Martin and Cunningham 10 reported that less debris was extruded when the intracanal preparation was accomplished with an ultrasonic instrument. They found that instrumentation with irrigant produced extrusion, whereas instrumentation without irrigant produced no collectible debris. 6 – 9 Vande Visse and Brilliant 6 first quantified the amount of debris apically extruded during instrumentation. 3Īll preparation techniques and instruments have been reported to be associated with extrusion of infected debris, even when preparation is maintained short of the apical terminus. Consequently, there will be a transient disruption in the balance between aggression and defense in such a way that the host will mobilize an acute inflammation to re-establish the equilibrium. During chemo-mechanical preparation, if the microorganisms are apically extruded, the host will face a situation in which it will be challenged by a larger number of irritants than it before. 2, 5 In asymptomatic chronic periradicular lesions associated with infected teeth, there is a balance between microbial aggression and host defense in the periradicular tissues. 2, 4 Apical extrusion of infected debris to the periradicular tissues is possibly one of the principal causes of postoperative pain. 3 The causative factors of inter-appointment flare-ups comprise mechanical, chemical and/or microbial injury to the pulp or periradicular tissues. ![]() The inter-appointment flare-up is a true complication characterized by the development of pain, swelling or both, which commences within a few hours or days after root canal procedures and is of sufficient severity to require an unscheduled visit for emergency treatment. This is of concern since material extruded from the apical foramen may be related to post-instrumentation pain or to a flare-up. 1 Dentine chips, pulp tissue fragments, necrotic tissue, microorganisms and intracanal irrigants may be extruded from the apical foramen during the canal instrumentation. ![]() The cleaning of dentin within the root canal and the removal of inflamed and/or necrotic tissue remains as one of the most important steps in endodontic theraphy.
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