The role of apical size determination and enlargement in the reduction of intracanal bacteria

The master apical preparation size in root canal therapy is debatable despite considerable research. The present study compared file sizes that bind at the apex before and during crown-down preparation and assessed the relation between apical size and extent of intracanal bacterial load. There were 100 single-rooted teeth biomechanically prepared after inoculation with Enterococcus faecalis. Canals were preflared, and apical size was ascertained by the first file to bind (FAB) at the working length (WL). During crown-down preparation, the first crown-down file to reach the apex during instrumentation was noted (CDF). Teeth were then divided into three master apical file size groups of CDF + 1, CDF + 2, and CDF + 3. Positive controls were inoculated postinstrumentation, whereas negative controls were instrumented without inoculation (n = 5). The samples were then cultured for intracanal bacterial counts. Fifteen samples and four controls were analyzed under SEM. The data were analyzed using ANOVA, Student's t-test, and chi(2) tests. The CDF was demonstrated to be an average of four file sizes larger than the FAB (p < 0.05). There was a significant increase in the number of samples with negative cultures from CDF + 1 to CDF + 3. SEM observation revealed bacteria on dentinal walls and in tubules even in most negative canal cultures.