Aim and objective: The aim of this study was to evaluate the apical extrusion of debris during root canal preparation with the use of different Nickel–Titanium (Ni–Ti) file systems. Materials and methods: Totally 60 single-rooted human mandibular premolar teeth with fully formed roots were chosen for the study. The coronal access cavity and all other preparations were done with the use of an access cavity kit and then 60 samples were randomly separated into three investigational groups (n = 20); group I: self-adjusting file, group II: WaveOne Gold, and group III: Mtwo rotary system. After instrumentation, the teeth were taken out from the tube and the root surface–adherent debris was collected by washing off the apical area of the tooth with distilled water (1 ml) into a centrifuge tube. The centrifuge tube was kept for 5 days in an incubator at 70°C to permit evaporation of the moisture prior to weighing the dry debris with the aid of an electrical analytical balance. Results: The highest quantity of debris extruded was by the Mtwo rotary system (0.0394 ± 0.880) followed by WaveOne Gold (0.0247 ± 1.030) and self-adjusting file (0.0198 ± 0.102). A statistically significant difference (p < 0.001) was found between the various file systems. Conclusion: After considering the drawbacks of this study, apical debris extrusion could be found with all three groups. However, the self-adjusting file demonstrated a significantly reduced quantity of apical debris extrusion compared to the Mtwo rotary system and WaveOne Gold. Clinical significance: The chief step during the procedure of root canal treatment is the preparation of the infected root canals biomechanically. This preparation may lead to forcing the apical debris into the periapical space through the apical foramen, resulting in host-initiated immunological response which leads to postoperative discomfort and pain. This consequently leads to selection of a specific rotary system for endodontic treatment.
Teixeira JM, Cunha FM, Jesus RO, et al. Influence of working length and apical preparation size on apical bacterial extrusion during reciprocating instrumentation. Int Endod J 2015;48:648–653. DOI: 10.1111/iej.12357.
Radeva EN and Vassileva RI. Comparative study of apically extruded debris and irrigant after using two rotary systems (K3, RACE). J Int Med Assoc Bulg 2014;20(1):459–463. DOI: 10.5272/jimab.2014201.459.
Patel AR, Ujariya UM, Kothari AK, et al. Comparative evaluation of apical debris extrusion during root canal preparation using three different file systems: an in vitro study. Endodontology 2020;32:20–25. DOI: 10.4103/endo.endo_42_19.
Webber J. Shaping canals with confidence: wave one GOLD singlefile reciprocating system. Roots 2015;1:34–40. Available from: http://www.moderndentistrymedia.com/june_july2016/webber.pdf.
Dass A, Saxena A, Chandak M, et al. Quantitative assessment of apical debris extrusion in apical third using two different NiTi rotary systems- an in vitro study. Int J Oral Health Dent 2016;2(4):220–223. DOI: 10.18231/2395-499X.2016.0004.
Metzger Z, Bassarani B, Good H. Instruments, materials and devices. In: Cohen S, Hargreaves K (eds.) Cohen's pathways of the pulp. Philadelphia, PA: Elsevier; 2010.
Myers Garry L and Montgomery S. A comparison of weights of debris extruded apically by conventional filing and Canal Master techniques. J Endod 1991;17(6):275–279. DOI: 10.1016/S0099-2399(06)81866-2.
Sharma U, Sharma J, Sharma M, et al. Quantitative evaluation of apically extruded debris during root canal instrumentation with reciproc, wave one, protaper universal and one shape file system - an in vitro study. EC Dent Sci 2019;18(4):812–822. Available from: https://www.ecronicon.com/ecde/pdf/ECDE-18-00992.pdf.
Alani MA and Al-Huwaizi H. Evaluation of apically extruded debris and irrigants during root canal preparation using different rotary instrumentation systems: an in vitro comparative study. Int J Med Res Health Sci 2019;8(2):21–26. Available from: https://www.ijmrhs. com/medical-research/evaluation-of-apically-extruded-debris-andirrigants- during-root-canal-preparation-using-different-rotaryinstrumentatio. pdf.
Adl A, Sahebi S, Moazami F, et al. Comparison of apical debris extrusion using a conventional and two rotary techniques. Iran Endod J 2009;4(4):135–138. PMID: 24019834. PMCID: PMC3766620.
Hof R, Perevalov V, Eltanani M, et al. The self-adjusting file (SAF). Part 2: mechanical analysis. J Endod 2010;36:691–696. DOI: 10.1016/j. joen.2009.12.028.
Ozsu D, Karatas E, Arslan H, et al. Quantitative evaluation of apically extruded debris during root canal instrumentation with ProTaper universal, ProTaper next, WaveOne, and self-adjusting file systems. Eur J Dent 2014;8:504–508. DOI: 10.4103/1305-7456.143633.
Dietrich MA, Kirkpatrick TC, Yaccino JM. In vitro canal and isthmus debris removal of the self-adjusting file, K3, and WaveOne files in the mesial root of human mandibular molars. J Endod 2012;38:1140–1144. DOI: 10.1016/j.joen.2012.05.007.
Pawar AM, Pawar MG, Metzger Z, et al. The self-adjusting file instrumentation results in less debris extrusion apically when compared to WaveOne and ProTaper NEXT. J Conserv Dent 2015;18:89–93. DOI: 10.4103/0972-0707.153057.
Vyavahare NK, Raghavendra SS, Desai NN. Comparative evaluation of apically extruded debris with V-taper, ProTaper next, and the self-adjusting file systems. J Conserv Dent 2016;19:235–238. DOI: 10.4103/0972-0707.181939.
Tinaz AC, Alacam T, Uzun O, et al. The effect of disruption of apical constriction on periapical extrusion. J Endod 2005;31(7):533–535. DOI: 10.1097/01.don.0000152294.35507.35.
Lambrianidis T, Tosounidou E, Tzoanopoulou M. The effect of maintaining apical patency on periapical extrusion. J Endod 2001;27(11):696–698. DOI: 10.1097/00004770-200111000-00011.
Mohammed Sadique KP, Anshana DM, Ravi SV, et al. Comparative evaluation of apical extrusion of E Faecalis using hand and rotary systems. Saudi J Oral Dent Res 2016;1(2):84–89. DOI: 10.21276/sjodr.2016.1.2.10.
