Evaluation of extruded debris by different nickel titanium systems and hand files from apical foramen and simulated root perforation areas

Debris extrusion from perforation

Aim: This study analyzed debris extrusion during canal preparation using different file systems for simulated root perforation areas and the apical foramen.

Methodology: 135 premolars were divided into three main groups (n: 45), and all the main groups were divided into three subgroups (n:15). Group 1 served as the control with no perforations, while Groups 2 and 3 had 0.5-mm-diameter perforation areas created in the apical and middle 1/3 of the buccal root surfaces, respectively. The apical foramen was covered with two layers of nail polish in Groups 2 and 3. In each main group, canals were prepared with hand files (a), ProTaper Next (b) (PTN), and WaveOne Gold (c) (WOG).

Debris weights extruded from the apical foramen in Group 1 and from the perforation areas in Groups 2 and 3 were calculated. Groups were compared with the two-way ANOVA test.

Results: The hand file (a) extruded significantly more debris than the PTN (b) and WOG (c) in Group 1 (P_ab < .001, P_ac< .001) and Group 2 (P_ab= .004, P_ac= .005). In Group 3, the hand file and the WOG file system caused a statistically higher amount of debris extrusion than the PTN file system (P_ab=.006 and P_cb=.024). The hand files, PTN system, and WOG system produced the most debris extrusion from the apical foramen, 1/3 apical perforation, and middle 1/3 perforation, respectively.

Conclusions: In the presence of middle 1/3 root surface perforations, a sequential rotary NiTi file system would be the suitable choice in terms of minimum debris extrusion.