Canal Preparation Techniques Research Articles

Microscopic Evaluation of Dentinal Defects after Root Canal Preparation with Different Hand and Nickel-Titanium Files; An In Vitro Study

ABSTRACT Background: Effective endodontic instrumentation aims to remove microorganisms, debris, and tissue from the root canal while maintaining dentinal integrity. This study compares dentinal defect incidence following canal preparation with different hand files, nickel-titanium rotary files, and reciprocating files Materials and Methods: Eighty single-rooted mandibular premolars with mature apices were collected. Four groups (n = 20) were established based on canal patency establishment, canal preparation technique, irrigation solution, and final irrigation. After root sectioning at 3 mm, 6 mm, and 9 mm from the apex, slices were examined under a stereomicroscope, and dentinal defects were recorded. A second examiner reviewed the images. Results: The results showed significant difference of P = 0.031 among Hand files vs. Rotary ProTaper files: In Hand files vs. Reciprocating WaveOne files significant difference was P = 0.048, and for rotary ProTaper files vs. Reciprocating WaveOne files: No significant difference (P = 0.643). Dentinal defect counts were similar at 3 mm, 6 mm, and 9 mm. Statistically significant variation was observed between hand files and rotary files, as well as hand files and reciprocating files Conclusion: Both rotary and reciprocating files showed a statistically significant increase in dentinal defect incidence compared to hand files. However, clinical implications should be considered cautiously. Instrumentation technique selection should be based on clinical context, operator experience, and patient factors. Further clinical studies are needed for validation.

Minimally invasive management of vital teeth requiring root canal therapy

The present study aimed to investigate the possible use of a non-instrumentation technique including blue light irradiation for root canal cleaning. Extracted human single rooted teeth were selected. Nine different groups included distilled water, NaOCl, intra-canal heated NaOCl, and NaOCl + EDTA irrigation after either instrumentation or non-instrumentation, and a laser application group following non-instrumentation technique. The chemical assessment of the root canal dentine was evaluated using energy dispersive spectroscopy (EDS) and Fourier transform infrared (FT-IR) spectroscopy. Surface microstructural analyses were performed by using scanning electron microscopy (SEM). The antimicrobial efficacy of different preparation techniques was evaluated using microbial tests. Light application didn’t change the calcium/phosphorus, carbonate/phosphate and amide I/phosphate ratios of the root canal dentin. The root canal dentin preserved its original chemistry and microstructure after light application. The instrumentation decreased the carbonate/phosphate and amide I/phosphate ratios of the root canal dentin regardless of the irrigation solution or technique (p < 0.05). The application of light could not provide antibacterial efficacy to match the NaOCl irrigation. The NaOCl irrigation both in the non-instrumentation and instrumentation groups significantly reduced the number of bacteria (p < 0.05). The use of minimally invasive root canal preparation techniques where the root canal is not instrumented and is disinfected by light followed by obturation with a hydraulic cement sealer reduced the microbial load and preserved the dentin thus may be an attractive treatment option for management of vital teeth needing root canal therapy.

The effect of various file systems on postoperative pain in primary Tooth Root Canal treatments: A randomized controlled clinical trial

Objective: All root canal preparation techniques can potentially result in debris protruding apically, leading to postoperative pain. This study aimed to assess the effects of different file systems on postoperative pain in root canal treatments performed on primary molar teeth. Material and Methods: The study included 100 patients aged 5-8 years. NiTi K-type hand files (NTK), rotary file systems ProTaper Next (PTN), AF Baby (AFB), EndoArt Niti Pedo Gold (EAN), and reciprocal file system WaveOne Gold (WOG) were employed in the canal treatment of mandibular primary molars. Postoperative pain was assessed using the Visual Analog Scale (VAS) at the 6th, 12th, 18th, 24th, 48th, 72nd hour, and 1st week following treatment, and the collected data were evaluated statistically. Results: When considering time as a factor, the postoperative pain values among the groups were compared using the Kruskal-Wallis H test, and no statistically significant differences were observed (p = 0.007). In numerical terms, the group using NTK, EAN, AFB, and PTN exhibited the highest average postoperative pain, while the group using WOG, a reciprocal system, had the lowest pain. Conclusion: In conclusion, the choice of file used impacts postoperative pain. There was no statistically significant difference in time-independent postoperative pain values between rotary files designed for primary teeth and those intended for permanent teeth. However, using files specifically designed for primary teeth is recommended, considering factors such as working comfort and suitability for working length.

The Comparative Efficacy of Conventional and Crown-Down Root Canal Preparation Techniques in Relation to the Extrusion of Apical Debris

Numerous scientific investigations have been undertaken to assess the efficacy of standard root canal preparation methods and the crown-down procedure in mitigating the ejection of apical debris. The aforementioned research examines multiple facets, encompassing the efficacy of canal cleaning, the potential for debris extrusion, and their influence on the outcome of root canal therapy. The objective of this study is to evaluate the efficacy of conventional and crown-down root canal preparation methods in relation to the extrusion of apical debris. The literature search used a lot of different databases, like PubMed, Web of Sciences, EMBASE, Cochrane Libraries, and Google Scholar, to look into how well traditional and crown-down root canal preparation methods work for getting debris out of the root canal. Traditional methods of root canal preparation have been extensively employed in the field of endodontics. While root canal cleaning and shaping techniques have demonstrated efficacy, there is still a potential danger of apical debris extrusion. Several factors contribute to the level of risk involved in dental procedures. These factors encompass the use of instruments, the amount of pressure applied during preparation, the effectiveness of irrigation, and the level of experience possessed by the dentist. In conclusion, the efficacy of both methodologies is contingent upon various aspects, including the level of expertise possessed by the dentist, the specific instruments employed, the irrigation technique employed, and the thoroughness of the case examination. The particulars of each case and the dentist's personal preference should guide the choice of either procedure.

Overview of instrumentation used in endodontics

The fundamentals of root canal therapy include thorough cleaning, suitable shape, and total root canal filling. There are numerous tools at our disposal to help us achieve these goals. A complicated range of files, filling techniques, and modern materials have been designed to speed up the process, increase its dependability, and enable the clinician to properly treat challenging patients and intricate anatomies. Hand instruments include barbed broaches, reamers, and files such as K-file, K-flex file, Flexofile, and Hedstrom files. Nickel-titanium alloys have been used to replace stainless steel in the production of endodontic equipment. Compared to stainless steel tools, these lead to more straightening of canal curvature, centering, tapering, and leading to a superior preparation. In an effort to speed up preparation of canals and lessen operator fatigue, a wide variety of electric power-run tools have been created like reciprocating handpieces, rotary NiTi files and handpieces. Accurate root canal length measurement is crucial to the effectiveness of root canal therapy. Radiography and the application of an electronic apex locator are the two methods used most frequently to confirm canal length. Instruments needed for filling canals are dependent on the procedure chosen to fill the root canal. Hand or finger spreader with a pointed tip are used in lateral condensation; hand or finger pluggers with blunt, flat ends are employed in vertical condensation; thermomechanical compaction uses an engine-powered compactor, thermoplasticized injectable gutta-percha and gutta-percha carrier devices. Careful use of canal preparation, sterilization, and obturation techniques, together with the appropriate instrument selection and use, can significantly increase the likelihood that endodontic procedures will be successful.

Treatment Outcome and Root Canal Preparation Techniques: 5-Year Follow-Up

This study aims at comparing treatment outcome and tooth survival of root canal-filled teeth following manual vs rotary instrumentation techniques over a 5-year period. This was a single-centre study conducted as a follow-up to a short-term parallel-arm randomised controlled noninferiority trial in which root canal treatment was performed on teeth using either rotary or manual instrumentation. Patients were monitored at post 6-month, 1-year, 4-year, and 5-year review periods by blinded evaluators. Treatment outcome was categorised as favourable, uncertain, and unfavourable (employing European Society of Endodontology categorisation based on strict clinical and radiographic criteria), and 5-year tooth survival was determined by assessing whether tooth was in situ in the oral cavity or extracted. The Kaplan-Meier method and log rank test evaluated tooth survival. P value <.05 was considered statistically significant. Ninety of 120 treated teeth were assessed in 37 men and 40 women with mean age of 30.6 ± 10.99 years. Treatment outcome was significantly more favourable in the rotary group compared to the manual group at post 6-month (P=.021) and 1-year (P=.043) review periods. The differences in favourable outcome (P=.498) and tooth survival (P=.296) between the 2 groups were, however, not significant at the 5-year review period. The rotary instrumentation technique was shown to be more effective in resolving clinical symptoms and promoting periapical healing after the post 6-month and 1-year review compared to the manual instrumentation technique; however, both groups had similar favourable outcomes and survival rates after an extended 5-year review period.

Attitudes, techniques and trends in endodontic treatment by general dental practitioners in Benghazi- Libya

Introduction: The success of the root canal treatment depends on the attitudes, techniques and different approaches that carried out by the dental practitioners who made major impact on performing a high standard level of dental treatment to get a great quality of work. Aim: The objective of this research was to investigate the current trends and attitudes in endodontic treatment exhibited by general dental practitioners worked in private and public dental clinics in Benghazi- Libya.&#x0D; Materials and Methods: This study was accomplished in March 2017 included 170 general dental practitioners worked in private and public dental clinics in Benghazi Libya. Each participant received structured questionnaires to assist the attitudes, techniques, current trends, materials and new technology used in a daily endodontic practice. All returned forms were evaluated by a single operator. Descriptive statistics and frequency distribution were analyzed using SPSS version 21 and Chi-square test.&#x0D; Results: The respond of participants was 150 represent 88.23% response rates. The results showed that 78% (117) of the respondents they did not build up the tooth before starting RCT and the majority preferred multiple visits per endodontic treatment. The main isolation method was cotton roll with saliva suction (77.3%). About (43.3%) of the practitioners used step-back technique for canal preparation and the most common used hand instruments was a K-files in conjunction with hedstrom files (50%). The finding of this study indicated that (52.7%) of the practitioners took 0.5 mm working distance from the apex. Sodium hypochloride was the common irrigant (55.3%) and (38%) of respondents used calcium hydroxide as intracanal medicament. Lateral condensation was more common among the respondents (64%) and the zinc oxide-eugenol was the common type of sealer used among them (45.3%). The most common restorations were composite materials (34.7%). Conclusion: It was concluded that the general participant dentists in Benghazi city did not keep up with the newly introduced techniques in endodontic as they were used more conventional methods in their work which could be attributed to lack in expertise and recognition of new technology in a daily endodontic work.

Endodontic flare-up incidence in pulp necrosis in Universitas Airlangga Dental Hospital (RSKGMP Universitas Airlangga)

Background : Dental caries occurs as a result of demineralization of the hard tissues of the teeth followed by the destruction of the organic matter, resulting in bacterial invasion and death of the pulp which can lead to pulp necrosis. One of the treatments for pulp necrosis is endodontic treatment. Endodontic treatment includes root canal preparation techniques, root canal irrigation materials, root canal dressing materials, and also root canal obturation techniques. In endodontic treatment can experience flare-ups. An endodontic flare-up is a pain or swelling after endodontic treatment that occurs in a relatively short time. Purpose : To describe the incidence of endodontic flare-ups in pulp necrosis at RSMKGP Universitas Airlangga. Methods : Conducted descriptive observasional research on patients who had endodontic treatment at UPF Dental Conservation, Dental and Oral Hospital, Faculty of Dental Medicine, Airlangga University in 2018, 2019, and 2020. Results : A total of 28 patients (30,1%) from 93 patients were experience pain or flare-ups after root canal treatment. Conclusion : From the result of this study, it can be concluded that there is still an incidence of endodontic flare-ups in pulp necrosis at RSKGMP Universitas Airlangga which is 30,1%.

Endodontic Flare-up Incidense in Irreversible Pulpitis in Universitas Airlangga Dental Hospital (RSKGMP Universitas Airlangga)

Background: Carious lesions that do not be treated, becomes infected and inflamed, leading to irreversible pulpitis. One of the treatments for irreversible pulpitis is root canal treatment. In root canal treatment can cause flare-ups. Purpose: Obtaining a data base on flare-ups with a diagnosis of irreversible pulpitis at RSKGMP and obtaining a picture of flare-ups in irreversible pulpitis based on root canal preparation techniques, root canal irrigation materials, root canal dressing materials, and root canal obturation techniques. Methods: The study used was a descriptive observational study with a study design cross sectional in patients with a diagnosis of irreversible pulpitis who had received root canal treatment at the UPF Dental Conservation RSKGMP University of Airlangga in 2018, 2019, and 2020. Results: A total of 14 patients (28%) of 50 patients experienced (flare-up). Conclusion: The incidence flare-ups of root canal treatment in irreversible pulpitis at RSKGMP University of Airlangga is 28%.

Present status and future directions: Removal of fractured instruments.

The success rate of fractured instrument retrieval varies because it is dependent mainly on several factors including the visibility of the fractured instrument, the length of the fractured instrument in relation to the curvature of the canal and the techniques applied to each case. This review aims to update the present status on removal of fractured instruments to identify factors and variables that could affect the success of fractured instrument retrieval based on both the preparation techniques and the instrument retrieval techniques. On the other hand, future directions of fractured instrument retrieval should focus on management of nonvisible fractured instruments since the removal of those instruments is deemed unpredictable with the current techniques, whereas the removal of visible fractured instruments is considered predictable now. Another possible direction of it is that there might be no more instrument fracture due to possible significant changes in the root canal preparation technique which may dispense with the use of rotary instruments.

Standards of Practice Among Endodontists in Kerala, India

Background: The field of endodontics is greatly evolving with the brisk entry of not just new materials but also numerous technology-based advances. Factors governed by the practitioner such as the canal preparation technique, the disinfection regimes followed, the standard of obturation, and the quality of coronal and apical seal all in turn greatly influence the prognosis of the endodontic treatment. Objective: To assess the attitude concerning the materials and techniques used during endodontic treatment among the endodontists in Kerala. Materials and Methods: An online questionnaire-based cross-sectional study was done among endodontists in Kerala. The questionnaire assessed several key aspects of endodontic practice. A comparison was made based on the nature of practice and years of practice. Results: A total of 165 responses were obtained. A high percentage of participants (&gt;75%) routinely employed preoperative radiographs. A combination of apex locators along with radiographs was most preferred for working length determination, and calcium hydroxide was the most preferred root canal sealant. Almost half of the endodontists did not use any form of magnification. Conclusion: Despite several booming advances in technology, endodontists still do not strictly follow the implementation of important regimes such as the incorporation of magnification or use of a rubber dam in their practice, which still needs to be meticulously incorporated into practice, which would raise the standards of clinical practice.

Comparing the Influence of Conventional and Rotary Instrumentation Techniques on the Behavior of the Children: A Randomized Clinical Trial.

BackgroundPulpectomy has gained popularity in the pediatric dental practice for preserving the primary teeth in its position until exfoliation. There has been a paradigm shift from using manual instrumentation to rotary instrumentation for canal preparation in primary teeth. While studies show that there is a reduction in the instrumentation time with the use of rotary instruments which in turn influences the behavior of the child, its direct effect on the behavior of the children has not been evaluated.AimTo compare the behavior of the children during manual and rotary instrumentation for pulpectomy in the primary molars.Materials and methodsA single-blinded randomized clinical trial was conducted in 88 children in any one of the mandibular primary molars indicated for pulpectomy. The canal preparation was done using manual K files and rotary ProTaper (44 children in each group). The influence of these instrumentation techniques on the children was assessed with three different scales- Frankl Behavior Rating Scale; Venham Interval Rating Scale; Wong Baker FACES Pain Scale for evaluating the behavior, anxiety, and the pain experienced by the children, respectively during canal preparation.ResultsA total of 88 participants, comprising 50 females and 38 males, participated in the study. An equal distribution of the participants with respect to age (p = 0.064), gender (p = 0.389), and teeth (p = 0.877) was observed between the groups. More cooperative behavior (p < 0.001); lesser anxiety levels (p < 0.001); lower intensity of pain (p < 0.001) were recorded in the children instrumented using Rotary files.ConclusionThe present study concludes that it is preferable to use rotary instrumentation for primary canal preparation in pediatric practice as it has a more positive influence on the behavior of the children, which eventually determines the success of the treatment.Clinical significanceWith rise in the use of rotary files for pulpectomy in primary teeth, the present paper demonstrates the influence of rotary instrumentation technique for canal preparation during pulpectomy on the behavior of the children in a dental chair. This paper throws light for the pedodontists to effectively perform pulpectomy in children with ease without leaving a psychological impact on the children.How to cite this articleGovindaraju L, Subramanian EMG, Jeevanandan G. Comparing the Influence of Conventional and Rotary Instrumentation Techniques on the Behavior of the Children: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2021;14(S-2):S179–S185.

In Vitro Analysis of the Fatigue Resistance of Four Single File Canal Preparation Instruments.

Instrument separation during root canal therapy is inevitable in endodontics with several unfavorable clinical consequences. Therefore, examining the cyclic flexural fatigue resistance of commonly used rotary endodontic files is crucial. This study aimed to determine the cyclic flexural fatigue resistance of four nickel–titanium (NiTi) rotary files used as a single canal preparation technique: WaveOne, Reciproc, Protaper F2, and Unicone medium instruments. According to the manufacturer’s instructions, each file was rotated freely within a 1.3 mm deep and 1.3 mm wide V-shaped groove in a stainless-steel block with a 40° and 5 mm radius of curvature. Cyclic fatigue resistance was compared between the NiTi files by verifying the time needed to crack. The data were analyzed using one-way analysis of variance (ANOVA) followed by Scheffé post hoc with a significant level set at p < 0.05. Our results demonstrated that the WaveOne instrument had the highest cyclic flexural fatigue resistance among the tested groups (p ≤ 0.05), while Unicone had the lowest cyclic flexural fatigue resistance. This study concluded that WaveOne size 25/0.08 could illustrate a superior cyclic flexural fatigue resistance when instrumenting root canals with the lowest possibility to cause instrument separation.

Apical transportation with different root canal preparation techniques using edgEEvolve rotary instruments

Apical transportation with different root canal preparation techniques using edgEEvolve rotary instruments

An Update on Root Canal Preparation Techniques and How to Avoid Procedural Errors in Endodontics

Background:Effective root canal treatment involves cleaning and shaping root canals using a range of instrumentation procedures and techniques. The aim of this review was to provide an update on root canal hand instrumentation techniques and how to overcome iatrogenic errors.Methods:A comprehensive search was carried out using multiple databases, PubMed, Medline, Google scholar, and Scopus, to identify relevant studies addressing the objective of this study and to summarize the current evidence to readers. Keywords,i.e., endodontics, root canal preparation, hand instrumentation, techniques and procedural errors, as well as, MeSH terms,i.e. “endodontics”, “instrumentation”, “root canal preparation” were used to conduct our comprehensive search.Results:The hybrid technique is a commonly-used approach that combines the benefits of both the crown-down and step-back techniques and was reported to be one of the best techniques to produce an optimal root canal preparation outcome. Hand-instrument manipulation using the balanced forced technique is also favoured as it rapidly and safely permits removal of canal contents allowing irrigants and medications to reach deep inside canal spaces.Conclusion:The use of hand files is still recommended for initial canal negotiation and preparation and is essential for the correction of procedural errors. This study provided an update on several hand instrumentation techniques commonly used in endodontics. The correct and safe application of these techniques can prevent iatrogenic procedural errors from occurring which optimizes the quality of treatment outcome.

The influence of different NiTi instrumentation techniques on postoperative pain after single-visit root canal treatment.

This study aimed to evaluate the effect of multi-file rotary (Protaper Universal) and reciprocating single-file (Reciproc Blue) root canal preparation techniques on the occurrence of postoperative pain in asymptomatic mandibular molar teeth with large periapical lesions in single-visit root canal treatment (RCT). A hundred and twenty teeth were randomly assigned to two groups: Protaper Universal (PTU) or Reciproc Blue (RB) instruments. Postoperative pain at 6, 12, 24, 48, 72 h and 7 days after obturation was measured. Mann-Whitney U-test was performed to compare the pain scores between the groups and to assess the relation of pain with patients' age and gender. Spearman's rank correlation was utilized to correlate the pain intensity and analgesic intake at different time points. There was no significant difference between the instrumentation techniques regarding postoperative pain at any time points evaluated (P > 0.05). There was a correlation between analgesic intake and intensity of pain (P < 0.05). No statistically significant difference was found among the groups assessed in the study in terms of analgesic intake (P > 0.05).

A Novel Root Canal Preparation Technique Hybridizing Heat-treated Nickel-Titanium Rotary Instruments

A Novel Root Canal Preparation Technique Hybridizing Heat-treated Nickel-Titanium Rotary Instruments

Root Microcracks Formation during Root Canal Instrumentation Using Reciprocating and Rotary Files

The aim of this study was to compare the formation of dentinal cracks with nickel-titanium (NiTi) instruments working in continuous rotation and reciprocating motion. One hundred sixty extracted human mandibular first molars were selected for the study. The mesial roots were resected and mounted in resin blocks with simulated periodontal ligaments. Those teeth were randomly assigned to five groups (n = 32 teeth/group). The first one was treated with K-files and served as control group, and the remaining 128 teeth were divided into 4 groups depending on the root canal preparation technique. Group 2 samples were prepared by sequential ProTaper Universal (PTU), group 3 samples with rotary ProTaper Universal (RPTU), group 4 achieved by the One Shape (OS), and group 5 with the WaveOne (WO) primary files. Roots were then horizontally sectioned at 3, 6, and 9 mm from the apex, and the slices were then observed under a stereomicroscope at ×40 magnification to determine the presence of internal dentinal microcracks. The presence or absence of dentinal defaults was recorded and the statistical analysis was performed by Pearson Chi-square test. The significance level was set at p < 0.05. The study was made in the oral biology and biotechnology research laboratory of the faculty of medical dentistry of Rabat, Morocco. No dentinal defect was seen with the stainless steel hand file (group 1). The manual PTU (group 2), the RPTU (group 3), the OS (group 4), and the WO (group 5) in reciprocating motion caused cracks in 15.6%, 12.4%, 21.9%, and 6.2% of samples, respectively. The highest percentage of dentinal defect was showed in group 4 but without significant difference with the other group (p > 0.05). Dentinal cracks are produced indifferently of motion kinematics. Within the limits of this study and the current literature, such incidence is less with instruments working in reciprocating motion compared with those working in continuous rotation. Manual and rotary NiTi sequential systems showed fewer microcracks than the single file system working by continuous rotation motion.

Development of apical root microcracks following different root canal preparation systems

Context: The most critical step in root canal therapy is cleaning and shaping of the root canal. A vast array of instruments both handheld and engine driven are available for root canal preparation. There are very few studies to compare the effect of different types of instruments on the development of apical root cracks. Hence, the aim of the study was to compare the development of apical root cracks following different root canal preparation techniques and instruments.Aims: The aim of this study is to compare the development of apical root cracks following different root canal preparation techniques and instruments.Settings and Design: This is an in vitro study.Subjects and Methods: Forty extracted mandibular premolar teeth were selected and mounted on resin blocks with simulated periodontal ligaments, after which the apex was exposed. All teeth were randomly divided into four groups; each group was earmarked for a specific technique and instrument used for root canal preparation. Digital images of external apical root surfaces of every tooth were taken before and after apical enlargement through optical microscope (×40). These images were compared, and the presence of cracks was evaluated.Statistical Analysis Used: Chi-square exact test was used to compare the four groups.Results: Overall P value was 0.167 which is not statistically significant and indicates that the proportion of teeth developing cracks was not statistically significant among the four groups.Conclusions: More cracks were developed with rotary system. However, the results were not statistically significant among the four groups.

Comparative Evaluation of Apical Extrusion Debris and Irrigant During Calcium Hydroxide Removal and Endodontic During Calcium Hydroxide Removal and Endodontic Instrumentation Using Three Types of Instrumentation Systems Instrumentation Using Three Types of Instrumentation Syste

Many root canal preparation techniques and instruments produce apically extruded materials to a certain extent depending on the preparation system adopted. The extrusion of debris from the apical foramen during chemomechanical preparation may cause postoperative pain and failure of endodontic treatment. Objective: This study evaluates the differences in the apical extrusion of debris and calcium hydroxide (CH) during endodontic instrumentation by using Reciproc Blue (RB), WaveOne Gold (WOG), and F6 Skytaper (F6). Methods: Six experimental study groups (n = 13) were established. The root canal procedures for all groups were prepared with different methods: Group I: One Shape (OS) instrumentation, CH filling for 21 days, removal of CH using RB; Group II: OS instrumentation, CH filling for 21 days, removal of CH using WOG; Group III: OS, CaOH filling for 21 days, removal of CH using F6; Group IV: root canal instrumentation using RB; Group V: root canal instrumentation using WOG; Group VI: root canal instrumentation using F6. Apically extruded debris was collected into preweighed Eppendorf tubes by using the Myers and Montgomery method. Data were statistically analyzed with one-way ANOVA and Kruskal–Wallis tests. Results: All the tested instruments caused the extrusion of debris and irrigant from the apical foramen. The difference among the six groups was not statistically significant (p &gt; 0.05). Conclusions: The tested instruments caused similar apical extrusions of debris and irrigant during CH removal or instrumentation procedures.