|Year : 2021 | Volume
| Issue : 6 | Page : 1398-1401
Quantitative evaluation of apically extruded debris in root canals prepared by single-file reciprocating and single file rotary instrumentation systems: A comparative In vitro study
Sonal Sinha1, Konark Singh2, Anju Singh3, Swati Priya1, Avanindra Kumar4, Sahil Kawle5
1 Department of Conservative Dentistry and Endodontics, Dr. B. R. Ambedkar Institute of Dental Sciences and Hospital, Bihar, India
2 Department of Conservative Dentistry and Endodontics, Patna Dental College and Hospital, Bihar, India
3 Department of Dentistry, Nalanda Medical College and Hospital, Patna, Bihar, India
4 Primary Health Center, Shamho, Begusarai, Bihar, India
5 Department of Conservative Dentistry and Endodontics, Dr. G D Pol Foundation's, YMT Dental College and Hospital, Mumbai, Maharashtra, India
|Date of Submission||23-Mar-2021|
|Date of Decision||11-Apr-2021|
|Date of Acceptance||09-May-2021|
|Date of Web Publication||10-Nov-2021|
Department of Conservative Dentistry and Endodontics, Dr. B. R. Ambedkar Institute of Dental Sciences and Hospital, Patna - 801 503, Bihar
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Prevention of the debris from extruding to the periapical region is an important aspect to be taken care of as its extrusion can result in pain, periapical inflammation, and delayed healing owing to the presence of highly infective components in the debris. Aim: The present trial was aimed to compare and assess the amount of debris extruded apically using the single-file reciprocating system - WaveOne GOLD and single file rotary system - OneShape in root canal preparations in vitro. Materials and Methods: Thirty mandibular premolars were divided into two groups (15 samples each) prepared with a single-file reciprocating system - WaveOne GOLD and single-file rotary system - OneShape. Debris extruded was collected and then stored in an incubator. The final weight was calculated after obtaining the mean of three consecutive weights obtained for each tooth. The data were compared using the ANOVA and Turkey's post hoc analysis. Results: Debris extrusions were recorded in both groups and analysis revealed statistical differences in weight before and after the instrumentation procedures in both groups. When compared, reciprocating single file – WaveOne GOLD extruded more debris than rotary single file system – OneShape with a P < 0.001. Conclusions: The rotary instrumentation systems extrude lesser debris apically than the reciprocating instrumentation system. The difference found was statistically significant.
Keywords: Apical extrusion, debris, irrigation, OneShape, reciprocating motion, rotating motion, WaveOne GOLD
|How to cite this article:|
Sinha S, Singh K, Singh A, Priya S, Kumar A, Kawle S. Quantitative evaluation of apically extruded debris in root canals prepared by single-file reciprocating and single file rotary instrumentation systems: A comparative In vitro study. J Pharm Bioall Sci 2021;13, Suppl S2:1398-401
|How to cite this URL:|
Sinha S, Singh K, Singh A, Priya S, Kumar A, Kawle S. Quantitative evaluation of apically extruded debris in root canals prepared by single-file reciprocating and single file rotary instrumentation systems: A comparative In vitro study. J Pharm Bioall Sci [serial online] 2021 [cited 2022 Aug 10];13, Suppl S2:1398-401. Available from: https://www.jpbsonline.org/text.asp?2021/13/6/1398/330020
| Introduction|| |
For a successful root canal preparation, adequate cleaning and shaping play a crucial role, which is achieved by instrumentation. This instrumentation aims at removed the diseased pulp tissue and bacterial products from the canal along with making adequate space for delivering the intra-canal medicaments, dressings, and the filling materials. Owing to the complex anatomy of the root canal, good thorough irrigation, and proper cleaning instruments are required to remove the debris from the root canal system.
The prevention of the debris from extruding to the periapical region is an important aspect to be taken care of as its extrusion can result in pain, periapical inflammation, and delayed healing owing to the presence of highly infective components in the debris. These components include dentin shavings, pulp remnants, necrotic tissues, and microorganisms. The extruded debris is termed as the worm of necrotic debris associated with postoperative pain, inflammation, and delayed healing.
Ideally, all the materials from the root canal should be removed without peri-apical extrusion. However, practically, this seems impossible. To avoid this extrusion, the working length should be adequately determined and strictly followed. Despite strict working length measures, some amount of debris is inadvertently pushed to the periapical area. Hence, an efficient and effective instrumentation technique is desirable and advised that causes the minimum extrusion of the debris to the periapical area.
Although all techniques used in endodontic lead to some amount of periapical extrusion, the degree of extrusion using different techniques varies. The preparation technique and design of the instrument chiefly govern the apical extrusion. It is reported that hand instruments cause more debris extrusion owing to their in and out motion compared to the rotational technique, showing less extrusion with rotary instruments.
A relatively new single file system WaveOne GOLD by DENTSPLY has advantages of better cutting efficiency, reduced treatment time, decreasing number of steps with adequate disinfection, and cleaning of the root canal. Another single file used in the rotary system is OneShape by Micromega OneShape (Micro Mega, France) is the only single-file nickel–titanium (NiTi) instrument system that has a cross-section designed to work in three different zones while in the canal. Furthermore, OneShape is flexible, safe, and highly efficient causing less fatigue and decreasing the treatment duration.
Very limited data in the literature are available regarding the debris extrusion with single-file reciprocating system and rotary use single file.
A few studies in the literature have compared such data. Hence, the present trial was aimed to compare and assess the amount of debris extruded apically using the single-file reciprocating system - WaveOne GOLD and single file rotary system - OneShape in root canal preparations in vitro.
| Materials and Methods|| |
The study sample comprised of 30 premolars of the mandible having one root and one canal with complete root and apex formation extracted for the orthodontic treatment purpose. The informed consent was taken from all the study participants before the extraction was done. Intra-oral periapical radiographs were taken for all the teeth using RadioVisioGraphy to determine the morphology of the canal and the root. The exclusion criteria for the study were teeth having curved canals, developmental anamoly, calcified canals and were restored.
After inclusion, the tooth roots were cleaned of any extrinsic stain, calculus, or debris with the ultrasonic scaler followed by the disinfection in 0.5% solution of Chloramine T. After disinfection, the teeth were stored in the normal saline till used further. To achieve a standard reference point for root canal length determination, buccal cusp edges were flattened for all the study sample teeth. The conventional technique using #2 round burs was adapted to gain straight-line access to the root canal with water cooling. A number 10 K file was used to confirm the apical patency through the apical foramina. The same number 10 K file was used to determine the root canal working length. The working length was noted by subtracting 1 mm from the length when the number 10 K file just left the apical foramina. The debris was collected in the glass vials using the conventional method suggested by Myers and Montgomery.
Before the canal preparation, the weights of the glass vials were measured thrice with microbalance having 10−5 g precision. The mea10−5 g precision of the three recorded values was take10−5 g precision as weight. The selected 30 teeth were divided into two groups randomly, each having 15 samples. The biomechanical preparation was done in Group I using WaveOne GOLD file at 300 rpm and for Group II using Single file rotary system OneShape at 400 rpm. Both had a size 25. Irrigation during the canal preparation was done using the distilled water (23 ml per tooth) as shown in [Figure 1] and [Figure 2].
|Figure 1: Biomechanical preparation done using wave OneGold and OneShape|
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Following instrumentation, glass vials were placed in a dry heat oven at a constant temperature of 140°C for 5 h, to evaporate the distilled water leaving behind the dry debris. The same microbalance was used to weigh the glass vials by taking the mean of three recordings. The debris weight was obtained by subtracting the empty vial weight from the vial having debris. The collected data were subjected to statistical evaluation.
| Results|| |
The present trial was aimed to compare and assess the amount of debris extruded apically using the single-file reciprocating system - WaveOne GOLD and single-file rotary system - OneShape in root canal preparations in vitro. The study sample consisted of 30 mandibular premolars extracted for orthodontic purposes.
The data were collected in terms of mean values with the standard deviation using one-way ANOVA and Tukey's post hoc analysis. The samples comprised of two groups based on the file system used including the single-file reciprocating system – WaveOne GOLD and Single file rotary system – OneShape.
- In Group I: Root canals were instrumented with a single file reciprocating system – WaveOne GOLD
- In Group II: Root canals were instrumented with a single file rotary system – OneShape.
Debris extrusion was recorded in both two groups. The intragroup analysis revealed statistically significant differences in the weight of the glass vial, and hence, debris, before and after the instrumentation and canal preparation in both the groups. The mean values for the weight of debris extruded for two groups: WaveOne GOLD and OneShape are listed in [Table 1]. It was also seen that reciprocating single file - WaveOne GOLD extruded more debris than rotary single file system - OneShape. The results showed that the mean value of the extruded debris for the WaveOne Group reciprocating single file system was 84.5 ± 9.0 with the minimum and maximum values of 74–99 g. The mean value of debris extrusion for the single file rotary system- OneShape was found to be 55.3 with the standard deviation of 7.0 with minimum and maximum values of 42 g–68 g, respectively, which was found to be significantly lower than a single-file reciprocating system - WaveOne GOLD with the P < 0.001.
|Table 1: Comparison of mean weight of apically extruded debris (×10-4 g) in both groups|
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On post hoc pairwise comparison using Turkey HSD, it was seen that the mean difference (×10−4 g) in WaveOne GOLD versus OneShape was found to be 29.2 which was statistically significant with the P < 0.001.
| Discussion|| |
The present trial was aimed to compare and assess the amount of debris extruded apically using the single-file reciprocating system - WaveOne GOLD and Single file rotary system - OneShape in root canal preparations in vitro.
The present study showed that some or more amount of the debris is inadvertently extruded to the periapical region in both the file systems used, single-file reciprocating system - WaveOne GOLD and Single file rotary system - OneShape. Similar findings were also suggested by Kirchhoff et al. in 2015 and Silva et al. in 2016 where authors have described the extrusion of the debris peri-apically during the root canal preparation.
Different techniques have resulted in a different amount of debris extrusion during the root canal biomechanical preparation. However, all the adapted techniques and instruments have demonstrated some or more debris being extruded peri apically. Rotary files using the NiTi system of files have shown lesser debris extrusion compared to the hand files which shows considerable debris extrusion owing to the push-pull motion which forces the debris to the periapical region. These findings were in agreement with the studies by Schafer and Vlassis in 2004 where authors have shown more periapical debris extrusion using the hand files compared to the rotary instruments.
This in vitro study was carried out to compare the amount of apically extruded debris after reparation of root canals in extracted human teeth using systems with different operating principles. The present study used the method to weigh the glass vials to evaluate the amount of debris extruded. Earlier studies have employed different methods such as keeping the sample at room temperature which might be affected by the temperature and moisture described by Myers and Montgomery in 1991.
The present in vitro study has shown that rotary instruments show more debris extrusion compared to reciprocating instruments. This can be due to the greater cutting efficiency of reciprocating files system owing to their sharp edges which can lead to more pushing of the debris to the periapical region. These findings were in agreement with the study by Burklein et al. in 2013 where more debris extrusions were associated with the NiTi rotary system files. Similar findings showing lesser debris extrusion with OneShape files compared to WaveOne GOLD were described in the study by Bonaccarso et al. in 2009. The study suggested that lesser debris is transported using the rotary technique because rotation leads to coronal transportation of the dentinal shavings. However, various studies showed contrasting results to the present study including the study by Kocak et al. in 2015 where more debris extrusion periapical was seen with the rotary system compared to the Protaper hand files. The authors depicted that this can be due to the offset design of the pro tapers.
| Conclusions|| |
Within the limitations of the present study, it can be concluded that rotary instrumentation systems extrude lesser debris apically than the reciprocating instrumentation system. As good shaping power is associated with the reciprocating single file system, further trials are needed to evaluate the effect of the findings of the present study on the outcomes assessed clinically since the clinical advantage of the debris extrusion peri-apically remains largely undetermined. The study results showed that the intragroup analysis revealed that there were statistically significant differences in weight before and after the instrumentation procedures in all groups. Also, when compared, the reciprocating single file extruded more debris than the rotary single file system.
The study had few shortcomings including the smaller sample size and geographical area biases. Hence, more studies with larger sample sizes, heterogeneous samples, and from different ecological niches are required to reach a definitive conclusion.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kumar M, Parashar A, Gupta B. Assessment of various causes for root canals failures in the study population. J Advan Med Dent Sci Res 2019;7:71-3.
Amza O, Dimitriu B, Suciu I, Bartok R, Chirila M. Etiology and prevention of an endodontic iatrogenic event: Instrument fracture. J Med Life 2020;13:378-81.
Western JS, Dicksit DD. Apical extrusion of debris in four different endodontic instrumentation systems: A meta-analysis. J Conserv Dent 2017;20:30-6.
] [Full text]
Tüfenkçi P, Yılmaz K, Adigüzel M. Effects of the endodontic access cavity on apical debris extrusion during root canal preparation using different single-file systems. Restor Dent Endod 2020;45:e33.
Lu Y, Chen M, Qiao F, Wu L. Comparison of apical and coronal extrusions using reciprocating and rotary instrumentation systems. BMC Oral Health 2015;15:92.
Ghivari SB, Kubasad GC, Deshpande P. Comparative evaluation of apical extrusion of bacteria using hand and rotary systems: An in vitro
study. J Conserv Dent 2012;15:32-5.
] [Full text]
Kuzekanani M. Nickel-titanium rotary instruments: Development of the single-file systems. J Int Soc Prev Community Dent 2018;8:386-90.
Myers GL, Montgomery S. A comparison of weights of debris extruded apically by conventional filing and canal master techniques. J Endod 1991;17:275-9.
Kirchhoff AL, Fariniuk LF, Mello I. Apical extrusion of debris in flat-oval root canals after using different instrumentation systems. J Endod 2015;41:237-41.
Silva EJ, Carapiá MF, Lopes RM, Belladonna FG, Senna PM, Souza EM, De-Deus G, Comparison of apically extruded debris after large apical preparations by full-sequence rotary and single-file reciprocating systems. Int Endo J 2016;49:700-5.
Schafer E, Vlassis M. Comparative investigation of two rotary nickel-titanium instruments: ProTaper versus RaCe. Part 1. Shaping ability in simulated curved canals. Intl Endod J 2004;37:229-38.
Burklein S, Schafer BE. Quantitative evaluation of apically extruded debris with different single-file systems: Reciproc, F360, and OneShape versus Mtwo. Intendod J 2013;6:1-5.
Bonaccorso A, Cantatore G, Condorelli GG, Schäfer E, Tripi TR. Shaping ability of four nickel-titanium rotary instruments in simulated S-shaped canals. J Endod 2009;35:883-6.
Koçak S, Koçak MM, Sağlam BC, Türker SA, Sağsen B, Er Ö. Apical extrusion of debris using self-adjusting file, reciprocating single-file, and 2 rotary instrumentation systems. J Endod 2013;39:1278-80.
[Figure 1], [Figure 2]