Uzun Ismail, Şenel Kevser, Alqawasmi Rawan
Department of Endodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey.
Department of Endodontics, Ordu Central Dental Hospital, Ordu, Turkey.
PLoS One. 2025 May 15;20(5):e0323807. doi: 10.1371/journal.pone.0323807. eCollection 2025.
One of the main challenges in endodontic retreatment is managing apical debris extrusion, which can influence both healing and patient comfort. Different retreatment methods result in varying levels of extrusion. This study aims to quantitatively compare the extent of apical debris extrusion caused by different auxiliary techniques during the extraction of root canal fillings in mandibular molars, to help guide the selection of an optimal endodontic approach.
Sixty mandibular molar teeth scheduled for extraction due to periodontal reasons, such as advanced bone loss and periodontal disease, which rendered them non-restorable, were collected. All extractions were performed with prior informed consent from the patients, ensuring adherence to ethical standards. Preparation was performed with the Protaper Next file system, focusing on X3 files according to the manufacturer's guidelines. Teeth were filled using the lateral compaction technique with AH Plus sealer and stored at 100% humidity at 37°C for two weeks for the sealant to set. The samples were divided into four groups (n = 15 each): Protaper Universal Retreatment (PTUR), Ultrasonic + PTUR, Orange Oil + PTUR, and System B + PTUR, with PTUR procedural steps followed to attain working length. During preparation, 15 ml of distilled water was used, followed by 1 ml of distilled water for debris collection post-procedure. The debris was incubated at 68°C for five days to evaporate the water, and tube weights were recorded and compared statistically across groups.
The study assessed debris extrusion during endodontic retreatment. The PTUR group showed the least extrusion (average 1.1 mg, SD ± 1.05 mg), indicating a more controlled approach. The Ultrasonic + PTUR group exhibited higher extrusion (average 4.2 mg, SD ± 2.12 mg), reflecting a more invasive technique with a greater potential for debris extrusion. The Orange Oil + PTUR group displayed moderate extrusion levels (average 2.5 mg SD ± 1.46 mg), reflecting the solvent's effect. The System B + PTUR group had the highest extrusion (average 4.3 mg, SD ± 1.87 mg), indicating it as the method associated with the greatest debris displacement. Statistically significant differences were found between the PTUR group and the other groups (P < 0.05). Additionally, a significant difference was observed between the Orange Oil + PTUR group and both the Ultrasonic + PTUR and System B + PTUR groups (P < 0.05). No significant difference was noted between the System B + PTUR and Ultrasonic + PTUR groups (P > 0.05).
The study concludes that auxiliary methods used during root canal filling removal significantly impact the degree of apical debris extrusion, with some methods leading to greater extrusion than others.
根管再治疗的主要挑战之一是处理根尖碎屑挤出问题，这会影响愈合和患者舒适度。不同的再治疗方法导致的挤出程度各不相同。本研究旨在定量比较下颌磨牙根管充填物取出过程中不同辅助技术引起的根尖碎屑挤出程度，以帮助指导最佳根管治疗方法的选择。
收集60颗因牙周原因（如严重骨丧失和牙周病）而无法修复需拔除的下颌磨牙。所有拔牙均在患者签署知情同意书后进行，确保符合伦理标准。使用Protaper Next锉系统进行预备，按照制造商的指南重点使用X3锉。采用侧向加压技术用AH Plus封闭剂充填牙齿，并在37°C、湿度100%的条件下储存两周以使封闭剂凝固。将样本分为四组（每组n = 15）：Protaper通用再治疗（PTUR）、超声 + PTUR、橙油 + PTUR和System B + PTUR，按照PTUR的操作步骤达到工作长度。预备过程中使用15毫升蒸馏水，术后用1毫升蒸馏水收集碎屑。将碎屑在68°C下孵育5天以蒸发水分，记录试管重量并进行组间统计学比较。
该研究评估了根管再治疗期间的碎屑挤出情况。PTUR组挤出量最少（平均1.1毫克，标准差±1.05毫克），表明该方法更可控。超声 + PTUR组挤出量较高（平均4.2毫克，标准差±2.12毫克），反映出该技术侵入性更强，碎屑挤出的可能性更大。橙油 + PTUR组挤出量中等（平均2.5毫克，标准差±1.46毫克），反映了溶剂的作用。System B + PTUR组挤出量最高（平均4.3毫克，标准差±1.87毫克），表明该方法与最大的碎屑移位相关。PTUR组与其他组之间存在统计学显著差异（P < 0.05）。此外，橙油 + PTUR组与超声 + PTUR组和System B + PTUR组之间均观察到显著差异（P < 0.05）。System B + PTUR组和超声 + PTUR组之间未观察到显著差异（P > 0.05）。
该研究得出结论，根管充填物去除过程中使用的辅助方法对根尖碎屑挤出程度有显著影响，某些方法导致的挤出量比其他方法更大。
