Comparison of Apical Extrusion of Sodium Hypochlorite Using 4 Different Root Canal Irrigation Techniques

E. Iriboz, K. Bayraktar, D. Türkaydın, and B. Tarçın

Journal of Endodontics. 2015 March; 41(3):380-4.


INTRODUCTION: We compared the apical extrusion of sodium hypochlorite delivered with a 27-G needle, self-adjusting file (SAF), passive ultrasonic irrigation, or the EndoVac system (SybronEndo, Orange, CA) during the instrumentation and final irrigation of root canals.

METHODS: Matched paired single-canal teeth were divided into 8 groups. The experimental groups were needle irrigation size #30 (NI30) and #50 (NI50), SAF size #30 (SAF30) and #50 (SAF50), passive ultrasonic irrigation size #30 (PUI30) and #50 (PUI50), and EndoVac size #30 (EV30) and #50 (EV50). Teeth were embedded in 0.2% agarose gel (pH = 7.4) containing 1 mL 0.1% m-Cresol purple (Sigma-Aldrich, St Louis, MO), which changes color at a pH level of 9.0. Root canals were irrigated with sodium hypochlorite and EDTA using 4 different techniques, and the amount of irrigant was controlled. Standardized digital photographs were taken 20 minutes after the first irrigant was used and were analyzed to determine the amount of extrusion (expressed as a percentage of total pixels).

RESULTS: The amounts of apical extrusion obtained in the NI30, NI50, SAF30, SAF50, PUI30, PUI50, EV30, and EV50 groups were 30% (3/10), 50% (5/10), 20% (2/10), 70% (7/10), 40% (4/10), 40% (4/10), 10% (1/10), and 10% (1/10), respectively. The overall extrusion frequency, regardless of the apical preparation size, was 40% (8/20) for needle, 45% (9/20) for SAF, 40% (8/20) for ultrasonic irrigation, and 10% (2/20) for EndoVac. Although the SAF group showed more extrusion, the percentage of pixels was significantly higher in the needle irrigation group (P < .01). The EndoVac group showed significantly lower extrusion values than the other techniques in terms of the number of teeth and pixels (P < .05 and P < .01, respectively).

CONCLUSIONS: The risk of apical extrusion is significantly lower with the EndoVac in comparison with the 3 other techniques.

Additional Info

  • ReDent Nova’s note:


    In this study, the canals were prepared up to ProTaper F3 and ProTaper F5 all the way to the
    major apical foramen, an action which is bound to destroy the apical constriction.


    The common and recommended practice is to prepare the canals up to the apical constriction, which would then result in more favorable results
    for the SAF System.

  • publisher: publisher
  • View abstract on PubMed. PMID: 25492488