There are three processes to root canal treatment, cleaning, shaping and filing the root canal. There is however considerable debate to how each of these elements should be achieved. The aim of this review was to determine if this is an optimal apical enlargement that leads to optimal healing in teeth requiring root canal treatment.
Searches were conducted in PubMed/Medline, Embase, and Cochrane Library, supplemented by searches of the bibliographies of relevant article and textbooks. In vivo studies with follow up of 12-months or greater comparing different size apical preparation were considered. Two reviewers carried out study selection independently.
- 4 studies involving a total of 840 patients were included.
- Follow up ranged for 12 – 60 months
- A qualitative summary of the studies is presented.
- 1 study reported a significant difference in favour of a larger apical preparation with a second one reporting a decrease. The other two reported no differences.
The authors concluded
The results of the systematic review confirmed that more evidence-based research in this area is needed. With the limited information available, the best current available clinical evidence suggests that for patients with necrotic pulps and periapical lesions, enlargement of the apical size would result in an increased healing outcome in terms of clinical and radiographic evaluations.
This review has a good search strategy but was only able to include one randomised trial which we have discussed in a previous blog ( Dental Elf 17th Oct- 2012) . The included studies are heterogeneous and are subject to a range of biases so the findings need to be interpreted with caution.
Aminoshariae A, Kulild JC. Master apical file size – smaller or larger: a systematic review of healing outcomes. Int Endod J. 2014 Aug 12. doi: 10.1111/iej.12370. [Epub ahead of print] PubMed PMID: 25113106.
Dental Elf -17th Oct-2013 – Apical preparation for root canal treatment, how much is needed?
SR aims to determine the apical enlargement that leads to optimal healing in teeth requiring root canal treatment http://t.co/wHlDEVMoQX
Considerable debate exists over the 3 processes to root canal treatment; cleaning, shaping and filing the root canal http://t.co/wHlDEVMoQX
1 study reported a significant difference in favour of a larger apical preparation with another one reported a fall http://t.co/wHlDEVMoQX
Available evidence suggests that for some patients enlargement of the apical size may increase the healing outcome http://t.co/wHlDEVMoQX
Don’t miss: Root canal master apical file size: is bigger better? http://t.co/wHlDEVMoQX
SR results confirmed that more evidence-based research in this area is needed, only limited information is available. http://t.co/wHlDEVMoQX
This SR has a good search strategy but was only able to include one randomised trial. http://t.co/wHlDEVMoQX
I think enlargement of the apical portion lead to changing the anatomy of the root and this lead to more risk in the treatment procedure i.e. because we see the root in x-ray in 2 dimension so we dont know how the root look like so when intending to make a larger apical size that mean more risk of ledge or perforation and need a perfect obturation