Comparative Evaluation of Apically Extruded Debris DuringRootCanal Preparation Using Three Different File Systems Applied Under 2.5% Sodium Hypochlorite or 2% CHX Irrigation

The chemomechanical cleaning of the root canal system is performed using manual and rotary files. This study aimed to compare the effect of ProTaper, Reciproc and HyFlex rotary files considering 2.5% sodium hypochlorite and 2% chlorhexidine (CHX) as irrigating solutions on apical extrusion of intracanal debris. Single-canal mandibular premolars (N=165) were evaluated. The teeth were divided into 6 experimental groups (N=25) for root canal instrumentation using 3 file systems, (Reciproc, HyFlex and ProTaper) and two irrigation solutions, namely 2.5% sodium hypochlorite or 2% CHX. Fifteen teeth were also assigned into three control groups (n=5) with saline as irrigation solution. Eppendorf tubes were weighed and the teeth were placed inside. The canals were instrumented and the tubes weighed to determine the dry weight of extruded debris. Data were analyzed using one-way ANOVA and Bonferroni test (alpha=0.05). The mean amount of extruded debris using the sodium hypochlorite solution was significantly higher than other irrigating solutions (p<0.001). The mean amount of extruded debris using the Reciproc file system was significantly higher compared to ProTaper and HyFlex (p<0.001). The use of the sodium hypochlorite solution, single-file systems and reciprocal movement are associated with higher debris extrusion and might be associated with higher risk of postoperative pain.