The study compared the amount of apically extruded debris during mechanical preparation of oval root canals using either a full-sequence self-adjusting file (SAF) system or a rotary file system supplemented by an XP-endo finisher file. Sixty teeth were instrumented using the two techniques and debris was collected and weighed. The rotary file system with XP-endo finisher extruded significantly more debris than the full SAF sequence. Both techniques resulted in apical extrusion but the SAF system extruded less debris, suggesting it may help reduce postoperative inflammation.

1. Apical extrusion of debris during the preparation of oval root
canals: a comparative study between a full-sequence SAF system
and a rotary file system supplemented by XP-endo finisher file
Anda Kfir & Rotem Moza-Levi1 & Moran Herteanu & Amir Weissman &
Ronald Wigler
DR.Athul Chandra.M
1st Year Postgraduate

2. Objectives
• The purpose of this study was to assess the amount
of apically extruded debris during the preparation of
oval canals with either a rotary file system
supplemented by the Xpendo Finisher file or a full-
sequence self-adjusting file (SAF) system.

3. Introduction
• During mechanical preparation debris extrusion
might cause postoperative inflammation, flare-ups
and/or delayed apical healing.
• the amount of extruded debris may differ according
to the preparation technique and file system design.
• Oval root canal systems may make the proper
cleaning and shaping difficult, when using rotary or
reciprocating file systems.

4. •SAFis a coreless, hollow, compressible
nickel-titanium (NiTi) instrument designed to adapt
itself to the walls of root canals with any cross
section.
• specifically designed to address the challenge of
oval-shaped root canals.
• It is claimed to circumvent many of the limitations
of rotary and reciprocating nickel titanium (NiTi)
instruments

5. • SAF has no penetration abilities.
• it requires pre-establishment of a #20/.04 glide path,
using Pre-SAF rotary instruments.
• the term full-sequence SAF system refers, in this
study, to a procedure that includes both the Pre-SAF
glide path files and the SAF files, as the rotary Pre-
SAF files might contribute to the total amount of
extruded debris.

6. •XP-endo Finisher file
• complementary universal instrument
• can be used following root canal preparation with
any file system of diameter ISO 25 or more, for
cleaning highly complex morphologies and difficult-
to-reach areas, such as oval canals.
• It has the capacity to greatly expand when rotating,
up to a diameter of 6 mm.
• And clean the canal with minimal impact on the
dentin of the canal walls.

7. null hypothesis
• The apical extrusion of debris in oval canals would
not differ between a full-sequence SAF system and
rotary file system supplemented by the XP-endo
Finisher file

8. Materials and methods
Specimen preparation
• Sixty mandibular incisors were selected from a
random collection of recently extracted teeth
Pre-SAF files and the SAF (group A),
a rotary file system, supplemented by the
XP-endo finisher file (group B)

9. Inclusion criteria
• The tooth should be straight.
• 18– 20 mm long, have a fully formed apex,
• no caries
• no coronal restorations or signs of resorption,
• and include a single straight (r < 5°) oval-shaped
root canal with a long:short canal diameter ratio of
≥2.5 at 5 mm from the apex

10. • 15 K-file was introduced into each canal, and roots
in which the file progressed freely to the apical
foramen were excluded.

11. • Standard endodontic access cavities were prepared,
• size 10 K-file introduced into the canal until it was
visible at the apical foramen.
• Working length (WL) was established 1 mm short
of this length
• To enhance standardization and obtain a reference
point, the crown of each tooth was ground, using a
highspeed diamond bur,
• and the WL length of all teeth was standardized to
17 mm.

12. Debris collection setup
• 60 Eppendorf tubes were then allocated to group A
and 90 to group B.
• These were pre weighed

13. • A hole was created in the center of the cap of a scintillation glass
vial,
• And the tooth was inserted, apex down, up to the cemento-enamel
junction.
• secured in place with Filtek Supreme flowable composite (3
M/ESPE, St Paul, MN, USA).
• A 25-gauge needle was also placed and secured in the vial cap to
equalize the air pressure inside and outside the vial.
• A small “socket” was created on the bottom of the glass vial, using
silicon impression material

14. which was later used to hold and stabilize each Eppendorf tube when
the caps were fitted onto the vials.
This was done so that the apical end of the root was positioned inside
the pre-positioned Eppendorf tube.
The teeth with their vials were then randomly divided into two groups
(A and B, n = 30) according to the instrumentation protocol to be
used for preparing the oval-shaped root canals.

15. • The vials were covered by a rubber dam to prevent
the operator from viewing debris extrusion during
tooth preparation. The entire apparatus was handled
by the outer vial alone.

16. Root canal instrumentation
Stage A1: glide
path preparation
Stage A2: SAF
instrumentation
Stage B1: GLIDE PATH
PREPARATION- A glide path
was created using
ProGlider file
Stage B2: ProTaper Next
instrumentation Following the
glide path preparation.
Stage B3: XP-endo Finisher
file

17. Debris collection
• Following each stage, the Eppendorf tube was removed from the
vial to be replaced by a new one.
• The debris adhering to the apical root surface was collected by
washing the root surface with 1 ml distilled water into the
Eppendorf tube
• A new Eppendorf tube was assigned to each tooth and each
instrumentation stage.
• The Eppendorf tubes were then stored in an incubator at 70 °C for 5
days to evaporate all moisture content before weighing the dry
debris.
• Three consecutive weights were obtained for each tube, and mean
value was calculated and recorded.
• The weight of the dried debris was calculated by subtracting the
weight of the empty tube from the weight of the tube containing the
debris

18. Statistical analysis
• D’Agostino-Pearson normality test.
Total debris extrusion of group B
was 62% higher than that of
group A (p < 0.05).
Results

19. Conclusions
• 1. Both instrumentation protocols resulted in
apical extrusion of debris from oval-shaped root
canals.
• 2. Each stage of both protocols had its own
contribution to the apical extrusion of debris
• 3. The sequence of rotary instruments, followed by
XP-endo Finisher file extruded significantly more
debris than the full SAF sequence.

20. References
1. Siqueira JF Jr, Rocas IN, Favieri A et al (2002) Incidence of postoperative
pain after intracanal procedures based on an antimicrobial
strategy. J Endod 28:457–460
2. Bürklein S, Benten S, Schäfer E (2014) Quantitative evaluation of
apically extruded debris with different single-file systems:
Reciproc, F360 and OneShape versus Mtwo. Int Endod J 47:405–
409
3. Siqueira JF Jr (2003) Microbial causes of endodontic flare-ups. Int
Endod J 36:453–463
4. al-Omari MA, Dummer PM (1995) Canal blockage and debris extrusion
with eight preparation techniques. J Endod 21:154–158
5. Reddy SA, Hicks ML (1998) Apical extrusion of debris using two
hand and two rotary instrumentation techniques. J Endod 24:180–
183
6. Azar NG, Ebrahimi G (2005) Apically-extruded debris using the
ProTaper system. Aust Endod J 31:21–22
7. Ferraz CC, Gomes NV, Gomes BP, Zaia AA, Teixeira FB, Souza-
Filho FJ (2001) Apical extrusion of debris and irrigants using two
hand and three engine-driven instrumentation techniques. Int
Endod J 34:354–358
8. Tinaz AC, Alacam T, Uzun O, Maden M, Kayaoglu G (2005) The
effect of disruption of apical constriction on periapical extrusion. J
Endod J 31:533–536