Evaluation of apically extruded debris during removal of gutta-percha and ResilonTM using different instrumentation techniques

Abstract

Background/Aim. Apical extrusion of material is considered as one of the very important factor for endodontic treatment success. Microorganisms, necrotic tissue, filling material and irrigants, which can be extruded apically during endodontic retreatment, may jeopardize the success of the therapy. The aim of this in vitro study was to quantitatively evaluate the amount of apically extruded debris during endodontic retreatment of teeth obturated with two different materials, using one hand and three rotary instrumentation techniques. Methods. Ninety-six extracted single-rooted teeth were endodontically treated and enlarged to size 40 using BioRaCe system, and then randomly divided into 8 groups of 12 specimens each. Half of the specimens were obturated with gutta-percha and AH Plus® sealer and another half with RealSeal SE system, using lateral condensation technique. Retreatment was performed using: Hedström files; ProFile rotary files; ProTaper Retreatment system and D-RaCe system. Apically extruded debris was collected in pre-weighed Eppendorf tubes and evaluated using an electronic microbalance. Data were analyzed statistically using t-test and analysis of variance. Results. In the AH Plus/gutta-percha group, all tested rotary instruments gave significantly less extruded debris compared with Hedström files (p < 0.05). In theRe-alSeal group, there was significant difference between D-RaCe and Hedström instruments (p < 0.05). Conclusion. All retreatment techniques resulted in apical extrusion. D-RaCe system produced significantly less extruded debris compared to hand files. No significant difference was found when comparing two instruments specially designed for retreatment: D-RaCe and ProTaper systems.

Apical extrusion of root canal filling material during the removal of gutta-percha and resilon

“…This study evaluated three different instruments (Hedstrom, ProTaper and Twisted File) during retreatment and their impact on apically extruded material. The present study showed that in vitro, all of the tested instruments produced apical extrusion of obturation material and these results are consistent with other apical extrusion studies [7,11,12,14,16,18]. As already mentioned, no studies are present in the current literature on the apical extrusion during retreatment with Twisted File instruments.…”

“…In the present study the highest mean score of extruded material during retreatment was observed in the manual Hedstrom group and the lowest when Twisted File rotary instruments were used. The results of the present study are in agreement with previous retreatment studies that also compared hand and engine-driven instruments and their impact on apical extrusion [7,12,14,16,17]. This could be explained with rotation and a crown-down preparation technique during instrumentation, which tends to pull dentinal debris into the flutes of the file and direct it toward the coronal part of the canal [3,19].…”

“…The authors concluded that the type of filling material did not play a statistically significant role on the amount of apically extruded material, which is consistent with the findings of the presented study. Another group of authors [12] evaluated apical extrusion during gutta-percha and resilon removal using a quantitative method, however the results regarding the difference between the two materials were also not statistically significant. Using an instrumentation technique that minimizes apical extrusion would be advantageous.…”

“…The majority of investigations used a quantitative method to determine the amount of apically transported material and debris, by collecting and measuring their amount in grams [12,13,16,20,21]. In some studies the amount of apically extruded filling material during retreatment was detected visually and evaluated with a scoring system [3,11,14], as in the present study.…”

“…Resilon (Resilon Research LLC, Madison, CT, USA) is a thermoplastic synthetic polymer-based root filling material that bonds to dentinal walls when used in conjunction with an adhesive root canal sealer (Epiphany/Real Seal) and forms a "monoblock" within the canal [10]. The retreatment efficacy of this material has been examined, although not in such extent as gutta-percha, while the apical extrusion during resilon removal has been examined in two studies only [11,12].…”