Quantitative Assessment of Apically Extruded Debris During Retreatment Procedures Using Three Nickel-Titanium Rotary Systems: An In Vitro Comparative Study

Abstract

Objectives: Apical extrusion of debris can affect the success of endodontic treatments, and the specific performance of certain retreatment systems has not been studied yet. Therefore, the aim of this in vitro study was to quantitatively assess the amount of apically extruded debris produced during retreatment procedures using three rotary NiTi retreatment systems in mature non-resorbed straight roots. Methods: Thirty extracted permanent human teeth with single straight roots were selected. The root canals were prepared with the ProTaper Next system up to size 30 and obturated with gutta-percha and AH Plus sealer using the continuous wave of condensation technique. The samples were stored for 30 days and randomized by computer sequence into three retreatment groups (n = 10): (1) ProTaper Universal Retreatment; (2) HyFlex Remover; and (3) VDW.Rotate Retreatment. Apically extruded debris was collected in Eppendorf tubes and weighed with a microbalance (10^-5 g) before and after retreatment procedure. As the data were not normally distributed, the Kruskal-Wallis test was applied for comparing data among groups, with an alpha level set at α = 0.05. Dunn's test was considered for post-hoc analyses, if appropriate. Results: Hyflex Remover was associated with the highest amount of extruded debris (0.85 ± 0.82 mg), followed by VDW.Rotate Retreatment (0.78 ± 0.41 mg) and ProTaper Universal Retreatment (0.62 ± 0.28 mg). However, the differences were not statistically significant (p > 0.05). Conclusions: All the retreatment systems tested were associated with apical extrusion of debris in vitro, with no significant quantitative differences between them, suggesting that clinicians can choose a retreatment system with features appropriate to the specific clinical situation without risk of increasing the amount of apically extruded debris.

Keywords: HyFlex Remover; ProTaper Retreatment; VDW.Rotate Retreatment; apically extruded debris; retreatment.

Figure 1

Eppendorf tube with root sample and 25 G needle fixed to vial stopper to balance internal and external pressures.

Figure 2

Schematic of the experimental procedures, including primary endodontic treatment and retreatment.