# Comparative Evaluation of Periapical Expulsion Using Manual, Rotary, and Reciprocating Instrumentation With EndoVac Irrigation: An In Vitro Study

## TL;DR

This study compared different dental instrumentation systems with EndoVac irrigation and found that FlexiCON rotary system expelled the least debris and bacteria.

## Contribution

The study introduces a comparative in vitro evaluation of FlexiCON rotary instrumentation with EndoVac irrigation against other systems.

## Key findings

- FlexiCON rotary system expelled the least debris, solution, and bacteria compared to other systems.
- Step-back instrumentation resulted in the highest microbial extrusion (39 CFUs).
- Control group showed no extrusion of debris, solution, or microorganisms.

## Abstract

Background

The present study aimed to assess the efficacy of a heat-treated, FlexiCON nickel-titanium (Ni-Ti) rotary instrumentation system and compare it with existing commonly used instrumentation systems (hand file, ProTaper Universal, and WaveOne) using the EndoVac irrigation system.

Methodology

A total of 210 single-rooted, human permanent anterior teeth were equally divided into four groups of 50 teeth each (Group I for step-back, group II for ProTaper rotary, Group III for WaveOne reciprocating, and Group IV for FlexiCON rotary instrumentation system), and 10 teeth were used as controls. Canals were irrigated with EndoVac irrigation in each group. Extruded debris, irrigating solution, and Enterococcus faecalis were quantified and statistically analyzed.

Results

Group IV exhibited the least amount of debris, irrigating solution, and microorganisms than other groups, while Group I presented the most. FlexiCON with EndoVac irrigation demonstrated the least amount of microbe extrusion (14 colony-forming units (CFUs)) among the four instrumentation systems, whereas step-back instrumentation with EndoVac irrigation demonstrated the most (39 CFUs). The control group showed no debris, irrigating solution, or microorganisms.

Conclusions

FlexiCON Ni-Ti rotary instrumentation showed the least debris, irrigating solution, and bacterial extrusion compared with hand, ProTaper Universal, and WaveOne reciprocating instrumentation systems when EndoVac irrigation methods were used.