Evaluation of Apically Extruded Debris During Root Canal Filling Material Removal in Teeth With External Apical Root Resorption: A Comparison of Different Obturation Techniques

Abstract

Background: Root canal retreatment is necessary when initial treatment fails. Nickel-titanium systems help remove filling materials; however, some methods can cause canal content extrusion, resulting in inflammation and delayed healing. This study aimed to examine the impact of different preparation techniques and endodontic file systems on apical debris volume to limit material dispersion to periradicular tissues. Methods: Ninety extracted maxillary incisors were evaluated. Simulated apical root resorption was created by removing the apical 2 mm of the root. The teeth were divided into two groups: one filled with a single cone and the other with cold lateral compaction (CLC). Each group was further divided into three subgroups (n = 15 each): Subgroup 1 used Reciproc R25 for removal and R50 for final preparation; Subgroup 2 used ProTaper Universal Retreatment (PTUR) files D1, D2, and D3 for removal and ProTaper Next X5 for finalization; and Subgroup 3 used VDW.Rotate Retreatment (VDW.RotateR) for removal and VDW.Rotate 50.04 for completion. Debris from retreatment was collected in pre-weighed tubes to determine the amount. The apical extrusion data underwent a two-way analysis of variance. Results: The Reciproc group had a mean extruded debris weight of 0.54 +/- 0.24 mg, higher than the PTUR (0.28 +/- 0.15 mg) and VDW.RotateR (0.39 +/- 0.29 mg) groups (p < 0.05). The single-cone technique (SCT) resulted in a mean debris weight of 0.34 +/- 0.23 mg, lower than the CLC technique, which had a mean of 0.46 +/- 0.27 mg (p < 0.05). SCT had a shorter retreatment duration (111.12 +/- 33.46 s) compared to CLC (176.26 +/- 52.26 s) (p < 0.05). Conclusion: The Reciproc file system and the CLC obturation technique resulted in greater apical debris extrusion than the other methods. SCT was quicker than CLC. The Reciproc groups are more susceptible to apex extrusion during retreatment.