Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Saraswati Dental College
Lucknow
On Sep 2018




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Calcutta National Medical College & Hospital , Kolkata




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On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : June | Volume : 17 | Issue : 6 | Page : ZC67 - ZC71 Full Version

Comparative Evaluation of Apical Debris Extrusion from the Root Canal using Hand Files, Continuous Rotary Files and Reciprocating File System: An In-vitro Study


Published: June 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/62318.18128
Gagandeep Singh, Navneet Kukreja, Rajan Dhawan, Anamika Thakur, Sunpreet Kaur, Swati Chhabra

1. Private Practitioner, Shri Guru Ramdas Dental Clinic and Implant Centre, Qilla Road, Near Purani Tehsil, Mukerian, Hoshiarpur, Punjab, India. 2. Professor and Head, Department of Conservative Dentistry and Endodontics, MM College of Dental Sciences and Research, Maharishi Markandeshwar (Deemed to be University), Mullana (Ambala), Haryana, India. 3. Professor, Department of Conservative Dentistry and Endodontics, MM College of Dental Sciences and Research, Maharishi Markandeshwar (Deemed to be University), Mullana (Ambala), Haryana, India. 4. Associate Professor, Department of Conservative Dentistry and Endodontics, MM College of Dental Sciences and Research, Maharishi Markandeshwar (Deemed to be University), Mullana (Ambala), Haryana, India. 5. Associate Professor, Department of Conservative Dentistry and Endodontics, MM College of Dental Sciences and Research, Maharishi Markandeshwar (Deemed to be University), Mullana (Ambala), Haryana, India. 6. Assistant Professor, Departmen

Correspondence Address :
Dr. Anamika Thakur,
#811-C, Tower 8, Trishla City, Zirakpur-140603, Punjab, India.
E-mail: anamikathakur1984@gmail.com

Abstract

Introduction: Root canal preparation is an important step of endodontic therapy. For successful endodontic therapy apical extrusion of debris through the apical foramen into the peri-radicular region should be minimal to avoid postoperative complication such as flare-ups.

Aim: To evaluate in-vitro, extrusion of apical debris from the root canal using continuous rotary files (using multiple files system and single rotary file system), reciprocating file system and hand files.

Materials and Methods: This in-vitro research was carried out in the Department of Conservative Dentistry and Endodontics, MM college of Dental Sciences and Research, Mullana, Ambala, Haryana, India, from November 2017 to January 2018. A total of 120 human mandibular premolar teeth that were caries free and single-rooted were split into four groups (each group with n=30) Group I: Hand ProTaper, Group II: Protaper Universal, Group III: F360 and Group IV: WaveOne Gold file system. The root canal was instrumented according to manufacturer’s Instructions; and standardised irrigation with distilled water was performed. The Myers and Montgomery’s Model was employed to gather irrigant and debris that had been apically ejected. The analysis of data obtained was done using Posthoc Bonferroni test, One-way Analysis of Variance (ANOVA) and paired t-test.

Results: The findings indicate that all instrumentation techniques produced significant amount of extruded debris and irrigant. The mean apical debris extrusion using the One-way ANOVA test showed significant difference (p-value <0.001). WaveOne Gold file group showed least (0.0005±0.0001 mg) and Hand ProTaper file showed maximum (0.0017±0.0002 mg) apical debris and irrigant extrusion.

Conclusion: Less apical extrusion of irrigant and debris was observed in the engine-driven nickel-titanium systems than manual technique. Reciprocating file system when compared with hand and continuous rotary file system showed less debris extrusion.

Keywords

Irrigant, Protaper, Rotary endodontics, Single file system, WaveOne gold file

In endodontic treatment, root canal preparation plays key role, for successful treatment, vital, necrosed tissue and dentinal debris must be removed from the root canal system [1,2]. However, there are chances that these materials get extruded during root canal preparation into the periapical tissues via apical foramen resulting in postoperative complications (such as flare-up), which is characterised by pain, periapical inflammation and swelling (3).

The root canal anatomy, instrument type, design and kinematics are the various variables which determine the apical extrusion of the debris. Studies have shown that less extrusion of debris with both crown-down and balanced force technique when compared with hand instrumentation using step back technique [4-6]. Biomechanical preparation of root canal can be done using hand files or rotary endodontic instruments. The two major movements that rotary instruments utilises are continuous rotating full sequence and reciprocating motion (7).

ProTaper Hand files (Dentsply Maillefer, Ballaigues, Switzerland) is a multiple file system consisting of shaping instruments (Sx, S1, S2) and finishing instrument (F1, F2, F3). ProTaper Universal NiTi rotary file system (Dentsply Tulsa Dental) was designed to offer more flexibility, greater safety and supreme efficiency (8). WaveOne (Dentsply/Maillefer, Ballaigues, Switzerland) single file systems are recommended for single use and feature a particular motor that executes the reciprocating motion (i.e. alternating clockwise and counterclockwise) (3),(9).

The F360 (Komet, Brasseler GmbH & Co., Lemgo, Germany) is a single-use and consists of two file system with tip diameter 25 and 35 (4% taper). It has an improved S-shaped cross-sectional design with improved cutting efficiency, increased flexibility with large chip space and a twisted blade in order to flush out all the infected debris (10),(11).

As endodontic instruments differ in design and use, therefore a lot of variances is seen in apical extrusion of debris. Dagna A et al., performed Scanning Electron Microscope (SEM) evaluation of cleaning efficiency with F360 and F6 Skytaper (10). Bürklein S et al., and Ehsani M et al., performed evaluation of apically extruded debris quantitatively using F360 with different file systems (12),(13). But still limited evidence is there that has assessed the amount of dentinal debris extruded during preparation with single rotary file system (F360 files system) and its comparison with reciprocation system. Thus, the present study was carried out with the null hypothesis to evaluate the extrusion of the debris from the apical portion of the root canal using hand, continuous (multiple and single rotary file system) and reciprocating file system.

Material and Methods

The present in-vitro study was performed in the Department of Conservative Dentistry and Endodontics, MM College of Dental Sciences and Research, Mullana, Ambala, Haryana, India, from November 2017 to January 2018. This study was approved by Review Board and Institutional Ethical Committee (IEC/726).
Sample size calculation: As per open EPI software version 3 (95% confidence interval and power of study 80%). The study’s sample size calculation resulted in 28 samples per group, which were rounded up to 30 samples per group.

Inclusion criteria: Intact single-rooted mandibular premolar, extracted due to orthodontic and periodontal reason with mature apices with 0-10 degree curvature (according to Schneider method) were selected, confirmed with radiographs and then were included in the study (3).

Exclusion criteria: Teeth with root caries, calcification and open apices were excluded from the study.

Study Procedure

Preparation of sample: The teeth sample collected were cleaned with ultrasonic scaler to remove any soft tissue, gross debris and calculus deposits and were kept in 0.1% thymol as antifungal agent until their use. Each tooth’s buccal cusp edge was flattened as a reference point using Endoaccess bur no. 2 (Dentsply Maillefer, Switzerland), to maintain length to 20 mm. The coronal access cavity was prepared and 10K file (Dentsply Maillefer, Switzerland) was used to check apical patency of all the canals. The apical width was approximated to a snug fit with a K file of size 15. The Working Length (WL) was achieved by subtracting 1 mm from apical foramen. Irrigation during instrumentation was done using 2 mL distilled water. The selected teeth were randomly assigned to four equal groups:

Group I: Hand ProTaper files (n=30): Protaper hand files were used for specimen preparation, according to manufacturer’s instructions in a crown-down manner using a gentle in and out motions. Firstly, SX shaping file was used to 2 mm short of the working length, followed by S1 and then S2 files for coronal two-third of the canal. The apical one-third of the canal was then finished using F1 and F2 files, sequentially upto the working length. (Sequence: S1-Sx-S2-F1-F2)

Group II : Protaper Universal (n=30): The specimens were prepared with protaper rotary files in a crown-down manner according to manufacturer’s instructions using a gentle in-and-out motions by torque-controlled electric motor (X-mart plus; Dentsply Maillefer). First, the shaping file SX was used upto 2 mm short of the working length, followed by S1 and S2 for the coronal two-third shaping of the canal. For apical one-third of the canal, F1 and F2 were used sequentially till working length. (Sequence: S1-Sx-S2-F1-F2).

Group III : F360 (n=30): A F360 file (Komet, Brasseler GmbH & CO., Lemago, Germany) with a size 25 at tip and taper 0.04 was used, with 300 rpm of rotational speed and 1.8 Ncm torque.

Group IV : WaveOne Gold (n=30): The WaveOne Primary file (25/08) was used with X-mart plus endomotor according to manufacturer’s instructions. The file was used with an amplitude of 3 mm in a smooth back-and-forth motion. After three passes, dense sponge was used to clean the blades. Next, 2 mL of distilled water was used to irrigate the canal. At least three times, this procedure was repeated until the file reached the WL.

Debris collection: Myers and Montgomery’s experiment model (1991) was used to assess the extruded debris (14). All tubes were incubated (at 37°C) in a biological incubator for 15 days; to evaporate the remaining irrigating solution from the tubes. The 68Eppendorf Tubes were preweighed using the analytical balance (Sartorius-Germany) with an accuracy of 10-4. The Eppendorf tubes’ stoppers were created with an opening, and the teeth were put through the orifice until the Cemento-enamel Junction (CEJ) was 1-2 mm above the stopper. A rubber-dam sheet was used to check seepage of overflowing irrigant during irrigation and this assembly was fitted onto a glass vial (Table/Fig 1),(Table/Fig 2).

Statistical Analysis

Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) software version 22.0 (Chicago. IL, USA). Data collected was analysed statistically to compare between the groups by using paired t-test, One-way ANOVA test and Posthoc Bonferroni test for multiple comparison. Level of statistical significance was set at p-value <0.05.

Results

Hand ProTaper file showed maximum and WaveOne Gold file group showed the least apical debris and irrigant extrusion. The mean apical debris extrusion using the One-way ANOVA test showed significant difference (p-value <0.001), when compared between Hand ProTaper, Protaper Universal, F360 and WaveOne Gold groups (Table/Fig 3).

The comparison of mean pre and post weight was done using the paired t-test. The mean weight increased significantly from pre to post weight measurement in all the groups (Table/Fig 4). The intergroup comparison of mean apical debris extrusion was done using the Posthoc Bonferroni test. Hand ProTaper had significantly more apical extrusion of debris followed by ProTaper Universal, then F360 and least with WaveOne Gold file system (Table/Fig 5).

Discussion

Major cause of intertreatment flare-ups and postoperative pain after root canal treatment is apical extrusion of debris during root canal preparation (15). The amount of extruded debris is affected by multiple factors, including design, number, and size of the instruments used in each system, preparation technique, and kinematics (16). Thus, the present study aim was to compare and evaluate hand, continuous rotary and reciprocating files regarding the amount of apically extruded debris after preparation of root canals of permanent mandibular premolar. As the presence of more than one canal may alter the final quantity of apical extrusion, the present study examined single-rooted mandibular premolars with a single apical foramen (17),(18).

Because distilled water does not have the same solvent effect as NaOCl, it was used as an irrigant in all of the experimental groups. As a result, the extrusion of debris is only dependent on the mechanical activity of the instruments. Additionally, the sodium crystallisation phenomenon is a side-effect of using NaOCl, which may have impacted the study’s findings (19). The amount of debris extruded apically has been measured using a variety of approaches, including the scoring system and microbalance weighing. The Myers and Montgomery’s method affords more precise measurements, repeatable and standardised method, hence was used in the present study (16),(20).

The result showed that the WaveOne Gold (Group IV) files produced significantly less debris than F360 (Group III), Universal Protaper (Group II) And Hand ProTaper (Group I) files. The result of present study is in accordance with previous study Cavides-Bucheli J et al., and Tomer AK et al., which claimed that balanced force and pressure-less mechanics are the factors for decreased debris extrusion of reciprocating systems (20),(21).

WaveOne Gold’s unique design includes an alternating cross-section that allows only one cutting edge to come into contact with the canal wall, thereby, decreasing the contact area between the file and canal. Thereby, providing more space for coronal debris removal and less extrusion of apical debris. These results are similar to the study which concluded that the reciprocating system produced smaller quantities of apical debris compared to the continuous rotary file system (22),(23),(24).

The F360 file taper (4%) is smaller when compared to the tapers of ProTaper Hand (8%), further the cross-sectional designs of the F360 is S-shaped which facilitate the movement of debris in coronal direction hence less debris extrusion when compared to Hand ProTaper and Universal Protaper File system (10),(16). Rotary ProTaper Universal System (Group IV) showed less apical extrusion when compared with Hand ProTaper as contact with apical area for rotary ProTaper is for a limited time period and also the torque and rotational speed are fixed (25).

Hand ProTaper had significantly more apical extrusion of debris than rotary instruments (Protaper Universal, F360 and WaveOne Gold), as rotary motion tends to direct debris towards the orifice which will avoid compaction, thereby decreasing the apical debris extrusion, this is in accordance with Goering AC et al., study (24). Comparative evaluation of similar studies has been done in (Table/Fig 6) (3),(21),(22),(26),[227],(28),(29). As a result, it was determined in the current study that rotary devices are superior to manual filing systems because they lessen apical extrusion of debris during canal preparation.

Limitation(s)

The utilisation of various rotary systems with various numbers of files, tapers, rotational speeds, and kinematics was one of the study’s drawbacks. In addition to offering better, more accurate settings to create consistent comparisons between the tested groups, in-vitro investigations could serve as a benchmark for future clinical studies. An in-vivo model may give different result, as no attempt in simulating the presence of vital pulp and periapical tissues has been done as these tissues may act as a natural barrier, inhibiting the extrusion of debris.

Conclusion

The null hypothesis tested stated that the amount of apically extruded debris does not vary in-between the instrumentation systems. According to the findings of the present study, it can be concluded that apical extrusion of debris is an unavoidable consequence of root canal instrumentation. WaveOne Gold (Reciprocating File system) extruded minimum amount of debris because, it is a single file technique having a unique design feature of alternating offset parallelogram-shaped cross-section when compared with Hand ProTaper (hand files), Rotary Protaper (continuous rotary Files) F360 (single rotary file system).

References

1.
Kus¸ tarci A, Akpinar KC, Sumer Z, Er K, Bek B. Apical extrusion of intracanal bacteria following use of various instrumentation techniques. Int Endod J 2008;41(12):1066-71. [crossref][PubMed]
2.
Chapman CE, Collee JG, Beagrie GS. A preliminary report on the correlation between apical infection and instrumentation in endodontics. J Br Ended Soc 1968;2(1):07-11. [crossref][PubMed]
3.
Ozsu D, Karatas E, Arslan H, Topcu MC. Quantitative evaluation of apically extruded debris during root canal instrumentation with ProTaper Universal, ProTaper Next, WaveOne, and self-adjusting file systems. Eur J Dent. 2014;8(4):504-08. [crossref][PubMed]
4.
Al-Omari MA, Dummer PM. Canal blockage and debris extrusion with eight preparation techniques. J Endod. 1995;21(3):154-58. [crossref][PubMed]
5.
Reddy SA, Hicks ML. Apical extrusion of debris using two hand and two rotary instrumentation techniques. J Endod. 1998;24(3):180-83. [crossref][PubMed]
6.
Ruiz-Hubard EE, Gutmann JL, Wagner MJ. A quantitative assessment of canal debris forced periapically during root canal instrumentation using two different techniques. J Endod. 1987;13(12):554-58. [crossref][PubMed]
7.
Ruddle CJ. The ProTaper technique. Endodontic Topics. 2005;10(1):187-90. [crossref]
8.
Azar NG, Ebrahimi G. Apically-extruded debris using the ProTaper system. Aust Endod J. 2005;31(1):21-23. [crossref][PubMed]
9.
van der Vyver P, Vorster M. WaveOne Gold reciprocating instruments: Clinical application in the private practice: Part 1. International Dentistry-African Edition. 2017;7(4):06-19.
10.
Dagna A, Gastaldo G, Beltrami R, Chiesa M, Poggio C. F360 and F6 Skytaper: SEM evaluation of cleaning efficiency. Ann Stomatol (Roma). 2016;12;6(3-4):69-74. [crossref][PubMed]
11.
Boijink D, Costa DD, Hoppe CB, Kopper PMP, Grecca FS. Apically extruded debris in curved root canals using the WaveOne Gold reciprocating and twisted file adaptive systems. J Endod. 2018; 44:1289-92. [crossref][PubMed]
12.
Bürklein S, Benten S, Schäfer E. Quantitative evaluation of apically extruded debris with different single-file systems: Reciproc, F360 and OneShape versus Mtwo. Int Endod J. 2014;47(5):405-09. [crossref][PubMed]
13.
Ehsani M, Farhang R, Harandi A, Tavanafar S, Raoof M, Galledar S. Comparison of Apical Extrusion of Debris by Using Single-File, Full-Sequence Rotary and Reciprocating Systems. J Dent (Tehran). 2016;13(6):394-99.
14.
Myers GL, Montgomery S. A comparison of weights of debris extruded apically by conventional filing and Canal Master techniques. J Endod 1991;17(6):275-79. [crossref][PubMed]
15.
Ferraz CC, Gomes NV, Gomes BP, Zaia AA, Teixeira FB, Souza-Filho FJ. Apical extrusion of debris and irrigants using two hand and three engine-driven instrumentation techniques. Int Endod J. 2001; 34:354-58. [crossref][PubMed]
16.
Üstün Y, Çanakçi BC, Dinçer AN, Er O, Düzgün S. Evaluation of apically extruded debris associated with several Ni-Ti systems. Int Endod J. 2015;48:701-04. [crossref][PubMed]
17.
Madhusudhana K, Mathew VB, Reddy NM. Apical extrusion of debris and irrigants using hand and three rotary instrumentation systems- An in vitro study. Contemp Clin Dent. 2010;1(4):234-36. [crossref][PubMed]
18.
Ghogre P, Chourasia HR, Agarwal M, Singh MP, Gurav S, Ghogre R. Quantitative evaluation of apical extrusion of intracanal bacteria using rotary ProTaper, K3XF, twisted and hand K file system: An ex vivo study. Indian J Dent Res. 2015;26(4):406-10. [crossref][PubMed]
19.
Tanalp J, Gungor T. Apical extrusion of debris: A literature review of an inherent occurrence during root canal treatment. Int Endod J. 2014;47:211-21. [crossref][PubMed]
20.
Caviedes-Bucheli J, Castellanos F, Vasquez N, Ulate E, Munoz HR. 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. Int Endod J. 2016;49:255-70. [crossref][PubMed]
21.
Tomer AK, Mangat P, Mullick S, Dubey S, Chauhan P, Kumari A, et al. Quantitative evaluation of apically extruded debris of different single file systems: Wave One Gold, One Shape, F360, and Reciproc: An in vitro Study. International Journal of Oral Care and Research. 2017;5(1):65-67. [crossref]
22.
Tinoco JM, De-Deus G, Tinoco EM, Saavedra F, Fidel RA, Sassone LM. Apical extrusion of bacteria when using reciprocating single-file and rotary multifile instrumentation systems. Int Endod J. 2014;47(6):560-66. [crossref][PubMed]
23.
Beeson TJ, Hartwell GR, Thornton JD, Gunsolley JC. Comparison of debris extruded apically in straight canals: Conventional filing versus profile. 04 Taper series 29. J Endod. 1998;24(1):18-22. [crossref][PubMed]
24.
Goering AC, Michelich RJ, Schultz HH. Instrumentation of root canals in molar using the step-down technique. J Endod. 1982;8(12):550-54. [crossref][PubMed]
25.
Kalra P, Rao A, Suman E, Shenoy R, Suprabha BS. Evaluation of conventional, protaper hand and protaper rotary instrumentation system for apical extrusion of debris, irrigants and bacteria- An in vitro randomized trial. J Clin Exp Dent. 2017;1:9(2):e254-58. [crossref][PubMed]
26.
Keskin C, Sariyilmaz E. Apically extruded debris and irrigants during root canal filling material removal using Reciproc Blue, WaveOne Gold, R-Endo and ProTaper Next systems. J Dent Res Dent Clin Dent Prospects. 2018;12(4):272-76. [crossref][PubMed]
27.
Elashiry MM, Saber SE, Elashry SH. Apical extrusion of debris after canal shaping with three single-file systems. Niger J Clin Pract. 2020;23(1):79-83.[crossref][PubMed]
28.
Roshdy NN, Hassan R. Quantitative evaluation of apically extruded debris using TRUShape, TruNatomy, and WaveOne Gold in curved canals. BDJ open. 2022;8(1):13. [crossref][PubMed]
29.
AlChalabi A, Alkhalidi E, Chakmakchi M. Apically extruded debris during instrumentation using different engine driven file systems: A comparative in vitro study. Maced J Med Sci. 2022;10(D):104-08.[crossref]

DOI and Others

DOI: 10.7860/JCDR/2023/62318.18128

Date of Submission: Dec 16, 2022
Date of Peer Review: Jan 17, 2023
Date of Acceptance: Apr 08, 2023
Date of Publishing: Jun 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Dec 17, 2022
• Manual Googling: Feb 15, 2023
• iThenticate Software: Mar 16, 2023 (17%)

ETYMOLOGY: Author Origin

EMENDATIONS: 8

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