The effect of the use of irrigation activation methods with different file systems on the amount of apical debris extrusion

This study evaluated apical debris extrusion caused by passive ultrasonic irrigation (PUI), sonic activation (SA) and conventional irrigation (CI) in combination with different file systems. A total of 135 extracted human mandibular premolar teeth were used. The samples were divided into nine groups (n = 15) based on three main irrigation activation techniques and three subgroups of file systems. After preparing the experimental setups and completing the root canal shaping procedures with XP-endo Rise Shaper, ProTaper Ultimate, and WaveOne Gold files, irrigation activation was performed in each group. Distilled water was used as the irrigation solution. Eppendorf tubes containing distilled water and debris were incubated at 37 °C for 14 days. The tubes were then weighed three times using a precision scale, and the mean of the measurements was calculated. The mean pre-recorded empty tube weights were subtracted from the final mean weights to determine the weight of the apically extruded debris. Among the irrigation activation methods, PUI resulted in the greatest amount of debris extrusion (p = 0.003). All file systems caused apical debris extrusion; however, there was no statistically significant difference among the file systems regarding debris extrusion (p > 0.05). When the combinations of file systems with irrigation activation methods were compared, the combination of the WaveOne Gold with SA resulted in significantly less debris extrusion (p = 0.009). PUI caused significantly more apical debris extrusion compared with SA and CI. The combined use of WaveOne Gold and SA during root canal treatments may serve as an option to reduce postoperative pain and acute flare-ups. XP-endo Rise Shaper; ProTaper Ultimate; WaveOne Gold; Debris Extrusion; Irrigation Activation.