Apical extrusion of debris: a literature review of an inherent occurrence during root canal treatment

Abstract

Extrusion of intracanal debris as well as irrigants is a common occurrence during root canal treatment, and no instrument or technique has thoroughly solved this problem. Because flare-ups may arise with any irritation directed towards periapical tissues, a shaping or irrigation technique should minimize the risk of apical extrusion, even though it may not be prevented. There has been a rapid evolution of root canal instruments and irrigation systems through the last decade, and many have been assessed for their debris extrusion potential. The purpose of this review was to identify publications regarding the evaluation of debris, bacteria and irrigant extrusion during root canal treatment. A PubMed, Ovid and MEDLINE search was conducted using the keywords "apical extrusion", "debris extrusion" and "endodontic treatment". The literature search extended over a period of more than 30 years up to 2012. Content of the review was limited to apical extrusion of debris and irrigants, extrusion of liquid by irrigation methods and bacterial extrusion. Issues relevant to apical extrusion were obtained by further search in the reference sections of the retrieved articles. The review provides an update on the current status of apical extrusion.

Apically extruded debris in filling removal of curved canals using 3 NiTi systems and hand files

“…The system that has been adopted by most studies was described by Myers and Montgomery (13), which consists of a rubber stopper, a glass vial and a flask made of glass. The assembly where the tooth is placed should be secured to prevent movement, and the flask should be shielded using a rubber dam so that the operator is not able to see the debris, simulating a clinical working environment (14).…”

The effect of four irrigation techniques on the amount of apically extruded debris in pulpectomy of primary teeth

“…There are several laboratory experimental set-ups to examine apically extruded debris. 12,28 In this study, we used the system described by Myers and Montgomery 28 to evaluate the amount of apically extruded debris. This system is the most known and used one in dental literature.…”

“…7,11 These extruded materials can cause periradicular inflammation, post-operative pain and failure after treatment. 12 Also, extruded materials can have toxic effects on underlying tooth germ during endodontic treatment. 13 Thus, prevention of the cytotoxic effects of apically extruded debris and irrigants on the periapical tissues and tooth germs is a relevant factor for safety endodontic procedures in pediatric root canal therapy.…”

“…As an important clinical factor during pedodontic patients treatment, and also because of its use of single-file with continuous irrigation, SAF can clinically reduce treatment time in primary teeth. Although several studies have examined the irrigation systems in permanent teeth regarding apical extrusion, 12,[21][22][23][24] to our knowledge, to date there is no study which is conducted in primary teeth. The anatomical variations show more importance and difference in primary teeth than permanent teeth, 7 since as physiological or pathological resorption begins and extends into the primary roots, resulting in additional anatomical communications with the periapical tissues that cause easily extrusion of intracanal content and irrigants to periapical tissue.…”

Glide Path in Endodontics

“…21 Microhardness values of human dentin may affect extrusion of debris. 22 In teeth with lower hardness, debris may be extruded more readily into the periapical tissues. But, ultimately, the amount of apically extruded debris was decreased when a glide path was created before canal preparation.…”