Comparison between Single-file Rotary Systems: Part 1—Efficiency, Effectiveness, and Adverse Effects in Endodontic Retreatment

Assessment of Debris Apical Extrusion, Unprepared Surface Areas, and Dentinal Crack Formation after Root Canal Preparation Using ProTaper Next, ProTaper Ultimate, and R-Motion File Systems

INTRODUCTION

This study evaluated and compared the amount of apically extruded debris, unprepared wall surface areas, and dentinal crack formation resulting from root canal preparation using ProTaper Next (PTN), ProTaper Ultimate (PTU), and R-Motion (RM) file systems.

METHODS

Forty-five palatal roots of maxillary first molars were shortened to a uniform length of 12 mm. The samples were divided randomly into 3 groups (n = 15/group) to be prepared using either PTN, PTU, and RM file systems. The investigator adopted modified Myers and Montgomery's approach to replicate the temperature of the human body. Debris was collected in vials and weighed before and after instrumentation with a sensitive balance. Every specimen was irrigated using distilled water during preparation, utilizing a side-vented needle. Weight before instrumentation was subtracted from weight after instrumentation to identify the weight of the collected debris. Cone-beam computed tomography (CBCT) scans were taken before and after canal preparation using a Planmeca ProMax CBCT machine. The unprepared canal surface area was calculated by superimposing preoperative and postoperative CBCT images using the Mimics Medical program. After preparation, a low-speed diamond disc horizontally sectioned the roots at 3, 6, and 9 millimeters from the apex. The specimens were examined under a digital microscope to detect crack formation. Statistical analysis was carried out using one-way (ANOVA) and Tukey (HSD) tests, with a significance level of P < .05.

RESULTS

There was no statistically significant difference in the quantity of debris extruded apically and dentinal crack numbers among the 3 shaping files (P > .05). Only the apical third of root canals prepared by PTU displayed a significantly lower unprepared surface area compared to PTN and RM.

CONCLUSIONS

Instrumentation with PTN, PTU, and RM yielded similar amounts of apically extruded debris and dentinal cracks. The PTU files demonstrated higher effectiveness in preparing the apical third by reducing the unprepared surface area in the prepared root canal.

Evaluation of apically extruded debris from root canal filling removal of the mesiobuccal canal of maxillary molars using XP shaper and protaper with two different irrigation

Background

Periapical extrusion of debris for root retreatment will effectively improve the posttreatment inflammation and pain. The aim of this study was to investigate the extruded debris for root retreatment using XP shaper and ProTaper files.

Materials and Methods

In his experimental laboratory study, 40 extracted human maxillary molars were used in this laboratory study. After disinfection and equalization of length, the samples were treated with a passive step-back technique and dressed. The samples placed in the tubes for retreatment were divided into four groups: (1) XP shaper file and hypochlorite, (2) XP shaper file and ethylenediaminetetraacetic acid (EDTA), (3) ProTaper file and hypochlorite, and (4) ProTaper file and EDTA. Then, the teeth were taken out of the tubes, and cleaned to collect the remaining apical debris. The weight of the tube and the extruded debris was measured again. Data were analyzed using the Kruskal-Wallis test (α =0.05).

Results

The highest average of extruded debris was related to the XP shaper file with EDTA solution, and the lowest average was related to the ProTaper file with hypochlorite solution. Between the two files used with EDTA and hypochlorite solution, the average debris extrusion of the XP shaper file with EDTA solution was significantly higher (P < 0.05) compared to the ProTaper and XP shaper files with hypochlorite solution (P < 0.05).

Conclusion

Regardless of the type of irrigant material, the ProTaper file can be a more suitable option than the XP shaper file for retreatment of the tooth root canal with minimal debris extrusion.

Quantitative Assessment of Apically Extruded Debris During Retreatment Procedures Using Three Nickel-Titanium Rotary Systems: An In Vitro Comparative Study

Objectives: Apical extrusion of debris can affect the success of endodontic treatments, and the specific performance of certain retreatment systems has not been studied yet. Therefore, the aim of this in vitro study was to quantitatively assess the amount of apically extruded debris produced during retreatment procedures using three rotary NiTi retreatment systems in mature non-resorbed straight roots. Methods: Thirty extracted permanent human teeth with single straight roots were selected. The root canals were prepared with the ProTaper Next system up to size 30 and obturated with gutta-percha and AH Plus sealer using the continuous wave of condensation technique. The samples were stored for 30 days and randomized by computer sequence into three retreatment groups (n = 10): (1) ProTaper Universal Retreatment; (2) HyFlex Remover; and (3) VDW.Rotate Retreatment. Apically extruded debris was collected in Eppendorf tubes and weighed with a microbalance (10-5 g) before and after retreatment procedure. As the data were not normally distributed, the Kruskal-Wallis test was applied for comparing data among groups, with an alpha level set at α = 0.05. Dunn's test was considered for post-hoc analyses, if appropriate. Results: Hyflex Remover was associated with the highest amount of extruded debris (0.85 ± 0.82 mg), followed by VDW.Rotate Retreatment (0.78 ± 0.41 mg) and ProTaper Universal Retreatment (0.62 ± 0.28 mg). However, the differences were not statistically significant (p > 0.05). Conclusions: All the retreatment systems tested were associated with apical extrusion of debris in vitro, with no significant quantitative differences between them, suggesting that clinicians can choose a retreatment system with features appropriate to the specific clinical situation without risk of increasing the amount of apically extruded debris.

Comparative Evaluation of the Removal of Gutta Percha From the Root Canal Using Various Retreatment File Systems With and Without Magnification: An In Vitro Study

AIM AND OBJECTIVE

The main goal was to compare the efficacy of gutta percha (GP) removal from the root canal using the Neo Endo Retreatment file system, Solite RS3, and ProTaper Universal Retreatment (PTUR) files with and without magnification under a direct operative microscope using stereomicroscopic evaluation.

MATERIALS AND METHODS

Sixty single-rooted teeth were randomly assigned to one of three groups after obturation till F2 mastercone with resin sealer: Group 1 (n=20): Neo Endo Retreatment Files, Group 2 (n=20): Solite RS3, Group 3 (n=20): PTUR files. Each group was further separated into two subgroups: Subgroup 1: without magnification (no direct operative microscope) and Subgroup 2: with magnification under a direct operative microscope at 12× magnification. After retreatment, the roots were grooved buccolingually and split into two halves using a diamond disc with the help of a chisel. The samples were examined under a stereomicroscope. Images were captured in a digital camera and analyzed using image analyzing software Image Pro v10 (Media Cybernetics).

RESULTS

The Neo Endo retreatment file system had a significantly greater percentage of remaining obturating material than the Solite RS3 Retreatment and PTUR file systems (p<0.05) in both groups with and without magnification. In the group without magnification, Solite RS3 showed a significant difference compared to ProTaper (p<0.05). In the group with magnification, there was no significant difference between the ProTaper Universal retreatment file system and Solite RS3 (p=0.589). Retreatment performed without magnification had more remnant GP when compared to the retreatment procedure performed under magnification of the direct operative microscope.

CONCLUSION

Under stereomicroscopic evaluation, the remnant GP was higher in the Neo Endo File System both with and without magnification than in the Solite Retreatment and PTUR file systems. ProTaper showed moderate significance in removing the obturation than Solite RS3 in the magnification group. The Solite RS3 file system performed as efficiently as the PTUR file system.

Effect of treatment variables on apical extrusion of debris during root canal retreatment: A systematic review and meta-analysis of laboratory studies

Background

This study aimed to systematically and comprehensively review the effect of various treatment variables on apically extruded debris (AED) during non-surgical root canal retreatment (NSRCRT).

Methods

The study protocol is shared in the Open Science Framework database (https://osf.io/kjtdg/?view_only=17060180705745ec9dae9a01614f3880). An electronic search was conducted up to July 2022 to reveal related studies. Two reviewers critically assessed the studies for eligibility against inclusion and exclusion criteria and data extraction. Quantitative data synthesis was performed, and the risk of bias in the studies was also evaluated.

Results

Forty-six studies were included in the systematic review and 14 in the meta-analysis. Conflicting or limited evidence was found for the effect of sealer type, obturation technique, and solvent use. The manual instrumentation increased the amount of AED compared to rotary instrumentation during the removal of filling materials (P<0.001). There was no significant difference in the amount of AED between the use of rotary and reciprocating files during the removal of filling materials (P=0.181).

Conclusion

Rotary instruments can be recommended instead of manual instruments during the removal of filling materials to control the amount of AED. Further studies with a low risk of bias are needed to clarify the effect of other treatment variables on AED during NSRCRT.

In vitro evaluation of filling material removal and apical debris extrusion after retreatment using Reciproc blue, Hyflex EDM and ProTaper retreatment files

OBJECTIVES

To evaluate the amount of remaining filing material and apical debris extrusion after retreatment using Reciproc Blue, Hyflex EDM and ProTaper Retreatment Files.

MATERIALS AND METHODS

Thirty-six extracted permanent mandibular first molars with moderately curved mesial roots were selected. Mesiobuccal canals were prepared using the ProTaper Next system up to size X2 and filled using gutta-percha and Adseal sealer via cold lateral compaction. Teeth were randomly divided into three equal groups (n = 12): Group 1: Reciproc Blue (RB)(VDW, Germany), Group 2: Hyflex EDM (HEDM)(Coltene/Whaledent, Switzerland), Group 3: ProTaper Universal Retreatment file system + ProTaper Next file system (PTUR + PTN)( Dentsply Maillefer, Switzerland). Eppendorf tubes were used to collect the apically extruded debris. Cone-beam computed tomographic scans were taken prior to and after retreatment and the volume of remaining filling material was assessed at the coronal, middle and apical levels. Statistical analysis was performed using the Kruskal-Wallis test, Friedman's test and Wilcoxon Sign Rank test. Significance level was set at p value 0.05.

RESULTS

There were no statistically significant differences among the three groups in the reduction of the volume of the filling material or in the amount of apically extruded debris.

CONCLUSION

All the tested filing systems showed similar efficacy in removing the filling material, however, none of them could achieve its complete removal. Apical extrusion of debris occurred with all the systems used with no significant difference between the three groups.

Micro-CT evaluation of the removal of root fillings using rotary and reciprocating systems supplemented by XP-Endo Finisher, the Self-Adjusting File, or Er,Cr:YSGG laser

Objectives

This study aimed to compare the effectiveness of a single-file reciprocating system (WaveOne Gold, WOG) and a multi-file rotary system (ProTaper Universal Retreatment, PTUR) in removing canal filling from severely curved canals and to evaluate the possible adjunctive effects of XP-Endo Finisher (XPF), the Self-Adjusting File (SAF), and an erbium, chromium: yttrium, scandium, gallium garnet (Er,Cr:YSGG) laser using micro-computed tomography (μCT).

Materials and Methods

Sixty-six curved mandibular molars were divided into 2 groups based on the retreatment technique and then into 3 based on the supplementary method. The residual filling volumes and root canals were evaluated with μCT before and after retreatment, and after the supplementary steps. The data were statistically analyzed with the t-test, Mann-Whitney U test, analysis of covariance, and factorial analysis of variance (p < 0.05).

Results

PTUR and WOG showed no significant difference in removing filling materials (p > 0.05). The supplementary techniques were significantly more effective than reciprocating or rotary systems only (p < 0.01). The supplementary steps showed no significant differences in canal filling removal effectiveness (p > 0.05), but XPF showed less dentin reduction than the SAF and Er,Cr:YSGG laser (p < 0.01).

Conclusions

The supplementary methods significantly decreased the volume of residual filling materials. XPF caused minimal changes in root canal volume and might be preferred for retreatment in curved root canals. Supplementary approaches after retreatment procedures may improve root canal cleanliness.

Postoperative pain perception and associated risk factors in children after continuous rotation versus reciprocating kinematics: A randomised prospective clinical trial

To compare the postoperative pain of continuous rotation and reciprocating movements after pulpectomy of non-vital primary molars and determine associated risk factors. 146 children aged 4-8 years with one primary molar indicated for pulpectomy were randomly assigned to two equal groups: those instrumented with continuous rotation motion (Hyflex EDM Coltene/Whaledent) and reciprocating motion (Reciproc R25 (VDW)). A 4-point pain scale was used to assess postoperative pain frequencies, which were compared at different intervals using the Chi-square test. Postoperative pain risk factors were determined using logistic regression analysis. There was no statistically significant difference between the follow-ups. Gender, pulp status, and radiographic radiolucency increased the risk of postoperative pain incidence. Postoperative pain likelihood in children with chronic apical periodontitis was 8.72 times that of children with necrotic pulps. Postoperative pain after instrumentation with both kinematics was comparable. Postoperative pain incidence is increased by preoperative pulp condition, radiographic radiolucency, and gender.

Retreatment of oval-shaped root canals filled with TotalFill bioceramic or AH plus sealer

This study investigated retreatment of oval canals filled with gutta-percha and different sealers using WaveOne Gold (WOG). Single oval canals were prepared to size 30, 0.04 and obturated with gutta percha and AH Plus (AHP) or TotalFill bioceramic (TFBC) sealer. After 6-month incubation, the canals were retreated with WOG Primary (25, 0.07) under simulated body temperature, and the developed load and torque were simultaneously measured. The time and regaining the apical patency were checked. Micro-computed tomography scanning was performed to calculate the remaining obturating materials. An independent t-test and chi-square test were performed at a 95% confidence level. A shorter retreatment time was needed in TFBC than in AHP (P = 0.003). However, a higher maximum apical load was reported with AHP (P = 0.000). Meanwhile, comparable maximum coronal load and maximum torque values were observed. Apical patency was regained in all TFBC roots and only 75% of the AHP samples (P = 0.217). The remaining obturating materials were comparable in TFBC (13.02 ± 8.12%) and AHP (10.11 ± 8.46%) (P = 0.398). WOG was able to remove 89.89% and 86.98% of obturating materials in TFBC and AHP, respectively. The TFBC presented lower apical loads and faster retreatment compared to AHP.

Retreatment of XP-endo Shaper and R-Endo files in curved root canals

OBJECTIVES

To compare the retreatment efficiency of XP-endo Shaper and R-Endo files in curved root canals using ImageJ software.

METHODS

Forty extracted mandibular first molars with curved mesial canals (25°-35°) were chosen. Access cavities, preparation and obturation of root canals were performed. Roots were randomly distributed into two groups corresponding to the retreatment files used. Group 1 retreated with XP-endo Shaper file, and group 2 retreated with R-Endo files. Each root was sectioned and photographed. ImageJ software was used to estimate the percentage of residual filling material that existed on the three root canal segments. Mann-Whitney U and the Kruskal-Wallis tests were used to compare the percentages of residual filling material between the teeth segments (P < .05).

RESULTS

The R-Endo group showed a significantly higher median percentage of residual filling material than the XP-endo Shaper group. In both groups, the coronal segments had the highest median of the residual filling material, followed by the middle and apical segments.

CONCLUSION

XP-endo Shaper is significantly more effective than R-Endo in removing root canal filling materials in the coronal, middle, and apical segments.

A Comparative Evaluation of the Apically Extruded Debris from Root Canals Prepared by R-Motion NiTi File System

Background

Apically extruded debris (AED) is an inherent concern during root canal treatment for both endodontists and general practitioners. The present study investigates the AED of the novel R-Motion single-file reciprocating system compared to standard single reciprocating and multifile rotary systems.

Materials and Methods

Fifty-six moderately curved palatal roots of upper maxillary first molars were selected for the present study. The samples were then divided randomly into four groups (n = 14)- Group I: R-motion (RM), Group II: WaveOne Gold (WOG), Group III: ProTaper Next (PTN), and Group IV: HyFlex EDM (HFEDM). The researcher has modified Myers and Montgomery's method to simulate human body temperature. Vials were used to collect debris and weighted using a 0.00001 sensitive balance before and after instrumentation. The instrumentation of all experimented groups was done at 37°C, terminated at master apical file #25. An auto syringe with a side vented needle was used to deliver 8 ml of deionized water for irrigation of each sample during preparation. Vials were stored in a dry sealed desiccator which contained CaSO₄ crystals, for 24 hr before weighing. The weight of the collected debris was obtained by subtracting the preinstrumentation weight from the postinstrumentation weight for each vial. The Kruskal-Wallis and Mann-Whitney U tests were performed to analyse the statistical difference in the amount of debris between the tested groups at a 0.05 significance level.

Results

The RM system produced less debris extrusion than all tested groups, with a significant difference between the former and the WOG and the PTN systems. However, WOG, PTN, and HFEDM showed no statistically significant difference in the amount of AED.

Conclusion

All tested groups produced apical debris in different amounts. The RM produced substantially less AED than WOG and PTN. Meanwhile, WOG, PTN, and HFEDM caused a comparable amount of AED.

Biofilm elimination from infected root canals using four different single files

INTRODUCTION

Enterococcus faecalis (E. faecalis) is the most commonly isolated bacterium from infected root canals. It is found in the form of a biofilm, which makes it more resistant to antimicrobials, and requires optimal chemomechanical strategies to maximize root canal disinfection.

AIM

To evaluate the efficacy of 4 different endodontic file systems against E. faecalis biofilm growth in root canals using colony-forming units per milliliter (CFU/mL) and scanning electron microscope (SEM).

METHODS

Eighty-five extracted human mandibular premolars with straight root canals and apical diameters not larger than the #15 K-file were randomly selected. After performing a pilot study (n = 15) to determine the ideal incubation period for E. faecalis biofilm development, sixty-five root canals were infected with E. faecalis, incubated for 3 weeks, and then mechanically prepared using one of four single files (XP-endo Shaper, Hyflex EDM, One Curve, and Fanta. AFTM F One) (n = 15). Five infected root canals were excluded for the positive control. Five non-contaminated root canals were included for the negative control. Samples were collected using sterile paper points pre- and post-instrumentation to determine the bacterial load (CFU/mL). Root canals from each group were topographically evaluated at the coronal, middle, and apical segments using scanning electron microscope (SEM). Bacterial reduction data were estimated and statistically analyzed by Kruskal-Wallis and Mann-Whitney U tests (post hoc test) (P ≤ .05).

RESULTS

XP-endo Shaper, Hyflex DEM, and One Curve significantly could eradicate E. faecalis biofilms in infected root canals with no significant difference among them compared to Fanta. AF™ F One.

CONCLUSION

None of the systems were capable of completely eliminating biofilms. XP-endo Shaper, Hyflex EDM, and One Curve mechanically eliminated E. faecalis biofilms compared to Fanta. AF™ F One from infected root canals.

Quantitative Assessment of Apically Extruded Debris after Single-Files Supplemental Retreatment considering Apical Patency Influence: In Vitro Study

Objective

This study aims to assess the impact of re-establishing apical patency on the quantity of debris extruded through the apex after three supplementary retreatment files (TruNatomy (TRN), WaveOne Gold (WOG), and XP endo Finisher R (XPFR)).

Materials and Methods

Eighty single-rooted mandibular premolars were prepared with ProTaper Universal rotary systems (PTU) up to F3 and obturated. The samples were divided into two main groups according to the presence or absence of the apical patency (n = 40), GI with apical patency and GII without apical patency. Based on the file system, which was adopted to eliminate the previous filling, each group had four subgroups (n = 10). In GI PTUR and GII PTUR, ProTaper Universal retreatment files (PTUR) were utilized only to remove the most primary filling material (control groups). In the other groups (PTUR) used, it was first followed by supplementary files. The quantity of debris extruded by different retreatment file systems was determined and compared to the corresponding control group with or without apical patency. Data were analyzed using a two-way ANOVA with a post hoc Tukey's multiple comparison test at a 5% significance level.

Results

There was a statistically significant difference among the control and experimental groups. XPFR had the least quantity of extruded debris. Apical patency did not affect the debris extrusion.

Conclusion

All tested files led to a significant apical debris extrusion regardless of apical patency.

Effect of solvent on root canal filling material removal by two different rotary file systems in C-shaped root canals

This study compared the percentage reduction of total obturation materials, gutta-percha and sealer, using two rotary file systems with/without solvent in retreating C-shaped root canals and to evaluate the effect of the solvent on instrument separation. C-shaped root canals were scanned using micro-CT to identify the root canal morphology and randomly assigned to four groups (n = 12). Retreatment was performed using ProTaper Universal Retreatment (PTUR) or XP-endo systems with/without solvent. The number of separated instruments were recorded. The samples were scanned pre- and post-retreatment. The percentage reduction of total obturation materials, gutta-percha and sealer, were calculated. The percentage reduction of gutta-percha in the PTUR without solvent group was significantly lower than the other groups (P = 0.018). The number of separated instruments in the solvent groups were significantly lower than the no solvent groups (P < 0.05). Solvent increased gutta-percha removal, when using PTUR and decreased the occurrence of separated instruments for both systems.

Influence of Apical Diameter on Filling Material Extrusion during Retreatment - A Micro-CT and CBCT evaluation

AIM

To investigate whether foraminal widening performed at primary treatment has an effect on the amount of apically extruded obturator material during retreatment and to evaluate the sensitivity of cone beam computed tomography (CBCT) in detecting extruded obturator material.

METHODS

Forty palatal roots of maxillary molars were selected based on micro-CT and divided into two groups (n=20): with foraminal widening (WE) and without foraminal widening (NE). To standardize the apical foramen, all specimens were instrumented to the foramen using the Protaper Next system, up to instrument X3. The WE group was instrumented to the foramen up to instrument X5, and the NE group was instrumented 1 mm lower. The canals were obturated 1 mm below the apical foramen with gutta-percha and AH Plus and stored for 7 days at 37 °C and 95% humidity. Roots were fixed in microtubes filled with 1.5% agar gel. The obturation material was removed with Reciproc R50. Scans of the teeth and agar were performed using micro-CT and CBCT. Comparison between groups and between methods was performed using Mann-Withney test (p ≤0.05).

RESULTS

No statistical difference was found when comparing the extruded material between groups using micro-CT (p = 0.589) or CBCT (p = 0.953). CBCT measured a greater volume of extruded material than micro- CT (p = 0.0004).

CONCLUSION

Foraminal widening had no effect on the extrusion of filling material during retreatment. The CBCT favored the evaluation of apically extruded filling material.

Assessment of Bioceramic Sealer Retreatability and Its Influence on Force and Torque Generation

This study assesses the retreatability of TotalFill bioceramic (TFBC) and AH Plus (AHP) sealers and their impact on retreatment force and torque. Twenty-six premolar teeth with single oval canals were instrumented, obturated using the matched gutta-percha cone technique with one of the tested sealers, and then temporized. After a 6-month incubation at 37 °C and 100% humidity, the canals were retreated with the XP Shaper system. During retreatment, the generated force and torque were measured. Micro-CT scanning was run before and after the retreatment procedure to analyze the remaining obturating materials in the canals. The apically directed maximum force in AHP was higher than that in TFBC. The coronally directed maximum force and the maximum torque were comparable between the groups. A higher amount of remaining obturating materials was found in the AHP compared to that in the TFBC. Based on these findings, endodontic sealer had an influence on retreatability, and the TFBC showed less remaining obturating materials and lower retreatment forces in the apical direction compared to the AHP in extracted teeth with oval canals.

Ability of two reciprocating Nickel-Titanium instruments for guttapercha/ sealer removal in simulated curved root canals

The aim of this study was to compare the capacity of two reciprocating NiTi instruments in removing gutta-percha/sealer material from simulated curved root canals (SCRC). The time required for filling material removal was also recorded. Twenty SCRCs were divided into two groups of 10 (n=10) samples each. In Group 1, the SCRC were prepared to a R25 Reciproc Blue instrument (RCPB; VDW, Munich, Germany). In Group 2 the SCRC were prepared to a Primary WaveOne Gold instrument (PWOG; Dentsply, Ballaigues, Switzerland). In both groups, the canals were filled with matched-taper single gutta-percha cones and AH Plus sealer. Filling materials were removed with R25 RCPB (Group 1) and PWOG (Group 2). The amount of remaining gutta-percha/sealer was calculated at three predetermined levels of evaluation located at 2, 6 and 10 mm from the WL and expressed in percentages. Canals re-treated with RCPB contained significantly less remaining gutta-percha/sealer compared tocanalspreparedwith PWOG (P=0.02). The RCPB instruments required significantly less time to complete the retreatment procedures (P<0.01). No unwinding or instrument separation was noted. RCPB instruments removed significantly more gutta-percha/sealer from simulated curved root canals than PWOG. However, neither of the tested instruments completely removed all filling materials.

Present status and future directions - Removal of fractured instruments

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 non-visible fractured instruments since the removal of those instruments are deemed unpredictable with the current techniques, whereas the removal of visible fractured instruments are considered predictable now. Another possible direction of it is 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.

Shaping Ability of Reciprocating and Rotary Systems After Root Canal Retreatment: a CBCT Study

The purpose of this in vitro study was to evaluate the shaping ability of reciprocating and continuous rotary systems after root canal retreatment. After preparation and root canal filling, mesial canals of 54 mandibular molars were distributed into 3 groups (n=18), according to the filling material removal and re-instrumentation protocols: WOG group - WaveOne Gold system; PTN group - ProTaper Next system; and PTU group - ProTaper Universal system. Cone-beam computed tomographic (CBCT) images acquisition of the mesial root canals was performed at different moments: (1) before instrumentation (unprepared root canals), (2) after preparation and filling, (3) after filling material removal and (4) re-instrumentation. The apical transportation (AT), centering ability (CA) and change in root canal diameter were assessed by CBCT analysis. The remaining filling material quantification was performed by radiographic examination. The statistical analyses were performed using the 3-way ANOVA, Tukey-Kramer, Kruskal-Wallis and Dunn multiple Comparison tests (p<0.05). The tested instruments did not show full CA (=1.0). PTN group had greater AT at the 5th mm in comparison with the WOG group (p<0.05). After re-instrumentation, WOG group had greater root canal diameter change at the 1st and 5th mm than PTN and PTU groups (p<0.05). There was no significant difference among groups when comparing the amount of remaining filling material after re-instrumentation (p>0.05). The tested systems provided minimal alteration in root canal morphology at the apical portion after root canal retreatment. However, WOG promoted greater change in root canal diameter.

A single-file endodontic treatment: A promising endodontic concept

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Critical analysis of research methods and experimental models to study removal of root filling materials

Despite enjoying high favourable outcome rates, root canal treatment is not always successful. Root canal retreatment is a widely practised option for managing a non-healing root treated tooth. A basic distinction between retreatment and initial treatment is the requirement to remove the existing root filling material occupying the root canal space. Only then, can the technical deficiencies and possible causes of failure be addressed. Hence, the successful removal of the root filling material is critical to achieving the objectives of retreatment. Many different materials and techniques have been used for root canal filling, which have been documented in a plethora of studies; these are mainly laboratory studies investigating the removal of root filling materials. To help guide future research, which may then better inform clinical practice in relation to retreatment procedures, the focus of this narrative review is on the research methods and experimental models employed to study the removal of root filling materials. The current available literature demonstrates great variation in the research methodologies used to study the removal of root filling material, including direct visualization by splitting tooth samples or clearing, three-dimensional radiographic imaging including using microcomputed tomography or cone-beam computed tomography, and a combination of these techniques. Depending on the research method employed, variation also exists in quantification of root filling material removal; these include measurements of surface area, volume or weight, and criteria-based (semi-quantitative) assessment. Experimental models, using human teeth or resin models, differ with respect to standardization techniques and replication of the clinical scenario including initial sample preparation, canal filling, allocation and technical aspects of retreatment procedures. Future models should replicate, as closely as possible, the clinical scenario. Currently, microcomputed tomography provides a highly detailed, non-invasive and non-destructive method of objectively assessing and quantifying root filling removal.

Deficiencies in Root Canal Fillings Subsequent to Adaptive Instrumentation of Oval Canals

Simple Summary

Employing a chemo-mechanical preparation, one of the primary procedural phases in endodontic therapy is carefully removing debris, pulp tissue, and bacteria from the root canal system. The cross-sectional root canal shapes comprise circular, oval, long oval, flattened, or irregular. The frequency of oval root canals in the apical third of human teeth is around 25 to 50%. Motorised endodontic files leave almost 60% of the oval root canal perimeter unaffected by their instrumentation, thus resulting in faulty obturation that is required to prevent reinfection and to restrict the passage of microorganisms and toxins to and from the periapical tissue.

Abstract

The purpose of this study was to explore the influence of instrumentation and the potential for debris deposition using XP-endo shaper plus (XP-SP) and full-sequence SAF (F-SAF) on the adaption of thermoplastic root canal fillings in oval canals. Following the manufacturer’s instructions, ninety human permanent mandibular incisors with a single oval canal 6 mm from the apex (verified using pre-operative CBCT scanning) were instrumented with XP-SP and F-SAF. Obtura III Max apparatus was used for root canal obturation without the use of a root canal sealer. The roots were then sectioned 6 mm from the apex and examined with a digital stereomicroscope at x25 magnification to assess the root canal fillings. The F-SAF was associated with a significantly higher (p < 0.01) percentage of entire adaptation of the root fillings (76%) compared to the XP-SP (57%). Furthermore, the XP-SP group was also associated with higher (p < 0.01) defective obturation with debris at 17% and with voids at 26%. However, the F-SAF had lower percentages of defective obturations (7% with debris and 17% with voids). The quality of obturation of oval canals instrumented using full-sequence SAF was better.

The effect of two rotary and two reciprocating NiTi systems on postoperative pain after root canal retreatment on single-rooted incisor teeth: A randomized controlled trial

AIM

This randomized clinical trial aimed to assess the effect of two rotary (ProTaper Retreatment + ProTaper Gold and Hyflex EDM) and two reciprocating (Reciproc Blue and WaveOne Gold) NiTi systems on postoperative pain after root canal retreatment on single-rooted incisor teeth.

METHODOLOGY

One hundred and eighty patients scheduled for root canal retreatment were randomly assigned to one of the four groups according to the NiTi system (ProTaper Retreatment + ProTaper Gold, Hyflex EDM, Reciproc Blue or WaveOne Gold) used for the removal of root canal fillings and further canal preparation. The working length was determined to be 1 mm shorter than the '0.0' mark of the apex locator. Root canals were filled with gutta-percha and an epoxy resin-based root canal sealer using a lateral compaction technique. The teeth were restored using a resin composite material. A single operator performed the retreatments in a single visit. The incidence and intensity of postoperative pain were rated on a numeric rating scale by patients 24, 48 and 72 h after retreatment. The number of analgesic tablets (400 mg Ibuprofen) taken by patients was also recorded. Data were analysed using the Mann-Whitney U, Wilcoxon and chi-square tests.

RESULTS

For the intensity of postoperative pain, the difference between the four groups was not significantly different (p > .05). No significant difference was found between the groups in terms of analgesic medication intake (p > .05).

CONCLUSIONS

The rotary and reciprocating NiTi systems tested in this study were associated with similar intensity of postoperative pain and intake of analgesics following root canal retreatment on single-rooted incisor teeth completed in one visit.

A comparative study of the effects of gutta-percha solvents on human osteoblasts and murine fibroblasts

We aimed to investigate the in vitro physiologic effects of xylene, chloroform, orange oil and eucalyptus oil solvents for dissolving gutta-percha on L929 and HOB cell lines; 2.5 and 10 μL mL^-1 of these solvents were tested for 24, 48 and 72 h. Gutta-percha solvents inhibited the proliferation rate of fibroblasts in a dose- and time-dependent manner; however, no inhibition was detected in HOB (evaluated using MTT assay). None of the solvents induced apoptosis/necrosis in HOB cells at ≤2.5 μL mL^-1 concentration in contrast to L929 (determined using acridine orange/ethidium bromide dual staining). Each solvent tested reduced the migration rate of both L929 and HOB cell lines in a dose-dependent manner (evaluated using a scratch assay). Gutta-percha solvents can damage fibroblast-rich tissues. Osteoblasts seemed to be more resistant to the tested solvents, and excessive extrusion of solvents from the root canal may also damage the periradicular tissues and reduce the ability to repair.

Debris Extrusion Using Reciproc Blue and XP Endo Shaper Systems in Root Canal Retreatment

This study aimed at assessing the performance of Reciproc Blue (RB) and XP Endo Shaper (XPS), used for canal retreatment on extracted teeth, in terms of debris extrusion and obturating materials removal. Thirty mandibular premolars were prepared to ProTaper X2 file, obturated using warm vertical compaction, and then incubated for 28 days at 100% humidity at 37°C. Teeth were randomly assigned into two groups, according to the system used for retreatment (RB and XPS). During retreatment, debris extruded beyond the apex was collected in preweighed Eppendorf tubes, and the retreatment time was measured. Afterward, the teeth were longitudinally sectioned to assess the remaining obturating materials. Data were statistically analyzed using the Mann-Whitney test and chi-square test at a 95% confidence level. All the samples had extruded debris at varying weights ranging from 0.125 mg to 3.680 mg. XPS extruded less debris than RB, but no difference was detected (Mann-Whitney test; P > 0.05). RB and XPS required 54.9 ± 17.9 and 22.3 ± 9.3 seconds to perform retreatment procedures, respectively (Mann-Whitney test; P < 0.05). The sealer was found in all the samples. Compared to the RB group, fewer samples with remaining gutta-percha were found in the XPS group (Chi-square test; P < 0.05). None of the files fractured during the retreatment procedure. The tested files appear to extrude debris beyond the apex. Although XPS was able to remove the gutta-percha completely from the majority of the canals, it was unable to remove the sealer.

Contribution of XP-Endo files to the root canal filling removal: A systematic review and meta-analysis of in vitro studies

This review was designed to analyse whether the supplementary use of XP-Endo Finisher and XP-Endo Finisher R contributes to the removal of root canal filling materials. Databases were searched up to November 2020. Studies were critically assessed according to inclusion and exclusion criteria. Risk of bias evaluation was performed. Pooled standardised mean differences (SMD) and 95% confidence intervals (95% CI) were calculated. Ten studies involving 192 teeth were eligible for systematic review and meta-analysis could be performed with eight of these studies. Strong evidence showed that XP-Endo Finisher R file contributed significantly to filling material removal from root canals (SMD (95% CI): 0.41 (0.06-0.76)). Although the evidence was conflicting, XP-Endo Finisher R file was superior than other irrigant activation techniques (SMD (95% CI): 0.47 (0.02-0.93)). The supplementary use of XP-Endo Finisher and XP-Endo Finisher R is beneficial in further removal of root canal filling materials from root canal system.

Impact of root canal curvature and instrument type on the amount of extruded debris during retreatment

Objectives

The aim of the current study was to assess whether the amount of extruded debris differs for straight and severely curved root canals during retreatment using H-files, R-Endo, Reciproc and ProTaper Universal Retreatment (PTU-R) files. Additionally, the area of residual filling material was evaluated.

Materials and Methods

Severely curved (n = 104) and straight (n = 104) root canals of maxillary molar teeth were prepared with WaveOne Primary file and obturated with gutta-percha and AH Plus sealer. Root canal filling materials were removed with one of the preparation techniques: group 1: H-file; group 2: R-Endo; group 3: Reciproc; group 4: PTU-R (n = 26). The amount of extruded material and the area of the residual filling material was measured. The data were analyzed with 2-way analysis of variance (ANOVA) and 1-way ANOVA at the 0.05 significance level.

Results

Except for Reciproc group (p > 0.05), PTU-R, R-Endo, and H-file systems extruded significantly more debris in severely curved canals (p < 0.05). Each file system caused more residual filling material in severely curved canals than in straight ones (p < 0.05).

Conclusions

All instruments used in this study caused apical debris extrusion. Root canal curvature had an effect on extruded debris, except for Reciproc system. Clinicians should be aware that the difficult morphology of the severely curved root canals is a factor increasing the amount of extruded debris during the retreatment procedure.

A Digital Microscopic Inspection of Dentinal Defects after Using Endodontic Retreatment Files

Aim

The study aimed at evaluating the incidence of dentinal defects after root canal retreatment with ProTaper Universal retreatment (PTUR) and XP-endo Shaper and Finisher R (XP).

Materials and Methods

Sixty extracted single-rooted human premolars were selected and divided into 4 groups of 15 teeth each. In the negative control group, the teeth were left unprepared. In the positive control group, the teeth were prepared with ProTaper Next and obturated with no further retreatment. In the PTUR and XP groups, the teeth were prepared and obturated followed by removal of the filling material at body temperature using PTUR and XP instruments, respectively. The roots were then sectioned at 3, 6, and 9 mm from the apex and observed under a digital microscope to detect defects.

Results

PTUR group showed significantly higher (p value <0.05) incidence of defects than the other groups. Comparison of no defects versus defects between groups in different areas of root canals demonstrated significant difference among the groups in the apical and cervical regions.

Conclusion

Within the limitations of the present study, PTUR files created significantly more dentinal defects than XP files, with most of those defects at the cervical and apical areas of the root canals.

Safety and Effectiveness of Additional Apical Preparation using a Rotary Heat-treated Nickel-Titanium file with Larger Diameter and Minimum Taper in Retreatment of Curved Root Canals

OBJECTIVE

 The aim of this study was to investigate the effect of additional apical preparation using the ProDesign Logic (PDL) 50/.01 rotary heat-treated nickel-titanium (NiTi) file with a larger diameter and minimal taper for retreatment of curved root canals.

MATERIALS AND METHODS

 Mesial curved root canals of 12 mandibular molars were prepared using PDL 25/.06 and filled using the continuous wave of condensation technique and AH Plus sealer. After retreatment using ProDesign S (PDS) 25/.08, PDL 25/.06 and PDL 35/05, a complementary procedure was performed with PDL 50/.01. Microcomputed tomography (micro-CT) scanning was performed before and after retreatment procedures. The cyclic fatigue resistance of unused PDS 25/.08, PDL 25/.06, PDL 35/.05 and PDL 50/.01 instruments (n = 12) was evaluated in a stainless-steel device.

STATISTICAL ANALYSIS

 Data on the volumes of the root canals and the remaining filling materials were submitted to the paired t-test. Cyclic fatigue resistance data was submitted to one-way ANOVA and Tukey's tests (α = 0.05).

RESULTS

 Use of PDL 50/.01 decreased the remaining filling materials in the apical third (p < 0.05). The root canal volume was similar in the cervical and middle thirds before and after preparation using PDL 50/.01 (p > 0.05). PDL 50/.01 presented the highest cyclic fatigue resistance (p < 0.05).

CONCLUSIONS

 Use of the PDL 50/.01 instrument as an additional apical preparation for retreatment of curved root canals improved filling material removal in the apical third, while maintaining the dentin in the cervical and middle thirds. In addition, PDL 50/.01 presented high-flexural resistance.

Comparative Analysis of Root Canal Filling Debris and Smear Layer Removal Efficacy Using Various Root Canal Activation Systems during Endodontic Retreatment

Background and objectives: The complete removal of obturation material can be a challenge in nonsurgical root canal retreatment. The insufficient removal of obturation material is a reason for root canal retreatment failure. Materials and Methods: The purpose of this study was to assess the efficacy of different final root canal irrigation activation methods in removing debris and smear layers in the apical and middle portions of root canals during retreatment. Sixty-six distal roots of freshly extracted molars were randomly divided into six groups: (1) primary root canal treatment with no obturation (negative control); (2) retreatment with only conventional instrumentation and irrigation (positive control); (3) retreatment with additional ultrasonic irrigation using the Piezon Master 700; (4) ultrasonic irrigation with the ENDOSONIC Blue; (5) sonic irrigation with the EDDY; and (6) multisonic irrigation with the GentleWave system. Roots were split and prepared for scanning electron microscopic (SEM) evaluation. Acquired images were assessed to quantify the amount of debris and smear remaining. Results: Among the treatment groups, Group 6 had a significantly lower debris score than Group 2 (positive control) in both the middle and apical regions (p = 0.004, p = 0.012). All treatment groups showed significantly lower smear scores than Group 2 in the middle and apical regions (p < 0.05). Conclusions: The GentleWave multisonic System showed a more optimal cleaning efficacy of the root canal debris but did not differ significantly with the tested passive ultrasonic or sonic irrigation method.

In vitro comparative evaluation of efficiency of XP-endo shaper, XP-endo finisher, and XP-endo finisher-R files in terms of residual root filling material, preservation of root dentin, and time during retreatment procedures in oval canals - A cone-beam computed tomography analysis

Background:

In an oval-shaped canal, no single instrumentation systems were effective in absolute removing obturation.

Aim:

The aim of the study was to evaluate the performance of ProTaper Universal Retreatment (PTUR) system, XP-endo Shaper (XPS), XP-endo Finisher (XPF), and XP-endo Finisher-R (XPF-R) in removing root-canal filling material and preservation of sound dentin during retreatment procedure.

Methodology:

Root-canal preparation was performed on 60 mandibular premolars with oval-shaped canals using the ProTaper Gold file system. Preobturation scans were performed to measure canal volume of the canal and recorded. Obturation was performed and the samples were randomly assigned into four groups according to the retreatment protocol used (n = 15): H-file, PTUR files, PTUR followed by XPF file, and XPS supplemented with XPF-R file. After retreatment, the specimens were re-scanned and volumetric analysis of remaining root filling material, volume of the canal space were measured using EZ-3Di Software Version 5.0.0.2. All the data were subjected to one-way ANOVA and post hoc Tukey's test with a significance of 5%.

Results:

XPS + XPF-R showed promising results in the removal of obturating material and preservation of root dentin than any other group. The difference is statistically significant.

Conclusion:

XPS + XPF-R removed gutta-percha more significantly without sacrificing the sound dentin along with instrumentation.

Endodontic Retreatment Using a Single Instrument from four Nickel-Titanium Systems - A Micro-CT Study

Abstract This study evaluated the efficiency of using a single instrument from three different rotary multi-file systems and compared them with that of a reciprocating single-file for endodontic retreatment by means of micro-CT. Sixty extracted canines were prepared using a size F2 ProTaper Universal file and obturated. After 30 days of storage at 37ºC and 100% humidity, the teeth were randomly divided into four groups (n=15) based on the type of instrument used to retreatment: ProTaper Next (PTN), ProTaper Gold (PTG), TRUShape 3D (TS), and WaveOne (WO). The canals were retreated using only the size 40 instrument from each system according to the manufacturer’s recommendations for torque and speed. The time required to remove the filling material was recorded in seconds. The amount of initial and residual filling material and the quantity of dentin removed were assessed by means of micro-CT. Data were statistically analyzed (ANOVA and Kruskal-Wallis) at a 5% significance level. TS instruments required the highest (p<0.05) amount of time (mean, 384.80 ±144.92) compared with the WO (229.67±68.16) and PTG (248.67±64.22) and not so different from PTN instruments (327.67±133.3). No differences in the amount of dentin removed, initial and residual filling volume, and percentages of filling material were observed among the groups. The use of a single rotary instrument from the PTG, TS, and PTN systems was as effective as that of the single-file reciprocating WO system. However, none of the instruments was able to remove the filling materials completely.

Apical extrusion of debris with different rotary and reciprocating single-file endodontic instrumentation systems: a systematic review and meta-analysis protocol

INTRODUCTION

Root canal treatment is one of the oldest dental procedures for the treatment of endodontic infection. Extrusion of debris beyond the root apex during root canal instrumentation and subsequent persistence of pain are common complications. A systematic review of the evidence on reciprocating single-file instrumentation systems and their comparison with rotary single-file systems, with apical extrusion of debris as primary outcome, will be done through this study.

METHODS AND ANALYSIS

Published ex vivo and in vitro studies with no language restriction will be included. We will search MEDLINE (Ovid), EMBASE (Ovid), Web of Science, Cochrane and Google Scholar. Strategies will be incorporated to search grey literature also. Thorough evaluation of search results, completion of data abstraction and assessment of quality will be done by two reviewers independent from each other. Assessment of included studies will be done by utilising an evidence model developed on the basis of standards of quality reported in guidelines to document ex vivo and in vitro studies regarding dental materials and pertained for extrusion of debris apically and has been already used in quality assessment of studies involving quantification of debris extrusion apically. We will calculate the standardised mean differences for apically extruded debris, with congruent 95% CIs. We will measure the statistical heterogeneity by applying the Cochrane Q test and quantify using the I² statistic. Existence of covariates and any potential heterogeneity will be explored through prespecified subgroup and sensitivity analyses.

ETHICS AND DISSEMINATION

Approval from an ethical research committee is not required because it will be done using data that have been already published and have no concerns related to the privacy of patients. Extensive dissemination of results from this review will be done through submission to a peer-reviewed journal for publication and conferences.

PROSPERO REGISTRATION NUMBER

CRD42019151804.

Secondary Root Canal Treatment with Reciproc Blue and K-File: Radiographic and ESEM-EDX Analysis of Dentin and Root Canal Filling Remnants

Secondary root canal treatment requires the complete removal of filling materials with different chemical-physical properties. A newly developed single-use NiTi instrument (Reciproc Blue, RB) may be more effective in root canal retreatment. The aim of the present study was to evaluate morphology and composition of remnants after retreatment with RB compared to traditional K-File technique, in canals obturated with Thermafil/AH Plus. Twenty-four single-rooted human teeth were shaped with NiTi obturated with AH-Plus/Thermafil and retreated using RB NiTi instruments or manual K-Files. Radiographs were taken to evaluate endodontic space and radiopacity of residual filling-material before/after procedures. After retreatment, samples were longitudinally split and observed by environmental scanning electron microscopy connected to energy dispersive X-Ray spectroscopy (ESEM-EDX) to analyze the debris/remnant position, microchemistry, and dentinal surface morphology. Time for retreatments was recorded and compared using one-way ANOVA (p-value = 0.05). Radiopaque filling residuals were found in both groups. RB system resulted statistically faster than manual K-File in retreatment procedure (p < 0.001). Root canal space radiographic appearance obtained after retreatment with RB was wider than K-File (p < 0.05). ESEM-EDX revealed 4 different morphological dentin area. Area-1: debris-free with typical Ca, P, and N composition of dentin and detected in 70% of the surface. Area-2: presence of deproteinized smear layer free from N and debris in 15% of the surface. Area-3: a thick packed smear layer N-free and with fine debris consisting of trace elements from sealer in 10% of the surface. Area-4: packed with debris and trace elements. No difference was observed between both instruments regarding root canal space appearance and ESEM-EDX analysis. Both systems were able to remove filling material but created a dentine morphology composed of packed debris and filling materials embedded into the smear layer. Dentin surface composition resulted in collagen depleted by irrigation procedures. The reciprocating system required less time to complete retreatment.

Cyclic Fatigue Resistance of Multiused Reciproc Blue Instruments during Retreatment Procedure

INTRODUCTION

Root canal retreatment procedure may reduce the mechanical resistance of nickel-titanium instruments and increase the frequency of instrument fracture. The aim of the present study was to evaluate the effect of multiuse of Reciproc Blue R25 instruments on cyclic fatigue resistance during retreatment procedure in mandibular molar teeth.

METHODS

Forty-eight Reciproc Blue R25 files were included in the study. In control group, 12 new Reciproc Blue R25 instruments were subjected to cyclic fatigue test by using a stainless steel artificial canal with a 90° angle and 3-mm radius of curvatures. In experimental groups, Reciproc Blue R25 files (n = 12) were used to remove the root canal filling (RCF) material of 1, 2, and 3 molar teeth, respectively. Then cyclic fatigue tests of these 36 instruments were performed. The number of cycles to fracture (NCF) and the length of the fractured fragment were calculated for each instrument. Working time for retreatment procedures was determined in seconds with a digital chronometer. The data were analyzed by using one-way analysis of variance followed by post hoc Tukey test and mixed-effect analysis (P = .05).

RESULTS

No significant difference was found between NCF values of new and first time used files (P > .05), but NCF values of new and first time used files were significantly higher than those of second and third time used files (P < .05). The second and third time used files revealed no difference (P > .05). As the number of uses increased, the average time for retreatment procedure statistically extended (P < .05).

CONCLUSIONS

Reciproc Blue R25 instrument can be used to remove RCF material of 2 molar teeth. However, because of its decreased NCF values, multiple use over 2 molars may not be suggested.

Efficacy of Two Different Nickel-Titanium Rotary Systems in Retreatment Procedure With or Without Laser-Activated Irrigation: An In Vitro Study

Objective: The aim of this study was to compare the efficacy of HyFlex EDM (Coltene/Whaledent, Altstätten, Switzerland) and ProTaper Universal Retreatment Nickel-Titanium (NiTi) Systems [The ProTaper Universal Retreatment (PTR), Dentsply Maillefer, Ballaigues, Switzerland] in the removal of the root canal filling materials with or without laser activated irrigation. Materials and methods: The root canals of 60 human mandibular premolars were instrumented with K files up to size 35 at a working length; the step-back procedure was performed in 1 mm increments up to size 50. Next, the teeth were obturated using the lateral compaction technique with gutta-percha and resin-based sealer, and they were randomly divided into two groups (n = 30) according to the retreatment systems: PTR and HyFlex EDM NiTi rotary files. Then, each group was divided into two subgroups (n = 15), laser [photon-induced photo-acoustic streaming (PIPS); Fotona, Ljubljana, Slovenia] activated irrigation and conventional needle irrigation group. Following these procedures, the specimens were evaluated using micro-computed tomography. Results: There was no significant difference between the instrumentation systems regarding the cleaning efficacy (χ² = 0.754; p = 0.86). Additionally, PIPS method did not have a significant effect on the removal of the filling material compared to conventional needle irrigation. Conclusions: Both instrumentation systems were effective in removing the filling material, but neither was able to remove the filling material completely. PIPS method did not show a significant additional effect regarding the removal of filling material.