Apical extrusion of debris and irrigants using hand and three rotary instrumentation systems- An in vitro study

Introduction: Sterilization of the root canal is a prime aim of successful endodontics. The cleaning and shaping of the canal is directed as achieving this goal. The extrusion of apical debris has a deleterious effect on the prognosis of root canal treatment. Several instrument designs and instrumentation techniques have been developed to prevent this. Materials and Methods: Forty caries free single rooted human mandibular premolar teeth were divided in four groups of ten teeth each. Teeth in each group were instrumented until the working length with rotary ProTaper, K3, Mtwo systems, and hand K-type stainless steel files. Debris and irrigant extruded from the apical foramen were collected into vials and the amounts were quantitatively determined. The data obtained were analyzed using Kruskal-Wallis one-way analysis of variance and Mann-Whitney U tests. Results: The results show that all instrumentation techniques produced significant amount of extruded debris and irrigant. The engine-driven nickel-titanium systems showed less apical extrusion of debris and irrigant than manual technique. No statistically significant difference was found between the groups at [P > 0.05]. Maximum apical debris and irrigant extrusion was seen with K-file group and least in the Mtwo group. Conclusions: The use of rotary files and techniques to perform instrumentation does show less extrusion of the debris and irrigant from the apex. This can contribute to more successful endodontic therapy.