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Ling D, Chen Y, Chen G, Zhang Y, Wang Y, Wang Y, He F. Outcome of nonsurgical management of large cyst-like periapical lesions using a modified apical negative pressure irrigation system: a case series study. BMC Oral Health 2024; 24:336. [PMID: 38491469 PMCID: PMC10943812 DOI: 10.1186/s12903-024-04110-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024] Open
Abstract
OBJECTIVE To assess the effectiveness of a self-constructed modified apical negative pressure irrigation (ANPI) system employing commonly used clinical instruments in nonsurgical root canal therapy (NSRCT) for large cyst-like periapical lesions (LCPLs). METHODS From 2017 to 2022, 35 patients diagnosed with LCPLs (5-15 mm) via preoperative clinical and radiographic evaluations of endodontic origin underwent NSRCT combined with ANPI. These patients were subjected to postoperative clinical and radiographic follow-up at 3 months, 6 months, 1 year, 2 years, 3 years, and 4 years, with a CBCT scan specifically conducted at 6-month follow-up. Through the reconstruction of three-dimensional cone beam computed tomography (CBCT) data, an early prognosis was facilitated by monitoring changes in lesion volume. Various treatment predictors-including sex, type of treatment, lesion size, preoperative pain, jaw, type of teeth involved, sealer extrusion, and the number of root canals-were meticulously analyzed. The evaluation of post-treatment outcomes leveraged both clinical observations and radiographic data collected during the follow-up periods. The Kruskal‒Wallis test and one-way ANOVA were also conducted to determine the independent factors influencing treatment outcomes. A significance level of 5% was established. RESULTS Thirty-five teeth from 35 patients with a median age of 28 years (range 24-34) were treated; the median follow-up duration was 19 months (range 12-26). The overall success rate was 91.4%, with a median lesion reduction of 77.0% (range 54.2-96.4%) at 6 months. Patients under 30 years of age exhibited a significantly greater success rate than older patients did (100.0% vs. 80.0%, p = 0.037). Other factors, such as sex, jaw, treatment type, preoperative pain, cyst size, tooth location, sealer extrusion, and the number of roots, did not significantly impact treatment outcomes. CONCLUSIONS Despite limitations related to the observational case-series study design and relatively small sample size, our findings suggest that utilizing the ANPI in the NSRCT for LCPLs may hold promise. The notably higher success rate in patients younger than 30 years is worth noting.
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Affiliation(s)
- Danhua Ling
- Department of General Dentistry, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- Department of Prosthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, 166 Qiutao North Road, Shangcheng District, Hangzhou, Zhejiang Province, China
| | - Yun Chen
- School of Stomatology, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Gongpei Chen
- Department of General Dentistry, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yanzhen Zhang
- Department of General Dentistry, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yanhong Wang
- Department of Comprehensive Dentistry, Jiangnan Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, 311221, China
| | - Ying Wang
- Department of General Dentistry, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Fuming He
- Department of Prosthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, 166 Qiutao North Road, Shangcheng District, Hangzhou, Zhejiang Province, China.
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Karasu AE, Goker Kamalı S, Turkaydın D. Comparison of apical extrusion of sodium hypochlorite in immature teeth after needle irrigation, ultrasonic irrigation, EDDY, Er:YAG, and diode lasers. Lasers Med Sci 2022; 38:8. [PMID: 36539627 DOI: 10.1007/s10103-022-03683-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/09/2022] [Indexed: 12/24/2022]
Abstract
This study aimed to assess the apical extrusion of sodium hypochlorite in immature teeth caused by needle irrigation, ultrasonic irrigation, EDDY, Er:YAG, and diode lasers. Seventy-five human maxillary anterior teeth were selected. After the apical 3 mm of the roots was resected, the canal lumen was enlarged with #2 to #5 Gates-Glidden burs. The teeth were fixed to the lid of a flat-sided clear plastic container, and the plastic containers were filled with 0.2% agarose gel containing 1 mL of 0.1% m-cresol purple. Then, the specimens were allocated into five groups according to the irrigation activation techniques: needle irrigation, ultrasonic irrigation, EDDY, Er:YAG laser, and diode laser. The apical extrusion of sodium hypochlorite caused the color change in the gel. The containers were digitally photographed, and the percentage of pixels of irrigant extrusion (the color change) in each photograph was calculated. The diode laser group showed a significantly lower percentage of pixels than needle irrigation, EDDY, and Er:YAG laser (p < 0.05). The irrigant extrusion value of the ultrasonic irrigation group was significantly lower than that of the EDDY and Er:YAG laser groups (p < 0.05). There was no significant difference between the other groups (p > 0.05). All the groups caused irrigant extrusion in the immature teeth. The diode laser and ultrasonic irrigation caused less sodium hypochlorite extrusion than EDDY and Er:YAG laser. The needle irrigation showed more irrigant extrusion than the only diode laser group.
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Affiliation(s)
- Alparslan Eren Karasu
- Department of Endodontics, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Selin Goker Kamalı
- Department of Endodontics, Faculty of Dentistry, Marmara University, Istanbul, Turkey.
| | - Dilek Turkaydın
- Department of Endodontics, Faculty of Dentistry, Marmara University, Istanbul, Turkey
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Namsoy E, Serefoglu B, Hulsmann M, Caliskan MK. Influence of various application systems on the amount of extruded irrigant in simulated immature teeth with regard to gravity: An ex-vivo study. Niger J Clin Pract 2022; 25:1831-1837. [DOI: 10.4103/njcp.njcp_270_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Dashtimoghadam E, Johnson A, Fahimipour F, Malakoutian M, Vargas J, Gonzalez J, Ibrahim M, Baeten J, Tayebi L. Vibrational and sonochemical characterization of ultrasonic endodontic activating devices for translation to clinical efficacy. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 109:110646. [PMID: 32228956 DOI: 10.1016/j.msec.2020.110646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 07/13/2019] [Accepted: 01/03/2020] [Indexed: 11/30/2022]
Abstract
Passive activation of endodontic irrigants provides improved canal disinfection, smear layer removal, and better subsequent sealing. Although evidence suggests that passive activating endodontic devices increase the effectiveness of irrigation, no study exists to quantitatively compare and validate vibrational characteristics and cavitation produced by different ultrasonic endodontic devices. The current study aims to compare the efficiency of various commercially available ultrasonic endodontic activating devices (i.e., EndoUltra™, EndoChuck, Irrisafe™, and PiezoFlow®). The passive endodontic activating devices were characterized in terms of tip displacement and cavitation performance using scanning laser vibrometry (SLV) and sonochemical analysis, respectively. The obtained results showed that activator tip displacements and speed correlate to established cavitation thresholds. The EndoUltra™ tip speed was measured to be 14.5 and 28.1 m/s at 45 and 91 kHz, respectively, which is greater than the threshold. The EndoUltra™ was found to be the only device that exceeds the cavitation thresholds (i.e. tip speed and displacement), as evident from laser vibrometry analysis, and subsequently yielded measurable cavitation quantified via sonochemical analysis. All other passive endodontic activation devices, despite ultrasonic oscillation, were unable to produce cavitation.
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Affiliation(s)
| | | | | | - Mohamadali Malakoutian
- Electrical and Computer Engineering Department, Marquette University, Milwaukee, WI, USA
| | - Jessica Vargas
- Marquette University School of Dentistry, Milwaukee, WI 53233, USA
| | - Jose Gonzalez
- Marquette University School of Dentistry, Milwaukee, WI 53233, USA
| | - Mohamed Ibrahim
- Marquette University School of Dentistry, Milwaukee, WI 53233, USA; Endodontic Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - John Baeten
- Inter Med-Vista Dental, Racine, WI 53404, USA
| | - Lobat Tayebi
- Marquette University School of Dentistry, Milwaukee, WI 53233, USA.
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Arruda-Vasconcelos R, Barbosa-Ribeiro M, Louzada LM, Mantovani GD, Gomes BPFA. Apically Extruded Debris Using Passive Ultrasonic Irrigation Associated with Different Root Canal Irrigants. Braz Dent J 2019; 30:363-367. [DOI: 10.1590/0103-6440201902674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 02/21/2019] [Indexed: 11/21/2022] Open
Abstract
Abstract The present study evaluated the amount of apically extruded debris after chemo-mechanical preparation (CMP) associated with passive ultrasonic irrigation (PUI) using four different root canal irrigants, namely, 6% sodium hypochlorite (NaOCl), 2% chlorhexidine gel + saline solution (2% CHXg+SS), 2% chlorhexidine solution (2% CHXs) and SS alone. Sixty mandibular premolars with single straight root canals were selected and randomly assigned into 4 groups (n=15) according to the root canal irrigant used as follows: G1 (PUI + NaOCl), G2 (PUI + CHXg+SS), G3 (PUI+CHXs) and G4 (PUI+SS). Reciproc® R25 files (25/.08) were used during CMP and the debris extruded from each tooth were collected in pre-weighted Eppendorf tubes and dried. The average weight of debris was assessed by using an analytical microbalance. Data were statistically analysed by using ANOVA and post-hoc Tukey’s test (a=0.05). Debris extrusion was observed in all groups, irrespective of the root canal irrigating, with 2% CHXg + SS being associated with lower debris extrusion compared to other irrigants (p<0.05). No significant differences were observed between 6% NaOCl, 2% CHXs and SS. In conclusion, passive ultrasonic irrigation did not completely prevent apically extrusion of debris. PUI performed with 2% chlorhexidine gel + saline solution significantly minimized debris extrusion compared to 6% sodium hypochlorite, chlorhexidine solution and saline solution.
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Barbosa-Ribeiro M, Arruda-Vasconcelos R, Fabretti FL, Silva EJNL, De-Deus G, Gomes BPFA. Evaluation of Apically Extruded Debris Using Positive and Negative Pressure Irrigation Systems in Association with Different Irrigants. Braz Dent J 2018; 29:184-188. [PMID: 29898066 DOI: 10.1590/0103-6440201801750] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/11/2017] [Indexed: 11/21/2022] Open
Abstract
This study evaluated the amount of apically extruded debris after chemo-mechanical preparation (CMP) using positive and negative pressure irrigation systems [Conventional irrigation (CI) and EndoVac (EV)] in association with different irrigants [6% Sodium Hypochlorite (NaOCl), 2% Chlorhexidine gel + saline solution (CHXg + SS), 2% Chlorhexidine solution (CHXs) or Saline solution (SS)]. Eighty mandibular premolars with single root canals were selected and randomly assigned into 8 groups (n = 10) according to the irrigation system and the irrigant used during CMP: G1 (EV + NaOCl), G2 (EV + CHXg + SS), G3 (EV + CHXs), G4 (EV + SS), G5 (CI + NaOCl), G6 (CI + CHXg + SS), G7 (CI + CHXs) and G8 (CI + SS). Reciproc® R25 files (25/.08) were used during the CMP and the extruded debris from each tooth was collected in pre-weighted Eppendorf tubes and dried. The average weight of debris was assessed using a microbalance, and the data were statistically analyzed using ANOVA and the post hoc Tukey's test (a = 0.05). All groups were associated with debris extrusion. EV was the irrigation system with less extruded debris (p < 0.05). No differences were observed regarding the irrigant when EV was used. When CI was used, CHXg + SS were associated with lower debris extrusion (p < 0.05). It was concluded that no irrigation protocol succeeded in preventing debris extrusion. EV resulted in lower levels of debris extrusion than CI. The use of CHXg + SS resulted in lower debris extrusion.
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Affiliation(s)
- Marlos Barbosa-Ribeiro
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State UNICAMP - Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | - Rodrigo Arruda-Vasconcelos
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State UNICAMP - Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | - Fabio L Fabretti
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State UNICAMP - Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | - Emmanuel J N L Silva
- Department of Integrated Clinical Procedures, Division of Endodontics, UERJ - Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Department of Endodontics, School of Dentistry, UNIGRANRIO - Universidade Grande Rio, Rio de Janeiro, RJ, Brazil
| | - Gustavo De-Deus
- Department of Endodontics, School of Dentistry, UNIGRANRIO - Universidade Grande Rio, Rio de Janeiro, RJ, Brazil.,Department of Endodontics, UFF - Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
| | - Brenda P F A Gomes
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State UNICAMP - Universidade Estadual de Campinas, Piracicaba, SP, Brazil
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Moreno D, Conde AJ, Loroño G, Adorno CG, Estevez R, Cisneros R. Comparison of the Volume of Root Canal Irrigant Collected by 2 Negative Pressure Needles at Different Flow Rates of Delivery. J Endod 2018; 44:838-841. [PMID: 29571908 DOI: 10.1016/j.joen.2018.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/09/2018] [Accepted: 01/14/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A greater irrigant volume improves the effectiveness of root canal irrigation. The purpose of this study was to compare 2 negative pressure systems regarding the volume of irrigant collected from the apical area in moderately curved canals at 3 different flow rates of delivery in vitro. METHODS The mesiobuccal canals of 30 molars with a curvature between 20° and 40° were prepared to size #40.04 taper. A closed system was created. The canals were irrigated at 3, 6, and 12 mL/min for 30 seconds using EndoVac (SybronEndo, Orange, CA) and the INP needle (Mixnus Fine Engineering Co Ltd, Nagano, Japan) (both independent variables). A recovery trap was used to collect the irrigant aspirated by the negative pressure needles. Irrigant volume (dependent variable) was measured in milliliters. Data were analyzed using mixed analysis of variance. RESULTS There was a statistically significant interaction between the negative pressure system and the irrigant volume collected (P < .0005). The mean irrigant volume collected by the different negative pressure systems was greater for INP at 3 (P < .001), 6 (P < .001), and 12 mL/min (P < .001) flow rate. Both negative pressure needles showed statistically significant differences (P < .001) between mean irrigant volume collected at different flow rates. CONCLUSIONS A greater volume was collected by increasing the flow rate of irrigant delivery for both EndoVac and INP. The INP needle could collect a greater volume of irrigant from the apical third compared with EndoVac at all 3 different flow rates.
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Affiliation(s)
- Diana Moreno
- Postgraduate Program in Endodontics, Universidad Europea de Madrid, Madrid, Spain
| | - Antonio J Conde
- Postgraduate Program in Endodontics, Universidad Europea de Madrid, Madrid, Spain
| | - Gaizka Loroño
- Postgraduate Program in Endodontics, Universidad Europea de Madrid, Madrid, Spain
| | - Carlos G Adorno
- Facultad de Odontología, Universidad Nacional de Asunción, Asunción, Paraguay.
| | - Roberto Estevez
- Postgraduate Program in Endodontics, Universidad Europea de Madrid, Madrid, Spain
| | - Rafael Cisneros
- Postgraduate Program in Endodontics, Universidad Europea de Madrid, Madrid, Spain
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Jamleh A, Suda H, Adorno CG. Irrigation effectiveness of continuous ultrasonic irrigation system: An ex vivo study. Dent Mater J 2018; 37:1-5. [PMID: 28883300 DOI: 10.4012/dmj.2016-411] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study evaluated the irrigation extrusion and smear layer (SL) removal of continuous ultrasonic irrigation (CUI). Forty root canals were shaped, embedded in warm sterile saline agar colored with 1% acid red, and distributed into four groups; three groups had the final irrigation sequence of sodium hypochlorite and EDTA solutions performed by using syringe irrigation (SI), EndoVac (EV), and CUI, respectively. Group 4 had the canals ultrasonically irrigated with saline (CUIS). Irrigant extrusion was verified by a color change of the agar. The SL was evaluated under scanning electron microscope. Irrigant extrusion was observed in two and four teeth in the CUI and SI, respectively, whilst none had irrigant extruded in the EV. In term of SL, the CUI was comparable to EV at 1 and 3 mm but different to SI at 1 mm. Although CUI might clean the root canal system effectively, it was unable to avoid irrigant extrusion.
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Affiliation(s)
- Ahmed Jamleh
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Restorative and Prosthetic Dental Sciences, College of Dentistry, Ministry of National Guard Health Affairs
| | - Hideaki Suda
- Department of Pulp Biology and Endodontics, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
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Toyota Y, Yoshihara T, Hisada A, Yawaka Y. Removal of smear layer by various root canal irrigations in primary teeth. PEDIATRIC DENTAL JOURNAL 2017. [DOI: 10.1016/j.pdj.2016.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Neelakantan P, Devaraj S, Jagannathan N. Histologic Assessment of Debridement of the Root Canal Isthmus of Mandibular Molars by Irrigant Activation Techniques Ex Vivo. J Endod 2016; 42:1268-72. [DOI: 10.1016/j.joen.2016.05.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 05/08/2016] [Accepted: 05/10/2016] [Indexed: 11/17/2022]
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