Establishing Apical Patency: To be or not to be?

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.

GIRFT and Measuring Outcomes in MCNs: endodontics in 646 teeth treated in Tier 2 (Primary Care) and Tier 3 (Secondary Care) settings in England

“…Patency filing may mean the full length of the canal is cleaned, and potentially more damage to the periodontal ligament (PDL), requiring more time to heal. 49 Is it possible that if time and effort is invested in achieving one endodontic objective, the same diligence is applied to other endodontic objectives?…”

Modelos de ensino da Endodontia em cursos de graduação em Odontologia do Estado do Amazonas

“…Outro ponto de divergência entre os cursos analisados foi a patência foraminal, assim como a determinação do comprimento de trabalho, apesar de as características relatadas estarem dentro dos limites aceitáveis pela ciência 19 .…”

Evaluation of apical transportation and apical root sealing in root canals prepared with mtwo rotary system with and without apical enlargement – an in vitro study

“…The success predictability of the root canal therapy does not depend only on the quality of instrumentation and filling, but also on complete elimination of organic substrate and microorganisms from the root canal, including the apical foramen area (Schilder 2006;Silva et al 2016). According to previous study, maintaining the patency of the apical foramen prevents the accumulation of pulp and dentinal debris, which can induce apical blockage, deviation, apical zip and root perforation (Mohammadi et al 2017). In addition, this step aids the penetration of irrigant solution in the apical third, enabling the tridimensional filling of the root canal (Buchanan 2000;Schilder 2006).…”