The influence of two reciprocating single‐file and two rotary‐file systems on the apical extrusion of debris and its biological relationship with symptomatic apical periodontitis. A systematic review and meta‐analysis

Abstract

This systematic review and meta-analysis investigated the influence of the number of files (full-sequence rotary-file versus reciprocating single-file systems) used during root canal preparation on the apical extrusion of debris and its biological relationship with the occurrence of symptomatic apical periodontitis. An extensive literature research was carried out in the Medline, ISI Web of Science and Cochrane databases, for relevant articles with the keyword search strategy. Based on inclusion and exclusion criteria, two reviewers independently rated the quality of each study determining the level of evidence of the articles selected. The primary outcome for the meta-analysis was determined by the amount of debris extruded into the periapical tissue during root canal preparation with multiple- or single-file systems in four laboratory studies. Analysis of in vivo release of neuropeptides (SP and CGRP) after root canal preparation with single- or multiple-file systems was also carried out. Amongst the 128 articles initially found, 113 were excluded for being nonrelevant or not fulfilling the selection criteria. Another four articles were excluded after methodology evaluation. Finally, nine laboratory studies and two in vivo studies were included in the systematic review. Four of the laboratory studies were further included for meta-analysis that revealed greater debris extrusion after the use of single-file techniques when compared to multiple-file systems. Analysis of in vivo neuropeptide expression in the periodontal ligament suggests that the design of the instrument is more important than the number of files used. Both rotary and reciprocating single-file systems generate apical extrusion of debris in laboratory studies, or expression of neuropeptides in vivo. Available evidence is limited, but supports the fact that this inflammatory reaction is not influenced by the number of files but the type of movement and the instrument design.

Apical extrusion of debris in four different endodontic instrumentation systems: A meta-analysis

“…A systematic review and meta-analysis conducted by Caviedes-Bucheli[8] concluded that inflammatory reaction due to apical extrusion of debris is not influenced by the number of files but the type of movement and the instrument design. Therefore, this meta-analysis aims at comparing four different endodontic instrumentation systems showing varied type of movements (manual, rotary, reciprocation, and transline in-and-out vibratory motion).…”

Apical transportation and canal straightening with different continuously tapered rotary file systems in severely curved root canals: F6 SkyTaper and OneShape versus Mtwo

“…, Caviedes‐Bucheli et al . ) and showed were associated with good cleaning efficiency in terms of debris and smear layer removal (Dagna et al . ).…”

Multiple-file vs. single-file endodontics in dental practice: a study in routine care

“…Recently it was demonstrated that different root canal preparation techniques lead to the expression of different levels of inflammatory neuropeptides in the periapical periodontal ligament linked with the possible emergence of symptomatic apical periodontitis (Caviedes-Bucheli et al, 2013). It is believed that this is connected to the different amounts of extruded debris beyond the apical foramen (Caviedes-Bucheli et al, 2016). Since nearly all root canal instrumentation techniques including hand instrumentation as well as engine driven instruments lead to apical extrusion of debris (Al-Omari & Dummer, 1995; Bürklein & Schäfer, 2012; Capar et al, 2014; De-Deus et al, 2010) in most cases there will be an inflammatory response to a certain extent.…”

“…In an in-vitro study reciprocating instruments extruded more debris than rotary instruments (Bürklein & Schäfer, 2012) with Reciproc producing most debris while another in-vitro study found Reciproc to produce significantly less extruded debris compared to rotary techniques (Kocak et al, 2013). The only clinical studies measuring the expression of inflammatory neuropeptides in the periodontal ligament found that the instrument design of engine driven root canal instruments has a greater impact on expression of neuropeptides than the instrumentation technique (Caviedes-Bucheli et al, 2016). Because of this contradictory data situation and the limited knowledge, if the amount of expressed neuropeptides can be directly correlated to the perceived pain it remains unclear if there is an impact on the postoperative pain levels of patients after root canal treatment.…”