Apically Extruded Debris Following Root Canal Instrumentation Using Three File Systems: A Comparative In-Vitro Study

Abstract

Background: Apically extruded debris induced during root canal instrumentation is of clinical importance associated with postoperative pain and flare-ups. Different file systems with different kinematics and designs may influence the amount of extruded debris.

Objective: This in-vitro study aimed to assess and compare the quantity of apically extruded debris after root canal instrumentation by three different endodontic file systems: EdgeFile X7, 2-Shape, and WaveOne Gold.

Methods: A total of thirty single-rooted extracted human mandibular premolars were collected and randomly allocated into three groups (n = 10). Group A was instrumented with the EdgeFile X7 rotary system, Group B with the 2-Shape rotary system, and Group C with the WaveOne Gold reciprocating system. Debris were collected in known-weighted glass vials following the Myers and Montgomery method. After instrumentation, the vials were dried at 68°C in an incubator for five days. The dry debris weight was calculated using a high-precision digital balance. Statistical analysis for the collected data was performed with one-way ANOVA and Duncan’s post-hoc tests (p < 0.05).

Results: All file systems resulted in extrusion of apical debris. The WaveOne Gold system led to significantly higher mean amount of debris comparing with the other two systems (p < 0.05). The EdgeFile X7 system induced the lowest mean amount of debris, followed by the 2-Shape system, with no statistically significant difference between them (p > 0.05).

Conclusion: Within this study's limitations, file systems with rotation motion (EdgeFile X7 and 2-Shape) were related to less extrusion of apical debris comparable to the reciprocating system (WaveOne Gold). The file design and motion kinematics were significantly related to amount of debris extruded beyond the apical foramen.

Keywords:

Apical extruded debris, EdgeFile X7, 2-Shape, WaveOne Gold, Reciprocation, Rotation

References

Garg N, Garg A. Textbook of Endodontics. 4th ed. New Delhi: Jaypee Brothers Medical Publishers; 2019.

Siqueira JF. Microbial causes of endodontic flare-ups. Int Endod J. 2002;35(5):435-448.

Al-Zaka IM. The incidence of pain after root canal treatment using different irrigation methods. Tikrit J Dent Sci. 2024 Jan 20;2(1):38-43. doi: 10.25130/tjds.2.1.7.

Reddy SA, Hicks ML. Apical extrusion of debris using two hand and three engine-driven instrumentation techniques. J Endod. 1998;24(3):180-183.

Micro-Mega. 2Shape: The sequence of 2 instruments in continuous rotation to shape the root canal. France: Micro-Mega; 2018.

Webber J. Shaping canals with confidence: WaveOne Gold single-file reciprocating system. Roots (Int Mag Endod). 2015;1:34-40.

Al-Amidi A, Al-Gharrawi HR. Effect of autoclave sterilization on the cyclic fatigue resistance of EdgeFile X7, 2Shape, and F-One nickel–titanium endodontic instruments. J Conserv Dent. 2023;26(1):26-31.

Garcia K, Limoeiro AG, Nascimento WM, Kadi EM, Radaic S, Neri L. The influence of different working lengths on apically extruded debris. Res Soc Dev. 2021;10(4):e50410414554.

Fontana CE, Ferraresso GM, Derigi LP, Pinheiro G da, Trevensoli VC, Bueno CE. Analysis of the influence of different kinematic instrumentation in extrusion of apical debris. Int J Adv Eng Res Sci. 2020;7(8):9-14.

Tomer AK, Mangat P, Mullick S, Dubey S, Chauhan P, Kumari A. Quantitative evaluation of apically extruded debris of different single file systems: WaveOne Gold, One Shape, F360, and Reciproc: An in vitro study. Int J Oral Care Res. 2017;5(1):65-67.

Al-Zaka IM, Al-Gharrawi HR. Evaluation of apically extruded debris using different nickel-titanium instrumentation systems. J Conserv Dent. 2022;25(3):294-298.

Khalil WA, Merdad K, Abu-Haimed TS, Howait M, Alsofi L. Cyclic fatigue resistance of ProTaper Gold, EdgeFile, OneShape and ProTaper Universal. Egypt Dent J. 2018;64:589-596.

Koch K, Brave D. Real world Endo: Design features of rotary files and how they affect clinical performance. Oral Health. 2002;92:39-49.

Serefoglu B, Miçooğulları Kurt S, Kaval ME. Apically extruded debris using different nickel-titanium systems: 2Shape, TruNatomy, and ProTaper Gold. J Dent Res Dent Clin Dent Prospects. 2022;16(2):102-106.

Nevares G, Albuquerque D, Xavier F, Fogel H, Freire L, Cunha R. Evaluation of apically extruded debris during root canal retreatment using ProTaper Next and Reciproc in severely curved canals. Iran Endod J. 2017;12(3):323-328.

Al-Gharrawi HR, Al-Zaka IM. Methodological limitations in evaluating apically extruded debris: A systematic review of in-vitro protocols. J Int Oral Health. 2024;16(1):12-19.

Silva EJ, Rocha MS, Perez R. The impact of body temperature and periapical lesion simulation on debris extrusion: A critical analysis. Int Endod J. 2024;57(2):210-222.