The Journal of Contemporary Dental Practice

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 18 , ISSUE 4 ( April, 2017 ) > List of Articles

REVIEW ARTICLE

Establishing Apical Patency: To be or not to be?

Hamid Jafarzadeh, Zahed Mohammadi, Sousan Shalavi, Jun-Ichiro Kinoshita

Citation Information : Jafarzadeh H, Mohammadi Z, Shalavi S, Kinoshita J. Establishing Apical Patency: To be or not to be?. J Contemp Dent Pract 2017; 18 (4):326-329.

DOI: 10.5005/jp-journals-10024-2040

Published Online: 01-04-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction

The apical portion of the root canal is very complex and challenging during endodontic treatment. Root canal preparation and obturation to the apical constriction may provide the best prognosis. Incomplete debridement, foramen transportation, and inadequate seal in the apical portion are considered to be responsible for treatment failure. The technique “apical patency” is considered as a way for maintaining the apical part the free of the debris by recapitulation, using a small K-file through the area of the apical foramen. This term was firstly proposed by Buchanan. In this technique, the smallest diameter file is set 1 mm longer than working length and recapitulated after each instrument to prevent packing of debris in the apical part. Apical patency has been found to be effective in achieving an apical seal with gutta-percha. Teeth prepared with a step back method and with maintained apical patency may show less leakage when obturated with cold lateral condensation technique. Data regarding the effect of apical patency on the healing of periapical tissue are very scarce, and it has been shown that the patency file has detrimental effect on the healing of periapical tissues in animal studies. However, using patency file in endodontic treatment is controversial and further studies are needed. The purpose of this article is to review the effect of using a patency file on the extrusion of root canal contents, the apical seal, postoperative pain, and healing of periapical tissues. Furthermore, the effect of establishing patency on reaching irrigation solutions to the apical portion of the canal and prognosis of root canal treatment are discussed.

Clinical significance

How to cite this article

Mohammadi Z, Jafarzadeh H, Shalavi S, Kinoshita J-I. Establishing Apical Patency: To be or not to be? J Contemp Dent Pract 2017;18(4):326-329.


PDF Share
  1. ; Castellucci, A. Cleaning and shaping the root canal system. In: Castellucci A, editor. Endodontics. 1st ed., Vol. II. Firenze: IlTridente; 2005. p. 429-457.
  2. Cleaning and shaping the root canal system. In: Cohen S, Burns RC, editors. Pathways of the pulp. 5th ed. St. Louis: CV Mosby; 1991. p. 166-192.
  3. Glossary of endodontic terms. 7th ed. Chicago: American Association of Endodontists; 2003.
  4. Working length and apical patency: the control factors. Endod Rep 1987 Fall-Winter;16-20.
  5. Prevalence of teaching apical patency and various instrumentation and obturation techniques in United States dental schools. J Endod 1997 Jun;23(6):394-396.
  6. The effect of maintaining apical patency on periapical extrusion. J Endod 2001 Nov;27(11):696-698.
  7. A comparison of weights of debris extruded apically by conventional filing and Canal Master techniques. J Endod 1991 Jun;17(6):275-279.
  8. The importance of apical patency and cleaning of the apical foramen on root canal preparation. Braz Dent J 2006 Feb;17(1):6-9.
  9. Reaction of periradicular tissues to root canal treatment: benefits and drawbacks. Endod Top 2005 Mar;10(1):123-147.
  10. Relationship between the size of patency file and apical extrusion of sodium hypochlorite. Indian J Dent Res 2009 Oct-Dec;20(4):426-430.
  11. An in vivo evaluation of the penetration of an irrigating solution in root canals. J Endod 1977 Oct;3(10):394-398.
  12. Effect of maintaining apical patency on irrigant penetration into the apical third of root canals when using passive ultrasonic irrigation: an in vivo study. J Endod 2011 Sep;37(9):1276-1278.
  13. Effect of maintaining apical patency on irrigant penetration into the apical two millimeters of large root canals: an in vivo study. J Endod 2012 Oct;38(10):1340-1343.
  14. Effect of vapor lock on root canal debridement by using a side-vented needle for positive-pressure irrigant delivery. J Endod 2010 Apr;36(4):745-750.
  15. Review of contemporary irrigant agitation techniques and devices. J Endod 2009 Jun;35(6):791-804.
  16. Effectiveness of sodium hypochlorite in preventing inoculation of periapical tissues with contaminated patency files. J Endod 2004 Feb;30(2):92-94.
  17. Dynamic movement of intracanal gas bubbles during cleaning and shaping procedures: the effect of maintaining apical patency on their presence in the middle and cervical thirds of human root canals – an in vivo study. J Endod 2012 Feb;38(2):200-203.
  18. ; Iacono, S. Entrapped gas action for one dimensional models of capillary dynamics. In: Proceedings of the World Congress on Engineering, July 2009, 1-3. Vol. II. London: World Congress of Engineering; 2009.
  19. Effect of apical patency on the apical seal of obturated canals. J Endod 1997 Apr;23(4):253.
  20. Periapical response to an apical plug of dentin filings intentionally placed after root canal over instrumentation. J Endod 1985 Aug;11(8):323-329.
  21. Tissue reactions following apical plugging of the root canal with infected dentin chips. A histologic study in dogs' teeth. Oral Surg Oral Med Oral Pathol 1980 Apr;49(4):366-369.
  22. Biological evaluation of the apical dentin chip plug. J Endod 1985 Jan;11(1):18-24.
  23. The effect of canal preparation on the formation and leakage characteristics of the apical dentin plug. J Endod 1984 Jul;10(7):308-317.
  24. The dentinal plug: its effect on confining substances to the canal and on the apical seal. J Endod 1983 Sep;9(9):355-359.
  25. An in vitro comparison of the sealing ability of three endodontic sealers used in canals with iatrogenic enlargement of the apical constriction. J Endod 2005 Mar;31(3):190-193.
  26. Influence of apical patency and filling material on healing process of dogs' teeth with vital pulp after root canal therapy. Braz Dent J 2005 Feb;16(1):9-16.
  27. Relationship between postendodontic pain, tooth diagnostic factors, and apical patency. J Endod 2009 Feb;35(2):189-192.
  28. Factors associated with endodontic interappointment emergencies of teeth with necrotic pulps. J Endod 1988 May;14(5):261-266.
  29. Detectability of residual Epiphany and gutta-percha after root canal retreatment using a dental operating microscope and radiographs – an ex vivo study. Int Endod J 2006 Jul;39(7):558-565.
  30. Computer-assisted photomicrographic evaluation of root canal morphology after removal of the filling material during retreatment. Rom J Morphol Embryol 2011 Jan;52(Suppl 1):443-448.
  31. Influence of ProTaper finishing files and sodium hypochlorite on cleaning and shaping of mandibuldar central incisors – a histological analysis. J Appl Oral Sci 2009 May-Jun;17(13):229-233.
  32. The effect of disruption of apical constriction on periapical extrusion. J Endod 2005 Jul;31(7):533-535.
  33. Influence of apical patency and cleaning of the apical foramen on periapical extrusion in retreatment. Braz Dent J 2013 Sep-Oct;24(5):482-486.
  34. Patency file and apical transportation: an in vitro study. J Endod 2002 Jul;28(7):510-511.
  35. Human teeth with periapical pathosis after over instrumentation and overfilling of the root canals: a scanning electron microscopic study. Int Endod J 1999 Jan;32(1):40-48.
  36. Apical transportation created using three different patency instruments. Int Endod J 2010 Jul;43(7):560-564.
  37. The effect of maintaining apical patency on canal transportation. Int Endod J 2008 May;41(5):431-435.
  38. ; Roane, JB.; Goerig, AC. Cleaning and shaping the root canal system. In: Cohen S, Burns RC, editors. Pathways of the pulp. 6th ed. St. Louis: The C.V. Mosby Company; 1994. p. 179.
  39. A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: Part 1: periapical health. Int Endod J 2011 Jul;44(7):583-609.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.