UNIVERSIDADE ESTADUAL PAULISTA

“JÚLIO DE MESQUITA FILHO”

Instituto de Ciência e Tecnologia

Campus de São José dos Campos

ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2023.e3769

Braz Dent Sci 2023 Apr/Jun;26 (2): e3769

Inﬂuence of traverse and waveone gold glider glide path ﬁles on

the amount of apically extruded debris

Inﬂuência das limas glide path Traverse e Wave One Gold Glider na quantidade de detritos extruídos apicalmente

Afra Rashid Saeed Ali ALMHEIRI

, Tarek ELSEWIFY

2,3*

, Bassem EID



1 - Ministry of Interior, Medical Services Department, Sharjah, United Arab Emirates

2 - Gulf Medical University, Restorative Dental Sciences Department, Ajman, United Arab Emirates

3 - Ain Shams University, Endodontic Department, Cairo, Egypt

How to cite: Almheiri ARSA, Elsewify T, Eid B. Inuence of traverse and waveone gold glider glide path les on the amount of apically

extruded debris. Braz Dent Sci. 2023;26(2):e3769. https://doi.org/10.4322/bds.2023.e3769

ABSTRACT

Objective: The aim of this study was to evaluate the effect of different glide path les on the amount of apically

extruded debris. Material and Methods: Sixty single-canaled mandibular premolars were accessed and randomly

divided into three groups (n= 20) according to the le used for glid path creation; group A using Traverse le,

group B using WaveOne Gold Glider, group C using stainless steel K le. All teeth were then instrumented using the

Reciproc system. The debris extruded apically during instrumentation were collected into pre-weighed Eppendorf

tubes which were then stored in an incubator at 70 °C for 5 days. The weight of the dry extruded debris was

established by subtracting the pre-instrumentation and post-instrumentation weights of the Eppendorf tubes. The

data were analyzed using one-way ANOVA test, and post hoc analysis. Results: WaveOne Gold Glider produced

the least amount of apical extruded debris (0.41±0.25) followed by the Traverse group (0.59±0.20) then the

K-le group (0.64±0.16) with a statistically signicant difference (p=0.003). Conclusion: Apical extrusion

of debris is inevitable during root canal cleaning and shaping. Creation of glide path using engine-driven les

produces less amount of apically extruded debris compared to hand-driven K-les.

KEYWORDS

Root canal preparation; Nickel titanium alloy; Dental instruments.

RESUMO

Objetivos: O objetivo deste estudo foi avaliar o efeito de diferentes limas glide path na quantidade de detritos

extruídos apicalmente. Metodologia: Sessenta pré-molares inferiores com canal único foram acessados e

divididos aleatoriamente em três grupos (n= 20) de acordo com a lima utilizada para criação do glid path;

grupo A usando lima Traverse, grupo B usando WaveOne Gold Glider, grupo C usando lima K de aço inoxidável.

Todos os dentes foram então instrumentados usando o sistema reciprocante. Os detritos extruídos apicalmente

durante a instrumentação foram coletados em tubos Eppendorf pré-pesados que foram então armazenados em

uma incubadora a 70°C por 5 dias. O peso dos detritos secos extruídos foi estabelecido subtraindo-se os pesos dos

tubos Eppendorf antes e após instrumentação. Os dados foram analisados por meio do teste one-way ANOVA e

análise post-hoc. Resultados: WaveOne Gold Glider produziu a menor quantidade de detritos apicais extruídos

(0,41±0,25) seguido pelo grupo Traverse (0,59±0,20) e depois pelo grupo K-le (0,64±0,16) com uma diferença

estatisticamente signicativa (p=0,003). Conclusão: A extrusão apical de detritos é inevitável durante a limpeza

e modelagem do canal radicular. A criação do glide path usando limas acionadas por motores produz menos

quantidade de detritos extruídos apicalmente em comparação com as limas K manuais.

PALAVRAS-CHAVE

Preparo do canal radicular; Liga de niquel-titânio; Instrumentos odontológicos.

Braz Dent Sci 2023 Apr/Jun;26 (2): e3769

Almheiri ARSA et al.

Influence of traverse and waveone gold glider glide path files on the amount of apically extruded debris

Almheiri ARSA et al.

Inﬂuence of traverse and waveone gold glider glide path ﬁles

on the amount of apically extruded debris

INTRODUCTION

Success of root canal treatment depends

mainly upon proper debridement and disinfection

of the root canal system, as well as three-

dimensional obturation [1]. During root canal

preparation, dentin chips, microorganisms,

and pulpal tissue may be extruded beyond the

apical foramen which may lead to flare-ups,

postoperative pain, delayed healing, and/or

periapical inammation.

By denition, glide path is the creation of a

smooth tunnel starting from the root canal orice

all the way to the apical foramen [2]. Glide path

helps in decreasing stresses, preventing rotary le

separation, and enhancing the performance of NiTi

les in addition to the reduction of the extrusion

of debris during root canal preparation [3].

Preparing a glide path is a crucial step in root

canal instrumentation to avoid procedural errors

during root canal treatment.

For better preservation of the root canal

anatomy, the majority of the NiTi les available

show improved flexibility through the use of

stabilized martensite crystalline arrangement

and various thermal treatments together with a

noncutting tip [4]. Therefore, it can’t be used for

the initial negotiation of the root canal, despite

the le being used in reciprocation or rotational

motion. Therefore, creating a glide path is highly

recommended when using any le system in order

to prevent torsional failure of the shaping le [5].

Traverse le (Kerr, Michigan, USA) is a glide

path le with an advanced technology that helps

creating a more tarped glide path reducing the

stresses upon the shaping les used thereafter.

Traverse file consists of one file that comes

in 21 mm, 25 mm, 31 mm with a 0.06 taper,

and a 0.13 and a 0.18 tip size. Traverse file

possesses a non-cutting tip and a triangular

cross-section. It is claimed to have high torsional

resistance, preserve the canal anatomy, and have

high cutting efciency. Traverse le is used in

continuous rotational motion [6].

WaveOne Gold Glider (WGG) (Dentsply

Sirona, Ballaigues, Switzerland) is a path file

manufactured using the heat-treated Gold-wire

which has been shown to signicantly improve the

exibility and cyclic fatigue resistance compared to

non-heat-treated les [7]. It shows a progressive

taper over the active portion reducing the taper

lock and screw-in effect. The WGG file has a

parallelogram cross-section with two cutting edges

and a 0.15 mm tip diameter. The WGG shows

a progressive taper ranging from 0.02 to 0.06.

WGG is available in three lengths 21 mm, 25 mm,

and 31 mm, used in reciprocation motion [8].

Traverse le is relatively a novel le, up to

our knowledge no studies have been performed

to assess its effect on apical debris extrusion.

Therefore, the aim of the current study was to

assess the effect of Traverse and WGG les on

the amount of apically extruded debris. The null

hypothesis tested is that there is no statistically

signicant difference between both les in the

amount of apically extruded debris.

METHODOLOGY

Ethical approval

This study was approved by the Institutional

Review Board with approval number IRB/COD/

STD/41/Apr-2021.

Sample size calculation

A power analysis was designed to have

adequate power to apply a statistical test of the

null hypothesis that there is no difference would

be found between tested groups. By adopting an

alpha and beta levels of (0.05) (i.e. power=95%),

and an effect size (f) of (0.521) calculated based

on the results of a previous study [9], the predicted

sample size (n) was a total of (60) samples (i.e.

20 samples per group). Sample size calculation

was performed using G*Power version 3.1 [10].

Sample selection

Mandibular premolars with complete root

development, one canal with one apical foramen,

and root canal curvature of less than 5° according

to the Schneider [11] method were selected.

Teeth with previous root canal treatment, apical

foramen diameter larger than #25, external or

internal root resorption, calcied canals, root

caries, and root cracks were excluded.

Samples preparation

Soft and hard deposits attached to the

external root surfaces were gently removed using

a sharp periodontal curette. The teeth were stored

in saline solution. Decoronation was performed

using a diamond disk 19 mm from the root apex

Braz Dent Sci 2023 Apr/Jun;26 (2): e3769

Almheiri ARSA et al.

Influence of traverse and waveone gold glider glide path files on the amount of apically extruded debris

Almheiri ARSA et al.

Inﬂuence of traverse and waveone gold glider glide path ﬁles

on the amount of apically extruded debris

in a 90-degree angulation relative to the long

axis of the root creating a relatively standard

root canal length [12]. Working length was then

determined at 0.5 mm short from the apical

foramen using a #10 K-le.

Sample classication

The samples were randomly allocated into

three groups (n=20) using a computer algorithm

(www.random.org) according to the glid path

le used; group A using Traverse, group B using

WGG and group C using K-les.

Apparatus setup and initial weighing

Myers and Montgomery’s [13] model

was followed for the current study (Figure 1).

An Eppendorf tube was marked and weighed

separately for each sample in the study using

an analytical weighing scale with a precision of

-4

g. The average of three subsequent weights

was used to determine and record the mean

weight of each tube.

A total of 60 glass vials with rubber caps

were used to x the sample teeth at the level of

the cementoenamel junction using cyanoacrylate.

Eppendorf tubes were then placed inside the

glass vials. Equalization of the air pressure was

achieved by inserting a needle along the rubber

cap. To eliminate operator bias, all vials were

covered using aluminum foil.

Glide path preparation

Group A: traverse glide path le

A stainless-steel K-file #10 was used to

negotiate the canal to the working length with

increasing amplitudes of 1–3 mm. Traverse le

0.18/06 was used in continuous rotation of

500 rpm and 150 g/cm torque according to the

manufacturer recommendations until the full

working length was achieved. After every 1-2 mm

of apical advancement, the le was removed and

cleaned from debris and reconrmed patency.

Group B: WaveOne gold glider le

A stainless-steel K-file #10 was used to

negotiate the canal to the working length with

increasing amplitudes of 1–3 mm. Glide path

preparation using WGG size 0.15 mm and

0.2 tapers using “WAVE ONE ALL” mode according

to the manufacturer recommendations with gentle

inward pressure. The le was passively progressed

until the full working length was reached.

Group C: stainless steel K-le

The glide path was initially established using

a stainless-steel K-le # 10 until the hand le

was loosely tted in the canal followed by K-le

# 15 and 20. K-le # 20 reaching the working

length was pulled coronoally 4 mm, then pushed

with light nger pressure to the working length

again to conrm a glide path.

Root canal preparation

Single le, Reciproc R40 (40/.06) was used

to prepare all canals in a reciprocating motion

with vertical strokes of 3 mm. After three strokes,

the blades were cleaned with a gauze. Patency

was maintained using K-file #15 file to the

working length. Instrumentation was performed

till the R40 reached the working length easily.

After the preparation, wash with 1 mL of

distilled water was performed for collection of

the adherend AED. Finally, patency was checked

using a #10 K-le after irrigation with distilled

water.

Irrigation protocol

Each canal was irrigated with 10 mL of distilled

water using Navi Tip 29 G irrigation needle (Navi

Tip, Ultradent Products, Utah, USA) 2 mm shorter

than the working length. A nal ush was then

performed with 2 mL of distilled water as well.

Final weighing of eppendorf tubes

After preparation, the Eppendorf tubes

were incubated for 5 days at 70°C to evaporate Figure 1 - Experimental model for AED evaluation.

Braz Dent Sci 2023 Apr/Jun;26 (2): e3769

Almheiri ARSA et al.

Influence of traverse and waveone gold glider glide path files on the amount of apically extruded debris

Almheiri ARSA et al.

Inﬂuence of traverse and waveone gold glider glide path ﬁles

on the amount of apically extruded debris

water remnants [14]. Weight calculation was

performed by the second author who was blinded

to the group assignment. The mean of three

readings was calculated.

Statistical analysis

Numerical data were represented as mean

and standard deviation (SD) values. Intraclass

correlation coefficient was calculated to test

for intra-rater reliability and yielded a value

of 0.99 which indicates highly correlated

measurements of each sample. Shapiro-Wilk’s

test was used to test for normality. Homogeneity

of variances was tested using Levene’s test. Data

showed parametric distribution and variance

homogeneity, so they were presented as mean

and standard deviation values and were analyzed

using one-way ANOVA followed by Tukey’s

post hoc test. The signicance level was set at

p ≤0.05 for all tests. Statistical analysis was

performed with R statistical analysis software

version 4.1.2 for Windows.

RESULTS

Mean, standard deviation values, and results

of intergroup comparisons for extruded debris

was presented in Table I and Figure 2.

Results of post hoc pairwise comparisons

showed WGG (0.41±0.25) to have a signicantly

lower value than K-file (0.64±0.16) and

Traverse le (0.59±0.20) (p=0.004 and 0.027),

respectively. However, the difference between

groups Traverse and K-le was not statistically

signicant (p=0.771).

DISCUSSION

Glide path creation is recommended when

using rotary NiTi le systems [15]. Creating a

patent channel from the coronal access cavity

to the apical terminus will help enhancing the

performance of the rotary NiTi les and reduces

the extrusion of debris.

As preparation of curved root canals shows a

great challenge, straight single-rooted premolars

were preferred in the current study to avoid

cleaning and shaping mishaps and allow for

better standardization [16,17]. Natural teeth

were chosen to better simulate

in vivo

situations

because resin blocks lack natural tooth properties,

such as dentin hardness, canal irregularities, and

natural apical constriction [18].

Myers & Montgomery’s experimental model

was used in the current study [13] despite its

limitations including lack of simulation of the

apical pressure of the periodontium, inability to

standardize the dentin surface hardness and the

very small amount of debris measured [19]. This

technique allows for differentiation between the

extruded debris and the irrigant [20].

Distal water was used as an irrigant for two

reasons; rst to avoid any impurities of different

irrigants which may affect the weight of dry

debris, second is to avoid sodium hypochlorite

crystallization [21,22]. Several factors affect

the amount of apically extruded debris. One of

which is the single versus multi-file shaping.

Tanalp et al. [23] has concluded that single le

systems yield less amount of apically extruded

debris and therefore, Reciproc R40 was used as

a single le for the root canal preparation.

Table I - Mean, standard deviation values, conﬁdence bounds and results of intergroup comparisons for extruded debris

Group

f-value p-value

Traverse WGG K ﬁle

0.59±0.20

0.41±0.25

0.64±0.16

6.34 0.003*

Means with diﬀerent superscript letters within the same horizontal row are signiﬁcantly diﬀerent. *signiﬁcant (p<0.05).

Figure 2 - Bar chart showing mean and standard deviation values

for extruded debris for diﬀerent glide path ﬁles.

Braz Dent Sci 2023 Apr/Jun;26 (2): e3769

Almheiri ARSA et al.

Influence of traverse and waveone gold glider glide path files on the amount of apically extruded debris

Almheiri ARSA et al.

Inﬂuence of traverse and waveone gold glider glide path ﬁles

on the amount of apically extruded debris

In the present study, all groups showed

AED with a statistical signicance of (p=0.003);

therefore, the null hypothesis is rejected.

K-les produced signicantly more AED than

both rotary glide path les tested. This comes in full

agreement with numerous studies [2,12,24-27]

who concluded that the engine-driven glide path

les yielded less amount of AED than hand-driven

ones. This can be mainly attributed to two main

factors; first is the file’s design features and

second is the kinematics applied [28]. The push-

and-pull action of the hand-driven les will result

in more pressure in the apical direction. Hence,

more AED will form. This push-and-pull action

of the hand-driven les will pack more debris in

the apical third of the root canal [22,29].

WGG showed the minimal amount of AED.

This can be also attributed to the le design and

kinematics applied. WGG shows a progressive

taper and a 0.15 mm tip diameter allowing for

minimal contact with the dentin surface to be

cut, minimizing the screw-in effect. In addition to

the parallelogram-shaped cross-sectional design

that allows for a considerable clearance space.

WGG is a reciprocating le that works with a

150/30 reciprocating angle. This motion allows

for better cutting efciency, less screw-in effect

and more clearance of debris coronally [27,30].

Less AED with reciprocating motion compared

to continuous rotation has been highlighted by

many studies [16,31,32] in agreement with the

current study. This could be attributed to the

enhanced debris extrusion control for reciprocating

kinematics instruments in comparison to rotational

systems due to their balanced force movement,

expelling lower apical pressure. Reciprocating

glide path instruments have higher cutting

efciency, advanced root canal shaping efciency,

and lower apically extruded debris amounts in

comparison to continuous rotation instruments.

Fontana et al. [32] has shown that clockwise-

counterclockwise reciprocating motion allows for

better preparation centralization, thus minimizing

pressure towards the apical direction in comparison

to continuous rotation systems hence lowering

debris extrusion.

Traverse results could not be directly compared

to other studies as none could be identied in the

literature till now evaluating its effect on AED. In this

study, Traverse le resulted in less debris than the

K-les; however, this difference was not statistically

significant, and it was statistically significantly

greater than the WGG. This could be attributed to

the differences in instrument geometric designs and

movement kinematics between systems. Traverses

le shows a triangular cross-sectional design with

sharp cutting angles offering increased cutting

efciency and more AED. Traverse le operates in

continuous rotational motion which will result in

more screw-in effect and less clearance of debris

during cutting.

CONCLUSION

Based on the results of the current study, it

can be concluded that apical extrusion of debris is

inevitable during root canal cleaning and shaping.

Creation of a glide path using engine-driven les

produce lower amounts of AED than hand-driven

K-type les. Reciprocation motion results in lower

amount of apically extruded debris when compared

to rotational motion. The file design also has a

signicant effect on the amount of debris extruded.

Author’s Contributions

ARSAA: Samples preparation, instrumen-

tation, manuscript preparation. TE: Statistical

analysis, manuscript preparation and revision.

BE: Study design, manuscript preparation and

revision.

Conict of Interest

No conicts of interest declared concerning

the publication of this article.

Funding

The authors declare that no nancial support

was received.

Regulatory Statement

This study was conducted in accordance with

all the provisions of the local human subjects

oversight committee guidelines and policies of

Gulf Medical University’s Institutional Review

Board. The approval code for this study is: IRB/

COD/ STD/41/Apr-2021.

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Braz Dent Sci 2023 Apr/Jun;26 (2): e3769

Almheiri ARSA et al.

Influence of traverse and waveone gold glider glide path files on the amount of apically extruded debris

Almheiri ARSA et al.

Inﬂuence of traverse and waveone gold glider glide path ﬁles

on the amount of apically extruded debris

Tarek Elsewify

(Corresponding address)

Gulf Medical University, College of Dentistry, Thumbay Medicity, Ajman, United

Arab Emirates.

Email: tarek_elsewefy@dent.asu.edu.eg

Date submitted: 2023 Jan 06

Accept submission: 2023 Mar 24