that groups A and B, retreatment with rotational ProTaper R and reciprocating retreatment system (Reciproc) showed a similar difference of initial and final weights, indicating similar apical extrusion of detritus.Conclusion:Both systems extruded a similar amount of detritus during the retreatment procedures.

Background and Objectives: Postoperative pain is a common symptom of a flare-up after root canal treatments (RCTs). Insufficient instrumentation, extrusion of irrigation solutions and debris, and the existence of a periapical lesion are the factors affecting postoperative pain after root canal treatments. The aim of this study was to evaluate the postoperative pain and instrumentation time of the single-file reciprocating system and multiple-file Ni-Ti rotary system in children ages 9-12 years old. Materials and Methods: Our study was conducted on 51 permanent mandibular molars with the diagnosis of irreversible pulpitis. Patients were randomly assigned into two groups, and RCTs were completed with either the Reciproc Blue or Protaper NEXT file systems. Instrumentation time for each system was noted, and patients were given a pain scale that included a visual analog scale for 6, 24, 48, and 72 h after treatment. Postoperative pain scores and instrumentation times were analyzed statistically with a chi-square test and Student's t-test. Results: There was no statistically significant difference in postoperative pain between the Reciproc Blue and Protaper NEXT systems at all time intervals. Instrumentation time was significantly shorter in the Reciproc Blue group in comparison with the Protaper NEXT group. Conclusions: Postoperative pain findings following RCT using single-file reciprocating systems were similar to the rotary system group. However, chair time in the reciprocating system group was significantly lower. This provided a comfortable and patient-friendly treatment approach for children, and could enhance their cooperation., Ege University Research Project Fund [16-DIS-013], FundingThis research project was funded by the Ege University Research Project Fund (16-DIS-013).

The objective of this study is to evaluate the retreatment time and weight of apically extruded debris yielded by two different kinematics during the removal of different root canal filling materials. Forty straight single-rooted extracted teeth were instrumented with HyFlex CM files and obturated with two different techniques: 25.04 HyFlex experimental carrier-based obturators (Coltène/Whaledent, Altstätten, Switzerland) (group 1) or 25.04 single gutta-percha cones (Roeko Coltène/Whaledent, Altstätten, Switzerland) (group 2) and Guttaflow Bioseal as the sealer. Samples were divided into four subgroups (n = 10) according to the used kinematics for the removal of root canal filling materials: continuous rotation (A) or retreatment motion (B) with a Remover and HyFlex EDM Nickel-Titanium instruments activated with a CanalPro Jeni micromotor (Coltène/Whaledent, Altstätten, Switzerland). Time for retreatment was digitally recorded, and debris extruded from the apex was collected in Eppendorf tubes and weighted with an analytical balance. Data on retreatment time and apical extrusion were statistically analyzed with the Kruskal–Wallis test ( p < 0.05 ). Working length was achieved in all the retreated samples. The removal of root filling material resulted significantly faster with the Jeni mode ( p < 0.001 ), and the difference was significant for the removal of both filling materials ( p < 0.05 ). No significant differences on debris extrusion between single cone and experimental obturators groups were noted ( p > 0.05 ), and no significant differences between kinematics (continuous rotation vs. Jeni motion) were observed ( p > 0.05 ). All the tested retreatment strategies lead to an extrusion of material from the apex, and the weight of apically extruded debris was similar. The use of the innovative CanalPro Jeni kinematics accelerates the time for the removal of root filling materials.

(1) Background: Apical extrusion of debris is an example of a complication that may arise during root canal treatment, and it has been proven to be an unavoidable occurrence during endodontic treatment by numerous authors. Even though it may not hinder the long-term outcome of treatment, it may lead directly to increased levels of postoperative pain and, therefore, lower levels of patient acceptance and satisfaction. The aim of the study was to assess the weight of apically extruded debris during root canal preparation with instruments that use different movement kinematics (rotary, reciprocating, and adaptive motion), (2) Methods: The study was performed using the Myers and Montgomery model. Sixty human premolar teeth were inserted into preweighed Eppendorf tubes and randomly classified into three groups. After manual glide-path preparation, teeth in each group were instrumented to working length set 1 mm short of the anatomical apex using the standard sequence provided by the manufacturers (for Group 1: ProTaper Next X1 &amp, X2, for Group 2: WaveOne Gold Primary, for Group 3: Twisted Files SM1-SM3). Root canals were irrigated with 1 mL of 0.9% NaCl solution between each file insertion. The tubes with collected debris were stored in an incubator at 70 °C for 5 days in order to evaporate the liquid component. Measurement of the weight of extruded debris was performed by subtracting the preinstrumentation from the postinstrumentation weight of the tubes. The results were analyzed with Kruskal–Wallis ANOVA, with significance level set at 0.05, (3) Results: The weight of extruded debris was 0.337 mg (SD = 0.148) for Group 1, 0.305 mg (SD = 0.201) for Group 2, and 0.348 mg (SD = 0.135) for Group 3. (4) Conclusions: Engine-driven root canal preparation with the use of instruments ProTaper Next, WaveOne Gold and Twisted Files that use different movement kinematics (rotary, reciprocating, and adaptive motion) was associated with apical extrusion of debris to a similar extent.

This study compared standard needle irrigation, passive ultrasonic irrigation, XP-Endo Finisher and Easy Clean in the apical extrusion of sodium hypochlorite (NaOCl) in a model simulating immature teeth. Ten bovine teeth were maintained in suspension in a container with the apical portion in contact with 0.2% agarose gel containing 0.1% metacresol purple. The canals were irrigated with 2.5% NaOCl, according to each irrigation protocol. After 3 min, apical extrusion of NaOCl was observed by the colour gel change when in contact with NaOCl. The containers were photographed, and the NaOCl extrusion area was measured. All protocols showed NaOCl extrusion, providing similar area (P > 0.05). Considering the similarity among the studied protocols, all of them can be considered during the endodontic treatment of immature teeth. Further studies on the particularities of immature teeth should be performed to evaluate cell viability, cleaning efficiency, disinfection capacity and dentin removal promoted by the irrigation protocols.

Hypochlorite accidents are relatively rare events. Therefore, there is a lack of precise and accurate reports in the scientific literature that could help clinicians better understand the phenomenon and associated risk factors. This study reported four hypochlorite accidents attributable to 5% NaOCl extrusion in patients who had undergone treatment of the maxillary elements canal treatments. In all cases, the accidents occurred during the irrigation phase and were characterised by intracanal bleeding, ecchymosis, and swelling on the hemiface corresponding to the treated tooth. Antibiotics, paracetamol, NSAID, corticosteroids, and cold or warm compresses for oedema were prescribed to treat the symptoms of the accidents. Significant improvement of symptoms was observed in all patients after 5–6 days. Anatomic risk factors such as apical fenestration, root perforation, and large foramina were identified as possible risk factors for the accidents. After the accidents, clinicians applied endodontic procedures for which there is no scientific evidence to continue endodontic treatments, such as changing the type of irrigant or the irrigation method. Our results suggest that using a standardised approach to document each hypochlorite accident will allow researchers to collect more accurate and detailed data that can subsequently be used to identify potential risk factors and better manage the symptomatology of hypochlorite accidents.

Apoptotic cell death eliminates unhealthy cells and maintains homeostatic cell numbers within tissues. Epithelia, which serve as fundamental tissue barriers for the body, depend on a physical expulsion of dying cells (apoptotic cell extrusion) to remain sealed and intact. Apoptotic cell extrusion has been widely studied over recent years, with researchers using various approaches to induce apoptotic cell death. Unfortunately, the majority of chemical-based approaches for cell death induction rely on sporadically occurring apoptosis and extrusion, making imagining lengthy, often unsuccessful, and difficult to capture in high-quality images because of the frequent frame sampling needed to visualise the key molecular processes that drive extrusion. Here, we present a protocol that describes steps needed for laser-mediated induction of apoptosis in a cell of choice, followed by imaging of apoptotic extrusion in confluent monolayers of epithelial cells. Moreover, we provide the description of a new approach involving the mixing of labelled and unlabelled cells. In particular, this protocol characterises how cells surrounding apoptotic cells behave, with high spatial and temporal resolution. This can be achieved without the optical interference that apoptotic cells cause as they are physically expelled from the monolayer and move out of focus for imaging. Finally, the protocol is accompanied by detailed procedures describing cell preparation for apoptotic extrusion experiments, as well as post-acquisition analysis required to evaluate rates of successful extrusion.

Aim: To evaluate the apical extrusion of debris in flat-oval canals, using three reciprocating systems at two different working lengths (WL), 0 mm and 1 mm from the apical foramen. Methods: Ninety mandibular incisors were randomly divided into three groups based on the systems: WaveOne Gold #25.07 (WOG), ProDesign R #25.06 (PDR), and X1 Blue #25.06 (X1B). Extruded debris were collected and dried in pre-weighed Eppendorf tubes. Three consecutive weighings were performed for each tube, and the mean was calculated. If the assumptions of normality and homogeneity of variance were not met, the Kruskal-Wallis test was used to analyze the amount of extruded debris between groups with the same WL, and the Mann-Whitney U test was used for comparison within groups for each WL. Results: All groups had extruded debris, with higher median values occurring at 1 mm. No significant difference regarding the amount of debris extrusion was observed at 0 mm (p>0.05) and 1 mm (p>0.05) between groups. However, within the groups, at different WL, there was greater extrusion at 1 mm (p

Objective: The aim of this study is to evaluate the influence of different instrument systems on the amount of extruded debris. Materials and methods: A total of 30 extracted mandibular molars with two separate canals and apical foramina in the mesial roots were selected. The root canals (n=10) were randomly assigned to the six groups of file systems as follows: ProTaper Next (PTN), WaveOne (WO), WaveOne Gold (WOG), One Shape (OS), Reciproc (R) and Reciproc Blue (RB). The extruded debris during the instrumentation was collected into Eppendorf tubes, which were weighed and then stored in an incubator at 70°C over a period of five days to evaporate the irrigant. After the incubation process, the Eppendorf tubes were weighed again. The difference between these two measurements, the first one before and the second one after the incubation process, was calculated. Data were statistically analyzed, and the significance level was set at p

Chemomechanical root canal preparation (CMRCP) is an important step in root canal treatment. However, one of its negative consequences is apical extrusion of debris of the root canal system contributing to treatment failure and flare-ups. Glide path preparation (GPP) is the initial phase of CMRCP and is crucial for assessing root canal anatomy and establishing unobstructed access to the apical part of the canal. Materials and methods: Forty human mandibular permanent central and lateral incisors were selected; the debris collection apparatus was prepared and the teeth were then divided into four groups: Group 1: Rotary glide path preparation with ProGlider followed by instrumentation with Wave One files. Group 2: Rotary glide path preparation with ProGlider followed by instrumentation with One Shape files. Group 3: Hand glide path preparation with K-file followed by instrumentation with Wave One files. Group 4: Hand glide path preparation with K-file followed by instrumentation with One Shape files. The collected debris was weighed in an analytical digital balance and the collected data were statistically analyzed. Results: No significant difference was present between groups with the same method of glide path preparation or between Wave One and One Shape files. Rotary glide path preparation produced less debris than hand preparation (p≤0.05). Conclusions: Extrusion of debris was observed in all test groups. Rotary glide path preparation could be preferred in clinical practice as it is associated with less debris extrusion than the manual method.

Aim: The aim of this study was to check the difference in the apical extrusion of 2.5% NaOCl and 17% EDTA irrigants using conventional technique (manual irrigation) and Endo Activator system irrigation. Materials and Methods: 40 human mandibular premolars which were freshly extracted having straight single canals and mature apices verified with radiograph were selected for this study. They were divided into two main groups (A and B) depending upon the irrigant used which was further divided into subgroup (I and II) depending upon irrigation technique manual or EndoActivator respectively. The canals of each tooth were prepared using Endomotor (X-SMART DUAL) and rotary Protaper (Dentsply Mallifer) upto size F3. Eppendorf tubes were used to mount each tooth specimen and this acted as a container for collecting irrigant. The specimens were weighed before and after irrigation and the difference was calculated. Results: Results were calculated using Mann Whitney U-test keeping level of significance set at P Conclusion: On manual irrigation more apical extrusion of 2.5% NaOCl as compared to 17% EDTA was seen. Agitation with EndoActivator caused more apical extrusion of both 2.5% NaOCl and EDTA compared to needle and syringe irrigation Keywords: Irrigants, Apical extrusion, NaOCl, EDTA, EndoActivator, Eppendorf, Agitation.

Introduction: A major objective in root canal treatment is to clean the root canal system. During the process, dentine chips, pulp tissue fragments, necrotic tissue, microorganisms, and intracanal irrigants may be extruded through the apical foramen. This in vitro study was conducted to evaluate the apical extrusion of Enterococcus faecalis with One Shape, F360, WaveOne, and Reciproc endodontic single-file systems. Materials and Methods: Seventy-five human single-rooted mandibular premolar teeth were selected. Endodontic access cavities were prepared. Pulp chamber was accessed, and a pure culture of E. faecalis was used to infect the root canals. Vials with rubber stoppers were selected as the test apparatus. Then, the samples were broadly divided into four main groups with a sample size of 15 teeth. Fifteen previously infected teeth were used as controls. All the root canals were instrumented with the size 25 instruments. A total volume of 2 ml of saline was used for each root canal as irrigant. After 24 h, colonies of bacteria were counted using classical bacterial counting technique as colony-forming units. Statistical Analysis: Data were analyzed statistically using Statistical Package for the Social Sciences, version – 21 (IBM Corp., NY) Software for Windows. Data were expressed in its mean and standard deviation. Results: The results indicated that all the four single-file systems tested caused a measurable apical extrusion of debris. Statistically, significant difference was observed between One Shape, F360, WaveOne, and Reciproc in terms of E. faecalis extrusion, P < 0.05. The highest mean value was with One Shape rotary single-file system and the lowest mean value was with WaveOne reciprocating single-file systems. Conclusion: Within the limitations of the present study, it can be concluded that the reciprocating single-file systems extruded less amount of E. faecalis than compared to rotary single-file systems.

Aim To evaluate the effect of instrumentation kinematics on debris extrusion by comparing the amount of apically extruded debris after canal preparation using ProTaper next in continuous rotation as well as forward reciprocating motion and WaveOne gold in reverse reciprocating motion. Materials and methods We randomly divided ninety buccal roots of maxillary bicuspids with fully formed apices into three groups. After achieving the coronal access, the patency of the root canals was established with a size 10 K file. The canals were then instrumented using ProTaper next in continuous rotation or in a forward reciprocating motion and WaveOne gold in reverse reciprocating motion. Eppendorf tubes were used to collect the debris extruded through the apical foramen. The tubes were placed in a -80° freezer for 8 hours and then in a lyophilizer for 24 hours. The quantity of the apically extruded debris was assessed by subtracting the weights of Eppendorf tubes before and after instrumentation. The analysis was done using a one-way ANOVA test and the Bonferroni test to compare the groups. Results The mean weight of extruded debris with WaveOne gold in reverse reciprocation was significantly lower than ProTaper next in forward reciprocation and ProTaper next in continuous rotation (p value = Conclusion WaveOne gold in reverse reciprocation was associated with a significantly lower amount of apical extrusion of debris than ProTaper next rotary files in forward reciprocation and continuous rotation. Clinical significance According to the results of this study, reciprocating instrumentation technique was associated with a less amount of debris extrusion compared to continuous rotation.

Background: The success of endodontic treatment depends on the chemomechanical preparation of the tooth. However, the debris produced during canal preparation may extrude through the apical foramen causing postoperative complications. Aim: The aim of this study is to compare the apical debris extrusion during root canal preparation in primary anterior teeth using hand files, rotary ProTaper files, and rotary Kedo-S files. Materials and Methods: Forty-five freshly extracted primary canine with mature apices and a single canal were randomly divided into three groups for instrumentation as follows (n = 15): Group 1: hand files; Group 2: rotary ProTaper files; and Group 3: rotary Kedo-S files. Myers and Montgomery experimental model was used for this study. Apically extruded debris collected in a preweighed Eppendorf tubes was placed in the incubator at 70°C for 5 days. The weight of the debris collected was determined by subtracting the pre- and post-instrumentation weight of the Eppendorf tubes. The data collected were analyzed using the analysis of variance and Tukey's post-hoc tests. Results: Hand files produced more apical debris extrusion than ProTaper and Kedo-S files (P < 0.05) while Kedo-S produced the least (P < 0.05). Conclusion: All instrumentation systems cause apical debris extrusion. Kedo-S produced less apical debris extrusion when compared to the hand files and ProTaper files.

Amaç: Bu çalışmanın amacı irrigant aktivasyonusırasında kullanılan sonik uçların boyutunun ve titreşim sıklığının irriganttaşmasına etkisini incelemektir.Gereç ve Yöntem: Bu çalışmada 20 adet yapay üst molar dişmodeli kullanıldı. Bu diş modellerinin palatinal kanalları apikal çap #40olacak şekilde genişletildi. Periapikal lezyonu taklit etmek için her bir dişmodeli salin solusyonu ile dolu cam şişelere yerleştirildi ve 10-5 g hassasiyetindeki hassas tartı ileilk ağırlıkları ölçüldü. Sonrasında sonik ucun boyutu (15/.02, 25/.04,35/.04) ve uygulama modu/hızı (düşük, orta, yüksek hız) esas alınarak irrigasyon protokolleri uygulandı. Kontrol grubunda irrigasyonherhangi bir sonik uç kullanmadan iğneucunun giriş kavitesinin girişinde tutulması ile gerçekleştirildi. Apikaldentaşan irrigant miktarı, test düzeneğinin başlangıç ağırlığının final ağırlıktançıkarılmasıyla hesaplandı. Veriler Kruskal-Wallis ve Siegel Castellan testlerianaliz edildi.Bulgular: Kontrol grubuna kıyasla, 15/.02uçlar sadece yüksek hızda daha fazla irrigant taşmasına yol açarken, 35/.04uçlar düşük hızda neden oldu (p< 0.05). 25/.04 uçlar tüm hızlarda kontrolgrubuna göre daha fazla irrigant taşması ile sonuçlandı (p < 0.05). Yüksekhızda 15/.02 ve 25/.04uçlar, 35/.04 uç kullanımına göre daha fazlairrigant taşmasına neden oldu (p < 0.05).Sonuçlar: Sonik aktivasyon sırasında kullanılan sonikucun hem çapı hem de titreşim sıklığı irrigant taşma miktarını anlamlı ölçüdeetkilemektedir., Objective: The purpose of this study was toevaluate the effects of size and oscillation frequency of sonic tips onirrigant extrusion during activation. Materials and Methods: Twenty artificial maxillary molar toothmodels were used in this study. The palatinal canal of each model wasprepared up to final apical size of #40. Each specimen was mountedon a glass vial filled with saline solution to simulate a periapical lesion.The mean initial weights were measured using ananalytical balance with 10-5 g accuracy. Then, a series ofirrigations were conducted according to the size (15/.02, 25/.04, 35/.04) andoperating mode/speed (low, medium, high) of the sonic tips. In control group, the irrigant was delivered byplacing the needle tip at the access cavosurface, without the insertion andactivation of the sonictip. The mean weights of apically extruded irrigant were calculated bysubtracting the mean initial weights from the final weights of test apparatus.Data were statistically analyzed by the Kruskal-Wallis and Siegel Castellantests.Results: The use of15/.02 tips resulted in higher irrigant extrusion than the control onlyat high speed while the 35/.04 tips only atlow speed (p < 0.05). The 25/.04 tipspresented higher extrusion than the control with all operating modes (p