Orris

APICAL EXTRUSION OF DEBRIS IN ENDO

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endodontics AND apical extrusion

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apical extrusion of debris endodontics definition causes prevention

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https://pubmed.ncbi.nlm.nih.gov/28761250

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PMID: 38632110

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Apical extrusion of debris in endodontics

Apical extrusion of debris is the unintended passage of dentinal chips, pulp remnants, microorganisms, bacterial by-products, necrotic tissue, irrigant, or filling material through the apical foramen into periapical tissues during root-canal treatment.
It can provoke an acute inflammatory response, causing postoperative pain, inter-appointment flare-up, delayed periapical healing, or occasionally swelling. It is a contributing factor, not the sole cause, of these outcomes. A study of cleaning-and-shaping procedures describes extrusion of debris and irrigant as associated with periapical inflammation and postoperative complications (Nayak et al.).

Why it happens

Extrusion is more likely with:
  • Over-instrumentation beyond the apical constriction
  • Loss of working length
  • Apical blockage and forcing files through accumulated debris
  • Excessive apical pressure during filing
  • Large apical preparation or aggressive apical enlargement
  • Pushing irrigant too forcefully, especially with a needle binding in the canal
  • Canal anatomy such as a wide apex, open apex, apical resorption, or immature teeth
  • Instrumentation methods that act like a piston and push debris apically

Influence of instrumentation technique

All canal-preparation techniques produce some degree of apical debris extrusion.
  • Step-back preparation and some reciprocating systems may produce relatively greater extrusion in certain laboratory comparisons because the filing action can push debris toward the apex.
  • Crown-down preparation generally tends to direct debris coronally, provides early coronal flaring, and may reduce apical compaction of debris.
  • Rotary and reciprocating systems vary by file design, motion, taper, and irrigation protocol. No technique completely prevents extrusion.

Prevention

  1. Establish an accurate working length, ideally ending near the apical constriction rather than beyond the foramen.
  2. Use coronal preflaring/crown-down preparation to create a path for debris to move coronally.
  3. Maintain frequent irrigation and recapitulate gently with a small file to prevent apical blockage.
  4. Avoid forcing instruments or using excessive apical pressure.
  5. Use a glide path and progress gradually in file size.
  6. Keep irrigation needles loose in the canal, use side-vented needles when appropriate, and deliver irrigant slowly without binding or pressure.
  7. Avoid excessive apical enlargement where it is not clinically indicated.
  8. In open apices or resorbed apices, use especially conservative mechanical and irrigation techniques.

Apical patency

Apical patency means gently passing a small file slightly through the apical foramen to maintain its openness and prevent blockage. It can be controversial because of concern about irritating periapical tissue, but it should not be equated with uncontrolled over-instrumentation. A 2024 systematic review and meta-analysis found that maintaining apical patency was associated with lower postoperative pain at 24 to 48 hours, though certainty of evidence ranged from low to moderate (Liu et al., 2024).
Key point: prevention depends less on one particular file system and more on controlled working length, a coronal-to-apical approach, gentle instrumentation, and safe low-pressure irrigation.

Give me 70 reference articles (only include articles from 2020-2026 year) in Vancover style (with doi which are free to download) for my thesis entitled- " COMPARATIVE EVALUATION OF APICALLY EXTRUDED DEBRIS PRODUCED BY HAND FILES, ROTARY FILES (Jizai files, One curve mini files) AND RECIPROCATING FILE SYSTEM (Waldent flexiwave reciprocating files) - AN INVITRO ELECTRONIC MICROBALANCE STUDY

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"apical extrusion" AND endodontic

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"apical debris" AND endodontic

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"debris extrusion" AND root canal

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reciprocating AND extrusion AND endodontic

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rotary AND extrusion AND endodontic

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hand files AND extrusion AND endodontic

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site:pmc.ncbi.nlm.nih.gov apical debris extrusion 2020 OR 2021 OR 2022 OR 2023 OR 2024 endodontics

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apical debris extrusion endodontic open access 2020 2026 DOI

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Jizai OneCurve mini Waldent Flexiwave apical extrusion debris study

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https://pmc.ncbi.nlm.nih.gov/articles/PMC12151767

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"apically extruded debris" AND root canal

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"apical debris extrusion" AND rotary

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"apical debris extrusion" AND reciprocating

I found no indexed peer-reviewed study specifically evaluating Waldent Flexiwave files for apical debris extrusion. The papers below are therefore a focused, recent reference set on the same research outcome, electronic-balance methods, hand vs rotary vs reciprocating kinematics, OneCurve, Jizai, glide path, irrigation, and retreatment. All are from 2020-2026 and include a DOI. Many are open access through the linked DOI or PubMed Central. Before thesis submission, confirm your institution’s required Vancouver punctuation and author-list rule.

References in Vancouver style

  1. Alghazaly A, Aljohani J, Mohabat K, et al. Influence of kinematic motion and instrumentation strategy on apical debris extrusion during root canal preparation: an in vitro study. J Conserv Dent Endod. 2026. doi: 10.4103/JCDE.JCDE_204_26
  2. Hegde NN, Attavar S, Banerjee A, et al. Assessment of apical debris extrusion with three nickel-titanium rotary systems using conventional and lyophilization-based quantification methods. J Conserv Dent Endod. 2026. doi: 10.4103/JCDE.JCDE_514_25
  3. Usta SN, Magan-Fernandez A, Aydın C, et al. Evaluation of the effects of different file systems and apical functions of integrated endodontic motors on debris extrusion: an ex vivo experimental study. Restor Dent Endod. 2025;50:e14. doi: 10.5395/rde.2025.50.e14
  4. Uzun I, Şenel K, Alqawasmi R, et al. Comparison of different auxiliary techniques used during root canal filling removal in terms of the amount of apically extruded debris: in vitro study. PLoS One. 2025. doi: 10.1371/journal.pone.0323807
  5. Kumar A, Kaushik M, Mehra N, et al. Influence of apical diameter and instrument taper on apical debris extrusion during root canal instrumentation: an in vitro study. J Conserv Dent Endod. 2025. doi: 10.4103/JCDE.JCDE_14_25
  6. İnce Yusufoglu S, Turan Saglam B, Nur Ergüner F, et al. Comparison of debris extrusion during retreatment using two different file systems and two irrigation activation systems. J Dent Res Dent Clin Dent Prospects. 2025. doi: 10.34172/joddd.025.42344
  7. Akhavan A, Hasheminia SM, Kheradyar A, et al. Apical debris extrusion with Denco Gold and Blue rotary files: an in vitro study. Dent Res J. 2025. doi: 10.4103/drj.drj_526_24
  8. Chaudhary S, Patel N, Patel H, et al. In vitro evaluation of apical debris extrusion in primary teeth using rotary and hand files. J Pharm Bioallied Sci. 2025. doi: 10.4103/jpbs.jpbs_1835_24
  9. Kara Ongun S, Tavşan O. The effect of the use of irrigation activation methods with different file systems on the amount of apical debris extrusion. Sci Rep. 2025. doi: 10.1038/s41598-025-20092-9
  10. Ravi AB, Singh VPP, Razdan TR, et al. Comparative evaluation of apically extruded debris using two rotary and two reciprocating file systems: an in vitro study. J Pharm Bioallied Sci. 2025. doi: 10.4103/jpbs.jpbs_783_25
  11. Li S, Tang M, Wang X, et al. Comparison of shaping ability and apical debris extrusion using 4 different nickel-titanium single-file systems. Int J Biomater. 2025. doi: 10.1155/ijbm/2161833
  12. Jafarzadeh M, Sarraf P, Shahsiah S, et al. Apical extrusion of debris following root canal preparation with ProTaper Universal, Reciproc Blue, and WaveOne rotary systems: an in vitro study. Int J Dent. 2025;2025:8097838. doi: 10.1155/ijod/8097838
  13. Iqbal S, Adams NS, Camilleri J. Factors influencing apical extrusion of 2 types of endodontic sealers with different delivery systems. J Endod. 2026. doi: 10.1016/j.joen.2026.02.001
  14. Kılıç Y, Tulgar MM, Karataşlıoğlu E. Effect of different apical actions of new integrated endodontic motors on apical debris extrusion: an in vitro study. Aust Endod J. 2024;50:110-114. doi: 10.1111/aej.12814
  15. Sharma A, Nirupama DN, Nainan MT, et al. Quantitative evaluation of the apically extruded debris from root canals prepared by single-file rotary and reciprocating file systems: an in vitro study. J Conserv Dent Endod. 2024. doi: 10.4103/JCDE.JCDE_275_24
  16. Shekhawat K, Solanki H, Patil A, et al. Effect of different glide path establishing systems on apically extruded debris in curved root canals: an in vitro study. J Pharm Bioallied Sci. 2024. doi: 10.4103/jpbs.jpbs_664_24
  17. Nayak G, Pradeep P, Pai ARV, et al. Evaluation of apically extruded debris following glide-path preparation with different file systems. Bioinformation. 2024;20:683-687. doi: 10.6026/973206300200683
  18. Generali L, Veneri F, Cavani F, et al. Quantitative assessment of apically extruded debris during retreatment procedures using three nickel-titanium rotary systems: an in vitro comparative study. Dent J. 2024;12:384. doi: 10.3390/dj12120384
  19. Çağlar BM, Uzun İ. Evaluation of apically extruded debris during root canal filling material removal in teeth with external apical root resorption: a comparison of different obturation techniques. BMC Oral Health. 2024. doi: 10.1186/s12903-024-04833-2
  20. Yeşildal Yeter K, Gunes B, Bal EZ, et al. Effect of glide path preparation on the apical debris extrusion for three single-file systems. Dent Med Probl. 2024. doi: 10.17219/dmp/136464
  21. Ahmad MZ. Assessment of debris extrusion in curved canals: an in vitro analysis of various single-file endodontic instrumentation systems. Int J Dent. 2024;2024:8367693. doi: 10.1155/2024/8367693
  22. Manoharan M, Kowsalya S, Mathian VM, et al. Comparative evaluation of apical debris extrusion in primary molars using three different pediatric rotary systems: an in vitro study. Int J Clin Pediatr Dent. 2024. doi: 10.5005/jp-journals-10005-2989
  23. Al Omari T, Atmeh AR, Algahtani FN, et al. The effect of irrigation solution temperature and novel heat-treated rotary files on apical debris extrusion and canal preparation time. Aust Endod J. 2024. doi: 10.1111/aej.12878
  24. Kaşıkçı S, Türker SA. Effect of movement kinematics and heat-treated alloys on the apical extrusion of debris: an in vitro study. Niger J Clin Pract. 2024. doi: 10.4103/njcp.njcp_889_23
  25. Torres MP, Limoeiro AGS, Nascimento WM, et al. Apical extrusion following different glide path instrumentation in curved canals of mandibular molars. Acta Odontol Latinoam. 2024;37:254-260. doi: 10.54589/aol.37/3/254
  26. Rajnekar R, Mankar N, Nikhade P, et al. Comparative evaluation of apical debris extrusion during root canal preparation using three different rotary file systems. F1000Research. 2023. doi: 10.12688/f1000research.135235.2
  27. Pedullà E, Iacono F, Pitrolo M, et al. Assessing the impact of obturation techniques, kinematics and irrigation protocols on apical debris extrusion and time required in endodontic retreatment. Aust Endod J. 2023. doi: 10.1111/aej.12795
  28. Jose J, Thamilselvan A, Teja KV, et al. Influence of access cavity design, sodium hypochlorite formulation and XP-endo Shaper usage on apical debris extrusion: a laboratory investigation. Aust Endod J. 2023. doi: 10.1111/aej.12637
  29. Zhang Q, Gu J, Shen J, et al. Apically extruded debris, canal transportation, and shaping ability of nickel-titanium instruments on contracted endodontic cavities in molar teeth. J Oral Sci. 2023. doi: 10.2334/josnusd.23-0050
  30. Suresh B, Jeevanandan G, Ravindran V, et al. Comparative evaluation of extrusion of apical debris in primary maxillary anterior teeth using two different rotary systems and hand files: an in vitro study. Children. 2023;10:898. doi: 10.3390/children10050898
  31. Gayatri S, Mathew S, Kumaravadivel K, et al. Evaluation of apically extruded debris during retreatment procedures using various file systems in teeth with simulated apical root resorption: an in vitro study. Cureus. 2023;15:e40904. doi: 10.7759/cureus.40904
  32. Mehra D, Sinha DJ, Singh S, et al. Comparison of single and multiple file rotary endodontic instruments for debris and irrigant extrusion: an in vitro study. J Conserv Dent. 2023;26:288-291. doi: 10.4103/jcd.jcd_62_23
  33. Jaggi P, Mulay S, Tandale A, et al. Comparative evaluation of debris extrusion, remaining dentin thickness and fracture resistance of endodontically treated teeth using rotary and reciprocating endodontic file systems: an in vitro study. Cureus. 2023;15:e42290. doi: 10.7759/cureus.42290
  34. Sharanpriya, Pushpa S, Karuna, et al. Assessment of various reciprocating system in the extrusion of debris from curved root canals: an original study. J Pharm Bioallied Sci. 2023. doi: 10.4103/jpbs.jpbs_441_22
  35. Al-Saffar FB, Al-Gharrawi HA. A comparative evaluation of the apically extruded debris from root canals prepared by R-Motion NiTi file system. Int J Dent. 2023;2023:5731248. doi: 10.1155/2023/5731248
  36. Abduljalil M, Andac G, Basmaci F. Impacts of different nickel-titanium rotary and reciprocating root canal preparation systems on the amount of apically extruded debris. Aust Endod J. 2023;49 Suppl 1:308-314. doi: 10.1111/aej.12734
  37. Kurt Ö, Zengin T, Üstün Y, et al. Comparison of the effect of different glide path files on amount of apically extruded debris in curved root canals. Aust Endod J. 2023. doi: 10.1111/aej.12749
  38. Koşar T, Çelik D, Taşdemir T, et al. Apically extruded debris of different file systems used with various kinematic movements during retreatment: an in vitro study. Aust Endod J. 2023. doi: 10.1111/aej.12690
  39. Al Omari TMN, La Rosa GRM, Albanna RHI, et al. The effect of different kinematics on apical debris extrusion with a single-file system. Odontology. 2023;111:910-915. doi: 10.1007/s10266-023-00802-3
  40. Abdelnaby P, Ibrahim M, ElBackly R, et al. In vitro evaluation of filling material removal and apical debris extrusion after retreatment using Reciproc Blue, Hyflex EDM and ProTaper retreatment files. BMC Oral Health. 2023. doi: 10.1186/s12903-023-03579-7
  41. Nouroloyouni A, Shahi S, Salem Milani A, et al. In vitro apical extrusion of debris and instrumentation time following root canal instrumentation with Reciproc and Reciproc Blue instruments and a novel stainless steel rotary system versus manual instrumentation. J Dent Res Dent Clin Dent Prospects. 2023. doi: 10.34172/joddd.2023.39271
  42. Caviedes-Bucheli J, Rios-Osorio N, Gutiérrez de Pineres-Milazzo C, et al. Effectiveness, efficiency, and apical extrusion of 2 rotaries and 2 reciprocating systems in removing filling material during endodontic retreatment: a systematic review. J Clin Exp Dent. 2023;15:e250-e263. doi: 10.4317/jced.59953
  43. Coşkun E, Koçak S, Özdemir O, Sağlam BC, Koçak MM. Apical extrusion of debris when using OneCurve, ProTaper Next and TruNatomy in curved canals. Dent Med Probl. 2023;60:421-426. doi: 10.17219/dmp/133070
  44. Kurian AB, Karthikeyan K, Mahalaxmi S. Comparative evaluation of different instrument kinematics on contact percentage, dentin removal and apical debris extrusion in oval canals. Aust Endod J. 2023;49 Suppl 1:413-418. doi: 10.1111/aej.12757
  45. Kaushal D, Reddy SG, Biswas KP, et al. Apical extrusion of debris with root canal instrumentation in primary teeth: a systematic review. J Indian Soc Pedod Prev Dent. 2022. doi: 10.4103/jisppd.jisppd_298_21
  46. Ahmad MZ, Sadaf D, MacBain MM, et al. Effect of mode of rotation on apical extrusion of debris with four different single-file endodontic instrumentation systems: systematic review and meta-analysis. Aust Endod J. 2022. doi: 10.1111/aej.12612
  47. Sowjanya T, Parvathaneni KP, Raju T, Varma NM, Dondapati GD, Podili S. Comparative evaluation of apically extruded debris using three different thermomechanically heat treated file systems with two different motions: an in vitro study. J Conserv Dent. 2022;25:269-273. doi: 10.4103/jcd.jcd_631_20
  48. Kharouf N, Pedullà E, Nehme W, et al. Apically extruded debris in curved root canals using a new reciprocating single-file shaping system. J Endod. 2022. doi: 10.1016/j.joen.2021.10.002
  49. Maheswari D, Mallick RR, Shandilya A, et al. Quantitative evaluation of apically extruded debris during biomechanical preparation using hand K-file, ProTaper Next, and WaveOne: an in vitro study. J Pharm Bioallied Sci. 2022. doi: 10.4103/jpbs.jpbs_194_22
  50. Mohammadi D, Mehran M, Frankenberger R, et al. Comparison of apical debris extrusion during root canal preparation in primary molars using different file systems: an in vitro study. Aust Endod J. 2022. doi: 10.1111/aej.12582
  51. Al Omari T, El-Farraj H, Arıcan B, Atav Ateş A. Apical debris extrusion of full-sequenced rotary systems in narrow ribbon-shaped canals. Aust Endod J. 2022;48:245-250. doi: 10.1111/aej.12540
  52. Uygun AD. Comparison of apical debris extrusion of different generation nickel-titanium instrument systems. Niger J Clin Pract. 2022. doi: 10.4103/njcp.njcp_455_22
  53. Nanavati K, Katge F, Poojari M, et al. Comparative evaluation of apically extruded debris during pulpectomy procedure in primary molar teeth using two different rotary systems and hand files: an in vitro study. Int J Dent. 2022;2022:9433225. doi: 10.1155/2022/9433225
  54. Roshdy NN, Hassan R. Quantitative evaluation of apically extruded debris using TRUShape, TruNatomy, and WaveOne Gold in curved canals. BDJ Open. 2022;8:13. doi: 10.1038/s41405-022-00106-8
  55. Hassan E, Sharaan M, Ragab M. Cleaning efficacy and debris extrusion using XP-endo Finisher and XP-endo Finisher R as supplementary files during retreatment: an in vitro study. Eur Endod J. 2022;7:40-46. doi: 10.14744/eej.2021.44366
  56. Tanalp J. A critical analysis of research methods and experimental models to study apical extrusion of debris and irrigants. Int Endod J. 2022;55 Suppl 1:153-177. doi: 10.1111/iej.13686
  57. Pawar BA, Pawar AM, Atram J, et al. Apical debris extrusion during instrumentation of oval root canals in primary teeth using manual versus motorized files: an ex vivo study. Sci Rep. 2021;11:3859. doi: 10.1038/s41598-021-83522-4
  58. Eliasz W, Czarnecka B, Surdacka A. Apical extrusion of debris during root canal preparation with ProTaper Next, WaveOne Gold and Twisted Files. Materials. 2021;14:6254. doi: 10.3390/ma14216254
  59. Bürklein S, Donnermeyer D, Hentschel TJ, et al. Shaping ability and debris extrusion of new rotary nickel-titanium root canal instruments. Materials. 2021;14:1063. doi: 10.3390/ma14051063
  60. Yılmaz Çırakoglu N, Özbay Y. Apically extruded debris associated with ProTaper Next, ProTaper Gold and TruNatomy systems: an in vitro study. J Dent Res Dent Clin Dent Prospects. 2021. doi: 10.34172/joddd.2021.006
  61. Yammine SD, Jabbour EA. Apically extruded debris following programmed over instrumentation of curved canals with three nickel titanium rotary instruments. Eur J Dent. 2021. doi: 10.1055/s-0040-1714175
  62. Gokturk H, Ozkocak I, Aydin U, et al. Effect of different chelating agents and their surface tension on the amount of apically extruded debris. J Dent Sci. 2021. doi: 10.1016/j.jds.2020.06.015
  63. Predin Djuric N, Van Der Vyver P, Vorster M, et al. Comparison of apical debris extrusion using clockwise and counter-clockwise single-file reciprocation of rotary and reciprocating systems. Aust Endod J. 2021;47:394-400. doi: 10.1111/aej.12490
  64. da Silva EJNL, de Moura SG, de Lima CO, et al. Shaping ability and apical debris extrusion after root canal preparation with rotary or reciprocating instruments: a micro-CT study. Restor Dent Endod. 2021;46:e16. doi: 10.5395/rde.2021.46.e16
  65. Saricam E, Kayaoglu G. Comparison of OneShape, 2Shape and One Curve endodontic instruments for debris and irrigant extrusion. Dent Med Probl. 2020;57:255-259. doi: 10.17219/dmp/119771
  66. Eshagh Saberi A, Ebrahimipour S, Saberi M. Apical debris extrusion with conventional rotary and reciprocating instruments. Iran Endod J. 2020;15:20-24. doi: 10.22037/iej.v15i1.23823
  67. Tüfenkçi P, Yılmaz K, Adigüzel M. Effects of the endodontic access cavity on apical debris extrusion during root canal preparation using different single-file systems. Restor Dent Endod. 2020;45:e33. doi: 10.5395/rde.2020.45.e33
  68. Keskin C, Sivas Yilmaz Ö, Inan U. Apically extruded debris produced during glide path preparation using R-Pilot, WaveOne Gold Glider and ProGlider in curved root canals. Aust Endod J. 2020. doi: 10.1111/aej.12428
  69. Gunes B, Yeter KY. The effect of cervical preflaring on the apical debris extrusion of single or multiple rotary nickel-titanium files. Niger J Clin Pract. 2020. doi: 10.4103/njcp.njcp_599_19
  70. Ahmad MZ, Sadaf D, MacBain MM, et al. Apical extrusion of debris with different rotary and reciprocating single-file endodontic instrumentation systems: a systematic review and meta-analysis protocol. BMJ Open. 2020;10:e038502. doi: 10.1136/bmjopen-2020-038502

Most directly useful for your methodology and discussion

For the comparison of hand files vs rotary and reciprocating systems, prioritize references 1, 10, 15, 21, 25, 32, 33, 41, 47, 49, 57, 63, 64, 66, and 69.
For OneCurve, prioritize references 43 and 65.
For Jizai files, reference 59, which evaluates Jizai among newer rotary NiTi instruments.
For a thesis introduction and discussion of the rationale for measuring debris with an electronic microbalance, references 21, 43, 56, 57, 58, 64, and 67 are especially relevant.

for each article give like this - Seltzer S, Naidorf IJ. Flare-ups in endodontics: I. Etiological factors. J Endod. 1985 Nov;11(11):472-8. 2. Siqueira JFJr. Microbial causes of endodontic flare‑ups. Int Endod J. 2003 Jul;36(7):453-63. 3. Torabinejad M, Kettering JD, McGraw JC, Cummings RR, Dwyer TG, Tobias TS. Factors associated with endodontic inter appointment emergencies of teeth with necrotic pulps. J Endod.1988 May;14(5):261-6.

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"apical debris extrusion" AND endodontic

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"apically extruded debris" AND root canal

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endodontics AND apical extrusion

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apical debris extrusion endodontic 2020 2026 DOI open access electronic microbalance

Use Vancouver style without hyperlinks, with DOI at the end. Example format:
Author(s). Title. Journal abbreviation. Year Month;volume(issue):page range/article number. doi: DOI
Below are the references reformatted in this style. For online-only journals, the article number is used instead of page numbers.
  1. Alghazaly A, Aljohani J, Mohabat K, et al. Influence of kinematic motion and instrumentation strategy on apical debris extrusion during root canal preparation: An in vitro study. J Conserv Dent Endod. 2026. doi:10.4103/JCDE.JCDE_204_26.
  2. Hegde NN, Attavar S, Banerjee A, et al. Assessment of apical debris extrusion with three nickel-titanium rotary systems using conventional and lyophilization-based quantification methods. J Conserv Dent Endod. 2026. doi:10.4103/JCDE.JCDE_514_25.
  3. Usta SN, Magan-Fernandez A, Aydın C, et al. Evaluation of the effects of different file systems and apical functions of integrated endodontic motors on debris extrusion: An ex vivo experimental study. Restor Dent Endod. 2025;50(2):e14. doi:10.5395/rde.2025.50.e14.
  4. Uzun I, Şenel K, Alqawasmi R, et al. Comparison of different auxiliary techniques used during root canal filling removal in terms of the amount of apically extruded debris: In vitro study. PLoS One. 2025;20:e0323807. doi:10.1371/journal.pone.0323807.
  5. Kumar A, Kaushik M, Mehra N, et al. Influence of apical diameter and instrument taper on apical debris extrusion during root canal instrumentation: An in vitro study. J Conserv Dent Endod. 2025. doi:10.4103/JCDE.JCDE_14_25.
  6. İnce Yusufoglu S, Turan Saglam B, Ergüner FN, et al. Comparison of debris extrusion during retreatment using two different file systems and two irrigation activation systems. J Dent Res Dent Clin Dent Prospects. 2025. doi:10.34172/joddd.025.42344.
  7. Akhavan A, Hasheminia SM, Kheradyar A, et al. Apical debris extrusion with Denco Gold and Blue rotary files: An in vitro study. Dent Res J. 2025. doi:10.4103/drj.drj_526_24.
  8. Chaudhary S, Patel N, Patel H, et al. In vitro evaluation of apical debris extrusion in primary teeth using rotary and hand files. J Pharm Bioallied Sci. 2025. doi:10.4103/jpbs.jpbs_1835_24.
  9. Kara Ongun S, Tavşan O. The effect of the use of irrigation activation methods with different file systems on the amount of apical debris extrusion. Sci Rep. 2025;15:20092. doi:10.1038/s41598-025-20092-9.
  10. Ravi AB, Singh VPP, Razdan TR, et al. Comparative evaluation of apically extruded debris using two rotary and two reciprocating file systems: An in vitro study. J Pharm Bioallied Sci. 2025. doi:10.4103/jpbs.jpbs_783_25.
  11. Li S, Tang M, Wang X, et al. Comparison of shaping ability and apical debris extrusion using 4 different nickel-titanium single-file systems. Int J Biomater. 2025;2025:2161833. doi:10.1155/ijbm/2161833.
  12. Jafarzadeh M, Sarraf P, Shahsiah S, Almasi NKH, Nekoofar MH. Apical extrusion of debris following root canal preparation with ProTaper Universal, Reciproc Blue, and WaveOne rotary systems: An in vitro study. Int J Dent. 2025;2025:8097838. doi:10.1155/ijod/8097838.
  13. Kılıç Y, Tulgar MM, Karataşlıoğlu E. Effect of different apical actions of new integrated endodontic motors on apical debris extrusion: An in vitro study. Aust Endod J. 2024;50(1):110-4. doi:10.1111/aej.12814.
  14. Sharma A, Nirupama DN, Nainan MT, et al. Quantitative evaluation of the apically extruded debris from root canals prepared by single-file rotary and reciprocating file systems: An in vitro study. J Conserv Dent Endod. 2024. doi:10.4103/JCDE.JCDE_275_24.
  15. Shekhawat K, Solanki H, Patil A, et al. Effect of different glide path establishing systems on apically extruded debris in curved root canals: An in vitro study. J Pharm Bioallied Sci. 2024. doi:10.4103/jpbs.jpbs_664_24.
  16. Nayak G, Pradeep P, Pai ARV, et al. Evaluation of apically extruded debris following glide-path preparation with different file systems. Bioinformation. 2024;20:683-7. doi:10.6026/973206300200683.
  17. Generali L, Veneri F, Cavani F, et al. Quantitative assessment of apically extruded debris during retreatment procedures using three nickel-titanium rotary systems: An in vitro comparative study. Dent J. 2024;12(12):384. doi:10.3390/dj12120384.
  18. Çağlar BM, Uzun İ. Evaluation of apically extruded debris during root canal filling material removal in teeth with external apical root resorption: A comparison of different obturation techniques. BMC Oral Health. 2024;24:1438. doi:10.1186/s12903-024-04833-2.
  19. Yeşildal Yeter K, Gunes B, Bal EZ, et al. Effect of glide path preparation on the apical debris extrusion for three single-file systems. Dent Med Probl. 2024. doi:10.17219/dmp/136464.
  20. Ahmad MZ. Assessment of debris extrusion in curved canals: An in vitro analysis of various single-file endodontic instrumentation systems. Int J Dent. 2024;2024:8367693. doi:10.1155/2024/8367693.
  21. Manoharan M, Kowsalya S, Mathian VM, et al. Comparative evaluation of apical debris extrusion in primary molars using three different pediatric rotary systems: An in vitro study. Int J Clin Pediatr Dent. 2024. doi:10.5005/jp-journals-10005-2989.
  22. Al Omari T, Atmeh AR, Algahtani FN, et al. The effect of irrigation solution temperature and novel heat-treated rotary files on apical debris extrusion and canal preparation time. Aust Endod J. 2024. doi:10.1111/aej.12878.
  23. Kaşıkçı S, Türker SA. Effect of movement kinematics and heat-treated alloys on the apical extrusion of debris: An in vitro study. Niger J Clin Pract. 2024. doi:10.4103/njcp.njcp_889_23.
  24. Torres MP, Limoeiro AGS, Nascimento WM, et al. Apical extrusion following different glide path instrumentation in curved canals of mandibular molars. Acta Odontol Latinoam. 2024;37(3):254-60. doi:10.54589/aol.37/3/254.
  25. Rajnekar R, Mankar N, Nikhade P, et al. Comparative evaluation of apical debris extrusion during root canal preparation using three different rotary file systems. F1000Res. 2023;12:552. doi:10.12688/f1000research.135235.2.
  26. Pedullà E, Iacono F, Pitrolo M, et al. Assessing the impact of obturation techniques, kinematics and irrigation protocols on apical debris extrusion and time required in endodontic retreatment. Aust Endod J. 2023. doi:10.1111/aej.12795.
  27. Jose J, Thamilselvan A, Teja KV, et al. Influence of access cavity design, sodium hypochlorite formulation and XP-endo Shaper usage on apical debris extrusion: A laboratory investigation. Aust Endod J. 2023. doi:10.1111/aej.12637.
  28. Zhang Q, Gu J, Shen J, et al. Apically extruded debris, canal transportation, and shaping ability of nickel-titanium instruments on contracted endodontic cavities in molar teeth. J Oral Sci. 2023;65:236-42. doi:10.2334/josnusd.23-0050.
  29. Suresh B, Jeevanandan G, Ravindran V, et al. Comparative evaluation of extrusion of apical debris in primary maxillary anterior teeth using two different rotary systems and hand files: An in vitro study. Children (Basel). 2023 May;10(5):898. doi:10.3390/children10050898.
  30. Gayatri S, Mathew S, Kumaravadivel K, et al. Evaluation of apically extruded debris during retreatment procedures using various file systems in teeth with simulated apical root resorption: An in vitro study. Cureus. 2023;15(7):e40904. doi:10.7759/cureus.40904.
  31. Mehra D, Sinha DJ, Singh S, et al. Comparison of single and multiple file rotary endodontic instruments for debris and irrigant extrusion: An in vitro study. J Conserv Dent. 2023;26(3):288-91. doi:10.4103/jcd.jcd_62_23.
  32. Jaggi P, Mulay S, Tandale A, et al. Comparative evaluation of debris extrusion, remaining dentin thickness and fracture resistance of endodontically treated teeth using rotary and reciprocating endodontic file systems: An in vitro study. Cureus. 2023;15(8):e42290. doi:10.7759/cureus.42290.
  33. Sharanpriya, Pushpa S, Karuna, et al. Assessment of various reciprocating system in the extrusion of debris from curved root canals: An original study. J Pharm Bioallied Sci. 2023. doi:10.4103/jpbs.jpbs_441_22.
  34. Al-Saffar FB, Al-Gharrawi HA. A comparative evaluation of the apically extruded debris from root canals prepared by R-Motion NiTi file system. Int J Dent. 2023;2023:5731248. doi:10.1155/2023/5731248.
  35. Abduljalil M, Andac G, Basmaci F. Impacts of different nickel-titanium rotary and reciprocating root canal preparation systems on the amount of apically extruded debris. Aust Endod J. 2023;49 Suppl 1:308-14. doi:10.1111/aej.12734.
  36. Kurt Ö, Zengin T, Üstün Y, et al. Comparison of the effect of different glide path files on amount of apically extruded debris in curved root canals. Aust Endod J. 2023. doi:10.1111/aej.12749.
  37. Koşar T, Çelik D, Taşdemir T, et al. Apically extruded debris of different file systems used with various kinematic movements during retreatment: An in vitro study. Aust Endod J. 2023. doi:10.1111/aej.12690.
  38. Al Omari TMN, La Rosa GRM, Albanna RHI, et al. The effect of different kinematics on apical debris extrusion with a single-file system. Odontology. 2023 Oct;111(4):910-5. doi:10.1007/s10266-023-00802-3.
  39. Abdelnaby P, Ibrahim M, ElBackly R, et al. In vitro evaluation of filling material removal and apical debris extrusion after retreatment using Reciproc Blue, Hyflex EDM and ProTaper retreatment files. BMC Oral Health. 2023;23:846. doi:10.1186/s12903-023-03579-7.
  40. Nouroloyouni A, Shahi S, Salem Milani A, et al. In vitro apical extrusion of debris and instrumentation time following root canal instrumentation with Reciproc and Reciproc Blue instruments and a novel stainless steel rotary system versus manual instrumentation. J Dent Res Dent Clin Dent Prospects. 2023. doi:10.34172/joddd.2023.39271.
  41. Caviedes-Bucheli J, Rios-Osorio N, Gutiérrez de Pineres-Milazzo C, et al. Effectiveness, efficiency, and apical extrusion of 2 rotaries and 2 reciprocating systems in removing filling material during endodontic retreatment: A systematic review. J Clin Exp Dent. 2023 Mar;15(3):e250-63. doi:10.4317/jced.59953.
  42. Coşkun E, Koçak S, Özdemir O, Sağlam BC, Koçak MM. Apical extrusion of debris when using OneCurve, ProTaper Next and TruNatomy in curved canals. Dent Med Probl. 2023;60(3):421-6. doi:10.17219/dmp/133070.
  43. Kurian AB, Karthikeyan K, Mahalaxmi S. Comparative evaluation of different instrument kinematics on contact percentage, dentin removal and apical debris extrusion in oval canals. Aust Endod J. 2023;49 Suppl 1:413-8. doi:10.1111/aej.12757.
  44. Kaushal D, Reddy SG, Biswas KP, et al. Apical extrusion of debris with root canal instrumentation in primary teeth: A systematic review. J Indian Soc Pedod Prev Dent. 2022;40(1):3-10. doi:10.4103/jisppd.jisppd_298_21.
  45. Ahmad MZ, Sadaf D, MacBain MM, et al. Effect of mode of rotation on apical extrusion of debris with four different single-file endodontic instrumentation systems: Systematic review and meta-analysis. Aust Endod J. 2022;48(3):457-69. doi:10.1111/aej.12612.
  46. Sowjanya T, Parvathaneni KP, Raju T, Varma NM, Dondapati GD, Podili S. Comparative evaluation of apically extruded debris using three different thermomechanically heat treated file systems with two different motions: An in vitro study. J Conserv Dent. 2022 May-Jun;25(3):269-73. doi:10.4103/jcd.jcd_631_20.
  47. Kharouf N, Pedullà E, Nehme W, et al. Apically extruded debris in curved root canals using a new reciprocating single-file shaping system. J Endod. 2022;48(2):255-61. doi:10.1016/j.joen.2021.10.002.
  48. Maheswari D, Mallick RR, Shandilya A, et al. Quantitative evaluation of apically extruded debris during biomechanical preparation using hand K-file, ProTaper Next, and WaveOne: An in vitro study. J Pharm Bioallied Sci. 2022;14 Suppl 1:S713-7. doi:10.4103/jpbs.jpbs_194_22.
  49. Mohammadi D, Mehran M, Frankenberger R, et al. Comparison of apical debris extrusion during root canal preparation in primary molars using different file systems: An in vitro study. Aust Endod J. 2022;48(1):68-74. doi:10.1111/aej.12582.
  50. Al Omari T, El-Farraj H, Arıcan B, Atav Ateş A. Apical debris extrusion of full-sequenced rotary systems in narrow ribbon-shaped canals. Aust Endod J. 2022 Jun;48(2):245-50. doi:10.1111/aej.12540.
  51. Uygun AD. Comparison of apical debris extrusion of different generation nickel-titanium instrument systems. Niger J Clin Pract. 2022;25:1895-900. doi:10.4103/njcp.njcp_455_22.
  52. Nanavati K, Katge F, Poojari M, et al. Comparative evaluation of apically extruded debris during pulpectomy procedure in primary molar teeth using two different rotary systems and hand files: An in vitro study. Int J Dent. 2022;2022:9433225. doi:10.1155/2022/9433225.
  53. Roshdy NN, Hassan R. Quantitative evaluation of apically extruded debris using TRUShape, TruNatomy, and WaveOne Gold in curved canals. BDJ Open. 2022;8:13. doi:10.1038/s41405-022-00106-8.
  54. Hassan E, Sharaan M, Ragab M. Cleaning efficacy and debris extrusion using XP-endo Finisher and XP-endo Finisher R as supplementary files during retreatment: An in vitro study. Eur Endod J. 2022;7(1):40-6. doi:10.14744/eej.2021.44366.
  55. Tanalp J. A critical analysis of research methods and experimental models to study apical extrusion of debris and irrigants. Int Endod J. 2022 Feb;55 Suppl 1:153-77. doi:10.1111/iej.13686.
  56. Pawar BA, Pawar AM, Atram J, et al. Apical debris extrusion during instrumentation of oval root canals in primary teeth using manual versus motorized files: An ex vivo study. Sci Rep. 2021 Feb;11:3859. doi:10.1038/s41598-021-83522-4.
  57. Eliasz W, Czarnecka B, Surdacka A. Apical extrusion of debris during root canal preparation with ProTaper Next, WaveOne Gold and Twisted Files. Materials (Basel). 2021 Nov;14(21):6254. doi:10.3390/ma14216254.
  58. Bürklein S, Donnermeyer D, Hentschel TJ, et al. Shaping ability and debris extrusion of new rotary nickel-titanium root canal instruments. Materials (Basel). 2021 Mar;14(5):1063. doi:10.3390/ma14051063.
  59. Yılmaz Çırakoglu N, Özbay Y. Apically extruded debris associated with ProTaper Next, ProTaper Gold and TruNatomy systems: An in vitro study. J Dent Res Dent Clin Dent Prospects. 2021;15(3):150-5. doi:10.34172/joddd.2021.006.
  60. Yammine SD, Jabbour EA. Apically extruded debris following programmed over instrumentation of curved canals with three nickel titanium rotary instruments. Eur J Dent. 2021;15(2):195-201. doi:10.1055/s-0040-1714175.
  61. Gokturk H, Ozkocak I, Aydin U, et al. Effect of different chelating agents and their surface tension on the amount of apically extruded debris. J Dent Sci. 2021 Jul;16(3):777-82. doi:10.1016/j.jds.2020.06.015.
  62. Predin Djuric N, Van Der Vyver P, Vorster M, et al. Comparison of apical debris extrusion using clockwise and counter-clockwise single-file reciprocation of rotary and reciprocating systems. Aust Endod J. 2021;47(3):394-400. doi:10.1111/aej.12490.
  63. da Silva EJNL, de Moura SG, de Lima CO, et al. Shaping ability and apical debris extrusion after root canal preparation with rotary or reciprocating instruments: A micro-CT study. Restor Dent Endod. 2021;46(2):e16. doi:10.5395/rde.2021.46.e16.
  64. Saricam E, Kayaoglu G. Comparison of OneShape, 2Shape and One Curve endodontic instruments for debris and irrigant extrusion. Dent Med Probl. 2020 Jul-Sep;57(3):255-9. doi:10.17219/dmp/119771.
  65. Eshagh Saberi A, Ebrahimipour S, Saberi M. Apical debris extrusion with conventional rotary and reciprocating instruments. Iran Endod J. 2020 Winter;15(1):20-4. doi:10.22037/iej.v15i1.23823.
  66. Tüfenkçi P, Yılmaz K, Adigüzel M. Effects of the endodontic access cavity on apical debris extrusion during root canal preparation using different single-file systems. Restor Dent Endod. 2020;45(3):e33. doi:10.5395/rde.2020.45.e33.
  67. Keskin C, Sivas Yilmaz Ö, Inan U. Apically extruded debris produced during glide path preparation using R-Pilot, WaveOne Gold Glider and ProGlider in curved root canals. Aust Endod J. 2020;46(3):364-9. doi:10.1111/aej.12428.
  68. Gunes B, Yeter KY. The effect of cervical preflaring on the apical debris extrusion of single or multiple rotary nickel-titanium files. Niger J Clin Pract. 2020;23(8):1062-6. doi:10.4103/njcp.njcp_599_19.
  69. Topçuoğlu HS, Demirbuga S, Topçuoğlu G, et al. Evaluation of apically extruded debris during the removal of canal filling material using three different Ni-Ti systems and hand files in teeth with simulated apical root resorption. Int Endod J. 2020;53(7):991-1000. doi:10.1111/iej.13234.
  70. Ahmad MZ, Sadaf D, MacBain MM, Mohamed AN. Apical extrusion of debris with different rotary and reciprocating single-file endodontic instrumentation systems: A systematic review and meta-analysis protocol. BMJ Open. 2020 Sep;10(9):e038502. doi:10.1136/bmjopen-2020-038502.
Important correction for your thesis: Jizai has published evidence related to shaping ability and debris extrusion, but I could not identify a peer-reviewed apical-debris-extrusion study specifically using Waldent Flexiwave reciprocating files. Your study can therefore be justified as generating primary evidence for Flexiwave.

give doi for this articles-Seltzer S, Naidorf IJ. Flare-ups in endodontics: I. Etiological factors. J Endod. 1985 Nov;11(11):472-8. 2. Siqueira JFJr. Microbial causes of endodontic flare‑ups. Int Endod J. 2003 Jul;36(7):453-63. 3. Torabinejad M, Kettering JD, McGraw JC, Cummings RR, Dwyer TG, Tobias TS. Factors associated with endodontic inter appointment emergencies of teeth with necrotic pulps. J Endod.1988 May;14(5):261-6. 4. Tanalp J, Kaptan F, Sert S, Kayahan B, Bayirl G. Quantitative evaluation of the amount of apically extruded debris using 3 different rotary instrumentation systems Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Feb;101(2):250-7 5. Madhusudhana K, Mathew VB, Reddy NM. Apical extrusion of debris and irrigants using hand and three rotary instrumentation systems–An in vitro study. Contemp Clin Dent. 2010 Oct;1(4):234-6. 6. Seltzer S, Soltanoff W, Smith J. Biologic aspects of endodontics: V. Periapical tissue reactions to root canal instrumentation beyond the apex and root canal fillings short of and beyond the apex. Oral Surg Oral Med Oral Pathol. 1973 Nov;36(5):725-37. 7. Patterson SM, Patterson SS, Newton CW, Kafrawy AH. The effect of an apical dentin plug in root canal preparation. J Endod. 1988 Jan;14(1):1-6.8. Radeva EN, Vassileva RI. Comparative study of apically extruded debris and irrigant after using two rotary systems (K3, Race). J of IMAB. 2014 Jan- Jun;20(1):459-463 9. VandeVisse JE, Brilliant JD. Effect of irrigation on the production of extruded material at the root apex during instrumentation. J Endod. 1975 Jul;1(7):243-6. 10. Martin H, Cunningham WT. The effect of endosonic and hand manipulation on the amount of root canal material extruded. Oral Surg Oral Med Oral Pathol. 1982 Jun;53(6):611-3. 11. Lambrianidis T, Tosounidou E, Tzoanopoulou M. The effect of maintaining apical patency on periapical extrusion. J Endod. 2001 Nov;27(11):696-8. 12. Elmsallati EA, Wadachi R, Suda H. Extrusion of debris after use of rotary nickel‑titanium files with different pitch: A pilot study. AustEndodJ. 2009 Aug;35(2):65-9 . 13. Ruiz-Hubard EE, Gutmann JL, Wagner MJ. A quantitative assessment of canal debris forced periapically during root canal instrumentation using two different techniques. J Endod. 1987 Dec;13(12):554-8. 14. Al-Omari MA, Dummer PM. Canal blockage and debris extrusion with eight preparation techniques. J Endod. 1995 Mar;21(3):154-8.15. Fairbourn DR, McWalter GM, Montgomery S. The effect of four preparation techniques on the amount of apically extruded debris. J Endod. 1987 Mar;13(3):102-8. 16. Abou-Rass M, Piccinino MV. The effectiveness of four clinical irrigation methods on the removal of root canal debris. Oral Surg Oral Med Oral Pathol. 1982 Sep;54(3):323-8. 17. McKendry DJ. Comparison of balanced forces, endosonic, and step-back filing instrumentation techniques: quantification of extruded apical debris. J Endod. 1990 Jan;16(1):24-7. 18. Garry L Myers and Steve Montgomery. A Comparison of Weights of Debris Extruded Apically by Conventional Filing and Canal Master Techniques. J Endod. 1991 Jun;17(6):275-9.

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Seltzer Naidorf flare-ups etiological AND Siqueira microbial flare-ups

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Torabinejad Kettering endodontic emergencies AND Tanalp Kaptan rotary debris

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Madhusudhana Mathew Reddy debris irrigants AND Seltzer Soltanoff Smith periapical

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Patterson Newton Kafrawy apical dentin plug AND Radeva Vassileva K3 Race

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VandeVisse Brilliant irrigation extruded material AND Martin Cunningham endosonic extruded

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Lambrianidis Tosounidou Tzoanopoulou apical patency AND Elmsallati Wadachi Suda pitch

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Ruiz-Hubard Gutmann Wagner canal debris AND Al-Omari Dummer canal blockage debris

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Fairbourn McWalter Montgomery apically extruded debris AND McKendry balanced forces endosonic

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Myers Montgomery weights debris apically conventional filing Canal Master

Searching the Web

"Seltzer" "Naidorf" "Flare-ups in endodontics" DOI "Siqueira" "Microbial causes"

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"Patterson" "apical dentin plug" DOI "Radeva" "K3" "Race" DOI "Elmsallati" debris pitch DOI

Searching the Web

"A Comparison of Weights of Debris Extruded Apically" DOI "McKendry" balanced forces endosonic DOI

Searching PubMed

"Factors associated with endodontic inter appointment emergencies" OR "effect of an apical dentin plug" OR "effect of irrigation on the production of extruded material"

Running Command

python -c "import requests, urllib.parse; titles=['Biologic aspects of endodontics V Periapical tissue reactions to root canal instrumentation beyond the apex and root canal fillings short of and beyond the apex','The effect of an apical dentin plug in root canal preparation','The effect of endosonic and hand manipulation on the amount of root canal material extruded','A quantitative assessment of canal debris forced periapically during root canal instrumentation using two different techniques','The effect of four preparation techniques on the amount of apically extruded debris','The effectiveness of four clinical irrigation methods on the removal of root canal debris']; for t in titles: u='https://api.crossref.org/works?query.title='+urllib.parse.quote(t)+'&rows=1'; d=requests.get(u,timeout=20).json()['message']['items'][0]; print('TITLE:',t,'\\nFOUND:',d.get('title',[''])[0],'\\nDOI:',d.get('DOI'),'YEAR:',d.get('published-print',d.get('published-online',{})).get('date-parts'), '\\n')"

Running Command

python -c "import requests, urllib.parse, time; titles=['The effect of endosonic and hand manipulation on the amount of root canal material extruded','Biologic aspects of endodontics V Periapical tissue reactions to root canal instrumentation beyond the apex and root canal fillings short of and beyond the apex','The effectiveness of four clinical irrigation methods on the removal of root canal debris','The effect of maintaining apical patency on periapical extrusion','A quantitative assessment of canal debris forced periapically during root canal instrumentation using two different techniques','Canal blockage and debris extrusion with eight preparation techniques','The effect of four preparation techniques on the amount of apically extruded debris','Comparison of balanced forces endosonic and step back filing instrumentation techniques quantification of extruded apical debris']; h={'User-Agent':'ReferenceChecker/1.0 mailto:example@example.com'}; for t in titles: try: r=requests.get('https://api.crossref.org/works?query.title='+urllib.parse.quote(t)+'&rows=3',headers=h,timeout=30); d=r.json()['message']['items']; print('\\nQUERY:',t); [print(x.get('DOI'),' | ',x.get('title',[''])[0],' | ',x.get('published-print',x.get('published-online',{})).get('date-parts')) for x in d] except Exception as e: print('ERR',e) time.sleep(1)"

Running Command

python -c "import requests,urllib.parse; qs=['Seltzer Soltanoff Smith Biologic aspects of endodontics V Periapical tissue reactions 1973 36 725','Tanalp Kaptan Sert Kayahan Bayirli Quantitative evaluation amount apically extruded debris 2006']; h={'User-Agent':'ReferenceChecker/1.0 mailto:example@example.com'}; for q in qs: r=requests.get('https://api.crossref.org/works?query.bibliographic='+urllib.parse.quote(q)+'&rows=5',headers=h,timeout=30); print('\\n',q); for x in r.json()['message']['items']: print(x.get('DOI'),x.get('title',[''])[0],x.get('container-title',[''])[0],x.get('published-print',x.get('published-online',{})).get('date-parts'))"

Here are the DOIs for all 18 articles:
  1. Seltzer S, Naidorf IJ. Flare-ups in endodontics: I. Etiological factors. J Endod. 1985 Nov;11(11):472-8.
    doi:10.1016/S0099-2399(85)80131-3
  2. Siqueira JF Jr. Microbial causes of endodontic flare-ups. Int Endod J. 2003 Jul;36(7):453-63.
    doi:10.1046/j.1365-2591.2003.00671.x
  3. Torabinejad M, Kettering JD, McGraw JC, Cummings RR, Dwyer TG, Tobias TS. Factors associated with endodontic interappointment emergencies of teeth with necrotic pulps. J Endod. 1988 May;14(5):261-6.
    doi:10.1016/S0099-2399(88)80181-X
  4. Tanalp J, Kaptan F, Sert S, Kayahan B, Bayırlı G. Quantitative evaluation of the amount of apically extruded debris using 3 different rotary instrumentation systems. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Feb;101(2):250-7.
    doi:10.1016/j.tripleo.2005.03.002
  5. Madhusudhana K, Mathew VB, Reddy NM. Apical extrusion of debris and irrigants using hand and three rotary instrumentation systems: An in vitro study. Contemp Clin Dent. 2010 Oct;1(4):234-6.
    doi:10.4103/0976-237X.76390
  6. Seltzer S, Soltanoff W, Smith J. Biologic aspects of endodontics: V. Periapical tissue reactions to root canal instrumentation beyond the apex and root canal fillings short of and beyond the apex. Oral Surg Oral Med Oral Pathol. 1973 Nov;36(5):725-37.
    doi:10.1016/0030-4220(73)90146-1
  7. Patterson SM, Patterson SS, Newton CW, Kafrawy AH. The effect of an apical dentin plug in root canal preparation. J Endod. 1988 Jan;14(1):1-6.
    doi:10.1016/S0099-2399(88)80234-6
  8. Radeva EN, Vassileva RI. Comparative study of apically extruded debris and irrigant after using two rotary systems (K3, RaCe). J IMAB. 2014 Jan-Jun;20(1):459-63.
    doi:10.5272/jimab.2014201.459
  9. VandeVisse JE, Brilliant JD. Effect of irrigation on the production of extruded material at the root apex during instrumentation. J Endod. 1975 Jul;1(7):243-6.
    doi:10.1016/S0099-2399(75)80227-5
  10. Martin H, Cunningham WT. The effect of endosonic and hand manipulation on the amount of root canal material extruded. Oral Surg Oral Med Oral Pathol. 1982 Jun;53(6):611-3.
    doi:10.1016/0030-4220(82)90350-4
  11. Lambrianidis T, Tosounidou E, Tzoanopoulou M. The effect of maintaining apical patency on periapical extrusion. J Endod. 2001 Nov;27(11):696-8.
    doi:10.1097/00004770-200111000-00011
  12. Elmsallati EA, Wadachi R, Suda H. Extrusion of debris after use of rotary nickel-titanium files with different pitch: A pilot study. Aust Endod J. 2009 Aug;35(2):65-9.
    doi:10.1111/j.1747-4477.2008.00128.x
  13. Ruiz-Hubard EE, Gutmann JL, Wagner MJ. A quantitative assessment of canal debris forced periapically during root canal instrumentation using two different techniques. J Endod. 1987 Dec;13(12):554-8.
    doi:10.1016/S0099-2399(87)80004-3
  14. Al-Omari MAO, Dummer PMH. Canal blockage and debris extrusion with eight preparation techniques. J Endod. 1995 Mar;21(3):154-8.
    doi:10.1016/S0099-2399(06)80443-7
  15. Fairbourn DR, McWalter GM, Montgomery S. The effect of four preparation techniques on the amount of apically extruded debris. J Endod. 1987 Mar;13(3):102-8.
    doi:10.1016/S0099-2399(87)80174-7
  16. Abou-Rass M, Piccinino MV. The effectiveness of four clinical irrigation methods on the removal of root canal debris. Oral Surg Oral Med Oral Pathol. 1982 Sep;54(3):323-8.
    doi:10.1016/0030-4220(82)90103-7
  17. McKendry DJ. Comparison of balanced forces, endosonic, and step-back filing instrumentation techniques: Quantification of extruded apical debris. J Endod. 1990 Jan;16(1):24-7.
    doi:10.1016/S0099-2399(07)80026-4
  18. Myers GL, Montgomery S. A comparison of weights of debris extruded apically by conventional filing and Canal Master techniques. J Endod. 1991 Jun;17(6):275-9.
    doi:10.1016/S0099-2399(06)81866-2
Small correction: reference 18 was published in 1991, not 1991/1990 ambiguously. The citation you wrote is otherwise correct.

" COMPARATIVE EVALUATION OF APICALLY EXTRUDED DEBRIS PRODUCED BY HAND FILES, ROTARY FILES (Jizai files, One curve mini files) AND RECIPROCATING FILE SYSTEM (Waldent flexiwave reciprocating files) - among this which has more apical extrusion of debris and why (give in descending order)

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"apical debris extrusion" AND endodontic

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Jizai AND debris extrusion

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"One Curve" AND debris extrusion

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Flexiwave AND endodontic

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Jizai One Curve mini Waldent Flexiwave apical debris extrusion endodontic study

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Waldent Flexiwave reciprocating files specifications cross section taper reciprocation

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One Curve mini files specifications apical size taper Jizai files specification endodontic

Finding Sources
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PMID: 33668333

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PMID: 39007058

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PMID: 35255170

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PMID: 40449882

Expected descending order of apically extruded debris

1. Hand files, especially hand K-files

2. Waldent Flexiwave reciprocating file

3. Jizai rotary file system

4. One Curve Mini rotary file

This is the most defensible expected order, but it is a hypothesis, not a confirmed result for your exact four systems. A direct published comparison including all four systems, particularly Waldent Flexiwave, is not available. Your electronic-microbalance study is needed to determine the actual order.
Expected rankInstrumentExpected extrusionMain explanation
1Hand K-filesHighestPush-pull filing can act as a piston, transporting dentin chips and pulp remnants toward the apex. Repeated filing and less efficient coronal removal allow debris to accumulate and be pushed apically.
2Waldent FlexiwaveHigh to moderateReciprocating movement may produce a piston-like apical movement of debris. It is a single-file reciprocating instrument with an S-shaped cross-section and R25 has a relatively large .08 taper, both of which can increase dentin removal and apical transportation of debris.
3JizaiModerate to lowContinuous rotation and its off-centered design facilitate coronal movement of debris. The radial land is designed to reduce screw-in effect, while spaces around the file can accommodate debris. Its mult-file rotary sequence may also reduce apical compaction compared with a single reciprocating file.
4One Curve MiniLowest, expectedIt is a heat-treated C-Wire rotary system with a smaller, more conservative apical size/taper intended for minimally invasive shaping. Continuous rotary movement and reduced engagement may favor coronal debris removal and less apical forcing.

Why hand files are expected to extrude the most

Hand K-files are used with filing, reaming, and push-pull strokes. In a narrow canal, these movements can compact debris in the apical third and force it through the foramen. A 2025 systematic review and meta-analysis found manual preparation associated with significantly greater apical debris extrusion than rotary glide-path systems (Talekar et al.).
Therefore, your first expected finding can be:
Hand K-files are expected to produce the greatest mean amount of apically extruded debris among the evaluated groups.

Why Flexiwave is expected to rank second

Flexiwave is a single-file reciprocating system. The manufacturer describes it as a blue NiTi file with an S-shaped cross-section and R25 size having .08 taper. A large apical taper can remove more dentin, while reciprocation may carry debris toward the apex when the file repeatedly advances and disengages.
A systematic review and meta-analysis concluded that reciprocating single-file systems tend to extrude more debris than full-rotation single-file systems (Ahmad et al.).
However, avoid writing that “reciprocation always extrudes more debris.” Extrusion also depends on taper, tip diameter, cross-sectional design, flute volume, number of instruments, working length, canal curvature, irrigation protocol, and apical enlargement.
A safe thesis statement:
Waldent Flexiwave is expected to extrude more debris than the rotary systems because of its reciprocating single-file action and R25 .08 taper; however, this prediction requires experimental validation because no direct published evidence for Flexiwave was identified.

Why Jizai is expected to be lower than Flexiwave

Jizai is a heat-treated rotary NiTi system used in a sequential approach. Its design includes an off-centered quasi-rectangular cross-section and a radial land, intended to reduce excessive screw-in and create space for debris removal. Its usual shaping sequence includes Jizai I 25/.04, Jizai II 25/.06, and Jizai III 35/.04.
In a microbalance study, Jizai caused apical debris extrusion, as all tested systems did, but had no statistically significant difference from several other rotary systems (Bürklein et al.). The result supports the expectation that Jizai may show moderate rather than very high extrusion.

Why One Curve Mini is expected to be lowest

One Curve is a heat-treated C-Wire, continuous-rotation system. Studies with standard One Curve show relatively low debris extrusion compared with several reciprocating systems.
In curved canals, One Curve extruded less debris than Reciproc Blue, WaveOne Gold, and One Reci, although all file systems caused some extrusion (Ahmad, 2024). Also, One Curve showed comparable extrusion to TruNatomy and ProTaper Next in another study (Coşkun et al.).
Because One Curve Mini uses more conservative sizes and tapers than the regular One Curve, it may preserve more dentin and produce less debris. But this is an inference. Do not state it as proven unless your own study confirms it.

Suggested hypothesis for your dissertation

Null hypothesis: There will be no statistically significant difference in the amount of apically extruded debris among hand K-files, Jizai rotary files, One Curve Mini rotary files, and Waldent Flexiwave reciprocating files.
Alternative hypothesis: Hand K-files will produce the greatest amount of apically extruded debris, followed by Waldent Flexiwave reciprocating files, Jizai rotary files, and One Curve Mini rotary files.

Important methodological caution

Your rank order may change if any of these are not standardized:
  • Apical size and taper of final preparation
  • Working length, especially instrumentation 0.5-1 mm short of the apical foramen
  • Tooth type, root length, canal curvature, and initial apical diameter
  • Coronal preflaring and glide-path protocol
  • Amount, concentration, and delivery method of irrigant
  • Frequency of recapitulation
  • Operator pressure and pecking amplitude
  • Drying conditions and electronic microbalance precision
The strongest comparison uses matched final apical preparation sizes. If Flexiwave R25/.08 is compared directly with a smaller One Curve Mini preparation, increased debris may reflect the larger taper, not reciprocation alone.
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