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      Evaluation of apical extrusion of debris and centering ability in different nickel-titanium files during curved root canal preparation


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          Curved root canals lead to difficulties in cleaning, shaping and filling the root canal system. Apical extrusion of debris and root canal transportation are important factors causing postoperative complications. In clinical practice, commonly selected instruments include multifile NiTi systems, such as M3-Pro PLUS (M3-PRO), Orodeka Plex 2.0 (ODP), Rotate (ROT), and Protaper Gold (PTG), as well as single-file NiTi systems, such as M3-L Platinum 2019 (M3L), Waveone Gold (WOG), and Reciproc Blue (RCB). This study aimed to comprehensively evaluate the differences in the apical extrusion of debris and centering ability of the above NiTi files.


          Seventy 3D-printed resin teeth were used (n = 10). The apically extruded debris was collected in a preweighed centrifuge tube. The resin teeth with or without root canal preparation were cut into separate cross sections at 1 mm, 3 mm, 5 mm, and 7 mm away from the root apex, and then the root canal transportation and centering ratio of each cross section were calculated.


          Apical extrusion of debris was highest in RCB but lowest in OD-P (P < 0.05). Root call deviation was lowest in ROT at the 3 mm level, in PTG at the 5 mm level, and in PTG and ROT at the 7 mm level (P < 0.05). The centering ratio of NiTi files was highest in the RCB group at the 3 mm level, in the PTG group at the 5 mm level, in the ROT group at the 7 mm level (P < 0.05).


          For NiTi files with the same system, the cross-sectional design is the greatest factor affecting the extrusion of debris, and motion mode is the second. In addition, the multifile system could reduce the degree of root canal transportation.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12903-023-03070-3.

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          Most cited references14

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          A comparison of canal preparations in straight and curved root canals

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            Comparison of nickel-titanium and stainless steel hand-file instrumentation using computed tomography.

            Computed tomography was used to evaluate root canals prepared by nickel-titanium (Ni-Ti) hand and stainless steel hand endodontic instruments. Thirty-six single-rooted teeth of similar shape and canal size were divided into three groups. The teeth were scanned by computed tomography before instrumentation. In group A, canals were instrumented using a quarter turn/pull technique with K-flex files. In group B, canals were prepared with Ni-Ti hand files (Mity files) using the same technique as group A. Group C was prepared with Ni-Ti hand files (Mity files) using a reaming technique. Instrumented teeth were again scanned using computed tomography, and reformated images of the uninstrumented canals were compared with images of the instrumented canals. Ni-Ti instruments (Mity file) used in a reaming technique caused significantly less canal transportation (p < 0.05), removed significantly less volume of dentin (p < 0.05), required less instrumentation time (p < 0.05), and produced more centered and rounder canal preparations than K-flex stainless steel files used in a quarter turn/pull technique. The computed tomography imaging system used in this study provided a repeatable, noninvasive method of evaluating certain aspects of endodontic instrumentation.
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              A comparison of weights of debris extruded apically by conventional filing and Canal Master techniques.

              Sixty extracted human teeth were divided into three groups of 20 each. Apically extruded debris and irrigant were collected, dried, and weighed by the following three instrumentation techniques: (a) group 1, filing 1 mm short of the foramen; (b) group 2, Canal Master instrumentation to the foramen; and (c) group 3, filing to the foramen (for a relative comparison). The results indicated that all three groups were significantly different from one another. Group 1 had the least amount of debris extruded. Of the two groups instrumented to the foramen, group 3 had twice as much debris extruded as group 2. An apical dentinal plug was frequently found in group 1 and was probably a major reason why this group had the least amount of extruded debris. The significance of this dentinal plug and possible indications for instrumentation to the foramen are discussed.

                Author and article information

                BMC Oral Health
                BMC Oral Health
                BMC Oral Health
                BioMed Central (London )
                15 June 2023
                15 June 2023
                : 23
                : 395
                [1 ]GRID grid.459985.c, Northern Department of Endodontics, , Stomatological Hospital of Chongqing Medical University, ; Chongqing, 404100 China
                [2 ]GRID grid.203458.8, ISNI 0000 0000 8653 0555, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, ; Chongqing, 404100 China
                [3 ]GRID grid.203458.8, ISNI 0000 0000 8653 0555, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, ; Chongqing, 404100 China
                © The Author(s) 2023

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                : 20 December 2022
                : 22 May 2023
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 31970783
                Funded by: Program for Top talent Distinguished Professor from Chongqing Medical University
                Award ID: [2021] 215
                Funded by: Program for Youth Innovation in Future Medicine from Chongqing Medical University
                Award ID: W0060
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                © BioMed Central Ltd., part of Springer Nature 2023

                apical extrusion of debris,canal transportation,centering ratio,nickel-titanium file,root canal preparation


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