Title: Factors affecting periapical extrusion of debris, irrigating solution and microorganisms during chemo-mechanical preparation of root canal system: A literature review
Abstract:
Aim: Aim of this presentation is to discuss the factors that influence the periapical extrusion of debris, irrigating solution and microorganisms during chemo-mechanical preparation of root canal system.
Background: Periapical extrusion is major concern in endodontic practice especially during cleaning and shaping of root canal system. This periapical expulsion may result in humoral or cell-mediated immunological reaction such as pain and/or, swelling, causing apical periodontitis and resulting in flare-up. The flare-up may arise due to irritation towards periapical tissue by instrumentation, irrigation and microorganisms which should be minimized even though it may not be avoided. To minimize these periapical expulsions, related factors should be scrutinizing evaluated and discussed. There are several factors that influence apical extrusion of debris, irrigating solution and microorganisms like root length, root curvature and so on.
Review result: Among the hand instrumentation techniques step-back produced more apical extrusion than others. Rotary instrumentation generally produced less apical extrusion than hand instrumentation. Cervical preflaring reduced the apical extrusion comparatively. EndoVac irrigation system expelled less irrigating solution than other systems/ techniques.
Conclusion: step-back hand instrumentation showed more apical extrusion so it should be chosen carefully. Over hand instrumentation, rotary instrumentation should be preferred. Cervical preflaring showed less apical extrusion so it should be followed routinely.
Clinical significance: This review article discusses various factors responsible for periapical expulsion in detail. This also focuses on how periapical expulsions can be minimized even though it cannot be avoided for successful endodontic treatment with least patient discomfort.
