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ORIGINAL RESEARCH
Year : 2023 | Volume
: 14
| Issue : 1 | Page : 25-28
Assessment of the amount of apically extruded debris using three different reciprocating single endodontic file systems: An ex vivo study
Hasanain M Alnajm1, Biland MS Shukri2
1 Ministry of Health, Karbala, Iraq
2 Department of Conservative Dentistry, College of Dentistry, Mustansiriyah University, Baghdad, Iraq
Correspondence Address:
Hasanain M Alnajm
Ministry of Health, Karbala
Iraq
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/denthyp.denthyp_163_22
Introduction: This study aimed to assess the amount of apical extrusion of debris after root canal instrumentation with three different reciprocating single endodontic file systems including R-motion, Edge One Fire, and Reciproc Blue. Methods: Forty-five human upper first molars that were extracted for periodontal reason included in the study and randomly assigned among three study groups (n = 15). Reciproc Blue, R-motion, and Edge One files were used to instrument the palatal root. Amount of apical extrusion of debris was assessed using the empty tube model of Myers and Montgomery. Data were analyzed blindly via one-way ANOVA and the Tukey post hoc test using R. Results: There was statistically significant difference among study groups (p < 0 .001). Post hoc test showed nonsignificant difference among Edge One and Reciproc Blue groups (p = 0.106). The difference between R-motion and Reciproc Blue was marginally significant (p = 0.055). Conclusion: Within the limitations of this study, R-Motion showed the most amount of apically extruded debris followed by Reciproc Blue and Edge One.
Keywords: apical extrusion, debris, Edge One Fire, empty tube model, endodontics, Reciproc Blue, reciprocating files, R-motion, root canal preparation, single file systems
It is well known that during root canal preparation, dentin, pulp tissue debris, and irrigating solutions may protrude into peri-apical tissues, leading to adverse consequences such as postoperative pain, inflammation, flare-up, and even postponement of the process of healing. Root canal preparation instruments and techniques extrude different amounts of root canal contents outside the apical foramen. A systematic review reported that reciprocating files be likely to extrude more debris than the continuous rotating files, but several controversial results have been reported in the literature.[1]
The literature outlines several novel instrumentation approaches to prepare root canals using a single nickel-titanium (NiTi) file with various designs, alloys, and kinematics. A new version of the single-file system used in reciprocation, Reciproc Blue, has been introduced by VDW (VDW, Munich, Germany). With an S-shaped horizontal cross-section and two cutting edges, Reciproc Blue resembles the Reciproc file; however, its structure has been upgraded with a new heat treatment, rendering it more flexible.[2] This innovative heat treatment procedure gives the file a blue color.[3]
The R-Motion (FKG Dentaire, La-Chaux-de-Fonds, Switzerland) is among the newly advertised reciprocating files. Its rounded triangular cross-section, combined with its thin core, allows the instrument to cut efficiently and provides more space for the file to travel along the variable canal anatomy.[4]
Edge One Fire features Heat-Treated Fire-Wire NiTi; its design shapes canals in a reverse-reciprocating motion. Edge One Fire was used with existing handpieces operated at the WaveOne® Gold parameter. Edge One Fire tests at twice the cyclic fatigue as WaveOne® Gold. Edge One Fire is available in four sizes, and this study used the primary one. Files have a parallelogram-shaped cross-section with a variable taper.[5]
Even extensive research did not unearth literature that measured the debris, which the files mentioned above may apically extrude.
This study aimed to assess the amount of apical extrusion of debris after root canal instrumentation with three different reciprocating single endodontic file systems including R-motion, Edge One Fire, and Reciproc Blue.
Materials and methodsThe local ethical committee of Mustansiriyah University approved the study protocol (Reference number: REC119, Apr 15, 2022). In line with a previous study by Fontana et al.[6] and prior work by Uslu et al.[13] to detect a difference of 0.0024 between groups, statistical power of 0.80, an alpha level of 0.05, and a sample size of 15 specimens per group would be required. Forty-five palatal roots of maxillary first molar teeth extracted for periodontal reasons included in the study and randomly assigned using www.random.org. All selected roots were required to have mature apices with a single apical foramen, no resorption/calcification, and no previous root canal treatment. The roots were disinfected using 0.5% chloramine-T trihydrate solution (Merck KGaA, Darmstadt, Germany) for 1 week. The root had to have 10- to 20-degree curvature.[7] After the intervention assignment, the data assessor and analyst was blinded.
The roots’ external surfaces were mechanically cleaned of soft and hard tissue debris using sharp periodontal cumine scaler. The canals were confirmed with a #10 K-file (Dentsply-Maillefer, Ballaigues, Switzerland). Additionally, the size of the apical foramen of the roots was determined with a #15 K-file to be less than 0.15 mm. The #10 K-file was advanced through the canal until the tip was visible through the major apical foramen; subtracting 1 mm from this measurement calculated the working length. Then, roots with comparable lengths (12 mm) were selected for standardization.
The investigation used 45 glass vials with rubber stoppers. First, heated instruments were employed to produce holes in the center of the rubber stopper, and individual root was put into the holes with pressure. Next, the glass vials were fitted with rubber stoppers and vented with a 27-gauge needle alongside the rubber stopper. Following this, empty vials with no stopper were weighed three times on an electronic balance, KERN (Kern & Sohn, Stuttgart, Germany), and the average weights were recorded in grams. Next, a rubber stopper with connected teeth was repositioned on the preweight vials.
Each tooth’s root canal was prepared with a new file. After three pecking motions, the file was removed from the canal in all groups, and an alcohol-soaked gauze strip aided the removal of debris attached to the file. Four milliliter of distilled water was used for irrigation of the root canals during instrumentation and 3 mL as a final flush. A 30-gauge, side-perforated and closed-ended needle facilitated the irrigation of each sample to the same level reached by the instrument during instrumentation (NaviTip; Ultradent, Utah, USA). The external surface of the root was washed with 2 mL distilled water with a 25-gauge tip vented needle to collect any adhering debris on the apical part of the root into the collecting glass vial.[8]
The Reciproc Blue (R25) group file was used with the respectively named software on the X-Smart IQ Endo Motor (Dentsply Sirona, Charlotte, USA) in a pecking motion with gentle strokes, as recommended by the manufacturer.
In the R-motion 25 reciprocating file motion group, the file was used with the FKG Rooter Universal Endo Motor (FKG Dentaire, La Chaux de Fonds, Switzerland) in a preset setting of reciprocation at the speed and torque values recommended by the manufacturer.
In Edge One Fire group, the PRIMARY file was employed in the preset program specific for the Wave One Gold instruments on the X-Smart IQ Endo Motor. Because the Edge One Fire does not have a preset motion, manufacturers claim it is fully compatible with the Wave One Gold program.[5]
After completing the root canal instrumentation, the root-cap assembly will be separated from the glass vial. Then the external surface of the root will be rinsed with 2 mL of distilled water into the glass vial to collect any adhering debris. The vials with the collected samples will be placed in a hot air oven at 100° C for 2 hours and checked every half hour until dry; then, they will be removed from the oven.[9]
Upon cooling, the vials will be weighed in the same way and circumstance as preinstrumentation weightings to avoid any errors. Three consecutive weights will be recorded blindly and the mean value will be calculated to represent the postinstrumentation weight. Subtracting the vial’s preweight from its postweight will determine each group’s debris weight.[10]
Data were analyzed blindly via one-way ANOVA and the Tukey post hoc test using R 3.6.3 software (R Foundation for Statistical Computing, Vienna, Austria).
ResultsThere was statistically significant difference among study groups (p < 0 .001). Post hoc test showed nonsignificant difference among Edge One and Reciproc Blue groups (p = 0.106). The difference between R-motion and Reciproc Blue was marginally significant (p = 0.055) [Figure 1].
Figure 1 Box and whisker plot displayed deviation in the amount of apically extruded debris. Discussion The present study used the same methodology as Myers and Montgomery as a standard method without modification.[11] We used distilled water instead of sodium hypochlorite to prevent any excess weight of debris extrusion because NaOCl crystallizes postextrusion.[7]
R-Motion (4.48e-4 g) showed the most amount of apically extruded debris followed by Reciproc Blue (3.30e-4 g) and Edge One (2.28e-4 g). To our knowledge apically, assessment of the extruded debris related to R-Motion and Edge One rarely reported in the literature. Abi Saad C and Abiad R reported 0.0885 mg apically extruded debris for R-Motion and 0.0657 mg for Reciproc Blue.[12] Uslu G, et al., reported 0.0115 mg,[13] Keskin C and Sariyilmaz E reported 0.054 mg,[14] and Amaral AP, et al., reported 0.0028 g[15] extruded debris for Reciproc Blue.
The design of the Reciproc Blue file is an S-shaped horizontal cross-sectional design and variable taper with only two cutting blades that touch the walls of the root’s dentin. A new heat treatment made the file’s metallurgy more flexible, lowering the instrument’s cutting efficiency and hence less debris production.[13]
The noncutting file tip gently treats near the apex, contributing to less apical extrusion of debris.[16] In addition, the progressive taper of the file provides ample space for the debris between the file and the dentine wall, allowing for debris removal in a coronal direction.[17] This spacing could be the main reason for the lessened apical debris in this study among the other files.
The R-Motion is flexible and resistant to cyclic fatigue.[18] Resulting in 60% less transportation than standard reciprocating NiTi systems,[19] R-Motion delivers better centering and respect for the canal anatomy and up to 40% less dentinal stress. It is less invasive than other files because of the thinner core sizes of R-Motion instruments; this decreases the risk of excessive dentine removal and minimizes the impact on the noninfected areas.[18] The unique R-Motion design and thinner core size reduce stress on dentine during root canal treatment. The sharp cutting edges, rounded triangular cross-section, and new, optimized file tip combine to maximize cutting efficiency down to the apex while preserving dentine.[18] Yet, in this study R-Motion showed the most amount of apically extruded debris.The Edge One Fire has a variable taper parallelogram cross-section; this may be the chief cause of the lowest apical extrusion of debris between the three groups in the present study. Edge One Fire files are flexible and strong enough to cut dentin and resist torsional forces. Firewire alloy’s three-dimensional crystalline matrix is unusual, making the instruments very flexible and resistant to cyclic fatigue.[20]
This research is limited by its ex vivo nature; the study conditions thus misfit in vivo ones. The method’s inability to successfully imitate apical vital tissues is its primary drawback. The presence of periapical tissues around the foramen may impede extrusion of debris and irrigating fluids from the apical foramen in vivo. Furthermore, the effects may vary depending on the resistance of the periapical tissues in each instance. This study has no apical tissues to perform as an apical extrusion’s natural barrier. However, we attempted to minimize the bias via blinding during the intervention, data collection, and analysis.
The study was not funded by any agency or organization.
Financial support and sponsorship
Nil.
Conflicts of interest
The authors declare that they do not have any conflict of interest.
References
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