Effectiveness of apical clearing: histological and radiographical evaluation

Preparation of the apical one-third in curved canals is difficult both in debridement and maintaining canal shape. A technique of final apical preparation, "apical clearing," attempted to debride and increase the apical size without transportation. Apical clearing is defined as: following cleaning and shaping, sequentially rotating files two to four sizes larger than the initial (master) apical file at working length, then rotating the largest apical file again after a final irrigation and drying. This study evaluated histologically and radiographically the quality of apical preparation with or without apical clearing. Examined were (a) extent of transportation and (b) debris accumulation in the apical third. Fifty-four extracted teeth with vital pulps and curved canals were divided into two groups. After step-back preparation, 29 had apical clearing and 25 did not. Pre- and postpreparation double-exposed radiographs evaluated canal deviation. The apical one-third of the canals was examined histologically and ranked, based on remaining tissue, predentin, dentin shavings, other debris, and canal walls planed. Radiographically, the apically cleared group showed slight deviation of the canal during preparation. Histologically, canals in the apically cleared group had significantly less remaining tissue, predentin and debris, as well as more canal walls planed. This experiment showed that apically the apical clearing technique resulted in better debridement, with minimal increase in apical transportation.