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. 2025 Jan 25;17(1):e77975.
doi: 10.7759/cureus.77975. eCollection 2025 Jan.

Comparative Evaluation of Periapical Expulsion Using Manual, Rotary, and Reciprocating Instrumentation With EndoVac Irrigation: An In Vitro Study

Sachin Metkari  1 , Sanpreet S Sachdev  2 , Pravin Patil  1 , Manoj Ramugade  3 , Kishor D Sapkale  3 , Kulvinder S Banga  1 , Dinesh Rao  4
Affiliations

Comparative Evaluation of Periapical Expulsion Using Manual, Rotary, and Reciprocating Instrumentation With EndoVac Irrigation: An In Vitro Study

Sachin Metkari et al. Cureus. .

Abstract

Background The present study aimed to assess the efficacy of a heat-treated, FlexiCON nickel-titanium (Ni-Ti) rotary instrumentation system and compare it with existing commonly used instrumentation systems (hand file, ProTaper Universal, and WaveOne) using the EndoVac irrigation system. Methodology A total of 210 single-rooted, human permanent anterior teeth were equally divided into four groups of 50 teeth each (Group I for step-back, group II for ProTaper rotary, Group III for WaveOne reciprocating, and Group IV for FlexiCON rotary instrumentation system), and 10 teeth were used as controls. Canals were irrigated with EndoVac irrigation in each group. Extruded debris, irrigating solution, and Enterococcus faecalis were quantified and statistically analyzed. Results Group IV exhibited the least amount of debris, irrigating solution, and microorganisms than other groups, while Group I presented the most. FlexiCON with EndoVac irrigation demonstrated the least amount of microbe extrusion (14 colony-forming units (CFUs)) among the four instrumentation systems, whereas step-back instrumentation with EndoVac irrigation demonstrated the most (39 CFUs). The control group showed no debris, irrigating solution, or microorganisms. Conclusions FlexiCON Ni-Ti rotary instrumentation showed the least debris, irrigating solution, and bacterial extrusion compared with hand, ProTaper Universal, and WaveOne reciprocating instrumentation systems when EndoVac irrigation methods were used.

Keywords: apical extrusion; debris; inoculation; irrigation; microorganism.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethical Committee, Nair Hospital Dental College issued approval 597/EC/2020. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. (A) Study model apparatus. (B) EndoVac irrigation system microcannula and master delivery tip in position.
Figure 2
Figure 2. Incubation in agar for microbial counts of samples belonging to (A) Group I (manual instrumentation), (B) Group II (ProTaper instrumentation), (C) Group III (WaveOne instrumentation), (D) Group IV (FlexiCON instrumentation).
See this image and copyright information in PMC

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