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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.

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.

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

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.

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: 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 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.

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.

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.

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.

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.

(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.

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.

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.

The present study examined the effects of irrigant flow rate and simulated intraosseous sinusoidal pressure on the rate of NaOCl extrusion from the apical terminus of a faux root canal.An extrusion setup was designed to enable irrigant extrusion to be opposed by 30 mm Hg simulated intraosseous pressure. The faux canal apex was opposed by atmospheric + 30 mm Hg pressure (experimental) or atmospheric pressure only (control group). Using five irrigant delivery rates (15.6 8.0, 4.0, 3.4 or 3.0 mL/min), the extrusion rates of 2% NaOCl from the faux apex were measured in both groups (n = 16). Data were analysed with two-factor ANOVA and pairwise comparisons at α = 0.05. Correlation between NaOCl delivery rates and extrusion rates in both groups were analysed with the Pearson product-moment procedure.Irrespective of the presence or absence of simulated sinusoidal pressure, NaOCl extrusion rates were positively-correlated with irrigant flow rates. For the factor "irrigant flow rates", significant differences in NaOCl extrusion rates were identified among all flow rates (p 0.05), except for the pairwise comparison between 4.0 and 3.4 mL/min in the control. For all irrigant flow rates, NaOCl extrusion rate was significantly lower in the presence of 30 mm Hg simulated sinusoidal pressure than that obtained in the absence of opposing pressure (p 0.05).In the presence of 30 mm Hg simulated intraosseous pressure, NaOCl delivered via a side-vented needle inserted to 1 mm short of working length may be prevented from extrusion when its flow rate is ≤ 3.0 mL/min.When opposed by intraosseous sinusoidal pressure, NaOCl delivered via a side-vented needle inserted to 1 mm short of working length may be prevented from extrusion when its flow rate is ≤ 3.0 mL/min.

Introduction This study compared the intensity of postobturation pain after unintentional apical extrusion of calcium silicate–based root canal sealers (EndoSequence BC Sealer [Brasseler USA, Savannah, GA] and Bio-C Sealer [Angelus, Londrina, PR, Brazil]) with a resin-based sealer (AH Plus; Dentsply Sirona, York, PA). Methods A total of 330 patients referred for root canal treatment on molar teeth with asymptomatic irreversible pulpitis were recruited. Root canals were prepared using WaveOne Gold instruments (Dentsply Sirona) in a crown-down technique and irrigated with 2% chlorhexidine gel and saline solution. Next, patients were randomly distributed into 3 groups according to the root canal sealer used (n = 110): AH Plus, BC Sealer, and Bio-C Sealer. Root canal filling was then accomplished with a vertical compaction technique. Patients presenting with an unintentional extrusion of sealers (n = 13/group) were assessed for postobturation pain experience using a visual descriptor scale ranging from 0–10 at 6-, 12-, 24-, and 48-hour and 1-week intervals after treatment. Mixed analysis of variance repeated measures were used to assess the results (α = 0.05). Results The extrusion rate was similar for all sealers (~12%). There was no significant difference in the postobturation pain results between the root canal sealers evaluated (P > .05). However, after the time interval of 12 hours, AH Plus (P = .04073) and Bio-C Sealer (P = .04327) demonstrated a significant reduction in pain, whereas BC Sealer did not show differences in pain intensity, even in the maximum period evaluated of 1 week (P > .05). Conclusions The occurrence of unintentional apical extrusion of calcium silicate–based root canal sealers presents similar postoperative pain results compared with resin-based sealers with low-intensity pain.

OBJECTIVE To compare the amount of apically extruded bacteria between hand-filed preparations, rotary and reciprocation glide path preparations in curved canals of extracted teeth infected with Enterococcus faecalis. METHODS Forty mandibular first molar teeth were decoronated, fitted into rubber stoppers and fixed onto glass vials. The mesiobuccal canals from mandibular first molar teeth were infected with Enterococcus faecalis, then randomly assigned to one of five groups for glide path preparation: manual stainless-steel file (K-files), rotary file (One G), reciprocating file (WaveOne Gold Glider) and two control groups. After glide path preparation, 0.01 mL of saline was taken from the experimental vials. The solution was plated on tryptic soy agar and colonies of bacteria were counted as colony-forming units. The results were analysed statistically using Kruskal-Wallis and post hoc Mann-Whitney U tests. RESULTS The manual K-file group was associated with significantly more bacteria extrusion compared to the rotary and reciprocating groups (P

Aim A laboratory study to determine the apical pressure generated by seven canal irrigation methods in an anterior tooth with an open apex. Methodology Canal irrigation was performed on a 3D-printed central maxillary incisor with an open apex (maximum diameter of 2.1 mm). Ultrasonically Activated Irrigation (UAI), sonic activation (EDDY), negative pressure irrigation (EndoVac), the self adjusting file (SAF) and the XP-endo Finisher were employed at tooth length (TL), TL - 1 mm, TL - 2 mm and TL - 3 mm. UAI was tested at three intensity levels additionally. Hydrodynamic irrigation with RinsEndo was performed in the pulp chamber, at the canal orifice, the coronal third, the middle of the canal and at TL. Er:YAG laser-activation, at four frequency settings, was performed in the pulp chamber and at the orifice of the canal. The pressure of the fluid towards the canal terminus generated by activation was directly transferred to a pressure sensor with a range of 0 to 120 mmHg and a response time of ≤ 0.5 milliseconds. The critical threshold for apical extrusion of the irrigant was set at 5.73 mmHg (lower limit of the central venous pressure: 5.88 ± 0.15 mmHg). Each experiment was repeated ten times. The tests were followed by descriptive analyses (maximum, mean, standard deviation, 95% confidence interval). Results EndoVac, the SAF, the XP-endo Finisher and UAI never exceeded the critical threshold at any insertion depth or intensity level. Er:YAG laser-activation exceeded the critical threshold exclusively at frequency settings varied from the manufacturer's recommendation. EDDY at TL and RinsEndo at any insertion depth exceeded the critical threshold in 100% of the measurements. EDDY at TL - 1, - 2 and - 3 mm crossed the critical threshold in 30%, 10% and 20% of the measurements, respectively. Conclusions In a simulated maxillary central incisor with an open apex, irrigation with EndoVac, Er:YAG laser-activation, UAI, the SAF and the XP-endo Finisher generated apical pressures below the critical threshold of 5.73 mmHg. By contrast, using EDDY and RinsEndo for irrigation produced higher apical pressures that exceeded the critical threshold.

This study aimed to assess the apical extrusion of debris during instrumentation of primary canines using three endodontic file types. Forty-five extracted primary canines were randomly assigned to three instrumentation groups (n = 15): Hand K-files; and the motorized Kedo-S files and XP-endo Shaper files. The apically extruded debris produced during the procedure was collected and dried in pre-weighed Eppendorf tubes, and the mass of debris was calculated. The time required for the endodontic procedure was also recorded. Analysis of variance (ANOVA) and Tukey’s post hoc test were used with a significance level set at 5%. XP-endo Shaper and Kedo-S files extruded significantly less debris compared with hand K-files with means of 0.84 ± 0.31 and 1.20 ± 0.67 mg respectively, compared to 2.13 ± 0.31 mg (p p p

Epithelia must eliminate apoptotic cells to preserve tissue barriers and prevent inflammation.1 Several different mechanisms exist for apoptotic clearance, including efferocytosis2,3 and apical extrusion.4,5 We found that extrusion was the first-line response to apoptosis in cultured monolayers and in zebrafish epidermis. During extrusion, the apoptotic cell elicited active lamellipodial protrusions and assembly of a contractile extrusion ring in its neighbors. Depleting E-cadherin compromised both the contractile ring and extrusion, implying that a cadherin-dependent pathway allows apoptotic cells to engage their neighbors for extrusion. We identify RhoA as the cadherin-dependent signal in the neighbor cells and show that it is activated in response to contractile tension from the apoptotic cell. This mechanical stimulus is conveyed by a myosin-VI-dependent mechanotransduction pathway that is necessary both for extrusion and to preserve the epithelial barrier when apoptosis was stimulated. Earlier studies suggested that release of sphingosine-1-phosphate (S1P) from apoptotic cells might define where RhoA was activated. However, we found that, although S1P is necessary for extrusion, its contribution does not require a localized source of S1P in the epithelium. We therefore propose a unified view of how RhoA is stimulated to engage neighbor cells for apoptotic extrusion. Here, tension-sensitive mechanotransduction is the proximate mechanism that activates RhoA specifically in the immediate neighbors of apoptotic cells, but this also must be primed by S1P in the tissue environment. Together, these elements provide a coincidence detection system that confers robustness on the extrusion response. Refereed/Peer-reviewed

The present study investigated the intracanal decontamination and apical extrusion of bacteria and debris from root canals instrumented with rotary and reciprocating systems (ProDesign Logic or ProDesign R), with different file diameters and using conventional syringe irrigation (CSI) or passive ultrasonic irrigation (PUI). Eighty extracted mandibular premolars were contaminated with Enterococcus faecalis and randomly assigned to eight experimental groups according to the root canal instrumentation and irrigation technique employed (n = 10): G1: Prodesign Logic 25.06; G2: Prodesign R 25.06; G3 and G4 were instrumented with the same single-file systems, respectively, using 35.05 diameters and CSI. G5, G6, G7, and G8 were instrumented like the previous groups, but with PUI. Apically extruded debris during instrumentation was collected into pre-weighed microtubes. The weight of the empty microtube was subtracted from the final weight to establish the amount of extruded debris. Bacteria from root canals and extruded debris were collected for a microbiological evaluation of colony forming units (CFU/mL). For statistical analyses, the Mann-Whitney and Kruskal-Wallis followed by the Dunn's tests were used (α = 0.05). All instruments caused extrusion of debris. For irrigation techniques, PUI promoted greater debris and bacterial extrusion (p < 0.05). The CFU/mL count indicated that the instrumentation of the experimental groups were equally effective in the decontamination of the root canal (p > 0.05). The systems tested (regarding file diameter and kinematics) were associated with similar amounts of apically extruded debris and root canal decontamination. PUI was associated with greater debris and bacterial extrusion.

Objectives This study was conducted to evaluate the effects of traditional and contracted endodontic cavity (TEC and CEC) preparation with the use of Reciproc Blue (RPC B) and One Curve (OC) single-file systems on the amount of apical debris extrusion in mandibular first molar root canals. Materials and Methods Eighty extracted mandibular first molar teeth were randomly assigned to 4 groups (n = 20) according to the endodontic access cavity shape and the single file system used for root canal preparation (reciprocating motion with the RCP B and rotary motion with the OC): TEC-RPC B, TEC-OC, CEC-RPC B, and CEC-OC. The apically extruded debris during preparation was collected in Eppendorf tubes. The amount of extruded debris was quantified by subtracting the weight of the empty tubes from the weight of the Eppendorf tubes containing the debris. Data were analyzed using 1-way analysis of variance with the Tukey post hoc test. The level of significance was set at p < 0.05. Results The CEC-RPC B group showed more apical debris extrusion than the TEC-OC and CEC-OC groups (p < 0.05). There were no statistically significant differences in the amount of apical debris extrusion among the TEC-OC, CEC-OC, and TEC-RPC B groups. Conclusions RPC B caused more apical debris extrusion in the CEC groups than did the OC single-file system. Therefore, it is suggested that the RPC B file should be used carefully in teeth with a CEC.

Aim: The aim of the study is to quantify the amount of debris extrusion after instrumentation with single-file rotary and reciprocating systems used either with conventional irrigation (CI) or passive ultrasonic irrigation (PUI) systems. Methodology: Sixty extracted human mandibular incisors were randomly assigned to two groups (n = 30); rotary single-file system, One Shape (OS-Group 1) and reciprocating single-file system, WaveOne (WO-Group 2) instruments. The two groups were further subdivided into two subgroups (n = 15); (A) PUI and (B) CI. The apically extruded debris was collected in preweighed glass vials as per the Myers and Montgomery method. After drying, the mean weight of debris was assessed with a microbalance and statistically analyzed using analysis of variance and Student's t-test. Results: The reciprocating file system produced significantly more debris compared to the rotary file system using either of the irrigation systems (P = 0.04). CI produced significantly more (P = 0.02) debris extrusion compared to PUI irrespective of the file system used. Conclusion: Under the conditions of this study, both systems caused apical debris extrusion. Rotary single-file system produced less debris extrusion compared to reciprocating single-file system. Use of PUI may be advocated as an alternative to CI, as it causes lesser apical debris extrusion.

Grande, Nicola Maria/0000-0003-3407-9768; Plotino, Gianluca/0000-0003-3003-8029 WOS: 000431942400030 PubMed: 29550013 Introduction: The purpose of this study was to investigate the amount of apically extruded debris by Reciproc Blue (REC Blue; VDW, Munich, Germany), HyFlex EDM (HEDM; Coltene/Whaledent, Altstatten, Switzerland), and XP-endo Shaper (XPS; FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) files during root canal preparation at body temperature. Methods: Sixty extracted single-rooted mandibular premolar human teeth were randomly assigned to 3 groups (n = 20). The canals were instrumented using 1 of the following instruments: REC Blue, HEDM, or XPS. Apically extruded debris during instrumentation was collected into pre-weighed Eppendorf tubes. All the procedures were performed at 35 degrees C. The amount of extruded debris was calculated by subtracting the weight value of the tooth-free apparatus from the postpreparation weight value. The data were analyzed using the KruskalWallis test at a 5% significance level. Results: All the instruments tested caused extrusion of some debris from the apical foramen. XPS extruded significantly less debris from the apex than REC Blue (P < .05). The difference among the HEDM group and the other groups was not significant (P > .05). Conclusions: Within the limitations of this in vitro study, the amount of apically extruded debris registered for the different files tested was REC Blue > HEDM > XPS, with a statistical difference only between XPS and REC Blue.

Aim: The aim of this study was to evaluate the apical extrusion of calcium hydroxide [Ca(OH) 2 ] paste, which placed into the root canal with lentulo usage at different speeds and a hand file. Material and Methods: 40 maxillary central incisors were used. Root canals were enlarged up to 40.06 Revo-S size. At each instrument change, root canal was irrigated with 2.5 mL of 5.25% NaOCl. Final irrigation was performed with 5 mL of 17% EDTA, 5 mL of 5.25% NaOCl, and 5 mL of saline; then, dried with paper-points. Each teeth were placed in the plastic tubes, and the tubes were covered with aluminium foil. Ca(OH) 2 powder and distilled water were mixed at a ratio of 1:1.5. Specimens were divided into 4 groups according to Ca(OH) 2 placement method (n=10): G1: #30 Lentulo spiral at 20000 rpm, G2: #30 Lentulo spiral at 10000 rpm, G3: #30 Lentulo spiral at 5000 rpm, G4: #40 K-Flexofile. Lentulo was used 2 mm short of the working length, and K-Flexofile at the working length. The apices of the specimens were inspected with a dental loop, and situation was scored. Data were subjected to statistical analysis using Chi-square test (α=0.05). Results: Minimum extrusion was seen in Group 3 and 4, and maximum was in Group 1. However, there was no significant difference among the groups ( P > 0.05). Conclusions: Lentulo should be used with lower speeds in clinical practice to prevent extrusion. Ca(OH) 2 placement with K-Flexofile and lentulo spiral at 5000 rpm can be considered safe . Keywords: Apical extrusion, calcium hydroxide, lentulo spiral FARKLI HIZLARDA LENTULO SPIRAL KULLANIMININ KALSIYUM HIDROKSITIN APIKAL EKSTRUZYONU UZERINE ETKISI OZ Amac: Bu calismanin amaci, bir el egesi ve farkli hizlarda lentulo kullanimi ile kanala yerlestirilen kalsiyum hidroksit [Ca(OH) 2 ] patinin apikal ekstruzyonunun degerlendirilmesiydi. Gerec ve Yontem: 40 adet maksiller santral keserler kullanildi. Kok kanallari 40.06 Revo-S boyutuna kadar genisletildi. Her enstruman degisiminde kok kanali 2.5 mL %5.25’lik NaOCl ile irrige edildi. Final irrigasyonu 5 mL %17’lik EDTA, 5 mL %5.25’lik NaOCl ve 5 mL serum fizyolojik ile yapildi; ardindan kagit konlar ile kurutuldu. Her bir dis plastik tuplere yerlestirildi ve tupler aluminyum folyo ile sarildi. Ca(OH) 2 ve distile su 1:1.5 oraninda karistirildi. Ca(OH) 2 yerlestirme yontemine gore disler 4 gruba ayrildi (n=10): Birinci, ikinci ve ucuncu gruplar 30 numara Lentulo ile sirasiyla 20000,10000 ve 5000 tur/dk da calisilarak dolduruldu. Dorduncu grupta ise #40 K-Flexofile kullanildi. Lentulo calisma boyundan 2 mm kisa, Flexofile ise calisma boyunda kullanildi. Orneklerin apeksleri dental loop ile gozlendi ve durum skorlandi. Ki-kare testi kullanilarak veriler istatistiksel analize tabi tutuldu (α=0.05). Bulgular: Minimum ekstruzyon Grup 3 ve 4’te, maksimum tasma Grup 1’de gozlendi. Ancak, Gruplar arasinda anlamli farklilik yoktu ( P > 0.05). Sonuc: Klinik pratikte ekstruzyondan korunmak icin lentulo daha dusuk hizlarda kullanilmalidir. K-Flexofile ve 5000 rpm’de lentulo spiral ile Ca(OH) 2 yerlestirilmesi guvenli olarak kabul edilebilir. Anahtar Kelimeler: Apikal ekstruzyon, kalsiyum hidroksid, lentulo

Objective: To evaluate the safety of sodium hypochlorite (NaOCl) irrigation using three different techniques during the final rinse in overinstrumented root canals. Background data: The effect of irrigant activation on irrigant extrusion from overinstrumented root canals is still unclear. Method: A total of 30 single-rooted teeth were decoronated. The working lengths were determined and the roots were divided into two groups of 15 teeth each: group 1, instrumentation 0.5mm short of the apical foramen and group 2, instrumentation 0.5mm beyond the apical foramen (overinstrumented). Needle irrigation (NI), sonic irrigation with EndoActivator (EAI), and laser-activated irrigation (LAI) were used for the final rinse in each group; each root underwent the three irrigation procedures in a randomized crossover manner. A modified container-foam model was used to collect apically extruded NaOCl. The weight of the extruded NaOCl was calculated by subtracting the initial weights of the containers from their final weights. All data were statistically analyzed. Results: The amount of NaOCl extrusion was similar with all three irrigation systems in group 1. In group 2, the amount of extruded NaOCl was significantly greater with EAI than with NI and LAI. EAI and LAI caused significantly greater extrusion in group 2 than in group 1. Conclusions: EAI, NI, and LAI are equally safe for irrigating canals with intact apices. However, the risk of irrigant extrusion can increase in overinstrumented canals, with EAI associated with a greater risk compared with NI and LAI.

Advances in endodontics have enabled the evolution of file manufacturing processes, improving performance beyond that of conventional files. In the present study, systems manufactured using state of the art methods and possessing special properties related to NiTi alloys (i.e., CM-Wire, M-Wire and R-Phase) were selected. The aim of this review was to provide a detailed analysis of the literature about the relationship between recently introduced NiTi files with different movement kinematics and shaping ability, apical extrusion of debris and dentin defects in root canal preparations. From March 2016 to January 2017, electronic searches were conducted in the PubMed and SCOPUS databases for articles published since January 2010. In vitro studies performed on extracted human teeth and published in English were considered for this review. Based on the inclusion criteria, 71 papers were selected for the analysis of full-text copies. Specific analysis was performed on 45 articles describing the effects of reciprocating, continuous and adaptive movements on the WaveOne Gold, Reciproc, HyFlex CM and Twisted File Adaptive systems. A wide range of testing conditions and methodologies have been used to compare the systems. Due the controversies among the results, the characteristics of the files used, such as their design and alloys, appear to be inconsistent to determine the best approach.

Objectives: This one-year retrospective study evaluated the effect of unintentionally apically-extruded sealers (bioceramic versus epoxy-resin) on apical healing, sealers’ resorbability, and sealers’ digital radiodensity. Materials and Methods Thirty patients with root canal treatment showing unintentional apically-extruded sealer (n= 15 for TotalFill sealer, and n= 15 for AH-plus sealer) were included in the study. One-year recall radiographs were compared with immediate post-obturation ones for presence or absence of apical healing, and extruded sealer’s resorption, and digital radiodensity, using digital radiography. Data were statistically analyzed using Mann Whitney U-test and student-t test. Results: TotalFill recorded higher observations (1.67) of apical healing as compared to AH-Plus (1.2). The difference was statistically significant P≤ 0.05. Regarding sealer resorption, TotalFill recorded lower observations (0.06) as compared to AH-Plus (0.4). The difference was statistically significant P≤ 0.05. Digital radiodensity of TotalFill (37.46) was higher than that of AH-Plus (-19.73). The difference was statistically significant P≤ 0.001. Conclusions Within the limitations of the present study, TotalFill recorded higher observations of complete apical healing, compared to AH-Plus. TotalFill had a lower dissolution (resorbability) rate when compared to AH-Plus within the 12 months’ timeframe. Digital radiodensity of TotallFill increased by time when compared to the declining radiodensity of AH-Plus within the same period of time.

The aim of this study was to evaluate if apical negative pressure (ANP) irrigation prevents the apical extrusion of debris and irrigant compared with conventional needle irrigation through a systematic review and meta-analysis. A computer search of dental literature was performed using four different databases. A combination of the terms 'apical negative pressure', 'endovac', 'apical extrusion', 'extrusion' and 'endodontics' was used. Studies that used extracted human teeth with a mature apex and that evaluated the apical extrusion of debris and/or irrigating solution were included. After an evaluation of the full studies according to the eligibility criteria, eight studies were critically analysed and subjected to quality assessment and risk of bias. Only four studies that evaluated extrusion of irrigant were considered as having high methodological quality and were subjected to a meta-analysis. Studies evaluating extrusion of debris did not have sufficient methodological quality to be subjected to the meta-analysis. The forest plot indicated that ANP irrigation prevents the risk of irrigant extrusion compared with conventional irrigation (OR 0.07 [95%CI 0.02-0.20]; P < 0.00001). This systematic review and meta-analysis showed that ANP prevents the apical extrusion of irrigant. There is no evidence if this type of irrigation prevents the extrusion of debris.

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%).

Objective: To evaluate apical extrusion during a novel erbium-doped yttrium aluminum garnet (Er:YAG) laser-activated irrigation (LAI) modality. Background data: A novel double-pulse Er:YAG...

Background Sodium hypochlorite (NaOCl) gel has been suggested as a safer substitute in open apices as compared to solution, with the same antimicrobial effect. Objectives This study aimed to compare the amount of the apical extrusion of NaOCl gel and solution in immature permanent teeth. Material and methods A crossover in vitro study was conducted at the Department of Pediatric Dentistry, Faculty of Dentistry of Damascus University, Syria. Thirty freshly extracted immature single-rooted human premolars were decoronated and the cavity was then accessed. The teeth were radiographed to determine the mesiodistal dimension of the apex. In addition, the surface area of the apical foramen was calculated with Adobe Photoshop® to evaluate the amount of extrusion from the whole surface of the apex. The teeth were divided into 2 groups according to the size of the apex: ≤2.5 mm (group A) and >2.5 mm (group B); each group was irrigated with 5 mL of NaOCl solution and 2 different commercial types of NaOCl gel for 60 s, and then the extruded irrigant was measured in a plastic vial. Results The data was analyzed using the Kruskal-Wallis analysis. Based on the observed results, a statistically significant difference was noted (p = 0) between NaOCl solution and gel when the apical diameter was ≤2.5 mm, while there was no significant difference between the 2 types of NaOCl gel. No statistically significant difference was observed (p = 0.2) between NaOCl solution and gel when the apical diameter was >2.5 mm. Conclusions Sodium hypochlorite gel is safer than solution when irrigating immature teeth with the apical diameter ≤2.5 mm.

Objective: The objective of the present study was to evaluate the influence of different irrigation solutions on the amount of extruded residues apically, varying the instrumentation technique in manual, continuous rotation, or reciprocation motions. The amounts of residue for each irrigation solution was also assessed. Methods: Two tests were performed. In the first test, 90 mandibular premolars were divided into nine groups (n=10). Each group was subjected to a different technique: ProTaper Universal, WaveOne Gold, or manual instruments, with different irrigation solutions [2.5% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX) gel, or distilled water]. During the preparation of the root canal, the apically extruded material was collected in previously weighed glass vials. In the second test, irrigation solutions were weighed separately with the same weighing method. Data were analyzed using the Kolmogorov–Smirnov, one-way and two-way ANOVA, Levene, Tukey, and Games–Howell tests. Results: Apically extruded debris was observed in all groups. ProTaper Universal with continuous rotation using 2% CHX gel resulted in the greatest amount of debris (P