Search

Introduction: The study aimed to determine the apical debris extrusion and microbial elimination from infected root canals after using different irrigant activation methods., Materials and Methods: Forty freshly extracted human mandibular premolars were selected and randomly assigned to four groups ( n = 10). The teeth were mechanically prepared, sterilized, and inoculated with Enterococcus faecalis for 1 week. Irrigation was done with 3% sodium hypochlorite following conventional syringe irrigation-Group 1, manual dynamic agitation (MDA)-Group 2, passive ultrasonic irrigation (PUI)-UltraX -Group 3, and sonic irrigation (SI)-EndoActivator -Group 4, and the extruded debris were collected using Myers and Montgomery model. The microbial samples were taken from the canals using sterile paper points, cultured and recorded as colonies. The amount of extruded debris was measured by subtracting the final weight of the Eppendorf tube with debris from the initial weight of the tube., Results: I. Group 3 showed the least apical debris extrusion ( P < 0.05), followed by Groups 2 and 1 and the highest with Group 4. II. Group 3 showed the least colony-forming units (CFUs)/ml, followed by Group 4, and finally, Group 2 showed lesser mean CFUs/ml compared to Group 1 ( P < 0.05)., Conclusion: All the irrigation activation methods were associated with apical debris extrusion, with the PUI system extruding the least amount of debris compared to the other groups. Irrigation activation techniques were beneficial in reducing the microbial load from the infected canals with the PUI system showing a complete elimination of the microbes, followed by SI and MDA., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Conservative Dentistry.)

Introduction and Aim: Postoperative inflammation and endodontic failure occur due to apical extrusion of debris. The purpose of this in vitro study was to assess the amount of apically extruded debris during the root canal preparation using rotary and reciprocating nickel-titanium instrumentation systems., Materials and Methods: The mesiobuccal canals of seventy five mature, human mandibular molars were randomly divided into three groups ( n = 25 teeth/group). Each group was instrumented using one of the three different instrumentation systems: Hyflex EDM (HEDM) rotary file, Flexicon X7 rotary, and Flexicon X1 reciprocating files. The canals were irrigated using distilled water. The debris extruded apically was collected in preweighed Eppendorf tubes and assessed with an electronic balance and compared., Statistical Analysis: Data were statistically analyzed by one-way analysis of variance and the intergroup comparison with single factor ANOVA., Results: The Flexicon X1 reciprocating system showed the maximum amount of apical extrusion of debris among all the groups. The least amount of debris was observed in Flexicon X7 rotary instrument ( P > 0.05)., Conclusion: Flexicon X7 rotary extruded significantly lesser amount of debris than Flexicon X1 reciprocating and HEDM rotary file systems., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Conservative Dentistry.)

Aim: The objective of this in vitro study was to assess the effect of different endodontic instrumentation systems on the amount of apically extruded bacteria., Materials and Methods: One hundred and twenty freshly extracted human mandibular premolars with single canal were collected. Endodontic access cavities were prepared and then contaminated with an Enterococcus faecalis suspension (ATCC 29212). After incubation at 37°C for 24 h, the root canals were instrumented with K flare files, F360 Single file system, K3XF files, Heroshaper files, Protaper Next files, and Hyflex EDM Single file system. During instrumentation, apically extruded bacteria were collected in the vials containing 0.9% NaCl. Samples were taken from the vials and incubated in brain-heart infusion agar medium for 24 h., Statistical Analysis: The number of colony-forming units was determined, and data were statistically analyzed using one-way analysis of variance and post hoc Tukey test., Conclusions: Both rotary and hand instrumentation systems extruded intracanal bacteria through the apical foramen, Group 1 (Hand K Flare files) showed maximum, whereas, Group 5 (Protaper Next) and Group 6 (Hyflex EDM) showed the least extrusion., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Conservative Dentistry.)

Background: Thorough cleaning of the pulp space is a challenging task. The mechanical instrumentation alone is usually not sufficient to completely debride the canals, and therefore, it requires the chemical action of irrigants also to disinfect the difficult to reach areas., Aim: The purpose of this study was to determine apical extrusion and assess irrigant penetration through cone-beam computed tomography (CBCT) for EndoActivator (EA) and XP Endo Finisher (XP)., Materials and Methods: Sixty single-rooted mandibular premolars with oval-shaped canals were equally divided into three groups after instrumentation, based on the final irrigation: Group-1 syringe needle (30G Max-I-probe), Group-2 EA, and Group-3 XP. After the final irrigation, the weight of the extruded sodium hypochlorite was calculated. The prepared canals were then irrigated with a radiopaque contrast medium, which was activated according to the group of the sample (Group-1, 2, or 3). The volume of irrigant filled in the canal, especially in the apical third was determined through special tools in CBCT imaging., Statistics: One-way ANOVA test was used to compare the different groups., Results and Conclusion: Significantly more apical extrusion was seen in XP ( P < 0.001). Both XP and EA have shown complete penetration of irrigant in the canal (100%)., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Conservative Dentistry.)

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., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Conservative Dentistry.)

Aim: The aim of this study is to compare the effects of conventional syringe, passive ultrasonic irrigation (PUI), and EndoIrrigator Plus on the amount of apically extruded debris., Materials and Methods: Thirty extracted human mandibular premolars were selected and randomly assigned to three groups ( n = 10). The root canals were irrigated with conventional syringe, PUI, and EndoIrrigator Plus. Sodium hypochlorite was used as an irrigant, and debris was collected in a previously described experimental model (Myers and Montgomery 1991). It was then stored in an incubator at 37°C for 10 days to evaporate the irrigant before weighing the dry debris. The mean weight of debris was assessed, one-way analysis of variance was used for comparison of values, and post hoc Tukey's test was used between groups ( P = 0.05)., Results: The EndoIrrigator Plus group extruded significantly less debris than PUI and conventional syringe groups ( P < 0.05). Furthermore, PUI group extruded significantly less debris than conventional syringe irrigation group ( P < 0.05)., Conclusions: 1. All the three irrigation systems were associated with apical extrusion of debris, 2. EndoIrrigator Plus system extruded significantly less debris than the PUI system and the conventional syringe irrigation system, 3. PUI system extruded significantly less debris than the conventional syringe irrigation system., Competing Interests: There are no conflicts of interest.

Background: Endodontic instrumentation is liable to cause some postinstrumentation pain (PIP). Rotary endodontic instruments differ in their design, metallurgy, surface treatment, etc., Aim: This randomized clinical trial aimed to assess the incidence of PIP after root canal instrumentation with three different rotary endodontic systems which differ in their design, namely, ProTaper, Mtwo, and K3., Materials and Methods: A total of 150 patients between the ages of 25 and 50 were chosen for the study. Teeth with asymptomatic irreversible pulpitis due to carious exposure were selected. The patients received local anesthesia by inferior alveolar nerve block. After preparing the access cavity, root canal instrumentation was done with one of the three instruments ( n = 50) and closed dressing was given. PIP was assessed every 12 h for 5 days, and tenderness to percussion was analyzed at the end of 1, 3, and 7 days., Statistical Analysis: Mann-Whitney U-test to determine significant differences at P < 0.01., Results: The PIP and tenderness were less in Mtwo group when compared to ProTaper and K3 groups up to 84 h and 72 h respectively and statistically significant ( P < 0.05). There was no statistically significant difference between ProTaper and K3 both in PIP and tenderness., Conclusion: Rotary endodontic instrumentation causes some degree of PIP and tenderness to percussion. Among the instruments used, Mtwo causes less PIP and tenderness when compared to ProTaper and K3, and there was no difference between ProTaper and K3., Clinical Relevance: PIP is highly subjective and may vary among different subjects. The apical (3 mm) taper of ProTaper was 0.08 followed by a smaller taper, whereas, the other two files were of a constant 0.06 taper, which means there could have been a greater apical extrusion and therefore more PIP. Despite, the mean of the age was similar, there could have been a difference in the size of the canal and therefore a difference in apical extrusion and PIP., Competing Interests: There are no conflicts of interest.

Aim: This study was intended to evaluate the amount of apically extruded debris following root canal preparation with three different instrumentation systems., Materials and Methods: Sixty mandibular incisor teeth were selected and randomly divided into three groups ( n = 20/group) according to the instrumentation system used: the ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), the Twisted File Adaptive (TFA; SybronEndo, Orange, CA, USA), and the WaveOne Gold (WOG; Dentsply Maillefer, Ballaigues, Switzerland). All apically extruded debris was collected and dried in preweighed glass vials. The mean weight of the apically extruded debris was obtained using a microbalance. The time for root canal preparation was also recorded. The data were analyzed using a one-way analysis of variance., Results: The mean weights of apically extruded debris were 0.00035 ± 0.00014 g (PTN); 0.00023 ± 0.0001 g (TFA); and 0.00019 ± 0.0001 g (WOG) ( P < 0.01). The mean preparation time value was 301,13 ± 62.14 s (PTN); 234.27 ± 34.88 s (TFA); and 239.8 ± 58.6 s (WOG) ( P < 0.05)., Conclusions: The PTN system extruded more debris than the TFA and WOG systems. The TFA and WOG systems were faster than the PTN system., Competing Interests: There are no conflicts of interest.

Aim: The aim of this study was to test the effect of new protocol of glide path preparation by 20/0.04 rotary file on apical extrusion of debris when instrumenting fine curved mesial canals in mandibular molars with Self-adjusting File (SAF) and compare it to a glide path prepared by 20/0.02 hand K-file and rotary OneShape (OS) and reciprocating WaveOne (WO) file instrumentation., Materials and Methods: Sixty mandibular molars with curved mesial roots were selected and randomly divided into three groups ( n = 20) for instrumentation. In two groups, glide path was prepared using 20/0.02 K-file for instrumentation by OS (size 25/0.06 taper) and WO (size 25/0.08 taper) files; in the remaining group, 20/0.04 rotary file was used for glide path preparation and instrumented by SAF (1.5 mm). The debris extruded during instrumentation was collected in preweighed Eppendorf tubes and stored in an incubator at 70°C for 5 days. Tubes containing the dry extruded debris were then weighed. One-way analysis of variance (ANOVA) was applied to the weights obtained, followed by Tukey's post hoc test for multiple comparison., Results: The mean debris (g) extruded apically was 0.000651 ± 0.000291, 0.000823 ± 0.000319, and 0.000473 ± 0.000238 for Group 1 (20/0.02 + OS), Group 2 (20/0.02 + WO), and Group 3 (20/0.04 + SAF), respectively. The groups exhibited a significant difference ( P < 0.01; ANOVA). Group 3 resulted in least debris extrusion compared to Groups 1 and 2 ( P < 0.01; Tukey's post hoc test)., Conclusion: Glide path prepared to size 20/0.04 and SAF 1.5 mm instrumentation produce less debris in curved mesial canals of mandibular molars, compared to glide path established by 20/0.02 and instrumentation by OS and WO files., Competing Interests: There are no conflicts of interest.

Background: Apical extrusion of debris during instrumentation is detrimental to the patient., Aim: The aim of this study was to evaluate the apical extrusion of debris during root canal instrumentation using two single file rotary Ni-Ti systems., Materials and Methods: Thirty freshly extracted mandibular premolars with straight roots were sterilized and divided into two groups instrumented using: One Shape rotary Ni-Ti system with Endoflare orifice shaper (Group 1) and Neo-Niti rotary Ni-Ti system with C1 orifice shaper (Group 2). Preweighed Eppendorf tubes fitted for each tooth before instrumentation. During instrumentation, 1 mL of distilled water with a 30-gauge needle was used to irrigate after every instrument. Tips of the tooth were irrigated with 2 ml distilled water after removal from Eppendorf tubes. The total volume of irrigant in each group was the same 8 ml. All tubes were incubated at 68°C for 15 days and subsequently weighed. The difference between pre- and post-debris weights was calculated, and statistical analysis was performed using independent t -test and level of significance was set at 0.05., Results: The difference between pre- and post-weights was significantly greater for the One Shape system., Conclusions: The Neolix Niti single file was associated with less extrusion compared to One Shape single file system., Competing Interests: There are no conflicts of interest.

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., Competing Interests: There are no conflicts of interest.

Background: The type of instrument affects the amount of debris extruded. The aim of this study was to compare the effect of retreatment systems and supplementary file application on the amount of apical debris extrusion., Materials and Methods: Forty-eight extracted mandibular premolars with a single canal and similar length were selected. The root canals were prepared with the ProTaper Universal system with a torque-controlled engine. The root canals were dried and were obturated using Gutta-percha and sealer. The specimens were randomly divided into four equal groups according to the retreatment procedures (Group 1, Mtwo retreatment files; Group 2, Mtwo retreatment files + Mtwo rotary file #30 supplementary file; Group 3, ProTaper Universal retreatment (PTUR) files; and Group 4, PTUR files + ProTaper F3 supplementary file). The extruded debris during instrumentation were collected into preweighed Eppendorf tubes. The amount of apically extruded debris was calculated by subtracting the initial weight of the tube from the final weight. Three consecutive weights were obtained for each tube., Results: No statistically significant difference was found in the amount of apically extruded debris between Groups 1 and 3 (P = 0.590). A significant difference was observed between Groups 1 and 2 (P < 0.05), and between Groups 3 and 4 (P < 0.05)., Conclusions: The use of supplementary file significantly increased the amount of apically extruded debris.

Background: Postoperative inflammation and endodontic failure occur due to apical extrusion of debris., Aim: To evaluate the amount of apically extruded debris after preparation of straight root canals in extracted human teeth using three rotary systems., Materials and Methods: Sixty single-rooted human teeth with single root canal and apical foramen were selected and randomly divided into three experimental groups (n = 20) according to the rotary system used: Group 1 - ProTaper, Group 2 - Revo-S, Group 3 - WaveOne. Apical enlargement was done up to size 40/0.06 for Groups 1 and 2 and 40/0.08 for Group 3. For debris collection, each tooth was held in a preweighed Eppendorf tube fixed inside a glass vial through rubber plug. After instrumentation, each tooth was separated from the Eppendorf tube and the debris adhering to the root surface was collected by washing the root with 1 mL of bi-distilled water and incubated at 70°C for 5 days. The dry weight of extruded debris was weighed in an electronic balance., Statistical Analysis: The mean weights of extruded debris were statistically analyzed using GraphPad prism version 6 and the intergroup comparison was done using unpaired t-test., Results: There was a statistically significant difference in the mean debris score among all the three groups - ProTaper (0.00065 g), Revo-S (0.00045 g) and WaveOne (0.00089 g)., Conclusion: Revo-S system was associated with significantly less debris extrusion compared with ProTaper or WaveOne.

Background/aim: To compare apically extruded debris using ProTaper Universal (PTU), ProTaper Next (PTN), WaveOne (WO), Twisted File (TF), M-Two (MT), and Revo-S (RS) after determining the working length (WL) with root ZX., Materials and Methods: Seventy-two teeth were selected. The WL determination was performed with root ZX. The teeth were divided into six experimental groups, randomly. In groups, root canals were prepared with PTU to size F4/0.06, with PTN to size X4/0.06, with WO to size 40/0.08, with TF to size 40/0.04, with MT to size 40/0.06, and with RS to size AS40/0.06. After preparations were completed, final irrigation was performed with 2 mL distilled water, and a total of 10 mL of distilled water was used in each tooth. Tubes were stored in an incubator at 68°C for 5 days to evaporate the distilled water before weighing the dry debris. Data were analyzed by the Mann-Whitney U-test., Results: The RS group led to the highest amount of extruded debris, however, WO led to the least amount of extruded debris. There was no statistically difference among the groups (P > 0.05)., Conclusions: The authors conclude that the results obtained might depend on the apex locator used to determine the WL.

Aims: The purpose of this ex vivo study was to evaluate and compare the weight of debris and volume of irrigant extruded apically from teeth using different preparation techniques., Subjects and Methods: Thirty extracted human mandibular premolars with single canals and similar lengths were instrumented using hand ProTaper F2 (25, 0.08; Dentsply Maillefer, Ballaigues, Switzerland), M-two (25, 0.06; VDW, Munich, Germany) and WaveOne Primary (25, 0.08; Dentsply Maillefer, Ballaigues, Switzerland). Debris and irrigant extruded during instrumentation were collected into preweighed Eppendorf tubes. The volume of the irrigant was measured, and then the tubes were stored in an incubator at 70°C for 2 days. The Eppendorf tubes were weighed to obtain the final weight when the extruded debris was included. Three consecutive weights were obtained for each tube., Statistical Analysis Used: Data were statistically analyzed by one-way analysis of variance and Student's t-test., Results: There were no statistically significant differences among the groups. The WaveOne reciprocating system showed the maximum amount of apical extrusion of debris and irrigant among all the groups. The least amount of debris and irrigant was observed in ProTaper hand instrument (P > 0.05)., Conclusion: All instrumentation techniques were associated with debris and irrigant extrusion.

Aim: The present ex vivo study aimed to evaluate the debris extrusion after instrumenting the root canals by three different files systems., Materials and Methods: Sixty extracted human mandibular premolars with single canals were selected and randomly divided into three groups (n = 20) for instrumentation with three different files. Group 1: WaveOne (primary) single reciprocating file (WO; Dentsply Maillefer, Ballaigues, Switzerland) (25/08), Group 2: Self-adjusting file (SAF; ReDent-Nova, Ra'anana, Israel) (1.5 mm), and Group 3: ProTaper NEXT X1 and X2 (PTN; Dentsply Tulsa Dental, Tulsa, OK) (25/06). Debris extruding by instrumentation were collected into pre-weighed Eppendorf tubes. These tubes were then stored in an incubator at 70°C for 5 days. The tubes were then weighed to obtain the final weight, with the extruded debris. Statistical analysis for the debris extruded apically was performed using one-way analysis of variance and post hoc Tukey's test., Results: The statistical analysis showed a significant difference between all the three groups tested (P < 0.01). The following post hoc Tukey's test confirmed that Group 2 (SAF) exhibited significantly least (P < 0.01) debris extrusion between the three groups tested., Conclusions: The SAF resulted in significantly less extrusion of debris when compared to reciprocating WO and rotary PTN.

Background and Aims: Extrusion of any debris during endodontic treatment may potentially cause post-operative complications such as flare-ups. The purpose of this in vitro study was to assess the amount of apically extruded debris during the root canal preparation using rotary and reciprocating nickel-titanium instrumentation systems., Materials and Methods: In this study, 60 human mandibular first premolars were randomly assigned to 3 groups (n = 20 teeth/group). The root canals were instrumented according to the manufacturers' instructions using the Reciprocating single-file system WaveOne™ (Dentsply Maillefer, Ballaigues, Switzerland) and full-sequence rotary Hyflex CM™ (Coltene Whaledent, Allstetten, Switzerland) and ProTaper™ (Dentsply Maillefer, Ballaigues, Switzerland) instruments. The canals were then irrigated using bidistilled water. The debris that was extruded apically was collected in preweighed eppendorf tubes and assessed with an electronic balance and compared., Statistical Analysis Used: The debris extrusion was compared and statistically analyzed using analysis of variance and the post hoc Student-Newman-Keuls test., Results: The WaveOne™ and ProTaper™ rotary instruments produced significantly more debris compared with Hyflex CM™ rotary instruments (P < 0.05)., Conclusions: Under the conditions of this study, all systems that were used resulted in extrusion of apical debris. Full-sequence rotary instrumentation was associated with less debris extrusion compared with the use of reciprocating single-file systems.

Aim: This aim of this study was to evaluate the number of bacteria extruded apically during root canal preparation using Four Rotary instrumentation techniques., Materials and Methods: A total of 50 extracted mandibular premolars were selected, access cavities prepared and inserted in to rubber stoppers of 10 mL glass vial. Root canals were contaminated with a suspension of Enterococcus faecalis (E. faecalis) American Type Culture Collection (ATCC) 29212 and incubated for 24 h at 37°C. Debris extruded from the apical foramen during instrumentation was collected into vials. The numbers of Colony-forming units were determined for each sample., Statistical Analysis: The data obtained were analyzed using the one-way ANOVA followed by post-hoc tukey's test with a P = 0.05 as the level for statistical significance., Results: Results suggested a statistically significant difference in the number of colony forming units between four experimental rotary Nickel-Titanium instrumentation groups (P < 0.001)., Conclusion: Although, extrusion of bacteria was found in all the experimental groups. There was less bacterial extrusion in K3 Group while more bacterial extrusion was seen in Mtwo Group.

Aim: To evaluate the bacteria extruded apically during root canal preparation using two hand and rotary instrumentation techniques., Materials and Methods: Eighty freshly extracted mandibular premolars were mounted in bacteria collection apparatus. Root canals were contaminated with the pure culture of Enterococcus fecalis (ATCC 29212) and dried at 37°C for 24 h. Bacteria extruded were collected, incubated in brain heart infusion agar for 24 h at 36°C and the colony forming units (CFU) were counted., Statistical Analysis: The mean number of colony forming units were calculated by One-way ANOVA and comparison between the groups made by multiple comparison (Dunnet D) test., Results: The step-back technique extruded highest number of bacteria in comparison to other hand and rotary Ni-Ti systems., Conclusion: Under the limitation of this study all hand and rotary instrumentation techniques extruded bacteria. Among all the instrumentation techniques step-back technique extruded more number of bacteria and K-3 system the least. Further in vivo research in this direction could provide more insight into the biologic factors associated and focus on bacterial species that essentially play a major role in post instrumentation flare-ups.

Aim: To evaluate and compare the amount of debris and irrigant extruded quantitatively by using two hand and rotary nickel-titanium (Ni-Ti) instrumentation techniques., Materials and Methods: Eighty freshly extracted mandibular premolars having similar canal length and curvature were selected and mounted in a debris collection apparatus. After each instrument change, 1 ml of distilled water was used as an irrigant and the amount of irrigant extruded was measured using the Meyers and Montgomery method. After drying, the debris was weighed using an electronic microbalance to determine its weight., Statistical Analysis Used: The data was analyzed statistically to determine the mean difference between the groups. The mean weight of the dry debris and irrigant within the group and between the groups was calculated by the one-way ANOVA and multiple comparison (Dunnet D) test., Results: The step-back technique extruded a greater quantity of debris and irrigant in comparison to other hand and rotary Ni-Ti systems., Conclusions: All instrumentation techniques extrude debris and irrigant, it is prudent on the part of the clinician to select the instrumentation technique that extrudes the least amount of debris and irrigant, to prevent a flare-up phenomena.