Rotary versus Manual Glide Path Preparation in Root Canal Treatment: A Systematic Review and Meta-Analysis on Apically Extruded Debris.

INTRODUCTION: This systematic review and meta-analysis evaluated the influence of rotary and manual glide path preparation techniques on apically extruded debris during root canal treatment, addressing a critical aspect of endodontic treatment outcomes. METHODS: Following PRISMA 2020 and COSMOS-E guidelines, a comprehensive search of Medline, Scopus, Embase, Epistemonikos, and grey literature identified ex vivo studies using human extracted teeth. Study quality was assessed with the RoBDEMAT tool, and meta-analysis (of four studies) used a random-effects inverse-variance model with a DerSimonian-Laird estimate. The level of evidence was evaluated using the DARE tool. A heat matrix was developed to map the confounding variables. RESULTS: Eleven studies (2016-2024) met the inclusion criteria. Rotary systems, especially ProGlider, One G, and PathFile, showed significantly less debris extrusion compared to manual K-files. Meta-analysis revealed a standardized mean difference of 1.35 (95% CI: 0.82-1.87; P < .01), indicating greater apical debris with manual techniques. Newer rotary systems exhibited progressive improvements in debris reduction capabilities. CONCLUSIONS: This systematic review provides strong evidence that rotary glide path systems are more effective than manual techniques in minimizing apical debris extrusion during root canal treatment. These findings have significant clinical implications for reducing postoperative complications and improving treatment outcomes in endodontic practice.