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Zhang SH, Gao ZR, Zhou YH, Tan L, Feng Y, Ye Q, Zhao J, Zhao YQ, Hu J, Chen Y, Liu Q, Aimee DM, Guo Y, Feng YZ. Comparison of Easydo Activator, ultrasonic and needle irrigation techniques on sealer penetration and smear layer removal in vitro. BMC Oral Health 2024; 24:56. [PMID: 38195412 PMCID: PMC10775461 DOI: 10.1186/s12903-023-03833-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 12/26/2023] [Indexed: 01/11/2024] Open
Abstract
The effects of Easydo Activator (EA), a new sonic irrigation system, on sealer penetration at the root apex were compared to needle irrigation (NI) and passive ultrasonic irrigation (PUI) in this study. Forty-two single-rooted teeth were prepared and randomly divided into three groups (n = 14): group 1: NI; group 2: PUI; and group 3: EA. A solution of 3% sodium hypochlorite (NaOCl) was used for irrigation. Nine teeth in each group were filled with AH Plus sealer mixed with CY5 fluorescent dye and a single gutta-percha cone. The sealer penetration area, maximum penetration depth and percentage of sealer penetration at 5 mm and 1 mm from the apex were analyzed by confocal laser scanning microscopy (CLSM). The remaining 5 teeth in each group were subjected to test smear layer scores by scanning electron microscopy (SEM). The CLSM evaluation showed that increases in the area, depth and percentage of sealer penetration were detected at 1 and 5 mm from the root apex in the PUI group compared with the NI group, and greater increases were observed in the EA group (P < 0.05). The SEM experiment showed that the lowest scores for the smear layer and debris removal were achieved by the EA group when compared with the PUI and NI groups (P < 0.05). In conclusion, EA was superior to PUI and NI regarding sealer penetration at the root apex during endodontic treatment, and it could provide a new technical idea for clinical root canal therapy.
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Affiliation(s)
- Shao-Hui Zhang
- Hunan Provincial Clinical Research Center for Oral Diseases, Hunan Provincial Engineering Research Center of Digital Oral and Maxillofacial Defect Repair, Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
- Department of Stomatology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, 441000, China
| | - Zheng-Rong Gao
- Hunan Provincial Clinical Research Center for Oral Diseases, Hunan Provincial Engineering Research Center of Digital Oral and Maxillofacial Defect Repair, Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Ying-Hui Zhou
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Li Tan
- Hunan Provincial Clinical Research Center for Oral Diseases, Hunan Provincial Engineering Research Center of Digital Oral and Maxillofacial Defect Repair, Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Yao Feng
- Hunan Provincial Clinical Research Center for Oral Diseases, Hunan Provincial Engineering Research Center of Digital Oral and Maxillofacial Defect Repair, Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Qin Ye
- Hunan Provincial Clinical Research Center for Oral Diseases, Hunan Provincial Engineering Research Center of Digital Oral and Maxillofacial Defect Repair, Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Jie Zhao
- Hunan Provincial Clinical Research Center for Oral Diseases, Hunan Provincial Engineering Research Center of Digital Oral and Maxillofacial Defect Repair, Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Ya-Qiong Zhao
- Hunan Provincial Clinical Research Center for Oral Diseases, Hunan Provincial Engineering Research Center of Digital Oral and Maxillofacial Defect Repair, Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Jing Hu
- Hunan Provincial Clinical Research Center for Oral Diseases, Hunan Provincial Engineering Research Center of Digital Oral and Maxillofacial Defect Repair, Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Yun Chen
- Hunan Provincial Clinical Research Center for Oral Diseases, Hunan Provincial Engineering Research Center of Digital Oral and Maxillofacial Defect Repair, Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Qiong Liu
- Hunan Provincial Clinical Research Center for Oral Diseases, Hunan Provincial Engineering Research Center of Digital Oral and Maxillofacial Defect Repair, Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Dusenge Marie Aimee
- Hunan Provincial Clinical Research Center for Oral Diseases, Hunan Provincial Engineering Research Center of Digital Oral and Maxillofacial Defect Repair, Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Yue Guo
- Hunan Provincial Clinical Research Center for Oral Diseases, Hunan Provincial Engineering Research Center of Digital Oral and Maxillofacial Defect Repair, Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.
| | - Yun-Zhi Feng
- Hunan Provincial Clinical Research Center for Oral Diseases, Hunan Provincial Engineering Research Center of Digital Oral and Maxillofacial Defect Repair, Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.
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de Oliveira Neto RS, de Souza Lima LA, Titato PCG, de Andrade FB, Vivan RR, Alcalde MP, Duarte MAH. Effectiveness of a new endodontic irrigation system for removing smear layer and dissolving simulated organic matter. Clin Oral Investig 2023; 28:10. [PMID: 38127289 DOI: 10.1007/s00784-023-05418-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES The study aimed to evaluate the potential for the dissolution of organic tissue in areas of simulated complexity and cleaning of root canal walls of the new iVac® endodontic irrigation system. MATERIAL AND METHODS Thirty mandibular premolars were evaluated by scanning electron microscopy before and after biomechanical preparation. Then, they were distributed according to the final irrigation protocol into groups with conventional irrigation, ultrasonic agitation with metallic insert (UA), and iVac® system, and new photomicrographs were obtained. For tissue dissolution analysis, glass capillaries filled with catgut were attached to the cervical and apical thirds of twenty-one prototyped upper incisors. They were weighed before and after the previously mentioned irrigation protocols. The data were statistically compared with a significance level of 5%. RESULTS The final irrigation provided greater cleaning of the root canal walls in the cervical, middle, and apical thirds of the root canals (P < 0.05), with no statistically significant difference between UA and iVac®, regardless of the analyzed thirds. Both ultrasonic irrigation protocols dissolved a significantly greater volume than the conventional irrigation protocol (P < 0.05), with no difference between the two protocols (P < 0.05). CONCLUSIONS The iVac® system showed root canal wall cleaning and tissue dissolution similar to UA with a metallic insert, and both were superior to conventional irrigation. CLINICAL RELEVANCE The new irrigation system iVac is more effective than conventional irrigation and has similar root canal wall cleaning and tissue dissolution to UA.
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Affiliation(s)
- Raimundo Sales de Oliveira Neto
- Department of Operative Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo - USP, Al. Octávio Pinheiro Brizolla 9-75, Vila Universitária Bauru, Bauru, SP, CEP: 17012-901, Brazil.
| | - Luana Arantes de Souza Lima
- Department of Operative Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo - USP, Al. Octávio Pinheiro Brizolla 9-75, Vila Universitária Bauru, Bauru, SP, CEP: 17012-901, Brazil
| | - Pedro Cesar Gomes Titato
- Department of Operative Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo - USP, Al. Octávio Pinheiro Brizolla 9-75, Vila Universitária Bauru, Bauru, SP, CEP: 17012-901, Brazil
| | - Flaviana Bombarda de Andrade
- Department of Operative Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo - USP, Al. Octávio Pinheiro Brizolla 9-75, Vila Universitária Bauru, Bauru, SP, CEP: 17012-901, Brazil
| | - Rodrigo Ricci Vivan
- Department of Operative Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo - USP, Al. Octávio Pinheiro Brizolla 9-75, Vila Universitária Bauru, Bauru, SP, CEP: 17012-901, Brazil
| | - Murilo Priori Alcalde
- Department of Operative Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo - USP, Al. Octávio Pinheiro Brizolla 9-75, Vila Universitária Bauru, Bauru, SP, CEP: 17012-901, Brazil
| | - Marco Antonio Hungaro Duarte
- Department of Operative Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo - USP, Al. Octávio Pinheiro Brizolla 9-75, Vila Universitária Bauru, Bauru, SP, CEP: 17012-901, Brazil
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Keles A, Askerbeyli Ors S, Purali N, Kucukkaya Eren S. Effect of different sealer activation techniques on dentinal tubule penetration. AUST ENDOD J 2023; 49:470-475. [PMID: 36723389 DOI: 10.1111/aej.12738] [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: 09/26/2022] [Revised: 01/09/2023] [Accepted: 01/18/2023] [Indexed: 02/02/2023]
Abstract
The aim of this study was to evaluate the influence of different activation techniques on dentin tubule penetration of root canal sealer. Seventy-five teeth with single canals were chemomechanically prepared. A calcium silicate-based sealer was stained with a fluorescent dye (rhodamine B), placed into the canals and activated according to the following groups: control (no activation), EDDY, EndoActivator, ultrasonic and XP-Endo Finisher. Then, the samples were obturated. The percentages of sealer penetration at various depth levels of root sections were measured with confocal laser scanning microscopy. XP-Endo Finisher presented the highest penetration at 50 μm (p < 0.05). XP-Endo Finisher showed similar penetration with EDDY at 100 and 200 μm (p > 0.05) while presented higher penetration than the other groups (p < 0.05). At 500 μm, XP-Endo Finisher presented higher penetration than EndoActivator (p < 0.05) while similar penetration with the other groups (p > 0.05). XP-Endo Finisher can be recommended for activation during sealer placement for better penetration into dentin tubules.
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Affiliation(s)
- Ahmet Keles
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Sevinc Askerbeyli Ors
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Nuhan Purali
- Departmant of Biophysics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Selen Kucukkaya Eren
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
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Wigler R, Herteanu M, Wilchfort Y, Kfir A. Efficacy of Different Irrigant Activation Systems on Debris and Smear Layer Removal: A Scanning Electron Microscopy Evaluation. Int J Dent 2023; 2023:9933524. [PMID: 37771362 PMCID: PMC10533223 DOI: 10.1155/2023/9933524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 08/19/2023] [Accepted: 09/02/2023] [Indexed: 09/30/2023] Open
Abstract
Background Irrigation is an essential component of root canal treatment to enable cleaning beyond the reach of mechanical instruments. The study aimed to assess and compare the efficacy of different final irrigation protocols, including sonic- and ultrasonic-powered irrigant-activation systems, on debris and smear layer removal in the coronal, middle, and apical thirds of straight oval root canals. Materials and Methods Straight oval root canals of 60 human mandibular incisors were prepared to size 40.04 and divided into four groups (n = 15) according to the final irrigation protocols: (a) Eddy sonic activation (b) endosonic passive ultrasonic irrigation (PUI), (c) irrisafe PUI, and (d) manual syringe and needle irrigation with no additional activation, which served as control. After the treatment procedures, the roots were split and observed using scanning electron microscopy. The presence of remaining debris and smear layer at the coronal, mid-root, and apical thirds of the canals were evaluated using a score system and statistically analyzed using multinominal models with significance level set at p < 0.05. Results None of the final irrigation protocols completely removed all debris and smear layer from all root canals. When the syringe and needle were used without activation, more debris and smear layer were found in the apical third of the canals. Activation of the final irrigant with each of the three devices significantly reduced the presence of debris in the apical third, compared to the syringe and needle final irrigation, with no difference among the three activation devices. Eddy and irrisafe activation also significantly reduced the residual smear layer in the apical third, compared to syringe and needle alone, while the reduction in the remaining smear layer by endosonic activation did not reach the significance level. Conclusions Removal of debris and smear layer from the apical part of the root canal by syringe and needle irrigation alone may be significantly improved by using sonic or ultrasonic activation of the final irrigant. Endosonic activation was less effective in removal of smear layer from the apical part of the canals compared to the other two activation systems.
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Affiliation(s)
- Ronald Wigler
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moran Herteanu
- The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Wilchfort
- The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anda Kfir
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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Plotino G, Özyürek T, Gündoğar M, Uslu G, Pedullà E, Careddu R, Franco V. Efficacy of different irrigant activation devices in removing dentin debris from an artificial isthmus connecting curved canals. AUST ENDOD J 2023; 49 Suppl 1:353-358. [PMID: 36960975 DOI: 10.1111/aej.12748] [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: 01/13/2022] [Revised: 01/27/2023] [Accepted: 03/06/2023] [Indexed: 03/25/2023]
Abstract
The aim of this study was to evaluate the debridement efficacy of sonic irrigation (EDDY; VDW, Munich, Germany and EndoActivator; Dentsply-Sirona, Ballaigues, Switzerland) and ultrasonically activated irrigation (Irrısafe; Satelec Acteon, Merignac, France) in a simulated canal isthmus connecting curved canals. Transparent resin blocks were produced containing two curved canals connected with an isthmus. The isthmus was then filled with dentin debris. Three irrigant activation cycles were performed and the amount of remaining debris was compared analysing pictures taken after each activation cycle. Data were statistically analysed using one-way ANOVA and post hoc Tukey tests at a significance level of p < 0.05. EDDY showed greater efficiency in removing dentin debris from the simulated isthmus than the other techniques tested. An increase in the activation time enhanced the efficiency of both EDDY and ultrasonically activated irrigation in debris removal.
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Affiliation(s)
- Gianluca Plotino
- Private Practice, Grande Plotino & Torsello - Studio di Odontoiatria, Rome, Italy
| | - Taha Özyürek
- Department of Endodontics, Faculty of Dentistry, Istanbul Medeniyet University, İstanbul, Turkey
| | - Mustafa Gündoğar
- Department of Endodontics, Faculty of Dentistry, Istanbul Medipol University, İstanbul, Turkey
| | - Gülşah Uslu
- Department of Endodontics, Faculty of Dentistry, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Eugenio Pedullà
- Department of General Surgery and Medical - Surgical Specialties, University of Catania, Catania, Italy
| | - Roberto Careddu
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Dublin, Ireland
| | - Vittorio Franco
- Private Practice, Studio di Odontoiatria Digitale, Rome, Italy
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Gündüz H, Özlek E. The effects of laser and ultrasonic irrigation activation methods on smear and debris removal in traditional and conservative endodontic access cavities. Lasers Med Sci 2023; 38:148. [PMID: 37358660 DOI: 10.1007/s10103-023-03816-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/17/2023] [Indexed: 06/27/2023]
Abstract
In this study, it was aimed to evaluate the smear and debris removal efficiency of laser and ultrasonic irrigation activation methods in traditional and conservative endodontic access cavity preparations. 60 freshly extracted human mandibular molar teeth were randomly divided into 2 groups according to the access cavity preparation (n = 30): Traditional endodontic access cavities (TEC) and Conservative endodontic access cavity (CEC). After the access cavity preparation, the mesiobuccal root canals were prepared to 35/0.4 with the VDW Rotate file system. Teeth with completed root canal preparation were randomly divided into 3 subgroups according to the final irrigation activation protocol (n = 30): Conventional needle irrigation, passive ultrasonic activation and laser activation. The crowns of the teeth were removed and the mesiobuccal roots were divided longitudinally into two halves, mesial and distal. Samples were scanned with scanning electron microscopy. Photomicrographs in the coronal, middle, and apical thirds of each specimen were taken at a magnification of 200 for debris and 1000 for evaluation of the smear layer. Data were analysed using the three-way Robust Anova test and Bonferroni test.The effect of access cavity design on remaining smear (p = 0.057) and debris (p = 0.5) was not statistically significant. The effect of the interaction of access cavity and irrigation activation on the remaining smear and debris was not statistically significant (p = 0.556, p = 0.333). Significantly fewer smears were detected in the laser activation group than in the ultrasonic activation and control groups. Conservative access cavities did not differ from conventional access cavities in terms of debris and smear.
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Affiliation(s)
- Hüseyin Gündüz
- Department of Endodontics, Faculty of Dentistry, Van Yüzüncü Yıl University, Van, Turkey.
| | - Esin Özlek
- Department of Endodontics, Faculty of Dentistry, Van Yüzüncü Yıl University, Van, Turkey
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Chu X, Feng S, Zhou W, Xu S, Zeng X. Cleaning efficacy of EDDY versus ultrasonically-activated irrigation in root canals: a systematic review and meta-analysis. BMC Oral Health 2023; 23:155. [PMID: 36932445 PMCID: PMC10024384 DOI: 10.1186/s12903-023-02875-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Ultrasonically-activated irrigation (UAI) is effective in root canal irrigation but may damage canal walls. EDDY is a sonic activation system with flexible working tips that cause no harm to dentinal walls. This review explores the intracanal cleaning efficacy of EDDY compared with UAI in vitro. METHODS The systematic review was registered in the PROSPERO database (CRD42021235826). A literature search was conducted in six electronic databases. In vitro studies that compared the removal of smear layer, debris, soft tissue or microbes in root canals between EDDY and UAI were included. Data extraction and quality assessment were performed. Meta-analyses were conducted on smear layer removal and debris elimination with the standardized mean difference (SMD). Heterogeneity was measured using the I2 test and the Chi2 test. The random-effect model was used when I2 > 50%, or p < 0.1, otherwise the fixed-effect model was applied. The level of significance was set at p < 0.05. RESULTS 19 articles were included in this systematic review and 7 articles were included in meta-analyses. Meta-analyses on smear layer removal showed unimportant differences between EDDY and UAI at any canal third (coronal [SMD = 0.08, 95% confidence interval (95%CI): -0.29 to 0.45; p = 0.44, I2 = 0%]; middle [SMD = 0.02, 95% CI: -0.44 to 0.47; p = 0.94, I2 = 0%]; apical [SMD = 0.01, 95%CI: -0.35 to 0.38; p = 0.70, I2 = 0%]). Meta-analyses on debris removal evaluated by scanning electron microscope (coronal [SMD = 0.03, 95% CI: -0.41 to 0.46; p = 0.27, I2 = 23%]; middle [SMD = -0.24, 95% CI: -0.83 to 0.35; p = 0.80, I2 = 0%]; apical [SMD = 0.24, 95%CI: -0.20 to 0.67; p = 0.36, I2 = 2%]) and micro-CT (SMD = 0.36, 95% CI: -0.67 to 1.40; p = 0.03, I2 = 70%) both found insignificant differences. No meta-analysis was undertaken on soft-tissue removal and disinfection due to the various study designs, but the qualitative analyses implied that EDDY achieved similar performance to UAI in both aspects. CONCLUSIONS Limited evidence indicated that EDDY was comparable to UAI in removing smear layer, debris, soft tissue and microbes ex vivo. Considering UAI may damage canal walls, EDDY might be a substitute for UAI in irrigation activation. But more randomized clinical trials are required to explore the clinical extrapolation of the results in this review.
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Affiliation(s)
- Xiaojun Chu
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, No 366 Jiangnan Avenue South, Guangzhou, 510280, Guangdong, China
| | - Shuting Feng
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, No 366 Jiangnan Avenue South, Guangzhou, 510280, Guangdong, China
| | - Weiqing Zhou
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, No 366 Jiangnan Avenue South, Guangzhou, 510280, Guangdong, China
| | - Shuaimei Xu
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, No 366 Jiangnan Avenue South, Guangzhou, 510280, Guangdong, China
| | - Xiongqun Zeng
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, No 366 Jiangnan Avenue South, Guangzhou, 510280, Guangdong, China.
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Al-Zuhair H, Su Z, Liu H, Wang Z, Haapasalo M, Hieawy A, Gao Y, Shen Y. Antimicrobial effects of agitational irrigation on single- and multispecies biofilms in dentin canals. Odontology 2023; 111:49-56. [PMID: 35713740 DOI: 10.1007/s10266-022-00719-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/19/2022] [Indexed: 02/05/2023]
Abstract
This study aimed to compare the antibacterial effects of different agitation devices on single- and multispecies biofilms in dentin canals using confocal laser scanning microscopy (CLSM). Dentin blocks were prepared from human root dentin. Enterococcus faecalis and multiple species were introduced into the dentinal tubules via centrifugation and incubation. Two infected dentin samples were placed at 8 and 16 mm in a customized model. Samples were randomly divided into eight groups according to the agitation device used: syringe needle irrigation, EndoActivator, passive ultrasonic irrigation (PUI), and EDDY, at 2.5% or 6% NaOCl concentrations. The samples were stained and observed using CLSM. Statistical analysis was performed using an independent sample t test and analysis of variance. Linear models were used to assess the joint impact of the experimental groups on the proportion of biofilms killed. No significant differences were observed between the killing rates of the single- and multispecies biofilms. Both concentrations of NaOCl significantly increased the percentage of dead bacteria compared with the control. Biofilms in dentin tubules was more effectively killed when NaOCl was agitated; however, the difference between PUI and EDDY was not significant. Significantly more bacteria were killed in dentin blocks placed at 8 mm than at 16 mm (p < 0.05). In conclusion, EDDY was as effective as PUI when combined with NaOCl. However, the apical portion, which had a low antimicrobial efficiency, remains a concern. Mechanical instrumentation is incapable of completely eradicating bacteria, and additional research is required to improve the efficacy of root canal disinfection.
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Affiliation(s)
- Hind Al-Zuhair
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Zheng Su
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Department of Endodontics, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - He Liu
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Department of Stomatology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Zhejun Wang
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Markus Haapasalo
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Ahmed Hieawy
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Yuan Gao
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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Rajamanickam K, Teja KV, Ramesh S, AbuMelha AS, Alkahtany MF, Almadi KH, Bahammam SA, Janani K, Choudhari S, Jose J, Srivastava KC, Shrivastava D, Patil S. Comparative Study Assessing the Canal Cleanliness Using Automated Device and Conventional Syringe Needle for Root Canal Irrigation-An Ex-Vivo Study. MATERIALS (BASEL, SWITZERLAND) 2022; 15:6184. [PMID: 36143496 PMCID: PMC9504894 DOI: 10.3390/ma15186184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 06/16/2023]
Abstract
The success of endodontic treatment relies on both apical and coronal sealing. To achieve a good three-dimensional seal, the removal of the smear layer becomes mandatory. This study aims to assess the difference in debris accumulation and smear layer formation while using automated root canal irrigation and conventional syringe needle irrigation. Single-rooted human mandibular premolar teeth (n = 30) which were indicated for orthodontic extractions were selected. An endodontic access cavity was prepared, and a glide path was created. Based on the irrigation protocol decided upon for the study, the teeth were randomly allocated into three study groups, namely Group 1, where the manual syringe needle irrigation method was adopted; Group 2, in which automated root canal irrigation was undertaken; and Group 3, in which teeth remained un-instrumented as it was considered the Control group. The teeth were decoronated at the cement-enamel junction (CEJ) and were subjected for scanning electron microscopy (SEM) examination. Debris and smear layers were viewed in 1000× magnification and scored. A statistically significant (p < 0.05) lower mean debris and smear layer score (p < 0.05) was observed in both study groups when compared with the control group. However, no significant difference (p > 0.05) in the debris and smear layer was observed between the manual syringe needle irrigation and automated irrigation, although automated irrigation devices can be a potential alternative. The present study concluded that the efficacy of smear layer removal remained the same with both automated irrigation and manual syringe irrigation.
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Affiliation(s)
- Keerthika Rajamanickam
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai 600077, Tamil Nadu, India
| | - Kavalipurapu Venkata Teja
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai 600077, Tamil Nadu, India
| | - Sindhu Ramesh
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai 600077, Tamil Nadu, India
| | - Abdulaziz S. AbuMelha
- Restorative Dental Science Department, College of Dentistry, King Khalid University, Abha 62529, Saudi Arabia
| | - Mazen F. Alkahtany
- Department of RDS, Division of Endodontics, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia
| | - Khalid H. Almadi
- Department of RDS, Division of Endodontics, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia
| | - Sarah Ahmed Bahammam
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, Taibah University, P.O. Box 344, Medina 42353, Saudi Arabia
| | - Krishnamachari Janani
- Department of Conservative Dentistry and Endodontics, SRM Dental College, SRM Institute of Science & Technology, Chennai 600089, Tamil Nadu, India
| | - Sahil Choudhari
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai 600077, Tamil Nadu, India
| | - Jerry Jose
- Private Practice, Aluva, Ernakulam District, Kochi 683106, Kerala, India
| | - Kumar Chandan Srivastava
- Department of Oral & Maxillofacial Surgery & Diagnostic Sciences, College of Dentistry, Jouf University, Sakaka 72388, Saudi Arabia
| | - Deepti Shrivastava
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka 72388, Saudi Arabia
| | - Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
- Centre of Molecular Medicine and Diagnostics (COMManD), Saveetha Dental College & Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India
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Comparison of EASYDO ACTIVATOR, passive ultrasonic, and needle irrigation techniques on the treatment of apical periodontitis: a study in rats. Clin Oral Investig 2022; 26:7157-7165. [PMID: 36053353 DOI: 10.1007/s00784-022-04677-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/10/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate the long-term therapeutic effect of EASYDO ACTIVATOR, passive ultrasonic irrigation, and needle irrigation in experimental apical periodontitis in rats. MATERIALS AND METHODS Sprague-Dawley male rats were used to produce periapical lesions. The pulp chambers of the bilaterally first mandibular molars were exposed and left open for 21 days. The rats were divided into four groups according to different irrigation protocols. Seven days after irrigation, the mandibles were removed for micro-CT, histological, and immunohistochemical analysis. Serum levels of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) were assessed by enzyme-linked immunosorbent assays (ELISA). Statistical data were analyzed by one-way analysis of variance (ANOVA) with LSD tests. RESULTS The passive ultrasonic irrigation and EASYDO ACTIVATOR groups had the smallest apical lesions compared to the other groups (P < 0.05), while the needle irrigation group had smaller lesions than the control group (P < 0.05). The EASYDO ACTIVATOR group had less inflammation infiltration compared to the control and needle irrigation groups (P < 0.05). The control and needle irrigation groups had more TNF-α expression compared to the passive ultrasonic irrigation and EASYDO ACTIVATOR groups (P < 0.05). The lowest IL-6 expression was observed in the EASYDO ACTIVATOR group. The EASYDO ACTIVATOR group had the lowest serum level of TNF-α than other groups (P < 0.05). IL-6 expression was significantly lower in the EASYDO ACTIVATOR group in comparison with the control and needle irrigation groups (P < 0.05). CONCLUSIONS EASYDO ACTIVATOR can significantly reduce the apical lesions and decrease the inflammatory response around the periapical area. CLINICAL RELEVANCE EASYDO ACTIVATOR is recommended for clinical application.
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Cytotoxicity and Efficacy in Debris and Smear Layer Removal of HOCl-Based Irrigating Solution: An In Vitro Study. J Funct Biomater 2022; 13:jfb13030095. [PMID: 35893463 PMCID: PMC9326542 DOI: 10.3390/jfb13030095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 12/10/2022] Open
Abstract
In the present study we evaluated the cytotoxicity of super-oxidized water on human gingival fibroblasts and its efficacy in debris and smear layer removal from root canal walls. Cultured gingival fibroblasts were exposed to super-oxidized water (Sterilox), which was diluted in Iscove’s modified Dulbecco’s medium (IMDM) at 30%, 40%, 50%, 60% and 70% concentrations. The control group was maintained in IMDM. The cell viability was evaluated by means of an MTT assay after incubation periods of 1 h, 2 h, 24 h and 48 h. Pathological cellular changes were also observed under fluorescence and phase contrast microscopes. The efficacy in debris and smear layer removal was evaluated in comparison to the conventional application of sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA). Forty maxillary premolars were randomly divided into two equal groups (n = 20) and shaped with ProTaper NEXT rotary instruments using Sterilox or NaOCl/EDTA for irrigation. Afterwards, roots were split longitudinally and examined under a scanning electron microscope. The results revealed that super-oxidized water and sterile distilled water have acceptable biological properties for endodontic applications at concentrations up to 50% (p > 0.05). Moreover, super-oxidized water is equally effective in debris and smear layer removal as compared to NaOCl/EDTA (p > 0.05).
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Effectiveness of Different Irrigant Activation Systems on Smear Layer Removal: A Scanning Electron Microscopic Study. J Clin Med 2022; 11:jcm11041003. [PMID: 35207275 PMCID: PMC8879012 DOI: 10.3390/jcm11041003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/08/2022] [Accepted: 02/13/2022] [Indexed: 02/06/2023] Open
Abstract
The aim of this study was to evaluate the effectiveness of smear layer removal after the use of different irrigation methods (passive ultrasonic irrigation (PUI), continuous ultrasonic irrigation (CUI), apical negative pressure irrigation and conventional irrigation) using scanning electron microscopy (SEM) as an analytical tool. A total of 100 single-canal teeth were decoronated and randomly divided into five groups (n = 20) according to the irrigation method used: conventional irrigation with front outlet syringe, conventional irrigation with lateral outlet syringe, apical negative pressure irrigation (EndoVac), PUI with Irrisafe and CUI with ProUltra PiezoFlow ultrasonic irrigation needle. Root canal preparation was performed with the ProTaper Gold system up to the F4 instrument, and 5.25% NaOCl was used as an irrigant. After chemical-mechanical preparation, the roots were split longitudinally, and the coronal, middle and apical thirds were examined. SEM digital photomicrographs were taken at ×1000 magnification to evaluate the amount of smear layer in each root canal third; CUI significantly removed more smear layer than any other irrigant activation protocol (p < 0.05); CUI was more effective in removing the smear layer than the other irrigation protocols. However, none of the irrigation protocols were able to produce root canals completely free from smear layer.
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Barbosa AFA, Lima COD, Sassone LM, Fares RD, Fidalgo TKDS, Silva EJNL. Effect of passive ultrasonic irrigation on hard tissue debris removal: a systematic review and meta-analysis. Braz Oral Res 2021; 35:e123. [PMID: 34878078 DOI: 10.1590/1807-3107bor-2021.vol35.0123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/15/2021] [Indexed: 12/22/2022] Open
Abstract
Accumulated hard tissue debris (AHTD) in root canal irregularities may negatively impact adequate root canal disinfection. In light of this, the efficacy of passive ultrasonic irrigation (PUI) to reduce AHTD has been largely studied in in vitro studies, which have adopted different analytic methods of varying accuracy to determine the extent of AHTD more correctly. Therefore, the aim of this study was to compare how well PUI and non-activated irrigation (NAI) systems perform in reducing AHTD during final irrigation protocols, based exclusively on studies whose analyses used microCT scanning. A systematic search of the studies published up to April 2020 was performed using MeSH terms and free terms, in the following databases: PubMed, Scopus, Web of Science, BVS (Lilacs and BBO) and Embase. The inclusion criteria consisted of laboratory studies that evaluated the amount of AHTD, and compared PUI with NAI protocols using microCT analysis. The risk of bias in the selected studies was assessed critically by two reviewers. A meta-analysis was performed using the RevMan software program (P<0.05), and included studies providing the standardized mean difference (SMD), using a fixed effect model, and adopting a confidence interval of 95%. In all, 3495 studies were identified, three of which met the inclusion criteria. All three were considered as having a low risk of bias. The meta-analysis comparing the ability of PUI and NAI protocols to remove hard tissue debris showed a higher percentage of AHTD reduction (P<0.01) for PUI, with a confidence interval of 1.41 [0.79, 2.02]. The heterogeneity among the studies was 82% (I2). Considering the limitations of the present study, this systematic review and meta-analysis showed that PUI was more effective than NAI in removing hard tissue debris, based exclusively on studies that used microCT scanning to provide a more precise analysis of the two techniques used. The findings presented in the present study reinforce the concept that PUI can increase residue removal and improve the cleanliness of the root canal in endodontic treatments.
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Affiliation(s)
- Ana Flávia Almeida Barbosa
- Universidade do Estado do Rio de Janeiro - UERJ, School of Dentistry, Department of Endodontics, Rio de Janeiro, RJ, Brazil
| | - Carolina Oliveira de Lima
- Universidade do Estado do Rio de Janeiro - UERJ, School of Dentistry, Department of Endodontics, Rio de Janeiro, RJ, Brazil
| | - Luciana Moura Sassone
- Universidade do Estado do Rio de Janeiro - UERJ, School of Dentistry, Department of Endodontics, Rio de Janeiro, RJ, Brazil
| | - Raissa Dias Fares
- Universidade do Estado do Rio de Janeiro - UERJ, School of Dentistry, Department of Preventive and Community Dentistry, Rio de Janeiro, RJ, Brazil
| | - Tatiana Kelly da Silva Fidalgo
- Universidade do Estado do Rio de Janeiro - UERJ, School of Dentistry, Department of Preventive and Community Dentistry, Rio de Janeiro, RJ, Brazil
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