Evaluation of Apical Third Enlargements to Twice and Thrice Larger Than Initial Apical Binding File in Final Treatment Outcome

Overview

Journal Bioinformation

Date 2025 Feb 7

PMID 39917216

Authors

Kranti Rajesh Khadse

Rana K Varghese

Malwika Sisodia

Naveen Kumar Gupta

Priyanka Damodhar Ippar

Anushri Arvind Uge

Affiliations

Soon will be listed here.

Abstract

Root canal treatment is a critical procedure in endodontics, aimed at eliminating microorganisms and pathological debris from the root canal system to prevent reinfection and ensure the health of the periradicular tissues. A total of 180 patients with asymptomatic apical periodontitis (PAI score >3) were included in this randomized clinical trial. Patients were divided into two main groups, each with three subgroups based on the biomechanical preparation of the canals using different file sizes and tapers. Biomechanical preparation was followed by intracanal medicament placement, and patients were recalled for obturation and final restoration. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 6, 12, 24, 48 and 72 hours post-treatment. Periapical healing was evaluated using the Periapical Index (PAI) at 3,6 and 12 months post-treatment. While larger apical preparation sizes and tapers can enhance periapical healing, excessive enlargement beyond three sizes larger than the IABF does not significantly improve outcomes. Optimal root canal treatment should balance adequate cleaning and disinfection with the preservation of tooth structure.

References

Nair P . On the causes of persistent apical periodontitis: a review. Int Endod J. 2006; 39(4):249-81. DOI: 10.1111/j.1365-2591.2006.01099.x. View

Torabinejad M, Kettering J, McGRAW J, Cummings R, Dwyer T, Tobias T . Factors associated with endodontic interappointment emergencies of teeth with necrotic pulps. J Endod. 1988; 14(5):261-6. DOI: 10.1016/S0099-2399(88)80181-X. View

Schilder H . Cleaning and shaping the root canal. Dent Clin North Am. 1974; 18(2):269-96. View

Glickman G, Koch K . 21st-century endodontics. J Am Dent Assoc. 2000; 131 Suppl:39S-46S. DOI: 10.14219/jada.archive.2000.0401. View

Holland R, de Souza V, Nery M, Otoboni Filho J, Bernabe P, Dezan Junior E . Reaction of rat connective tissue to implanted dentin tubes filled with mineral trioxide aggregate or calcium hydroxide. J Endod. 1999; 25(3):161-6. DOI: 10.1016/s0099-2399(99)80134-4. View

Parirokh M, Rekabi A, Ashouri R, Nakhaee N, Abbott P, Gorjestani H . Effect of occlusal reduction on postoperative pain in teeth with irreversible pulpitis and mild tenderness to percussion. J Endod. 2012; 39(1):1-5. DOI: 10.1016/j.joen.2012.08.008. View

Siqueira Jr J, Rocas I . Clinical implications and microbiology of bacterial persistence after treatment procedures. J Endod. 2008; 34(11):1291-1301.e3. DOI: 10.1016/j.joen.2008.07.028. View

Pak J, White S . Pain prevalence and severity before, during, and after root canal treatment: a systematic review. J Endod. 2011; 37(4):429-38. DOI: 10.1016/j.joen.2010.12.016. View

Sathorn C, Parashos P, Messer H . The prevalence of postoperative pain and flare-up in single- and multiple-visit endodontic treatment: a systematic review. Int Endod J. 2007; 41(2):91-9. DOI: 10.1111/j.1365-2591.2007.01316.x. View

10.

Huskisson E . Measurement of pain. Lancet. 1974; 2(7889):1127-31. DOI: 10.1016/s0140-6736(74)90884-8. View

11.

Roane J, Sabala C, Duncanson Jr M . The "balanced force" concept for instrumentation of curved canals. J Endod. 1985; 11(5):203-11. DOI: 10.1016/S0099-2399(85)80061-3. View

12.

Heft M, Parker S . An experimental basis for revising the graphic rating scale for pain. Pain. 1984; 19(2):153-61. DOI: 10.1016/0304-3959(84)90835-2. View

13.

Oginni A, Udoye C . Endodontic flare-ups: comparison of incidence between single and multiple visit procedures in patients attending a Nigerian teaching hospital. BMC Oral Health. 2004; 4(1):4. PMC: 539257. DOI: 10.1186/1472-6831-4-4. View

14.

Walton R, Fouad A . Endodontic interappointment flare-ups: a prospective study of incidence and related factors. J Endod. 1992; 18(4):172-7. DOI: 10.1016/S0099-2399(06)81413-5. View