COMPARISON OF APICAL EXTRUSION OF DEBRIS AFTER CANAL SHAPING USING DIFFERENT ROTARY SYSTEMS: AN IN VITRO STUDY

BACKGROUND : Chemo-mechanical preparation, a key step in root canal therapy, involves mechanical instrumentation and the use of irrigants. During this process, debris such as pulp tissue, dentin chips, bacteria, and irrigants may be extruded into the periradicular tissues, potentially causing postoperative pain. Accurate working length determination and the choice of instrumentation technique and file system can influence the extent of debris extrusion. Therefore, techniques that minimize apical extrusion are preferred to enhance patient comfort and treatment outcomes. AIMS AND OBJECTIVES : The aim of this study was to evaluate the amount of apically extruded debris using different file systems. To compare the amount of apical extrusion of debris after biomechanical preparation using multiple rotating rotary file systems ( Hyflex CM and TruNatomy), single rotating rotary file systems ( Hyflex EDM and One Shape ) and single reciprocating rotary file systems ( Reciproc Blue and Wave One Gold MATERIALS AND METHODS : Sixty extracted mandibular premolar teeth with single canals and similar lengths were used and divided into six groups – Hyflex CM, TruNatomy, Hyflex EDM, One Shape, Reciproc Blue and Wave One Gold. The initial weight of each Eppendorf tube to be used was calculated using an analytical balance before instrumentation. For all canals apical preparation was done till size 25 except TruNatomy which was prepared till size 26. Distilled water was used as irrigant. After instrumentation, the tubes were then stored for 14 days in an incubator at 37°C. The Eppendorf tubes were weighed again to determine their final weight which contained the extruded debris. The data were statistically analysed using a one way ANOVA test and Tukey’s post hoc test. The level of significance was set at P<0.05. RESULTS : Among the file systems evaluated, the TruNatomy (TN) system resulted in the lowest amount of apically extruded debris, with the difference being statistically significant when compared to all other groups. This was followed, in increasing order of extrusion, by HyFlex CM, OneShape, WaveOne Gold, Reciproc Blue, and with the highest amount of debris extrusion observed in the HyFlex EDM group CONCLUSION : Apical debris extrusion is an intrinsic characteristic of all file systems. However, among the systems evaluated in this study, the TruNatomy (TN) file system demonstrated the lowest level of debris extrusion. CLINICAL RELEVANCE : Apical debris extrusion can lead to postoperative discomfort, flare-ups, and the potential need for retreatment, all of which may negatively impact the patient’s experience and the overall prognosis of endodontic therapy. Ongoing research in this area supports the refinement of clinical protocols, promoting enhanced patient safety and improved treatment outcomes.