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Endodontics Supporting Your Practice

Apical extrusion of debris: a literature review


Abstract Tooth Cross SectionThis summary is based on the article published in the International Endodontic Journal: Apical extrusion of debris: a literature review of an inherent occurrence during root canal treatment (March 2014)

J. Tanalp & T. Güngör


Extrusion of intracanal debris as well as irrigants is a common occurrence during root canal treatment, and no instrument or technique has thoroughly solved this problem. Because flare-ups may arise with any irritation directed towards periapical tissues, a shaping or irrigation technique should minimize the risk of apical extrusion, even though it may not be prevented.

There has been a rapid evolution of root canal instruments and irrigation systems through the last decade, and many have been assessed for their debris extrusion potential.

Purpose of the Review

The purpose of this review was to identify publications regarding the evaluation of debris, bacteria and irrigant extrusion during root canal treatment.

Key Findings

  • The clinical relevance and scientific reliability of the reported studies are questionable and difficult to draw out definite conclusions.
  • Apical extrusion should not solely be the decisive factor in the selection of a specific methodology because there are also other parameters that determine the clinical success of root canal treatment. On  the other hand, prevention of all types of damage and irritation to surrounding tissues is one of the major clinical responsibilities of a practitioner. Caution must be exercised in the selection and utilization of instruments, specifically taking into consideration the diagnosis of the clinical case.
  • Rotary instruments used in a crown-down manner seem to produce less extrusion than hand instruments used conventionally. Also, simple modifications in irrigation methodologies by selecting side-vented needles may be advantageous for the prevention of apical extrusion.
  • Negative pressure creating irrigating devices also seem promising though meticulous care should be taken to prevent complications such as the clogging of delivery tips. Reciprocating movement is a recent concept that has not been evaluated extensively in terms of debris extrusion and warrants further research.


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