In vitro study to assess apical extrusion of intracanal bacteria using NiTi file instruments
DOI:
https://doi.org/10.64252/ty6t4s23Keywords:
Apical extrusion, NiTi instruments, Enterococcus faecalis, root canal therapy, WaveOne Gold, ProTaper, TruNatomy, bacterial contamination.Abstract
Background:
Apical extrusion of bacteria during root canal instrumentation is a major concern, as it can lead to postoperative pain and flare-ups. Nickel–Titanium (NiTi) rotary and reciprocating instruments are commonly used in endodontics due to their efficiency and safety. However, their role in bacterial extrusion remains debated.
Materials and Methods:
An in vitro study was conducted on 45 extracted single-rooted human mandibular premolars. The canals were contaminated with Enterococcus faecalis and divided into three groups (n = 15 each) based on the instrumentation system: Group A - ProTaper Universal (rotary), Group B - WaveOne Gold (reciprocating), and Group C - TruNatomy (rotary). Each canal was instrumented according to the manufacturer's protocol. Bacterial extrusion was collected in vials containing sterile saline and incubated. Quantification was performed by measuring colony-forming units (CFUs) using standard microbiological techniques.
Results:
All systems caused some degree of bacterial extrusion. Group B (WaveOne Gold) showed the highest mean CFU count (4.1 × 10⁴ ± 1.3 × 10³), followed by Group A (ProTaper Universal) (2.8 × 10⁴ ± 1.1 × 10³), and Group C (TruNatomy) demonstrated the least extrusion (1.5 × 10⁴ ± 9.5 × 10²). The differences were statistically significant (p < 0.05).
Conclusion:
Although bacterial extrusion was evident with all tested NiTi systems, reciprocating instrumentation resulted in greater bacterial extrusion compared to rotary systems. TruNatomy files exhibited the least apical extrusion, suggesting better control and potential clinical advantage.
