Influence of working length and apical preparation size on apical bacterial extrusion during reciprocating instrumentation

Abstract

Aim: To evaluate the influence of reciprocating single-file instrumentation with different working lengths (WL) and apical preparation sizes on apical bacterial extrusion.

Methodology: Sixty-eight human single-rooted pre-molars were used. Conventional access cavities were prepared, and the root canals were contaminated with an Enterococcus faecalis suspension and incubated at 37°C for 30 days. Teeth were then divided into four groups of 15 specimens each (Reciproc size 25, .08 taper and Reciproc size 40, .06 taper instruments were used at the foramen; Reciproc size 25, .08 taper and Reciproc size 40, .06 taper instruments were used 1 mm short of the foramen). Positive and negative controls consisted of four infected and four uninfected pre-molars that were instrumented according to each experimental group. Bacteria extruded from the apical foramen during instrumentation were collected into vials containing 0.9% NaCl. The microbiological samples were then incubated in a brain-heart agar medium for 24 h. The resulting bacterial titre, in colony-forming units (CFU) per mL, was determined, and these data were analysed using a Wilcoxon matched-pairs signed rank test and a Kruskal-Wallis H-test. The level of significance was set at α = 0.05.

Results: No growth was observed in the negative control group. All positive controls demonstrated bacterial growth after the experimental time interval. No significant difference was found in the number of CFU amongst all experimental groups (P = 0.95).

Conclusions: This study showed that the WL and the apical preparation size did not have a significant effect on bacterial extrusion when performing reciprocating instrumentation.

Keywords: apical extrusion; bacteria; engine-driven techniques; rotatory instruments.