Extrusion of debris with and without intentional foraminal enlargement – A systematic review and meta‐analysis

Machado, Ricardo; Vigarani, Gislayne; Macoppi, Tainara; Reinke, Stella Maria Glaci; Gonçalves, Ana Cristina Kovalik

doi:10.1111/aej.12539

Cited by 6 publications

(4 citation statements)

References 55 publications

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“…One of these limitations is that the tooth apex was exposed to air and the periapical tissues were not replicated. Therefore, the findings from this study, like the previous ones, cannot be completely extrapolated to a clinical scenario where the apex is surrounded by periodontal tissues that could potentially limit apical extrusion [28]. Some previous studies have proposed the use of flower foam to simulate the back pressure exerted by periapical tissues [29, 30], but this method has also faced criticism because the foam may absorb irrigant while acting as a barrier [29].…”

Section: Discussionmentioning

confidence: 91%

The use of sodium hypochlorite mixed with etidronic acid during canal preparation increases debris extrusion

Tartari,

Wilchenski,

de Souza Lima

et al. 2023

Aust Endodontic J

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The purpose of this study was to compare the impact of different irrigation protocols on debris extrusion. Single‐rooted teeth were distributed into groups based on the irrigation protocols (n = 40): 2.5% NaOCl (biomechanical preparation: 20 mL and final irrigation: 5 mL); 2.5% NaOCl (biomechanical preparation: 20 mL) + 17% EDTA (final irrigation: 2 mL) + 2.5% NaOCl (final irrigation: 3 mL); and a mixture of 5% NaOCl +18% HEDP (biomechanical preparation: 20 mL and final irrigation: 5 mL). The canals were prepared using a reciprocating instrument size 40/0.06. For final irrigation, the groups were reassigned based on the agitation methods (n = 10): (a) no agitation; (b) ultrasonic; (c) sonic; and (d) continuous rotation. The control group (n = 10) received saline solution without agitation. The amount of debris extruded was measured by weight and analysed using One‐way ANOVA (α < 0.05). The subgroups treated with NaOCl + HEDP mixture showed a significantly higher amount of extruded debris (p < 0.05), while there was no difference among agitation methods in all groups (p > 0.05).

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Section: Discussionmentioning

confidence: 91%

The use of sodium hypochlorite mixed with etidronic acid during canal preparation increases debris extrusion

Tartari,

Wilchenski,

de Souza Lima

et al. 2023

Aust Endodontic J

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“…There is common sense that associates the extrusion of debris with postoperative pain in necrotic teeth, and IFE could contribute to that. However, Machado et al [ 51 ] conducted a systematic review and meta-analysis to assess whether IFE was responsible for extruding more debris from extracted human teeth with fully formed apexes. Following the recommendations of Preferred Reporting Items for Systematic Review and Meta-Analysis – PRISMA, electronic and manual searches were performed to identify studies that evaluated the extrusion of debris, comparing different apical limits of instrumentation (with/without IFE).…”

Section: Discussionmentioning

confidence: 99%

Postoperative pain after single-visit root canal treatments in necrotic teeth comparing instruments’ kinematics and apical instrumentation limits – a prospective randomized multicenter clinical trial

Machado,

Moreira,

Comparin

et al. 2024

BMC Oral Health

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Objectives This prospective randomized multicenter clinical trial (PRMCT) investigated postoperative pain after single-visit root canal treatments in teeth affected by pulp necrosis (PN), and asymptomatic apical periodontitis (AAP) (with apical radiolucent areas) or normal periradicular tissues (without apical radiolucent areas) comparing different instruments' kinematics and apical instrumentation limits. Methods Before chemomechanical preparation, 240 patients/teeth were randomly distributed into four groups (n = 60) according to the instruments' kinematics (rotary or reciprocating) and apical instrumentation limits (with or without intentional foraminal enlargement [IFE]). After that, specimens were submitted to the same irrigation and obturation techniques, and the patients were referred to undergo the definitive restorations. No medication was prescribed, but the patients were instructed to take either paracetamol (750 mg every 6 h for three days) or ibuprofen (600 mg every 6 h for three days) in pain cases. Postoperative pain incidence and levels were assessed at 24-, 48-, and 72 h following treatment completion according to a verbal rating scale (VRS) following a score. The Kolmogorov–Smirnov test was applied to assess the normality of the data. Mann–Whitney U, Chi-square, Friedman's ANOVA, and Friedman's multiple 2 to 2 comparison tests were employed to identify potential significant statistical differences among the variables in the study groups (P < .05). Results Significant statistical differences were only observed among the groups considering tooth, periradicular status, and the occurrence of overfilling (sealer extrusion) (P < 0.00). Patients with teeth instrumented through rotary kinematics and without IFE experienced lower rates of postoperative pain; however, this difference was relevant only at 24 h (P < 0.05). Conclusions Postoperative pain was lower after using a rotary file system (Profile 04) inserted up to the apical constriction (AC). However, this finding was just statistically meaningful at 24 h. Trial registration This PRMCT was approved by the Human Research Ethics Committee of the Paranaense University – UNIPAR, Francisco Beltrão, PR, Brazil (CAAE. 46,774,621.6.0000.0109) on 02/09/2021. It was registered at The Brazilian Registry of Clinical Trials – ReBEC (RBR-3r967t) on 01/06/2023, was performed according to the Principles of the Helsinki Declaration and is reported following the Consolidated Standards of Reporting Trials Statement.

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“…The amount of extrusion of debris is influenced by factors such as cavity design, preparation technique and the irrigant used [18]. A previous study in mandibular first molars teeth using distilled water testing single‐file systems reported limited differences when two access cavities were compared [4].…”

Section: Discussionmentioning

confidence: 99%

Influence of access cavity design, sodium hypochlorite formulation and XP‐endo Shaper usage on apical debris extrusion – A laboratory investigation

et al. 2022

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This study assessed the amount of apically extruded debris during root canal preparation using XP‐endo shaper and the supplemental use of XP‐endo finisher comparing the use of traditional endodontic access or conservative endodontic access cavities and liquid or gel‐based formulations of 5.25% sodium hypochlorite or distilled water as supplemental agents. Maxillary first premolar teeth (N = 148) were randomly divided based on their access cavity design and sub‐grouped according to the supplemental agent used. The amount of extruded debris was analysed based on the dry weight of the debris collected using a previously established laboratory methodology. Debris extrusion occurred in all groups. Overall, the traditional endodontic access cavity design was associated with more debris extrusion compared to the conservative type. The use of sodium hypochlorite solution showed higher debris extrusion than the gel, whilst distilled water had intermediate values.

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Extrusion of debris with and without intentional foraminal enlargement – A systematic review and meta‐analysis

Cited by 6 publications

References 55 publications

The use of sodium hypochlorite mixed with etidronic acid during canal preparation increases debris extrusion

The use of sodium hypochlorite mixed with etidronic acid during canal preparation increases debris extrusion

Postoperative pain after single-visit root canal treatments in necrotic teeth comparing instruments’ kinematics and apical instrumentation limits – a prospective randomized multicenter clinical trial

Influence of access cavity design, sodium hypochlorite formulation and XP‐endo Shaper usage on apical debris extrusion – A laboratory investigation

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