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Yoo YJ, Kim JH, Hwang JJ, Sigurdsson A, Kim HC. Efficacy of Different Irrigation Needles and Ultrasonic Activation on Calcium Hydroxide Removal: A Micro-CT Study Using 3D-Printed Endodontic Models. J Endod 2024; 50:1478-1483. [PMID: 39033800 DOI: 10.1016/j.joen.2024.07.008] [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: 04/07/2024] [Revised: 07/11/2024] [Accepted: 07/12/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION The aim of this study was to evaluate the efficacy of different irrigation needles and passive ultrasonic activation in removing Ca(OH)2 from an endodontic model that duplicated a root canal configuration of a human natural tooth. METHODS An extracted human maxillary premolar was subjected to root canal preparation and scanned with microcomputed tomography. A 3-dimensional reconstruction model of the natural tooth was printed to endodontic models using a polyjet printer. The root canals of the models were filled with Ca(OH)2 paste and divided into 2 groups based on the irrigation protocol: conventional syringe-needle irrigation (conventional group) and passive ultrasonic irrigation (PUI) group. Each group was subdivided into 3 groups (n = 10) according to the type of needle: half-cut, side-vented, and TruNatomy irrigation needle. Microcomputed tomographyimaging was used to assess the percentage of reduction of Ca(OH)2. Data were analyzed using two-way analysis of variance test (α = .05). RESULTS The side-vented and TruNatomy irrigation needles showed significantly higher percentage reductions than the half-cut needle (P < .05) in the conventional irrigation group. The PUI group showed significantly higher percentage reductions of Ca(OH)2 than the conventional group regardless of the type of needle (P < .05). However, no significant difference was found among the needles in the PUI group. CONCLUSIONS The type of irrigation needle and the use of PUI influenced the removal efficacy of Ca(OH)2. PUI enhanced the removal of Ca(OH)2 regardless of the type of irrigation needle.
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Affiliation(s)
- Yeon-Jee Yoo
- Department of Conservative Dentistry and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Jae-Hoon Kim
- Department of Dental Education, Dental and Life Science Institute, School of Dentistry, Pusan National University and Dental Research Institute, Yangsan, Republic of Korea
| | - Jae-Joon Hwang
- Department of Oral and Maxillofacial Radiology, Dental and Life Science Institute, School of Dentistry, Pusan National University and Dental Research Institute, Yangsan, Republic of Korea
| | - Asgeir Sigurdsson
- Department of Endodontics, College of Dentistry, New York University, New York, New York
| | - Hyeon-Cheol Kim
- Department of Conservative Dentistry, Dental and Life Science Institute, School of Dentistry, Pusan National University and Dental Research Institute, Yangsan, Republic of Korea.
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Baasch A, Campello AF, Rodrigues RCV, Alves FRF, Voigt DD, Mdala I, Perez R, Brasil SC, Rôças IN, Siqueira JF. Effects of the Irrigation Needle Design on Root Canal Disinfection and Cleaning. J Endod 2024; 50:1463-1471. [PMID: 39029891 DOI: 10.1016/j.joen.2024.07.006] [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: 01/28/2024] [Revised: 06/19/2024] [Accepted: 07/09/2024] [Indexed: 07/21/2024]
Abstract
INTRODUCTION This ex vivo study evaluated the disinfecting and cleaning effects of root canal preparation using sodium hypochlorite irrigation with 3 different needle designs. METHODS Mesial roots from extracted mandibular molars with Vertucci class II configuration were anatomically matched based on micro-computed tomography (micro-CT) analyses and distributed into 3 groups (n = 18/group). The canals were contaminated with a mixed bacterial culture for 30 days and then subjected to preparation using 2.5% sodium hypochlorite irrigation with open-ended flat needle (3 mm short of the working length - WL), closed-ended side-vented irrigation needle (1 mm short of the WL), or a closed-ended plastic needle with 2 lateral outlets (TruNatomy) (1 mm short of the WL). Bacteriological samples were taken from the canals before (S1) and after preparation (S2). After another micro-CT scan, the roots were sectioned and samples were also taken from the apical canal segment (S3). Bacterial reduction was assessed by quantitative real-time polymerase chain reaction. The amount of accumulated hard tissue debris was evaluated by micro-CT. RESULTS A substantial reduction in bacterial counts was observed in all 3 groups when comparing S1 with S2 (99.95%, 98.93%, and 98.90% in the open-ended, closed-ended, and TruNatomy needle groups, respectively) (P < .01). No significant differences were observed between groups for bacterial reduction in the full and apical canal (P > .05). There were no intergroup differences in the amount of accumulated hard tissue debris either (P > .05). The open-ended needle group showed significantly more specimens with quantitative real-time polymerase chain reaction negative results for bacteria in S3 than TruNatomy (P < .05). CONCLUSION When used up to an appropriate insertion depth, the 3 needle types result in similar antibacterial and cleaning performance, provided variables such as needle size and irrigant type, volume and flow rate are controlled. Exclusive analysis of the apical segment, including the isthmus, revealed that the open-ended needle yielded more cases negative for bacteria.
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Affiliation(s)
- Alessandra Baasch
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
| | - Andrea F Campello
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil
| | - Renata C V Rodrigues
- Department of Endodontics, Faculty of Dentistry, Veiga de Almeida University (UVA), Rio de Janeiro, RJ, Brazil
| | - Flávio R F Alves
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil; Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil.
| | - Danielle D Voigt
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
| | - Ibrahimu Mdala
- Department of General Practice, University of Oslo, Norway
| | - Renata Perez
- Department of Endodontics, North of Minas United Faculty, Ipatinga, MG, Brazil
| | - Sabrina C Brasil
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
| | - Isabela N Rôças
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil; Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil
| | - José F Siqueira
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil; Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil
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Singh S, Zuber M, Verekar PP, Shetty T, Srikant N, Thomas MS. Irrigant dynamics of a back-to-back double side-vented needle in root canals with various tapers: a computational fluid dynamics study. Odontology 2024; 112:1248-1256. [PMID: 38703256 DOI: 10.1007/s10266-024-00940-2] [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: 01/28/2024] [Accepted: 04/15/2024] [Indexed: 05/06/2024]
Abstract
Understanding the apical pressure and irrigant flow patterns in root canals is crucial for safe and effective irrigation. Therefore, this study aimed to assess the flow characteristics of irrigants in root canal models with varying tapers during final irrigation by employing various needle designs, including a back-to-back double-side-vented needle, through computational fluid dynamics. The root canal model was configured as a closed geometrical cone with a simulated apical zone (size 30) and features tapers of 4%, 6%, and 8%. Three needle types-open-ended needle (OEN), single side-vented needle (SSVN), and double side-vented needle (DSVN)-were investigated. The results indicated that for the 4% taper models, the open-ended needle generated the maximum apical pressure, followed by the double side-vented needle and the single side-vented needle. However, in the 6% and 8% tapering root canal models, the double-side-vented needle applied the lowest maximum apical pressure. Consequently, the DSVN can pose a risk for irrigant extrusion in minimally prepared canals due to heightened apical pressure. In wider canals, the DSVN exhibited lower apical pressure. The maximum irrigant replacement was observed with OEN compared to that of the closed-ended group for both flow rates. Additionally, compared with OENs, closed-ended needles exhibited nonuniform and lower shear wall stress.
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Affiliation(s)
- Surmayee Singh
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Mohammad Zuber
- Department of Aeronautical and Automobile Engineering, Manipal Institute of Technology, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Prathmesh Pravin Verekar
- Department of Aeronautical and Automobile Engineering, Manipal Institute of Technology, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Tejaswini Shetty
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - N Srikant
- Department of Oral Pathology, Manipal College of Dental Sciences Mangalore, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Manuel S Thomas
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
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Dai Y, Wang S, Gao J, Liu Q, Xiong Z, Gao Y. The effects of aperture position and length in side-vented needles on root canal irrigation: A computational fluid dynamics study. Comput Biol Med 2024; 179:108940. [PMID: 39059213 DOI: 10.1016/j.compbiomed.2024.108940] [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: 04/07/2024] [Revised: 06/02/2024] [Accepted: 07/23/2024] [Indexed: 07/28/2024]
Abstract
INTRODUCTION Root canal irrigation is crucial for infection control during root canal treatment. Side-vented needles for positive pressure irrigation are commonly used in clinical practice. However, variations in needle design among manufacturers can impact the fluid dynamics of irrigation. This study aims to use computational fluid dynamics to explore the flow characteristics of different needle aperture lengths and positions, and their effects on the effectiveness and safety of irrigation, using a validated passive scalar transport numerical model. METHODS The validation of the CFD irrigant model was achieved by comparing it with an in vitro irrigation experiment model. The CFD model used scalar concentration, while the in vitro experiment model used red dye tracing. Using a standard 30G side-vented needle as a reference, virtual needle models featuring four aperture lengths and three positions were created. These virtual irrigation needles were then placed in two root canal geometries for CFD simulation to evaluate fluid exchange capabilities and related fluid dynamic parameters. RESULTS The results of the CFD simulation, using a scalar transport model, closely matched the in vitro tracer tests for irrigation experiments across seven root canal geometries. The CFD analysis indicated that positioning the aperture lower increased the irrigant exchange distance. Notably, decreasing the aperture length to 0.25x, and positioning it at the lower end of the needle significantly increased exchange distance and shear stress, while reducing apical pressure. CONCLUSIONS These results indicate that the position and length of the aperture affect the exchange distance of irrigant flow, wall shear stress, and apical pressure. The CFD validation model for scalar transport, based on a steady state, can function as a valuable tool for optimizing the side-vented needle in research. Further research on the design of side-vented needles will enhance the understanding of flow characteristics beneficial for irrigation efficiency in clinical practice.
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Affiliation(s)
- Yuhua Dai
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Shizhao Wang
- The State Key Laboratory of Nonlinear Mechanics, Institute of Mechanics, Chinese Academy of Sciences, Beijing, China; School of Engineering Sciences, University of Chinese Academy of Sciences, Beijing, China.
| | - Jiayang Gao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Qi Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Zhe Xiong
- Clinical Medical College of Tianjin Medical University, Tianjin, China.
| | - Yuan Gao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Sun X, Tan Y, Liu R, Li P. Numerical investigation and optimization of innovative root canal irrigation needles with composite flow control structures. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024:e3852. [PMID: 39049450 DOI: 10.1002/cnm.3852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024]
Abstract
Needle syringe irrigation is frequently used in root canal therapy, and the flow pattern during irrigation can be efficiently manipulated by means of passive flow control technique, resulting in expected irrigation performance improvement. Therefore, novel needles with composite flow control structures are numerically investigated and optimized in this study. Based on the 30G needle, six single/double side-vented needles with dimple and protrusion are proposed. Two flow rates in line with clinical applications, 5.3 and 8.6 m/s, are used in the analysis. Three performance parameters are investigated. The safety of the irrigation system is evaluated by the root canal apical pressure, whereas the irrigant extension and the flushing efficiency are evaluated by the extending depth and the effective cleaning area, respectively. The results demonstrate that the shear stress of the double-side-vented needle is higher while the irrigant extension is enhanced with a dimple structure. The performance of the double-side-vented needle with a dimple is superior to that of other designs, with up to 33% improvement in extending depth and a 22% increase in effective cleaning area over the prototype. New needles do not raise risk of irrigant extrusion. Furthermore, the effect of dimple depth and outlet angle are investigated. The needle with a dimple of 0.04 mm depth shows the highest extending depth within the confines of the investigation. The effective cleaning area is significantly influenced by the needle outlets, and the effective cleaning area expands with an increase in needle outlet angle, while the extending depth gradually declines.
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Affiliation(s)
- Xiaoyu Sun
- MOE Key Laboratory of Thermo-Fluid Science and Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Youwei Tan
- MOE Key Laboratory of Thermo-Fluid Science and Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ruirui Liu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ping Li
- MOE Key Laboratory of Thermo-Fluid Science and Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Govindaraju L, Shruthi ST, Gopal R, Jenarthanan S, Rajendran MR. Does increase in temperature of sodium hypochlorite have enhanced antimicrobial efficacy and tissue dissolution property? - A systematic review and meta-regression. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2024; 27:675-684. [PMID: 39262604 PMCID: PMC11385910 DOI: 10.4103/jcde.jcde_110_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 09/13/2024]
Abstract
Objectives The objective of this study was to analyze the available evidence on the performance of increase in temperature of sodium hypochlorite on its antimicrobial efficacy and tissue dissolution property. Materials and Methods The study was conducted according to PRISMA guidelines, and a modified Joanna Briggs Institute (JBI) tool was used for quality assessment of the included studies. Two reviewers independently performed an electronic search in four databases along with the reference lists of the included articles. Results This systematic review included a total of 12 studies: antimicrobial efficacy (n = 6) and tissue dissolution property (n = 6). For the studies that were chosen, the overall risk of bias was moderate. Quantitative assessment through meta-regression was performed for tissue dissolution property. Low-concentration sodium hypochlorite irrigant (≤3%) shows a 0.13-unit times increase in tissue dissolution ability with a degree rise in temperature although not statistically significant. Conclusion Due to inconsistency in the study parameters, results pertaining to the exclusive effect of increase in the temperature of sodium hypochlorite remain inconclusive.
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Affiliation(s)
- Lokhasudhan Govindaraju
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
| | - S T Shruthi
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Rajeswari Gopal
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Sowjanyaa Jenarthanan
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Mathan Rajan Rajendran
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
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Silva EJNL, Peña-Bengoa F, Ajuz NC, Vieira VTL, Martins JNR, Marques D, Pinto R, Rito Pereira M, Braz-Fernandes FM, Versiani MA. Multimethod analysis of large- and low-tapered single file reciprocating instruments: Design, metallurgy, mechanical performance, and irrigation flow. Int Endod J 2024; 57:601-616. [PMID: 38376108 DOI: 10.1111/iej.14047] [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: 11/16/2023] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 02/21/2024]
Abstract
AIM To compare eight large- and low-tapered heat-treated reciprocating instruments regarding their design, metallurgy, mechanical properties, and irrigation flow through an in silico model. METHODOLOGY A total of 472 new 25-mm E-Flex Rex (25/.04 and 25/.06), Excalibur (25/.05), Procodile (25/.06), Reciproc Blue R25 (25/.08v), WaveOne Gold Primary (25/.07v), and Univy Sense (25/.04 and 25/.06) instruments were evaluated regarding their design (stereomicroscopy, scanning electron microscopy, and 3D surface scanning), metallurgy (energy-dispersive X-ray spectroscopy and differential scanning calorimetry), and mechanical performance (cyclic fatigue, torsional resistance, cutting ability, bending and buckling resistance). Computational fluid dynamics assessment was also conducted to determine the irrigation flow pattern, apical pressure, and wall shear stress in simulated canal preparations. Kruskal-Wallis and one-way anova post hoc Tukey tests were used for statistical comparisons (α = 5%). RESULTS Instruments presented variations in blade numbers, helical angles, and tip designs, with all featuring non-active tips, symmetrical blades, and equiatomic nickel-titanium ratios. Cross-sectional designs exhibited an S-shaped geometry, except for WaveOne Gold. Univy 25/.04 and Reciproc Blue displayed the smallest and largest core diameters at D3. Univy 25/.04 and E-Flex Rec 25/.04 demonstrated the longest time to fracture (p < .05). Reciproc Blue and Univy 25/.04 exhibited the highest and lowest torque to fracture, respectively (p < .05). Univy 25/.04 and Reciproc Blue had the highest rotation angles, whilst E-Flex Rec 25/.06 showed the lowest angle (p < .05). The better cutting ability was observed with E-Flex Rec 25/.06, Procodile, Excalibur, and Reciproc Blue (p > .05). Reciproc R25 and E-Flex Rec showed the highest buckling resistance values (p < .05), with WaveOne Gold being the least flexible instrument. The impact of instruments' size and taper on wall shear stress and apical pressure did not follow a distinct pattern, although Univy 25/.04 and E-Flex Rec 25/.06 yielded the highest and lowest values for both parameters, respectively. CONCLUSIONS Low-tapered reciprocating instruments exhibit increased flexibility, higher time to fracture, and greater angles of rotation, coupled with reduced maximum bending loads and buckling strength compared to large-tapered instruments. Nevertheless, low-tapered systems also exhibit lower maximum torque to fracture and inferior cutting ability, contributing to a narrower apical canal enlargement that may compromise the penetration of irrigants in that region.
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Affiliation(s)
- Emmanuel João Nogueira Leal Silva
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
- Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
| | - Fernando Peña-Bengoa
- Department of Endodontics, School of Dentistry, Universidad Andres Bello, Viña del Mar, Chile
| | - Natasha C Ajuz
- Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
| | - Victor T L Vieira
- Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
| | - Jorge N R Martins
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Grupo de Investigação em Bioquimica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE) - Cochrane Portugal, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
| | - Duarte Marques
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Grupo de Investigação em Bioquimica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE) - Cochrane Portugal, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
| | - Ricardo Pinto
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Grupo de Investigação em Bioquimica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
| | - Mario Rito Pereira
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
| | - Francisco Manuel Braz-Fernandes
- CENIMAT/I3N, Department of Materials Science, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
| | - Marco A Versiani
- Oral Health Center, Brazilian Military Police, Minas Gerais, Brazil
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Rito Pereira M, Silva G, Semiao V, Martins JNR, Silverio V, Pascoal-Faria P, Duarte I, Alves N, Ginjeira A. Syringe irrigation in confluent canals: A sequential computational fluid dynamics assessment. AUST ENDOD J 2024; 50:40-51. [PMID: 37849412 DOI: 10.1111/aej.12805] [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: 12/13/2022] [Revised: 08/18/2023] [Accepted: 10/07/2023] [Indexed: 10/19/2023]
Abstract
This study aims to assess the influence of root canal preparation, irrigation needle design and its placement depth in the irrigation flow of confluent canals during syringe irrigation. A mandibular molar presenting two confluent canals in its mesial root was sequentially prepared and scanned by micro-computed tomography after mechanical preparation up to ProTaper Next system sizes X2 (25/.06v), X3 (30/.07v) and X4 (40/.06v). In each of the root canal preparation models, a side-vented and an open-ended needle at 5, 3 and 2 mm from the working length were included, and irrigation flow was assessed by a validated computational fluid dynamics model. The results revealed that the irrigant flowed out of the confluent canals mainly through the canal that did not have the needle. Apical penetration and renewal of the irrigant were most efficiently achieved with the use of a 30G open-ended needle and a 30/.07v preparation.
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Affiliation(s)
- Mário Rito Pereira
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Almada, Portugal
| | - Goncalo Silva
- IDMEC, Department of Mechatronics, Universidade de Évora, Évora, Portugal
| | - Viriato Semiao
- IDMEC, Instituto Superior Técnico, Departamento de Engenharia Mecânica, Universidade de Lisboa, Lisboa, Portugal
| | - Jorge N R Martins
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
| | - Vania Silverio
- Instituto de Engenharia de Sistemas e Computadores - Microsistemas e Nanotecnologias, INESC MN, Lisboa, Portugal
- Department of Physics, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - Paula Pascoal-Faria
- Mathematics Department of the School of Technology and Management (ESTG) and Centre for Rapid and Sustainable Product Development (CDRSP) from the Polytechnic of Leiria, Marinha Grande, Portugal
| | - Isabel Duarte
- Department of Mechanical Engineering, Centre for Mechanical Technology and Automation (TEMA), University of Aveiro, Aveiro, Portugal
- LASI - Intelligent Systems Associate Laboratory, Guimarâes, Portugal
| | - Nuno Alves
- Centre for Rapid and Sustainable Product Development, Instituto Politécnico de Leiria, Marinha Grande, Portugal
| | - António Ginjeira
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
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Yu M, Li Y, Zhao M, Huang Z, Zhou N, Jin H. Computational fluid dynamics investigation on the irrigation of a real root canal with a side-vented needle. BMC Oral Health 2024; 24:321. [PMID: 38461300 PMCID: PMC10924978 DOI: 10.1186/s12903-024-03966-8] [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: 12/23/2023] [Accepted: 02/01/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Root canal therapy is one of the main treatments for root canal diseases, and effective irrigation is the key to successful treatment. Side-vented needle is one of the commonly used needle types in clinic. In the real root canal, due to the influence of the curvature of the root canal, the irrigation flow field in different needle directions shows obvious differences. At the same time, changes in root canal curvature and working depth will lead to changes in irrigation efficiency and the flow field. Both the mainstream of the irrigation flow and the shear stress near the wall changes significant. Consequently, either the replacement in the root canal or the removal efficiency of the smear layers is apparently modified. MATERIALS AND METHODS In this paper, the permanent root canal of the maxillary first molar prepared until 15/04 were scanned by micro-CT, and then imported into the software for 3D reconstruction. The key parameters of flushing efficiency of 30G side needle at different working depths of 4.75 mm, 5 mm, 5.25 mm and 5.5 mm were compared. Meanwhile, the simulated models with different curvatures of 0°, 5°, 10°, 20° and 30° based on the real root canal were reconstructed to investigate the curvature effect on the irrigation efficiency. RESULTS The results show that moderate working depth (such as 4.75 mm and 5.25 mm in present paper) helps to improve the replacement capacity of irrigation flow. At the same time, the apical pressure decreased as the working depth increased. The curvature of the root canal seriously affects the removal depth of the smear layers of the root canal. A root canal with a large curvature (especially 20° and 30°) can significantly improve the difficulty of irrigation. CONCLUSIONS (1) Moderate working depth helps to improve the displacement capacity, the ERD of the irrigation flow is generally improved at the working depths of 4.75 mm and 5.25 mm, and the apical pressure will decrease with the increase of working depth. (2) The large curvature of the root canal can significantly improve the difficulty of irrigation. The curvature of the root canal can severely influence the removal depth of the smear layer on the wall. It can be found both the span and the depth of the ESS for little curvatures (5° and 10°) root canals are higher than those for large curvatures (20° and 30°).
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Affiliation(s)
- Mingzhou Yu
- School of Aeronautics and Astronautics, Zhejiang University, Hangzhou, 310027, People's Republic of China
- Aerosol Science and Technology Laboratory, China Jiliang University, Hangzhou, 310018, People's Republic of China
| | - Yi Li
- Aerosol Science and Technology Laboratory, China Jiliang University, Hangzhou, 310018, People's Republic of China
| | - Mengdie Zhao
- Aerosol Science and Technology Laboratory, China Jiliang University, Hangzhou, 310018, People's Republic of China
| | - Zhengqiu Huang
- Aerosol Science and Technology Laboratory, China Jiliang University, Hangzhou, 310018, People's Republic of China
| | - Na Zhou
- Aerosol Science and Technology Laboratory, China Jiliang University, Hangzhou, 310018, People's Republic of China.
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China.
| | - Hanhui Jin
- School of Aeronautics and Astronautics, Zhejiang University, Hangzhou, 310027, People's Republic of China.
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, 310027, People's Republic of China.
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10
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Koulogiannis A, Walmsley AD, Angeli P, Balabani S. Ultrasonic irrigation flows in root canals: effects of ultrasound power and file insertion depth. Sci Rep 2024; 14:5368. [PMID: 38438434 PMCID: PMC10912427 DOI: 10.1038/s41598-024-54611-x] [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: 09/06/2023] [Accepted: 02/14/2024] [Indexed: 03/06/2024] Open
Abstract
Ultrasonic irrigation during root canal treatment can enhance biofilm disruption. The challenge is to improve the fluid flow so that the irrigant reaches areas inaccessible to hand instrumentation. The aim of this study is to experimentally investigate how the flow field and hydrodynamic forces induced by ultrasonic irrigation are influenced by the ultrasound power and file insertion depth. A root canal phantom was 3D printed and used as a mold for the fabrication of a PDMS channel. An ultrasonic instrument with a #15K-file provided the irrigation. The flow field was studied by means of Particle Image Velocimetry (PIV). The time averaged velocity and shear stress distributions were found to vary significantly with ultrasound power. Their maximum values increase sharply for low powers and up to a critical power level. At and above this setting, the flow pattern changes, from the high velocity and shear stress region confined in the vicinity of the tip, to one covering the whole root canal domain. Exceeding this threshold also induces a moderate increase in the maximum velocities and shear stresses. The insertion depth was found to have a smaller effect on the measured velocity and shear stresses. Due to the oscillating nature of the flow, instantaneous maximum velocities and shear stresses can reach much higher values than the mean, especially for high powers. Ultrasonic irrigation will benefit from using a higher power setting as this does produce greater shear stresses near the walls of the root canal leading to the potential for increased biofilm removal.
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Affiliation(s)
- A Koulogiannis
- FluME, Department of Mechanical Engineering, University College London (UCL), London, UK
| | - A D Walmsley
- School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - P Angeli
- ThAMes, Department of Chemical Engineering, University College London (UCL), London, UK.
| | - S Balabani
- FluME, Department of Mechanical Engineering, University College London (UCL), London, UK.
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London (UCL), London, UK.
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11
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Zou X, Zheng X, Liang Y, Zhang C, Fan B, Liang J, Ling J, Bian Z, Yu Q, Hou B, Chen Z, Wei X, Qiu L, Chen W, He W, Xu X, Meng L, Zhang C, Chen L, Deng S, Lei Y, Xie X, Wang X, Yu J, Zhao J, Shen S, Zhou X, Yue L. Expert consensus on irrigation and intracanal medication in root canal therapy. Int J Oral Sci 2024; 16:23. [PMID: 38429299 PMCID: PMC10907616 DOI: 10.1038/s41368-024-00280-5] [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: 11/05/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 03/03/2024] Open
Abstract
Chemical cleaning and disinfection are crucial steps for eliminating infection in root canal treatment. However, irrigant selection or irrigation procedures are far from clear. The vapor lock effect in the apical region has yet to be solved, impeding irrigation efficacy and resulting in residual infections and compromised treatment outcomes. Additionally, ambiguous clinical indications for root canal medication and non-standardized dressing protocols must be clarified. Inappropriate intracanal medication may present side effects and jeopardize the therapeutic outcomes. Indeed, clinicians have been aware of these concerns for years. Based on the current evidence of studies, this article reviews the properties of various irrigants and intracanal medicaments and elucidates their effectiveness and interactions. The evolution of different kinetic irrigation methods, their effects, limitations, the paradigm shift, current indications, and effective operational procedures regarding intracanal medication are also discussed. This expert consensus aims to establish the clinical operation guidelines for root canal irrigation and a position statement on intracanal medication, thus facilitating a better understanding of infection control, standardizing clinical practice, and ultimately improving the success of endodontic therapy.
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Affiliation(s)
- Xiaoying Zou
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
- Center of Stomatology, Peking University Hospital, Beijing, China
| | - Xin Zheng
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yuhong Liang
- Department of Emergency, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Chengfei Zhang
- Restorative Dental Sciences, Endodontics, Faculty of Dentistry, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Bing Fan
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jingping Liang
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Clinical Research Center for Oral Diseases; National Center for Stomatology; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Junqi Ling
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology , Guangzhou, China
| | - Zhuan Bian
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Qing Yu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xián, China
| | - Benxiang Hou
- Center for Microscope Enhanced Dentistry, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Zhi Chen
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xi Wei
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology , Guangzhou, China
| | - Lihong Qiu
- Department of Endodontics, School of Stomatology, China Medical University, Shenyang, China
| | - Wenxia Chen
- College & Hospital of Stomatology, Guangxi Medical University, Nanning, China
| | - Wenxi He
- Department of Stomatology, Air Force Medical Center, The Air Force Medical University, Beijing, China
| | - Xin Xu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Liuyan Meng
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Chen Zhang
- Department of Endodontics, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Liming Chen
- Department of Endodontics, Guiyang Stomatological Hospital, Guiyang, China
| | - Shuli Deng
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Yayan Lei
- Department of Endodontics, the Affiliated Stomatological Hospital of Kunming Medical University, Kunming, China
| | - Xiaoli Xie
- Department of Endodontology, Hunan Xiangya Stomatological Hospital, Central South University, Changsha, China
| | - Xiaoyan Wang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Jinhua Yu
- Institute of Stomatology, Nanjing Medical University & Department of Endodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Jin Zhao
- Department of Endodontics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Song Shen
- Center of Stomatology, Peking University Hospital, Beijing, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Lin Yue
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China.
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12
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Uematsu T, Yahata Y, Ohnishi K, Suzuki S, Kanehira M, Tanaka T, Sudo S, Suresh VV, Saito M. Irrigation with reduced sodium hypochlorite solution concentration using laser-induced cavitation is effective and safe in rat intraradicular biofilm model. AUST ENDOD J 2023; 49:544-553. [PMID: 37489629 DOI: 10.1111/aej.12783] [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: 01/01/2023] [Revised: 07/08/2023] [Accepted: 07/08/2023] [Indexed: 07/26/2023]
Abstract
This study aimed to investigate the optimal sodium hypochlorite solution (NaOCl) concentration to effectively remove the root canal biofilm without stimulating periradicular inflammation using coronal laser-activated irrigation (CLAI). To compare the efficacy of different NaOCl concentrations combined with CLAI in removing the biofilm, an in vivo intraradicular biofilm rat model was used. Root canals were irrigated using an Er:YAG laser with either 5% or 0.5% NaOCl. Biofilm removal efficacy of CLAI was compared to that of conventional needle irrigation using scanning electron microscopy (SEM) and quantitative polymerase chain reaction (qPCR). Histological observation of CLAI-associated periradicular inflammation was also conducted. In both the 5% and 0.5% CLAI groups, SEM observation showed the opening of the dentin tubules and biofilm removal. qPCR analysis indicated that the residual bacteria counts after cleaning were significantly lower in the 5% and 0.5% CLAI groups than in the conventional needle irrigation and positive control groups (Tukey test, p < 0.05), and no significant difference was observed between the 5% and 0.5% CLAI groups (p > 0.05). Periapical inflammation in the 5% CLAI group revealed the most severe, including significant neutrophilic and lymphocytic infiltration with abscess formation, while only mild vasodilation was observed in the 0.5% CLAI group. CLAI can remove the biofilm independently of chemical action, which avoids the risks associated with high NaOCl concentrations. Therefore, this root canal irrigation technique ensures safety and effectiveness, promising to contribute to new treatment strategies intended to remove intraradicular biofilm.
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Affiliation(s)
- Takehiro Uematsu
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Yoshio Yahata
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Koyuki Ohnishi
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Shigeto Suzuki
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Masafumi Kanehira
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Toshinori Tanaka
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Susumu Sudo
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Venkata Venkataiah Suresh
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Masahiro Saito
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
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13
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Brochado Martins JF, Jautze A, Georgiou AC, Tulp BMT, Crielaard W, van der Waal SV. Well-being, postoperative pain and outcome after clinical application of a novel root canal irrigation fluid-RISA-in teeth with apical periodontitis: A first-in-human study. Int Endod J 2023; 56:1488-1498. [PMID: 37771316 DOI: 10.1111/iej.13977] [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: 08/31/2023] [Indexed: 09/30/2023]
Abstract
AIM The aim of the study was to assess the tolerance to the new root canal irrigation fluid RISA after root canal treatment (RCT) by evaluating the subject's postoperative well-being, postoperative pain (PP) and treatment outcome. METHODOLOGY A single-arm prospective study with 16 subjects (17 teeth) diagnosed with asymptomatic apical periodontitis. Endodontic treatment in one session performed using RISA for root canal irrigation. Well-being was assessed on the same day and after 24 h by telephone. For pain intensity, a visual analogue scale was used at 0-5 days. Clinical and radiographic evaluations were performed at ≥12 months. Well-being, occurrence of PP and outcome were qualitatively reported. Friedman test for paired samples and Spearman correlation coefficient were used. Significance was set at p < .05. RESULTS At the same day and after 24 h, 14/16 subjects felt 'good'. 9/16 presented intra- or extra-oral swelling. The frequency of PP ≥36 (weak) was 82.4%. On the same day, 1 and 2 days postoperatively, there was more pain compared with preoperative pain p < .05. At Day 3, PP equalled preoperative pain (p > .05). 62.5% of subjects needed analgesics Day 0-2. The recall rate was 94.1%, and resolution of apical periodontitis was observed in 87.5%. CONCLUSIONS The well-being of subjects was good, and the overall PP intensity was low. However, postoperative intra- and extra-oral swelling occurred often. At the recall visit, the effectiveness of the RCT with RISA appeared high (87.5%). The encouraging outcome results plus the fact that RISA has a broader action range than NaOCl in vitro, justify further work on the RISA solution. To reduce postoperative swelling, it is advised to further investigate the optimal way of application of RISA in the laboratory before clinical application is recommended.
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Affiliation(s)
- João Filipe Brochado Martins
- Department of Endodontics, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Anthony Jautze
- Department of Endodontics, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Athina Christina Georgiou
- Department of Endodontics, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Birgitte Maria Theresia Tulp
- Department of Endodontics, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Wim Crielaard
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Suzette Veronica van der Waal
- Department of Endodontics, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
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14
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de Rabello DGD, Valera MC, Corazza BJM, Dos Santos LM, Carvalho CAT. Clinical efficacy of endodontic protocols on reducing cultivable bacteria and endotoxin in infected root canal in patients submitted to head and neck radiotherapy: a randomised clinical trial. Clin Oral Investig 2023; 27:7199-7207. [PMID: 38038750 DOI: 10.1007/s00784-023-05283-w] [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: 11/04/2021] [Accepted: 11/10/2022] [Indexed: 12/02/2023]
Abstract
OBJECTIVES Assess the efficacy of biomechanical preparation using a reciprocating system followed by final irrigation protocols, then intracanal medication, on reducing endotoxins and cultivable bacteria of infected teeth in irradiated patients. MATERIALS AND METHODS Twenty-two infected single-rooted canals in patients submitted to head and neck radiotherapy were prepared by reciprocating motion and 2.5% NaOCl. Patients were randomly divided into two groups of 11 patients before the final irrigation protocol: apical positive pressure (APP) or passive ultrasonic activation (PUA). Both groups were treated in two sessions, using Ca(OH)2 as intracanal medication for 14 days. Root canal content sampling was performed after canal access (S1), after biomechanical preparation plus the irrigation protocol (S2), and after intracanal medication (S3). Chromogenic limulus amoebocyte lysate assay measured endotoxin levels (EU/mL), and bacterial load was determined by culture techniques (CFU/mL). RESULTS Treatment protocols reduced bacterial counts after S2 in both groups (p = 0.01). S3 differed from S1 (p = 0.01), but not from S2 (p = 0.4). Endotoxin levels were reduced in both groups after S2 (P = 0.03) and were lower in S3 than in S2, with significant differences in the APP group (p = 0.03). CONCLUSIONS Biomechanical preparation using a reciprocating system and 2.5% NaOCl in irradiated teeth, followed by the irrigation protocol (APP or PUA), demonstrated efficacy in reducing endodontic contaminants. Ca(OH)2 as intracanal medication should be performed in irradiated patients with infected root canals. CLINICAL RELEVANCE This clinical study demonstrated that endodontic treatment in irradiated patients is efficacious at reducing bacterial load and endotoxin levels.
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Affiliation(s)
- Diego Guilherme Dias de Rabello
- Department of Restorative Dentistry, Endodontic Division, Institute of Science and Technology, São Paulo State University - UNESP, Av. Eng. Francisco José Longo, 777, São José dos Campos, São Paulo, Brazil
| | - Marcia Carneiro Valera
- Department of Restorative Dentistry, Endodontic Division, Institute of Science and Technology, São Paulo State University - UNESP, Av. Eng. Francisco José Longo, 777, São José dos Campos, São Paulo, Brazil.
| | - Bruna Jordão Motta Corazza
- Department of Restorative Dentistry, Endodontic Division, Institute of Science and Technology, São Paulo State University - UNESP, Av. Eng. Francisco José Longo, 777, São José dos Campos, São Paulo, Brazil
| | - Lúcio Murilo Dos Santos
- Department of Diagnosis and Surgery, Maxillofacial Surgery Division, Institute of Science and Technology, São Paulo State University - UNESP, São José dos Campos, São Paulo, 12245-000, Brazil
| | - Claudio Antônio Talge Carvalho
- Department of Restorative Dentistry, Endodontic Division, Institute of Science and Technology, São Paulo State University - UNESP, Av. Eng. Francisco José Longo, 777, São José dos Campos, São Paulo, Brazil
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15
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Cimpeanu R, Castrejón-Pita AA, Lim LN, Vatish M, Georgiou EX. A new flow-based design for double-lumen needles. J Biomech 2023; 160:111832. [PMID: 37837837 DOI: 10.1016/j.jbiomech.2023.111832] [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: 05/17/2023] [Revised: 08/28/2023] [Accepted: 10/05/2023] [Indexed: 10/16/2023]
Abstract
Oocyte retrieval forms a crucial part of in vitro fertilisation treatment and its ultimate outcome. Standard double-lumen needles, which include a sequence of aspiration and flushing steps, are characterised by a similar success rate to single-lumen needles, despite their increased cost. A novel hydrodynamics-based needle called the OxIVF needle is proposed here, which is geared towards the generation of an internal flow field within the full follicular volume via laterally, rather than frontally, oriented flushing, leading to successful retrievals with no additional stress on the oocyte. A two-dimensional digital twin of the follicular environment is created and tested via multi-phase flow direct numerical simulation. Oocyte initial location within the follicle is varied, while quantities of interest such as velocity magnitude and vorticity are measured with a high level of precision. This provides insight into the overall fluid motion, as well as the trajectory and stresses experienced by the oocyte. A comparative benchmark set of tests indicated a higher success rate of the OxIVF needle of up to 100%, marking a significant improvement over the traditional double-lumen design whose success rate of no more than 75% was also highly dependent on the location of the needle tip inside the follicle. All forces measured during these tests showcase how the oocyte experiences stresses which are no larger than at the aspiration point, with the flow field providing a gentle steering effect towards the extraction region. Finally, the flow generation strategy maximises oocyte yield, unlocking new capabilities in both human and veterinary contexts.
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Affiliation(s)
- Radu Cimpeanu
- Mathematics Institute, University of Warwick, Coventry, CV4 7AL, United Kingdom; Mathematical Institute, University of Oxford, Oxford, OX2 6GG, United Kingdom.
| | | | - Lee Nai Lim
- Gynaecology Department, Oxford University Hospital NHS Foundation Trust, Oxford, OX3 9DU, United Kingdom
| | - Manu Vatish
- Nuffield Department of Women's Health and Reproductive Research, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Ektoras X Georgiou
- Gynaecology Department, Oxford University Hospital NHS Foundation Trust, Oxford, OX3 9DU, United Kingdom
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16
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Martins JNR, Silva EJNL, Marques D, Pinto R, Francisco H, Ajuz N, Rito Pereira M, Braz Fernandes FM, Versiani MA. Characterization of four heat-treated reciprocating instruments: Design, metallurgy, mechanical performance, and irrigation flow patterns. Int Endod J 2023; 56:1412-1428. [PMID: 37698946 DOI: 10.1111/iej.13971] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/14/2023]
Abstract
AIM To compare the design, metallurgy, and mechanical properties of four heat-treated reciprocating instruments coupled with the evaluation of the irrigation flow using an in silico model. METHODOLOGY New EdgeOne Fire Primary, Easy-File Flex Regular 25, WaveOne Gold Primary and Reciproc Blue R25 instruments (n = 124) were initially evaluated regarding their design through stereomicroscopy, scanning electron microscopy and 3D surface scanning. In addition, energy-dispersive X-ray spectroscopy was utilized to determine their elemental composition, and differential scanning calorimetry tests to evaluate their phase transformation temperatures. Their mechanical performance was further assessed through torsional and bending tests. Using scans obtained from a real tooth and the instruments, a computational fluid dynamics assessment was conducted to determine the irrigation flow pattern, apical pressure, and wall shear stress in simulated canal preparation. Mood's median and One-way anova post hoc Tukey tests were used for statistical comparisons (α = 5%). RESULTS Reciproc Blue exhibited a superior number of blades (n = 8), whereas EdgeOne Fire had the highest overall volume (4.38 mm3 ) and surface area (32.32 mm2 ). At the 3-mm axial level, EdgeOne Fire displayed the lowest core diameter (0.13 mm), while Reciproc Blue had the highest (0.16 mm). All blades were symmetrical, and the tips of the instruments were non-active but differed from each other. The most irregular surfaces were observed in EdgeOne Fire and Easy-File Flex. All instruments were manufactured from nickel-titanium alloys and exhibited distinct phase transformation temperatures. WaveOne Gold and Reciproc Blue demonstrated the highest maximum torque values (1.87 and 1.62 N cm, respectively), while the lowest was observed on EdgeOne Fire (1.21 N cm) (p < .05). The most flexible (p < .05) were EdgeOne Fire (angle of rotation: 602.6°; maximum bending load: 251.4 g.f) and Reciproc Blue (533.2° and 235.6 g.f). There were no significant differences observed in the irrigation flow among the four domains generated by the tested instruments. CONCLUSIONS Despite observing variations in the design, phase transformation temperatures, and in the torsional and bending test outcomes among the four heat-treated reciprocating instruments, no significant differences were found in the irrigation flow pattern among the different groups in the simulated root canal preparations.
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Affiliation(s)
- Jorge N R Martins
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Grupo de Investigação em Bioquimica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE)-Cochrane Portugal, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Implantologia, Lisboa, Portugal
| | - Emmanuel João Nogueira Leal Silva
- School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil
- Fluminense Federal University, Rio de Janeiro, Brazil
| | - Duarte Marques
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Grupo de Investigação em Bioquimica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE)-Cochrane Portugal, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Implantologia, Lisboa, Portugal
- LIBPhys-FCT UID/FIS/04559/2013, Lisboa, Portugal
| | - Ricardo Pinto
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Grupo de Investigação em Bioquimica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Implantologia, Lisboa, Portugal
| | - Helena Francisco
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Implantologia, Lisboa, Portugal
- Grupo de Investigação Implantologia e Regeneração Óssea (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
| | - Natasha Ajuz
- School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil
| | - Mário Rito Pereira
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
| | - Francisco Manuel Braz Fernandes
- CENIMAT/I3N, Department of Materials Science, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
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Habeeb MA. Comparative evaluation of debris and irrigation extruded apically using different design of needles and penetration depth - An In Vitro study. Indian J Dent Res 2023; 34:266-269. [PMID: 38197344 DOI: 10.4103/ijdr.ijdr_32_23] [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] [Indexed: 01/11/2024] Open
Abstract
Aim : The aim of this study was to measure the amount of material extruded in the periapical area using three irrigation needles (Max-I-Probe, NaviTip Fx and IrriFlex flexible needle). Materials and Methods : Mandibular premolars were selected for this study and glass vials were used to gather the extruded debris and they were preweighed. The samples were divided into two groups: Group A (1 mm penetration of needle from working length), which was subdivided into three subgroups: Subgroup A1: Irrigation was made by Max-I-Probe. Subgroup A2: Irrigation was made by NaviTip Fx. Subgroup A3: Irrigation was made by IrriFlex flexible needle. Group B (3 mm penetration of needle), which was subdivided into three subgroups: Subgroup B1: Irrigation was made by Max-I-Probe. Subgroup B2: Irrigation was made by NaviTip Fx. Subgroup B3: Irrigation was made by IrriFlex flexible needle. XP-endo Shaper was used for chemomechanical preparation. After removal from vials, the teeth were incubated and then removed from the incubator and weighed again three times. The average of the readings was taken. Analysis of variance (ANOVA) and least significance difference tests were applied to analyse data. Results : All of the needles caused debris extrusion. There was a significant difference between groups (P ≤ 0.001) according to the depth of penetration. The lowest value for debris was observed in subgroup B3 while subgroup A2 had shown the highest mean. Conclusion Results revealed that the design and depth of needles significantly affected the debris extrusion. Using more flexible needles and shorter penetration depth for irrigation so that we don't need to push the needles so far apically.
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Affiliation(s)
- Maha A Habeeb
- Department of Conservative Dentistry, College of Dentistry, University of Uruk, Baghdad, Iraq
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18
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Rödig T, Westbomke V, Haupt F, Münster M, Baxter S. Effect of preparation size on the removal of accumulated hard-tissue debris from the mesial root canal system of mandibular molars using SWEEPS technology. Clin Oral Investig 2023; 27:2787-2796. [PMID: 36642725 PMCID: PMC10264281 DOI: 10.1007/s00784-023-04862-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 01/06/2023] [Indexed: 01/17/2023]
Abstract
OBJECTIVES This study assessed the influence of preparation size on the efficacy of shock wave-enhanced emission photoacoustic streaming (SWEEPS) and conventional irrigation (CI) on removal of accumulated hard tissue debris (AHTD) from isthmus-containing mandibular molars using micro-computed tomographic analysis. MATERIALS AND METHODS Sixty extracted mandibular molars with two mesial canals connected by an isthmus were selected. Canals were shaped with Mtwo instruments (VDW, Munich, Germany) up to sizes 25/.06, 40/.04 or 40/.06 (n = 20), and specimens were distributed into 2 final irrigation groups (n = 10): SWEEPS and CI. Roots were scanned at a resolution of 10.5 µm before and after preparation and final irrigation. Data sets were co-registered, and the percentage reduction of AHTD calculated for each specimen was statistically compared using analysis of variance with a of 5% significance level. RESULTS The preparation size did not significantly influence the percentage reduction of AHTD (p < 0.05), whereas the final irrigation technique had a significant effect on debris removal (p < 0.05). A significant reduction of AHTD was achieved after final irrigation in all groups (p < 0.05); however, SWEEPS was associated with a significantly greater percentage reduction of debris than CI (p < 0.05). None of the specimens presented a completely clean isthmus. CONCLUSIONS Removal of AHTD was not significantly affected by the preparation size. SWEEPS was associated with significantly less debris than CI. CLINICAL RELEVANCE SWEEPS performed significantly better than CI regarding the removal of AHTD from isthmus-containing mandibular molars irrespective of the preparation size.
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Affiliation(s)
- Tina Rödig
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Valerie Westbomke
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Franziska Haupt
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Marc Münster
- Endopur, Clinic for Endodontology, Frankfurt, Germany
| | - Steffi Baxter
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
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Chan WS, Gulati K, Peters OA. Advancing Nitinol: From heat treatment to surface functionalization for nickel–titanium (NiTi) instruments in endodontics. Bioact Mater 2023; 22:91-111. [PMID: 36203965 PMCID: PMC9520078 DOI: 10.1016/j.bioactmat.2022.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/04/2022] [Accepted: 09/09/2022] [Indexed: 11/27/2022] Open
Abstract
Nickel-titanium (NiTi) alloy has been extensively researched in endodontics, particularly in cleaning and shaping the root canal system. Research advances have primarily focused on the design, shape, and geometry of the NiTi files as well as metallurgy and mechanical properties. So far, extensive investigations have been made surrounding surface and thermomechanical treatments, however, limited work has been done in the realm of surface functionalization to augment its performance in endodontics. This review summarizes the unique characteristics, current use, and latest developments in thermomechanically treated NiTi endodontic files. It discusses recent improvements in nano-engineering and the possibility of customizing the NiTi file surface for added functionalization. Whilst clinical translation of this technology has yet to be fully realized, future research direction will lie in the use of nanotechnology. Nitinol (Nickel Titanium alloy) is widely used to clean/shape root canal system in endodontics. To enhance its performance, various thermo-mechanical and nano-engineering modifications have been performed. This comprehensive review summarizes the latest advances and future trends relating to functionalized NiTi endodontic files.
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20
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Iandolo A. The Endodontic Space. Healthcare (Basel) 2023; 11:healthcare11040628. [PMID: 36833161 PMCID: PMC9957440 DOI: 10.3390/healthcare11040628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
Modern endodontics allows for the use of new materials and techniques in treating and saving teeth in a simple and reproducible way [...].
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Affiliation(s)
- Alfredo Iandolo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via S. Allende, 84081 Baronissi, Italy
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21
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Iandolo A, Pisano M, Abdellatif D, Sangiovanni G, Pantaleo G, Martina S, Amato A. Smear Layer and Debris Removal from Root Canals Comparing Traditional Syringe Irrigation and 3D Cleaning: An Ex Vivo Study. J Clin Med 2023; 12:jcm12020492. [PMID: 36675419 PMCID: PMC9867447 DOI: 10.3390/jcm12020492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/21/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Background: Endodontic treatment objectives comprise eliminating or decreasing bacterial load inside the complex endodontic space. Removing the smear layer and debris becomes mandatory to achieve good three-dimensional (3D) cleaning. Aim: This study assesses the difference in smear layer removal using the 3D cleaning technique and traditional syringe needle irrigation. The 3D cleaning technique includes the ultrasonic activation of intracanal-heated NaOCl. Materials and Methods: Our current study used single-rooted human mandibular premolar teeth to test the earlier-mentioned technique (n = 30). Initially, an endodontic access cavity was performed. Consequently, specimens were randomly distributed into three study groups according to irrigation protocol. The groups were Group 1, where the traditional syringe needle irrigation system was applied; Group 2, where the 3D cleaning technique was performed; and Group 3, in which teeth remained uncleaned as it was regarded as the control group. Once the experiment was completed, the teeth were decoronated at the cementoenamel junction (CEJ) and examined using scanning electron microscopy (SEM). Debris and smear layers were viewed in 1000× magnification and scored. Results: Statistical analysis was performed with a standard statistical software package (SPSS, version 28.0; SPSS IBM, Armonk, NY, USA). Data were analyzed with a nonparametric analysis of variance (Kruskal−Wallis ANOVA) among the groups tested and among the thirds of the canals. The level of significance was set at p < 0.05. A statistically significant (p < 0.05) lower mean smear layer and debris score was observed in both study groups compared to the control group. Group 2 showed better results compared to Group 1. Conclusions: The present study concluded that the 3D cleaning technique is an effective irrigation method for removing debris and smear layers. Future research, such as CLSM (Confocal Laser Scanning Microscopy) and Histological study, should be employed to confirm this study’s conclusion.
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Affiliation(s)
- Alfredo Iandolo
- Department of Medicine and Surgery, University of Salerno, 84081 Salerno, Italy
- Correspondence: ; Tel.: +39-328-7028-233
| | - Massimo Pisano
- Department of Medicine and Surgery, University of Salerno, 84081 Salerno, Italy
| | - Dina Abdellatif
- Department of Endodontics, Faculty of Dentistry, University of Alexandria, Alexandria 21531, Egypt
| | | | - Giuseppe Pantaleo
- Department of Medicine and Surgery, University of Salerno, 84081 Salerno, Italy
| | - Stefano Martina
- Department of Medicine and Surgery, University of Salerno, 84081 Salerno, Italy
| | - Alessandra Amato
- Department of Medicine and Surgery, University of Salerno, 84081 Salerno, Italy
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22
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Vivekananda Pai AR. Factors influencing the occurrence and progress of sodium hypochlorite accident: A narrative and update review. J Conserv Dent 2023; 26:3-11. [PMID: 36908722 PMCID: PMC10003279 DOI: 10.4103/jcd.jcd_422_22] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 12/12/2022] Open
Abstract
Sodium hypochlorite (NaOCl) is one of the most commonly used irrigant because of its several advantages. However, it is highly cytotoxic and can lead to severe tissue damage. NaOCl accident occurs when it is extruded beyond root confines into periapical or periradicular tissues. It is an irrigant mishap which can be life threatening and/or cause residual or long term or permanent consequences with malpractice and medico-legal implications. There are many factors which can influence the occurrence and progress of NaOCl accident. These factors can be broadly categorized as patient (host)-, tooth-, operator-, and NaOCl-related factors. They can be further categorized as predisposing and extent factors. It is vital for a clinician to thoroughly understand and identify various influencing factors to prevent NaOCl accident with its associated consequences including any potential medico-legal issues. The purpose of this article is to provide a narrative review on various factors which predispose to the occurrence of NaOCl accident and influence its extent and/or outcome.
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Affiliation(s)
- A. R. Vivekananda Pai
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Manipal University College Malaysia, Jalan Batu Hampar, Bukit Baru, 75150 Melaka, Malaysia
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23
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Park R, Choi M, Seo J, Park EH, Jang SW, Shon WJ, Kim HY, Kim W. Root canal irrigation system using remotely generated high-power ultrasound. ULTRASONICS SONOCHEMISTRY 2022; 90:106168. [PMID: 36137469 PMCID: PMC9493060 DOI: 10.1016/j.ultsonch.2022.106168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/27/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
Root canal treatment is performed to remove the bacteria proliferating in the root canals of a tooth. Many conventional root canal irrigation methods use an instrument inserted into the root canals. However, bacteria removal is often incomplete in the apical region of the root canal, and the treatment carries clinical risks, such as instrument fracture and extrusion of irrigation liquid through the canal apex. We here suggest a novel, remotely generated high-intensity ultrasound irrigation system that exhibits better irrigation performance and a reduced clinical risk. Our device employs powerful ultrasonic waves generated by a transducer placed outside a target tooth. The generated ultrasonic waves are guided to travel into the root canals. In the root canals of the target tooth, acoustic cavitation occurs, and vapor bubbles are created. The dynamic motions of vapor bubbles create remarkable cleaning effects. Using root canal models, we tested the cleaning performance of the proposed system and compared it with other conventional irrigation methods. The results revealed that biofilm in the apical region of the root canal models can be removed exclusively using the proposed system, thus demonstrating an improvement in cleaning performance. We also measured pressure at the apex of the root canals of an extracted tooth while operating the proposed system. Our system exhibited a smaller pressure compared to the syringe irrigation method, thus suggesting a reduced risk of apical extrusion of the irrigation liquid. Since the proposed system operates without inserting instruments into the root canal, it can clean multiple root canals in a tooth simultaneously with a single treatment. The proposed device would be a breakthrough in root canal treatment in terms of irrigation performance, clinical safety, and ease of treatment.
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Affiliation(s)
- Ryeol Park
- Department of Mechanical Engineering, Sogang University, Seoul 04107, Republic of Korea
| | - Minsu Choi
- Department of Mechanical Engineering, Sogang University, Seoul 04107, Republic of Korea
| | - Jaedeok Seo
- Department of Mechanical Engineering, Sogang University, Seoul 04107, Republic of Korea
| | - Eun Hyun Park
- Department of Conservative Dentistry, Dental Research Institute and School of Dentistry, Seoul National University, Seoul 03080, Republic of Korea.
| | | | - Won-Jun Shon
- Department of Conservative Dentistry, Dental Research Institute and School of Dentistry, Seoul National University, Seoul 03080, Republic of Korea
| | - Ho-Young Kim
- Department of Mechanical Engineering, Seoul National University, Seoul 08826, Republic of Korea.
| | - Wonjung Kim
- Department of Mechanical Engineering, Sogang University, Seoul 04107, Republic of Korea; Institute of Emergent Materials, Sogang University, Seoul 04107, Republic of Korea.
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24
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Elheeny AAH, Abdelmotelb MA. Postoperative pain after primary molar pulpectomy using rotary or reciprocating single files: A superior, parallel, randomized clinical trial. Int J Paediatr Dent 2022; 32:819-827. [PMID: 35152509 DOI: 10.1111/ipd.12959] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 01/30/2022] [Accepted: 02/09/2022] [Indexed: 11/29/2022]
Abstract
AIM To compare postoperative pain intensity between two single-file systems with different kinetics (the OneShape file with continuous rotation vs. the WaveOne Gold file with reciprocation movement) after primary molar pulpectomy. DESIGN This superiority, parallel, randomized clinical trial included 164 healthy children aged 6 to 8 years with asymptomatic, necrotic, maxillary primary second molars due to caries. An equal number of children were assigned to the two groups. The teeth of children in Group 1 were instrumented with the OneShape rotary system (Micro-Mega), whereas teeth of children in Group 2 were instrumented with the WaveOne Gold reciprocating system (Dentsply Maillefer). Postoperative pain intensity was assessed using a 4-point pain scale at 6, 12, 24, 48 and 72 h and 1 week after treatment. The parent of each participant received 6 flashcards that included four faces and a word describing each face. A chi-square test was used to compare postoperative pain intensity. The level of significance was set to 5%. RESULTS Over the follow-up period, no significant difference in postoperative pain intensity was found between the two groups (p > .05). Although the absolute risk reduction maximum limit of 95% CI equal or exceeded the predetermined proportional difference of 0.15, pain intensity was inconclusive at 6, 24, and 48 hours denoting that the superiority of the OneShape single-file over the WaveOne Gold single-file could not be declared. CONCLUSIONS Postoperative pain intensity associated with a rotary vs. reciprocating file system was nearly similar.
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25
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SERÇE FİKİRLİ B, ALTUNKAYNAK B, KAYAOĞLU G. Kök kanal geometrisinin ve iğne tipinin apikalden irrigan taşmasına etkisi: ex vivo çalışma. ACTA ODONTOLOGICA TURCICA 2022. [DOI: 10.17214/gaziaot.945129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective: The aim was to evaluate the effect of root canal geometry on the amount of apical extrusion of irrigant, by testing different tapers and needle types.
Materials and Method: Forty-three extracted single-rooted human mandibular premolar teeth were accessed. Experimental groups were instrumented to produce increasing amounts of taper in each successive group: Group 1 (#25/.02), Group 2 (#25/.04), Group 3 (#25/.06), and Group 4 (#25/.08) (n=43, each). Irrigation was done sequentially by using a 30-G open-ended flat needle, 30-G close-ended side-vented needle, and 27-G open-ended beveled needle. Flat and side-vented needles were each placed 3 mm short of the apex, while the beveled needle was placed as far as possible in the canal without binding. Extruded irrigant was collected in preweighed foam cubes. Statistical significance was set at p<0.05.
Results: An increase in canal taper led to a decrease in the amount of extruded irrigant for the flat needle (p<0.05; Groups 1 and 2 versus 3 and 4) and side-vented needle (p<0.05; Groups 1 and 2 versus 4), but no significant effect was found for the beveled needle. The amount of extruded irrigant was greater with the flat than with the side-vented needle at all tapers and with the beveled needle at most tapers (p<0.05). The side-vented needle was generally associated with the least amount of extrusion.
Conclusion: Given a constant needle insertion depth, the amount of apically extruded irrigant decreased as canal taper increased. The greatest and least amounts of extrusion were generally observed with the flat and side-vented needle, respectively.
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Affiliation(s)
| | | | - Güven KAYAOĞLU
- Department of Endodontics, Faculty of Dentistry, Gazi University
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26
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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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27
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Pereira MR, Silva G, Semiao V, Silverio V, Martins JNR, Pascoal-Faria P, Alves N, Dias JR, Ginjeira A. Experimental validation of a computational fluid dynamics model using micro-particle image velocimetry of the irrigation flow in confluent canals. Int Endod J 2022; 55:1394-1403. [PMID: 36040378 DOI: 10.1111/iej.13827] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/27/2022]
Abstract
AIM This study aimed to experimentally validate a computational fluid dynamics (CFD) model, using micro-particle image velocimetry (micro-PIV) measurements of the irrigation flow velocity field developed in confluent canals during irrigation with a side-vented needle. METHODOLOGY A microchip with confluent canals, manufactured in polydimethylsiloxane (PDMS) was used in a micro-PIV analysis of the irrigation flow using a side vented needle placed 3 mm from the end of the confluence of the canals. Velocity fields and profiles were recorded for flow rates of 0.017 mL/s and 0.1 mL/s and compared with those predicted in CFD numerical simulations (using a finite volume commercial code - FLUENT) for both laminar and turbulent regimes. RESULTS The overall flow pattern, isovelocity and vector maps as well as velocity profiles showed a close agreement between the micro-PIV experimental and CFD predicted data. No relevant differences were observed between the results obtained with the laminar and turbulent flow models used. CONCLUSIONS Results showed that the laminar CFD modelling is reliable to predict the flow in similar domains.
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Affiliation(s)
- Mário Rito Pereira
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
| | - Goncalo Silva
- IDMEC, Department of Mechatronics, Universidade de Évora, Évora, Portugal
| | - Viriato Semiao
- IDMEC, Instituto Superior Técnico, Departamento de Engenharia Mecânica, Universidade de Lisboa, Lisboa, Portugal
| | - Vania Silverio
- Instituto de Engenharia de Sistemas e Computadores - Microsistemas e Nanotecnologias, INESC, MN, Lisboa, Portugal.,Department of Physics, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - Jorge N R Martins
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
| | - Paula Pascoal-Faria
- Mathematics Department of the School of Technology and Management (ESTG) and Centre for Rapid and Sustainable Product Development (CDRSP) from the Polytechnic of Leiria, Marinha Grande, Portugal
| | - Nuno Alves
- Centre for Rapid and Sustainable Product Development, Instituto Politécnico de Leiria, Marinha Grande, Portugal
| | - Juliana R Dias
- Centre for Rapid and Sustainable Product Development, Instituto Politécnico de Leiria, Marinha Grande, Portugal
| | - António Ginjeira
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
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28
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Swimberghe RCD, Tzourmanas R, De Moor RJG, Braeckmans K, Coenye T, Meire MA. Explaining the working mechanism of laser‐activated irrigation and its action on microbial biofilms: a high‐speed imaging study. Int Endod J 2022; 55:1372-1384. [DOI: 10.1111/iej.13824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/11/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Affiliation(s)
- R. C. D. Swimberghe
- Department of Oral Health Sciences, Section of Endodontology Ghent University Ghent Belgium
| | - R. Tzourmanas
- Department of Oral Health Sciences, Section of Endodontology Ghent University Ghent Belgium
| | - R. J. G. De Moor
- Department of Oral Health Sciences, Section of Endodontology Ghent University Ghent Belgium
| | - K. Braeckmans
- Department of Pharmaceutics, Bio‐Photonics Research Group, Laboratory of General Biochemistry & Physical Pharmacy Ghent University Ghent Belgium
| | - T. Coenye
- Department of Pharmaceutics, Laboratory of Pharmaceutical Microbiology Ghent University Ghent Belgium
| | - M. A. Meire
- Department of Oral Health Sciences, Section of Endodontology Ghent University Ghent Belgium
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29
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Özdemir O, Hazar E, Koçak S, Sağlam BC, Koçak MM. The frequency of sodium hypochlorite extrusion during root canal treatment: an observational clinical study. Aust Dent J 2022; 67 Suppl 1:S57-S64. [PMID: 35707880 DOI: 10.1111/adj.12924] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND To determine the frequency of sodium hypochlorite (NaOCl) extrusion and evaluate the outcome of the injury. METHODS A total of 1123 teeth indicated root canal treatment were included. Open-ended needle was used during/after the instrumentation. Acute burning pain during irrigation was considered as NaOCl extrusion. Negative aspiration was applied for patients with extrusion, and appropriate treatment was planned due to the symptoms. The number of patients who experienced extrusion and symptoms were recorded. Analysis of variance (ANOVA), at p<0.05, was used to compare the data groups. RESULTS NaOCl extrusion rate was found at 0.89%, and the injury with swelling that differential diagnosis of NaOCl accident caused by extrusion rate was 0.18%. The most common findings besides acute pain, as a sign of extrusion (n=10), were accompanying apical bleeding (n=6), and swelling (n=2). According to the number of visits, a significant correlation was found between the symptoms (p = 0.010). No serious injury such as a neurological sign, tissue necrosis, or trismus occurred in any patient. CONCLUSIONS Demographic characteristics of the patients and preoperative condition of teeth were not related to NaOCl extrusion. The increasing number of visits may affect the probability of an accident. Negative aspiration immediately may be crucial in preventing severe injuries. © 2022 Australian Dental Association.
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Affiliation(s)
- Olcay Özdemir
- Karabük University, Faculty of Dentistry, Department of Endodontics, 78050, Karabük, Turkey
| | - Ecehan Hazar
- Zonguldak Bülent Ecevit University, Faculty of Dentistry, Department of Endodontics, 67600, Zonguldak, Turkey
| | - Sibel Koçak
- Zonguldak Bülent Ecevit University, Faculty of Dentistry, Department of Endodontics, 67600, Zonguldak, Turkey
| | - Baran Can Sağlam
- Zonguldak Bülent Ecevit University, Faculty of Dentistry, Department of Endodontics, 67600, Zonguldak, Turkey
| | - Mustafa Murat Koçak
- Zonguldak Bülent Ecevit University, Faculty of Dentistry, Department of Endodontics, 67600, Zonguldak, Turkey
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30
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Zhou N, Huang Z, Yu M, Deng S, Fu B, Jin H. Influence of needle working length and root canal curvature on irrigation: a computational fluid dynamics analysis based on a real tooth. BMC Oral Health 2022; 22:179. [PMID: 35568838 PMCID: PMC9107698 DOI: 10.1186/s12903-022-02205-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/27/2022] [Indexed: 11/25/2022] Open
Abstract
Backgrounds To compare the irrigation efficiency with different needle working length and different root canal curvature based on a real unshaped root canal using computational fluid dynamics (CFD) method. Methods Images of the root canal of the maxillary first molar after being prepared to .04/15 were scanned using micro-CT, and then imported into the software for three-dimensional reconstruction. A palatal root canal with a curvature of 23.4° was selected as the experiment canal. The needle working length of the 30-G flat needle was 4.75 mm, 5 mm, 5.25 mm and 5.5 mm short of apical foramen respectively, the flow pattern, irrigation velocity, shear stress were compared. The modified curved canals with a curvature of 0°, 5°, 10°, 20° and 30°were reconstructed via software. The flat needle was replaced at the optical inserted depth, and key parameters of irrigation efficiency were analyzed. Results Decreased needle working length had a positive impact on irrigation efficiency. With the optimal needle working length, the replacement of the apical irrigation fluid, the effective velocity, and wall shear stress were significantly improved in more severely curved root canals. With the same needle working depth and analogous canal curvature, irrigation efficiency is higher in real canal than that of modified canal. Conclusions Short needle working depth, large curvature and the anomalous inner wall of canals help to improve irrigation efficiency.
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Affiliation(s)
- Na Zhou
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, 310006, Hangzhou, People's Republic of China
| | - Zhengqiu Huang
- College of Mechanical and Electrical Engineering, China Jiliang University, 310006, Hangzhou, People's Republic of China
| | - Mingzhou Yu
- College of Mechanical and Electrical Engineering, China Jiliang University, 310006, Hangzhou, People's Republic of China
| | - Shuli Deng
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, 310006, Hangzhou, People's Republic of China
| | - Baiping Fu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, 310006, Hangzhou, People's Republic of China.
| | - Hanhui Jin
- School of Aeronautics and Astronautics, Zhejiang University, 310006, Hangzhou, People's Republic of China.
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Provoost C, Rocca GT, Thibault A, Machtou P, Bouilllaguet S. Influence of Needle Design and Irrigant Flow Rate on the Removal of Enterococcus faecalis Biofilms In Vitro. Dent J (Basel) 2022; 10:dj10040059. [PMID: 35448053 PMCID: PMC9030241 DOI: 10.3390/dj10040059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 01/27/2023] Open
Abstract
This study aimed to evaluate the influence of needle design and irrigant flow rate on the removal of Enterococcus faecalis mature biofilms during sodium hypochlorite irrigation. Forty-eight single-rooted human teeth were instrumented (ProTaper F3), autoclaved and inoculated with Enterococcus faecalis to establish a two-week-old biofilm. E. faecalis biofilms were treated with Sodium hypochlorite that was injected in the root canals using three types of needles (NaviTip, ProRinse, IrriFlex). For the IrriFlex needle, one, two, or four bars of pressure was applied to the irrigating solution to increase flow rates. Bacteria were labeled with the LIVE/DEAD BacLight Bacterial Viability kit, and viability was assessed by flow cytometry (FCM). Results were statistically analyzed using one-way ANOVA and Tukey multiple comparison intervals (α = 0.05). Bacterial viability was significantly reduced after sodium hypochlorite passive irrigation but the number of viable bacteria retrieved from root canal specimens irrigated with the Pro-Rinse needle was significantly higher compared to NaviTip and IrriFlex needles (p < 0.05). When the irrigant flow rate was increased, the viability of bacterial biofilms was significantly reduced compared to passive irrigation using the IrriFlex needle (p < 0.05). Applying higher flow rates during irrigation using the IrriFlex needle did not further reduce bacterial viability.
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Bogari DF, Alessa M, Aljaber M, Alghamdi F, Alamoudi M, Alhamed M, Alghamdi AJ, Elsherief S, Almalki M, Alhazzazi TY. The Biological and Mechanical Effect of Using Different Irrigation Methods on the Bond Strength of Bioceramic Sealer to Root Dentin Walls. Cureus 2022; 14:e24022. [PMID: 35573588 PMCID: PMC9092210 DOI: 10.7759/cureus.24022] [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] [Accepted: 04/08/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives This study aimed to evaluate the biological and mechanical effect of different irrigation methods on the bond strength of Bioceramic (BC) sealer to root canal dentin walls. Material and Methods Forty-Five single-rooted teeth were decoronated and then prepared using rotary instrumentation. Teeth were randomly divided into three groups. Group 1: using the conventional syringe method; Group 2: using the ultrasonic (US) activation method; and Group 3: using the Nd:YAG laser activation method. The BC sealer (TotalFill® BC Sealer™, FKG Dentaire, Switzerland) was used for obturation according to the manufacturer's recommendation. The bond strength was evaluated using the push-out test, and the adaptation of the sealer/dentin interface was assessed using Scanning Electron Microscope (SEM). Data were analyzed by Welch's ANOVA analysis of variance and Games-Howell for pairwise comparison. The level of statistical significance was set at 95% (p-value ≤ 0.05). Results The push-out bond strength values of the Nd:YAG (6.46 ± 0.5) laser group were statistically significant than both conventional (3.33 ± 1.8) and US groups (4.21 ± 2.2). The mean gaps that were formed between the root walls and GP/BS sealer interface were statistically significant only between the Nd:YAG laser group (25.54 ± 13.8) compared to both conventional (62.00 ± 15.3) and US groups (58.82 ± 23.8) (p ≤0.05). No significant difference was found between the conventional and US groups in both rested parameters (p >0.05). Conclusion The method protocol of RC system irrigation affects the adhesion and bond strength of BS sealers to the root canal dentin walls.
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Affiliation(s)
- Dania F Bogari
- Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | | | | | - Faisal Alghamdi
- Oral Biology, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | | | | | | | - Samia Elsherief
- Restorative Dentistry, Faculty of Dentistry, Umm Al-Qura University, Makkah, SAU
| | - Majed Almalki
- Restorative Dentistry, Faculty of Dentistry, Umm Al-Qura University, Makkah, SAU
| | - Turki Y Alhazzazi
- Oral Biology, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
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Boutsioukis C, Arias-Moliz MT. Present status and future directions - irrigants and irrigation methods. Int Endod J 2022; 55 Suppl 3:588-612. [PMID: 35338652 PMCID: PMC9321999 DOI: 10.1111/iej.13739] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
Irrigation is considered the primary means of cleaning and disinfection of the root canal system. The purpose of this review was to set the framework for the obstacles that irrigation needs to overcome, to critically appraise currently used irrigants and irrigation methods, to highlight knowledge gaps and methodological limitations in the available studies and to provide directions for future developments. Organization of bacteria in biofilms located in anatomic intricacies of the root canal system and the difficulty to eliminate them is the main challenge for irrigants. Sodium hypochlorite remains the primary irrigant of choice, but it needs to be supplemented by a chelator. Delivery of the irrigants using a syringe and needle and activation by an ultrasonic file are the most popular irrigation methods. There is no evidence that any adjunct irrigation method, including ultrasonic activation, can improve the long‐term outcome of root canal treatment beyond what can be achieved by instrumentation and syringe irrigation. It is necessary to redefine the research priorities in this field and investigate in greater depth the penetration of the irrigants, their effect on the biofilm and the long‐term treatment outcome. New studies must also focus on clinically relevant comparisons, avoid methodological flaws and have sufficiently large sample sizes to reach reliable conclusions. Future multidisciplinary efforts combining the knowledge from basic sciences such as Chemistry, Microbiology and Fluid Dynamics may lead to more effective antimicrobials and improved activation methods to bring them closer to the residual biofilm in the root canal system.
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Affiliation(s)
- C Boutsioukis
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M T Arias-Moliz
- Department of Microbiology, Faculty of Dentistry, University of Granada, Granada, Spain
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Çiftçioğlu E, Yücel Ö, Işık V, Keleş A, Kayahan MB. Irrigant flow characteristics in the root canal with internal root resorption: a computational fluid dynamics evaluation. Odontology 2022; 110:769-776. [PMID: 35218447 DOI: 10.1007/s10266-022-00698-5] [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: 12/06/2021] [Accepted: 02/11/2022] [Indexed: 11/30/2022]
Abstract
Irrigation dynamics of syringe irrigation with different needle designs (side-vented, double side-vented, notched) and ultrasonic irrigation in the root canal with internal root resorption were evaluated using a computational fluid dynamics model. A micro-CT scanned mandibular premolar was used for modeling internal root resorption. The needles and the ultrasonic tip were positioned at 2, 4, and 5 mm from the working length. The insertion depth and the irrigation model were found influential on the shear stress and the irrigant extension. The extension of the irrigant increased toward 2-5 mm from the working length. Ultrasonic irrigation revealed the highest shear stress values regardless of the insertion depth. The shear stress distribution on the resorption cavity walls gradually increased when the needles were positioned coronally. The residence time of the irrigant in the canal was affected by the needle position relative to the internal root resorption cavity and the needle type.
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Affiliation(s)
- Elif Çiftçioğlu
- Department of Endodontics, İstanbul Okan University Faculty of Dentistry, İstanbul, Turkey.
| | - Özgün Yücel
- Department of Chemical Engineering, Gebze Technical University Faculty of Engineering, Kocaeli, Turkey
| | - Vasfiye Işık
- Department of Endodontics, İstanbul Health and Technology University Faculty of Dentistry, İstanbul, Turkey
| | - Ali Keleş
- Department of Endodontics, Ondokuz Mayıs University Faculty of Dentistry, Samsun, Turkey
| | - Mehmet Baybora Kayahan
- Department of Endodontics, İstanbul Health and Technology University Faculty of Dentistry, İstanbul, Turkey
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S. DPA, Solete P, Jeevanandan G, Syed AA, Almahdi S, Alzhrani M, Maganur PC, Vishwanathaiah S. Effect of Various Irrigant Activation Methods and Its Penetration in the Apical Third of Root Canal-In Vitro Study. Eur J Dent 2022; 17:57-61. [PMID: 35189642 PMCID: PMC9949917 DOI: 10.1055/s-0041-1742122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the irrigant penetration using iohexol dye with four irrigation techniques. METHODOLOGY Single-rooted premolars were recently extracted and preserved in physiological saline solution. All the samples were standardized to 16 mm. Standard endodontic access was prepared using endoaccess bur (Dentsply Maillefer, Switzerland). The initial patency was established using #10 k file (Mani, Utsunomiya, Tochigi, Japan) to the working length. The cleaning and shaping were performed using the file system ProFit S3 in the following sequence: P0 (orifice enlarger), PF1 (yellow), PF2 (red) #25, and PF3 (blue) #30. The samples were randomly allocated in concealed opaque envelopes into four groups. This was performed by a trained dentist. Fifteen samples were allocated to one group. The groups were divided as follows: Group A-conventional needle (CN), Group B-side-vented needle (SVN), Group C-manual dynamic agitation (MDA), and Group D-EndoActivator (EA). The radiopaque dye irrigant agitation/activation was performed by one operator to prevent operator bias. Following irrigation using the different techniques, digital radiographs were taken, and the measurement was taken from the apical foramen to the point where the dye had penetrated apically for each tooth and the data were entered into an Excel sheet for all the four groups. RESULTS Comparing the four groups, there was a statistically significant difference among the four groups (p < 0.05), thus, favoring the alternate hypothesis. EA had resulted in better penetration of the irrigant compared with the other three groups (p < 0.05). CONCLUSION It was evident that irrigant penetration was best achieved with the use of an EA followed by MDA, SVNs, and then the CN when the preparation was done till size 30 (PF3 #30) using ProFit S3 rotary file system.
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Affiliation(s)
- Delphine Pricilla Antony S.
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - Pradeep Solete
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - Ganesh Jeevanandan
- Department of Pediatric and Preventive Dentistry, Saveetha Dental College, Saveetha Institute of Medical and Technical Science, Chennai, Tamil Nadu, India,Ganesh Jeevanandan, BDS, MDS, PhD Department of Pediatric and Preventive Dentistry, Saveetha Dental College, Saveetha Institute of Medical and Technical ScienceChennai, Tamil NaduIndia
| | - Ather Ahmed Syed
- Division of Pedodontics, Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Samaher Almahdi
- Division of Pedodontics, Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
| | | | - Prabhadevi C. Maganur
- Division of Pedodontics, Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Satish Vishwanathaiah
- Division of Pedodontics, Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia,Address for correspondence Satish Vishwanathaiah, BDS, MDS, FICD, FPFA Division of Pedodontics, Department of Preventive Dental Sciences, College of Dentistry, Jazan UniversityJazanKingdom of Saudi Arabia
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Chaniotis A, Ordinola Zapata R. Present status and future directions -Management of curved and calcified root canals. Int Endod J 2022; 55 Suppl 3:656-684. [PMID: 35106792 DOI: 10.1111/iej.13685] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 12/01/2022]
Abstract
Root canal curvature and calcification introduce factors that increase the risk of procedural accidents during root canal treatment. The inability to achieve patency to the apical third, asymmetrical dentine removal leading to transportation, perforation and instrument fracture inside the curved trajectories are some of the procedural problems that might jeopardize the management of intraradicular infection and result in poor treatment outcomes. In fact, curved and constricted canals introduce such complexity that total instrumentation concepts and specially designed instruments have been developed to deal with the challenge. This narrative review seeks to provide and consolidate the principles necessary for understanding the dynamics of curved and constricted canal management and to improve the understanding for future developments in this field.
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Affiliation(s)
- Antonis Chaniotis
- Private practice, National and Kapodistrian University of Athens, Dental School, Athens, Greece
| | - Ronald Ordinola Zapata
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA
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Teja KV, Ramesh S, Battineni G, Vasundhara KA, Jose J, Janani K. The effect of various in-vitro and ex-vivo parameters on irrigant flow and apical pressure using manual syringe needle irrigation: Systematic review. Saudi Dent J 2022; 34:87-99. [PMID: 35241897 PMCID: PMC8864379 DOI: 10.1016/j.sdentj.2021.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/14/2021] [Accepted: 12/01/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Fluid dynamics is a majorly neglected aspect to be studied in root canal irrigation. The fundamental rule to understand mechanics is to observe patterns of flow during the process. Thus, this work is conducted to do a systemic assessment of the in-vitro and ex-vivo based studies to evaluate the effect of various parameters on the irrigant flow and apical pressure on using a manual syringe needle for root canal irrigation. METHODS The literature search was conducted through libraries such as PubMed (Medline), CINAHL, Embase, Scopus and other hand literature from Google Scholar, the British medical library etc. The systematic review was reported following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. As they include studies that were in-vitro and ex-vivo based, the risk of bias of the selected articles was assessed using a customized tool based on the previous literature and parameters evaluated in the studies included. RESULTS The literature search resulted in 101 items of which 19 records were included in this review. Results reported that multiple factors and parameters were assessed to evaluate the flow and apical pressures on using manual syringe needle irrigation. CONCLUSIONS Present systematic review gives insights in-depth about the irrigation dynamics of manual syringe needle irrigation. Besides, it is inconclusive to compile a single factor or a single parameter contributing to the enhanced irrigant flow and least apical pressures.
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Affiliation(s)
- Kavalipurapu Venkata Teja
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, TamilNadu, India
| | - Sindhu Ramesh
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, TamilNadu, India
| | - Gopi Battineni
- Telemedicine and Telepharmacy Centre, School of Medicinal and Health Product Sciences, University of Camerino, Camerino, Italy
| | | | - Jerry Jose
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, TamilNadu, India
| | - Krishnamachari Janani
- Department of Conservative Dentistry and Endodontics, MDS, Private Consultant, Chennai, Tamil Nadu, India
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Tashkandi N, Alghamdi F. Effect of Chemical Debridement and Irrigant Activation on Endodontic Treatment Outcomes: An Updated Overview. Cureus 2022; 14:e21525. [PMID: 35223300 PMCID: PMC8863357 DOI: 10.7759/cureus.21525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 12/20/2022] Open
Abstract
Chemical debridement is considered one of the most important steps during root canal treatment to target unreached areas and provide thorough disinfection of the canals. The efficiency of this step efficiency can be increased using different agitation and irrigation techniques/devices. This comprehensive review aimed to summarize the effect of various irrigant activation and agitation techniques/devices on endodontic treatment outcomes. Using mechanical active irrigation, which enables the activation or agitation of the irrigating solution, is beneficial in root canal treatment by increasing the efficiency of delivering the irrigant up to working length and ensuring isthmus cleanliness. However, considerable variation was noticed between the protocols used in each technique with a lack of well-designed randomized clinical trials to focus on the long-term outcome. Moreover, a low level of evidence was noticed regarding the effectiveness of certain activation techniques over others. Therefore, each study needs to be carefully weighed before using its results and embracing its conclusion. Future studies need to focus more on the antimicrobial effect of each technique and its effect on the healing of apical periodontitis. Also, recent advances, such as multisonic and laser activation, are promising tools that need more clinical investigations to show their efficiency.
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Comparison of Herbal Agents with Sodium Hypochlorite as Root Canal Irrigant: A Systematic Review of In Vitro Studies. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:8967219. [PMID: 34868334 PMCID: PMC8639255 DOI: 10.1155/2021/8967219] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/10/2021] [Indexed: 11/18/2022]
Abstract
During endodontic treatment, eliminating microorganisms from the root canals should be considered with utmost importance. Before filling the canal, every effort should be made to ensure optimal shaping and adequate disinfection of the root canal system. This systematic review aimed to compare the efficacy of herbal agents with sodium hypochlorite (NaOCl) in reducing the microbial load while used as a root canal irrigant. The research question in the present study was to assess “Is there a significant difference in reducing microbial load comparing sodium hypochlorite (NaOCl) and herbal agents.” Electronic databases (PubMed, Scopus, and Web of Science) were searched from their start dates to November 2020 using strict inclusion and exclusion criteria and reviewed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Only in vitro studies comparing herbal agents with NaOCl regarding antimicrobial efficiency were included. Two reviewers independently assessed the included article. 825 articles were obtained from an electronic database. Twenty papers were included for review of the full text. Eleven papers were excluded because they did not meet the inclusion criteria. Finally, nine articles were included in the systematic review. The present systematic review was at the in vitro level; therefore, the result cannot translate the exact clinical conditions. This systematic review concludes that herbal agents cannot be used as a main irrigant for canal disinfection.
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Examination of Irrigant Flow on a Tooth With Internal Root Resorption by Using a Computational Fluid Dynamics Model. Eur Endod J 2021; 6:177-182. [PMID: 34650013 PMCID: PMC8461487 DOI: 10.14744/eej.2021.29290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: This study investigated the flow of an endodontic irrigant in a single-rooted tooth with internal root resorption (IRR). Methods: A simulation of a prepared central incisor with internal root resorption was created and irrigation with a 30-G needle was performed. The fluid pattern of the irrigant was evaluated using a Computational Fluid Dynamics model. In addition, the effects of the needle-insertion depth in the root canal and the size of root resorption on the fluid flow and the wall shear stress (WSS) values were assessed. The IRR was placed immediately below the canal orifice. Results: Inadequate irrigant washout was observed inside the resorption cavity when the needle was positioned 1 mm from the working length while placing the needle slightly above the resorption cavity resulted in significant irrigant circulation inside the resorption cavity. Moreover, when the needle was placed slightly above the defect, the calculated WSS values in the resorption cavity walls were significantly higher (approximately 20 times higher in every case). In cases where the needle was placed 1 mm from the working length, the average and maximum WWS values were between 3 Pa and 51 Pa, while in cases where the needle was placed coronal to the IRR, the values were between 55 Pa and 528 Pa. The radius of the resorption cavity did not affect the irrigant flow patterns. Conclusion: During the endodontic treatment of cases with internal root resorption, complementary irrigations with the needle tip placed slightly above the resorption cavity should be followed to better debride the root canal.
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Accidental Extrusion of Sodium Hypochlorite in a Patient Taking Alendronate: A Case Report With an 8-Year Follow-up. J Endod 2021; 47:1947-1952. [PMID: 34626612 DOI: 10.1016/j.joen.2021.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 12/22/2022]
Abstract
Extrusion of sodium hypochlorite (NaOCl) is a very rare accident with the most common complications including pain, swelling, and hematoma. It can occur even if procedural guidelines, predisposing conditions, and risk factors are taken into consideration. A 59-year-old female patient was admitted to the endodontics department to treat a left maxillary first premolar (World Dental Federation tooth 24). The medical history included osteoporosis and systemic medication with alendronate. Initially, the diagnosis was "symptomatic irreversible pulpitis" with "normal apical tissues." During instrumentation of the buccal canal, accidental extrusion of 2.5% NaOCl occurred into the periapical tissues, resulting from misinterpretation of the working length, and caused severe pain and bleeding. The canal was immediately flushed using copious irrigation with saline solution. An analgesic and corticosteroid were prescribed. At 3 and 7 days, ecchymosis and slight hematoma were observed extraorally in the area of the affected tooth and an intraoral ulceration at the apex of the affected tooth. At 15 days, minimal signs of ecchymosis were observed, and the treatment was resumed. At 30 days after the accident, there was complete remission of the sequelae. The clinical, radiographic, and tomographic assessment after 1 month, 1 year, and 8 years showed favorable case evolution. During the 8-year follow-up, the patient maintained the systemic use of alendronate. It can be concluded that NaOCl extrusion is an accident that causes patients and clinicians to experience an unpleasant consequence. The radiographic working length should always be determined carefully. A successful outcome can be achieved in patients who take alendronate.
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Dafer Al Wadei MH, Kader MA, Mohamed Ali AB, Alaajam WH, Sainudeen S, AlQahtani SM. Examining the Effect of Gravity on Different Irrigation Systems: An In vitro Study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2021; 13:S692-S695. [PMID: 34447183 PMCID: PMC8375912 DOI: 10.4103/jpbs.jpbs_813_20] [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: 12/07/2020] [Revised: 01/01/2021] [Accepted: 01/08/2021] [Indexed: 11/04/2022] Open
Abstract
Background Periapical extrusion is frequently observed during endodontic therapy. It can lead to acute injury of periapical tissues, resulting in interappointment pain or swelling. The effect is pronounced in teeth with immature apex, which are more susceptible to the extrusion of irrigant. The aim of this study was to evaluate the effect of gravity on the apical extrusion of irrigating solution with different irrigation protocols in single-rooted premolars. Methodology A total number of 80 permanent single-rooted teeth (premolars) with same working length (WL) were divided into two main groups: Group A: Penetration depth of irrigation syringe to 2 mm from the WL and Group B: Penetration depth of irrigation syringe to 4 mm from the WL. Each group was subdivided into four subgroups. (n = 10). The extruded debris and irrigants were weighed, and the data were statistically analyzed by the analysis of variance and the Tukey test. Results Irrespective of the irrigation technique used, the amount of irrigant extruded from the apex showed a statistically significant difference related to the effect of gravity (P < 0.05). There was no statistically significant difference observed between irrigation methods (P > 0.05). Conclusion The degree of apical extrusion of irrigant was dependent on the type of irrigation technique and gravity. Greater caution should be taken during irrigation to prevent postoperative pain.
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Affiliation(s)
| | - Mohammed Abdul Kader
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Ahmed Babiker Mohamed Ali
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Wafa Hassan Alaajam
- Department of Substitutive Dental Science, King Khalid University, Abha, Saudi Arabia
| | - Shan Sainudeen
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Saeed M AlQahtani
- Department of Substitutive Dental Science, College of Dentistry, King Khalid University, Abha, Saudi Arabia
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The ability of different irrigation methods to remove mixtures of calcium hydroxide and barium sulphate from isthmuses in 3D printed transparent root canal models. Odontology 2021; 110:27-34. [PMID: 34143348 DOI: 10.1007/s10266-021-00628-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
The purpose is to evaluate the efficacy of different irrigation techniques in the removal of various calcium hydroxide [Ca(OH)2] and barium sulfate [BaSO4] formulations from three isthmuses in 3-dimensional (3D) printed molar root canal models. 3D printed transparent models were designed, fabricated, and filled with pure Ca(OH)2 paste, Ca(OH)2-BaSO4 8:1 paste, Ca(OH)2-BaSO4 1:1 paste, pure BaSO4 paste, all in water, and Diapaste. Open-ended needle irrigation (ONI) at 5 and 15 mL/min, double-side-vented needle irrigation (DNI) at 5 mL/min, the GentleWave system (GW), PiezoFlow (PF), and passive ultrasonic activation (PUI) with distilled water, 0.5% sodium hypochlorite (NaOCl) and 3% NaOCl were used to remove the materials from the isthmuses. Ninety groups (n = 10) were established. The removal time was recorded from the start of irrigation to the completion of removal. GW and PF were the only methods that removed all tested materials from the isthmuses. PF required 2-3 × as much time as GW for complete removal, depending on the BaSO4 content of the paste. ONI at 15 mL/min removed pure Ca(OH)2 paste, Ca(OH)2-BaSO4 (8:1) paste, Ca(OH)2-BaSO4 (1:1) completely but could not completely remove pure BaSO4 paste and Diapaste. PUI with intermittent needle irrigation, ONI, and DNI at 5 mL/min were not able to completely remove any of the materials within 7.5 min. The GW removed all materials faster than PF, whereas other methods failed to remove all materials from the isthmuses. Pure Ca(OH)2 and the mixture with BaSO4 paste in the proportion 8:1 were removed in less time than the other mixtures by the GW, PF and ONI systems, the latter only when using 15 mL/min flow rate.
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44
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Boutsioukis C, Gutierrez Nova P. Syringe Irrigation in Minimally Shaped Root Canals Using 3 Endodontic Needles: A Computational Fluid Dynamics Study. J Endod 2021; 47:1487-1495. [PMID: 34118256 DOI: 10.1016/j.joen.2021.06.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of this study was to compare the irrigant flow in curved root canals prepared to various apical sizes by constant-taper or variable-taper instruments during syringe irrigation with 3 endodontic needles at 2 different flow rates. METHODS Two matched curved mesial root canals of human mandibular molars were imaged by micro-computed tomographic imaging after preparation to apical size 20, 25, and 30/.06 taper either by constant-taper or variable-taper instruments. A Computational Fluid Dynamics model was used to simulate the irrigant flow in the 2 root canals prepared to each apical size during syringe irrigation with a 30-G open-ended needle and 30-G and 31-G closed-ended needles at 0.05 and 0.15 mL/s. RESULTS The irrigant could not penetrate up to the working length in root canals prepared to apical size 20 or 25/.06 taper. The 30-G open-ended needle combined with the low flow rate allowed the irrigant to reach the working length in size 30/.06 taper root canals while maintaining a relatively low apical pressure, but the wall shear stress was very low. The 31-G closed-ended needle combined with the high flow rate also delivered the irrigant to the working length in size 30 root canals and developed higher wall shear stress, but the apical pressure was also higher. CONCLUSIONS Syringe irrigation using 30-G and 31-G needles was compromised in minimally shaped root canals.
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Affiliation(s)
- Christos Boutsioukis
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Patricia Gutierrez Nova
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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45
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Sarwar H, Qazi F, Ahmed S, Abidi Y, Naeem M, Shabbir J, Khurshid Z. Efficacy of Handpiece Mounted Continuous Irrigation System for the Removal of Residual Pulpal Debris During Root Canal Preparation. Eur J Dent 2021; 15:551-556. [PMID: 33975373 PMCID: PMC8382463 DOI: 10.1055/s-0041-1726160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective
The removal of residual pulpal debris (RPD) from the root canal walls, especially in necrotic teeth is important for successful endodontic outcome. The aim of this study was to evaluate the RPD removal efficacy of handpiece mounted continuous irrigation with simultaneous root canal preparation from the apical third of root canals as compared to conventional syringe irrigation (SI).
Materials and Methods
Ninety extracted teeth were randomly divided into three groups: SI; handpiece mounted continuous irrigation (CI); and both syringe and continuous irrigation (CI+SI). After root canal preparation, roots were sectioned at 1 (a), 3 (b) and 5 (c) mm from apex and prepared for Hematoxylin-Eosin staining. Sections were microscopically examined for presence of RPD.
Statistical Analysis
Intergroup difference in average percentage of RPD at different root levels was calculated by using analysis of variance test (ANOVA). Tuckey test was used for pairwise comparison.
Results
ANOVA showed significant difference between all three groups (
p
< 0.05). SI group showed a significantly higher percentage of RPD as compared with CI and CI+ SI groups at all root levels (
p
< 0.01). At root level a, CI showed a significantly higher percentage of RPD as compared with CI+SI (
p
< 0.01).
Conclusion
Handpiece mounted CI during rotary instrumentation showed a significant reduction in RPD as compared with conventional syringe irrigation. This technique was found to be an effective method for an enhanced root canal debridement.
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Affiliation(s)
- Huma Sarwar
- Department of Operative Dentistry & Endodontics, Dr. Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan.,Department of Periodontology, Dr Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
| | - Fazal Qazi
- Department of Operative Dentistry & Endodontics, Dr. Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan.,Department of Periodontology, Dr Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
| | - Shahbaz Ahmed
- Department of Operative Dentistry & Endodontics, Dr. Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan.,Department of Periodontology, Dr Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
| | - Yawar Abidi
- Department of Operative Dentistry & Endodontics, Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Meshal Naeem
- Department of Operative Dentistry & Endodontics, Dr. Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan.,Department of Periodontology, Dr Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
| | - Juzer Shabbir
- Department of Operative Dentistry & Endodontics, Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Zohaib Khurshid
- Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Al Ahsa, Saudi Arabia
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46
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Tanaka T, Yahata Y, Handa K, Venkataiah SV, Njuguna MM, Kanehira M, Hasegawa T, Noiri Y, Saito M. An experimental intraradicular biofilm model in the pig for evaluating irrigation techniques. BMC Oral Health 2021; 21:177. [PMID: 33827540 PMCID: PMC8028066 DOI: 10.1186/s12903-021-01536-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We established an in vivo intraradicular biofilm model of apical periodontitis in pigs in which we compared the efficacy of different irrigant activation techniques for biofilm removal. METHODS Twenty roots from the deciduous mandibular second premolar of 5 male pigs were used. After pulpectomy, canals were left open for 2 weeks and then sealed for 4 weeks to enable the development of an intracanal biofilm. The intraradicular biofilms was evaluated using SEM and bacterial 16S rRNA gene-sequencing. To investigate the efficacy of biofilm removal, root canal irrigations were performed using conventional needle, passive ultrasonic, subsonic, or laser-activated irrigation. Real-time PCR was conducted to quantitate the remaining biofilm components. Statistical analysis was performed using ANOVA followed by a Tukey kramer post-hoc test with α = 0.05. RESULTS The pulp exposure model was effective in inducing apical periodontitis and SEM analysis revealed a multi-layer biofilm formation inside the root canal. 16S rRNA sequence analysis identified Firmicutes, Bacteroidetes, and Fusobacteria as the predominant bacterial phyla components, which is similar to the microbiome profile seen in humans. None of the tested irrigation techniques completely eradicated the biofilm components from the root canal, but the subsonic and laser-activated irrigation methods produced the lowest bacterial counts (p < 0.05). CONCLUSIONS An experimental intraradicular biofilm model has been successfully established in pigs. Within the limitations of the study, subsonic or laser-activated irrigation demonstrated the best biofilm removal results in the pig system.
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Affiliation(s)
- Toshinori Tanaka
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Yoshio Yahata
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aobaku, Sendai, Miyagi, 980-8575, Japan.
| | - Keisuke Handa
- Division of Molecular Biology and Oral Biochemistry, Department of Oral Science, Graduate School of Dentistry, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, Kanagawa, 238-8580, Japan
| | - Suresh V Venkataiah
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Mary M Njuguna
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Masafumi Kanehira
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Tatsuya Hasegawa
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Yuichiro Noiri
- Division of Cariology, Operative Dentistry and Endodontics, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakko-cho-dori, Chuo-ku, Niigata, Niigata, 951-8514, Japan
| | - Masahiro Saito
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aobaku, Sendai, Miyagi, 980-8575, Japan
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47
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Krastl G, Weiger R, Filippi A, Van Waes H, Ebeleseder K, Ree M, Connert T, Widbiller M, Tjäderhane L, Dummer PMH, Galler K. Endodontic management of traumatized permanent teeth: a comprehensive review. Int Endod J 2021; 54:1221-1245. [PMID: 33683731 DOI: 10.1111/iej.13508] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 03/05/2021] [Indexed: 12/15/2022]
Abstract
The pulp plays a key role in the treatment of traumatic dental injuries (TDIs) and is strongly associated with the outcome, particularly in severe cases. A correct pulp diagnosis is essential as it forms the basis for developing the appropriate management strategy. However, many TDIs are complex, and their treatment requires a profound knowledge of the physiological and pathological responses of the affected tissues. This comprehensive review will look at the dentine-pulp complex and its interaction with the surrounding tissues following TDIs. The literature up to 2020 was reviewed based on several searches on PubMed and the Cochrane Library using relevant terms. In addition to the recently revised guidelines of the International Association of Dental Traumatology, this article aims to provide background information with a focus on endodontic aspects and to gather evidence on which a clinician can make decisions on the choice of the appropriate endodontic approach for traumatized permanent teeth.
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Affiliation(s)
- G Krastl
- Department of Conservative Dentistry and Periodontology, Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Germany
| | - R Weiger
- Department of Periodontology, Endodontology and Cardiology, University School of Dental Medicine, Basel, Switzerland.,Center of Dental Traumatology, University School of Dental Medicine, Basel, Switzerland
| | - A Filippi
- Center of Dental Traumatology, University School of Dental Medicine, Basel, Switzerland.,Department of Oral Surgery, University School of Dental Medicine, Basel, Switzerland
| | - H Van Waes
- Department of Paediatric Dentistry, Clinic for Orthodontics and Paediatric Dentistry, University of Zürich, Zürich, Switzerland
| | - K Ebeleseder
- University Clinic of Dental Medicine and Oral Health, Medical University Graz, Graz, Austria
| | - M Ree
- Private Practice, Purmerend, Netherlands
| | - T Connert
- Department of Periodontology, Endodontology and Cardiology, University School of Dental Medicine, Basel, Switzerland.,Center of Dental Traumatology, University School of Dental Medicine, Basel, Switzerland
| | - M Widbiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - L Tjäderhane
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Research Unit of Oral Health Sciences, Medical Research Center Oulu (MRC Oulu), Oulu University Hospital, University of Oulu, Oulu, Finland
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - K Galler
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
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48
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Liapis D, De Bruyne MAA, De Moor RJG, Meire MA. Postoperative pain after ultrasonically and laser-activated irrigation during root canal treatment: a randomized clinical trial. Int Endod J 2021; 54:1037-1050. [PMID: 33595920 DOI: 10.1111/iej.13500] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 12/18/2022]
Abstract
AIM To compare the intensity of postoperative pain after primary root canal treatment of asymptomatic teeth when using ultrasonically (UAI) or laser-activated irrigation (LAI). METHODOLOGY In this superiority randomized clinical trial (ClinicalTrials.gov ID: NCT03981237) with parallel design, fifty-six patients with an asymptomatic tooth in need of primary root canal treatment were enrolled. After chemo-mechanical canal preparation using rotary instruments and NaOCl irrigation, teeth were randomly assigned to two groups and patients were blinded to the final irrigation protocol. In the UAI group (n = 28), 60s activation with an Irrisafe tip was done per canal. In the LAI group (n = 28), NaOCl was activated with a pulsed Er:YAG (2940 nm) laser, equipped with a conical tip, with settings of 50 µs, 20 mJ at 15 Hz for 60 s. Patients recorded their pain intensity 6, 24, 48 and 72 h after treatment on a 100 mm visual analogue scale (VAS), as well as their analgesic consumption. Pain levels and incidence were compared across groups using the Mann-Whitney U-test and chi-square test. RESULTS Overall, mean postoperative pain intensity was low, with the majority of patients having no or minimal pain 24 h postoperatively. At 6 h postoperatively, pain intensity and incidence were significantly higher in the UAI group compared to the LAI group (P < 0.05). For the other time intervals, no significant differences in postoperative pain incidence or intensity were found. The frequency of analgesic intake did not differ significantly between the two groups. Neither of the activation methods resulted in any adverse effects. CONCLUSIONS Ultrasonically and laser-activated irrigation resulted in low and comparable levels of postoperative pain in asymptomatic patients receiving primary root canal treatment.
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Affiliation(s)
- D Liapis
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - M A A De Bruyne
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - R J G De Moor
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - M A Meire
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
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49
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Ordinola-Zapata R, Crepps JT, Arias A, Lin F. In vitro apical pressure created by 2 irrigation needles and a multisonic system in mandibular molars. Restor Dent Endod 2021; 46:e14. [PMID: 33680903 PMCID: PMC7906849 DOI: 10.5395/rde.2021.46.e14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/21/2020] [Accepted: 12/27/2020] [Indexed: 11/12/2022] Open
Abstract
Objectives The aim of this study was to evaluate the apical pressure generated by 2 endodontic irrigation needles and the GentleWave system in mandibular molars. Materials and Methods The mesial and distal root canals of 12 mandibular molars were irrigated with a 30-gauge close-end needle or with a 30-gauge open-end needle. Procedures were performed in the mesial and distal canals. The GentleWave procedure and irrigation at 1 mm from the apex in the distal roots using an open-end needle were used, respectively, as negative and positive controls. The apical pressure was measured using a data acquisition pressure setup. Apical pressure exerted by the different needles in the 2 different canal types was statistically compared using 2-way analysis of variance. Results Significant differences were found in the apical pressure for both needles and the canal type. The lowest values were obtained with close-end needles and in mesial canals. Negative apical pressure values were obtained using GentleWave. Conclusions The needle and the canal type influenced the apical pressure. The GentleWave procedure produced negative apical pressure.
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Affiliation(s)
- Ronald Ordinola-Zapata
- Division of Endodontics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Joseph T Crepps
- Division of Endodontics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Ana Arias
- Conservative Dentistry Department, School of Dentistry, Universidad Complutense de Madrid, Madrid, Spain
| | - Fei Lin
- Division of Endodontics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.,Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing, China
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50
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Salas H, Castrejon A, Fuentes D, Luque A, Luque E. Evaluation of the penetration of CHX 2% on dentinal tubules using Conventional Irrigation, Sonic Irrigation (EDDY) and Passive Ultrasonic Irrigation (PUI) techniques: An in vitro study. J Clin Exp Dent 2021; 13:e37-e42. [PMID: 33425229 PMCID: PMC7781212 DOI: 10.4317/jced.57065] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/10/2020] [Indexed: 11/30/2022] Open
Abstract
Background Various procedures and techniques have been developed to increase the effectiveness and penetration of irrigants into the dentinal tubules and anatomical anfractuosities. Objective: The purpose of this in vitro study was to compare the effect of different irrigation techniques such as conventional irrigation with a syringe, sonic activation irrigation with EDDY and Passive Ultrasonic Irrigation. All these on dentinal tubule penetration using Chlorhexidine.
Material and Methods 45 lower premolar teeth extracted for orthodontic reasons were used. These teeth were decoronated to a length of 18mm. This working length was achieved by inserting a size 15 K file into the root canal until it was observed in the ápex. Then the length was reduced to 1 mm. The instrumentation was performed with the Wave One Gold system up to a file # 45. Irrigated with 2mL of CHX between instruments. A final irrigation was performed using 5 mL of 17% EDTA with an E1 - Irrisonic insert for 30 seconds. Then, the root canal was irrigated with 5 mL of distilled water and dried with paper tips. The final irrigation of the 2% CHX with Rhodamine B was carried out with the different techniques of irrigation. Syringe irrigation with 5 mL, sonic irrigation and passive ultrasonic activation activated for 30 seconds in two stages. Axial cuts were made at 200 microns, the observation was done with stereomicroscope and image analysis in Image J software.
Results Statistically significant differences were found only in the apical region, where the depth penetration in the PUI group was 76 µm, MI 48 µm and SI 41 µm, while in the penetration area, the PUI group was 99 µm2, MI 77 µm2 and finally SI 53 µm2.
Conclusions The CHX was able to penetrate the dentinal tubules of three-thirds of the roots, for which the technique that showed the greatest penetration capacity was the ultrasonic activation. Key words:Clorhexidine. Dentinal tubule. Dentinal penetration. Passive ultrasonic irrigation. Eddy. Manual irrigation.
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Affiliation(s)
- Hair Salas
- DDs, MSc, PhD. Facultad de Odontología de Universidad Católica de Santa María, Arequipa, Perú
| | | | | | | | - Edson Luque
- DDS. Práctica privada exclusiva a la endodoncia
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