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Parkar A, Banga KS, Pawar AM, Luke AM. Extrusion of Sodium Hypochlorite in Oval-Shaped Canals: A Comparative Study of the Potential of Four Final Agitation Approaches Employing Agarose-Embedded Mandibular First Premolars. J Clin Med 2024; 13:2748. [PMID: 38792290 PMCID: PMC11121930 DOI: 10.3390/jcm13102748] [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: 04/05/2024] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
Background: The aim of this investigation was to assess the apical extrusion potential of sodium hypochlorite (NaOCl) in agarose-embedded mandibular first premolars employing four final agitation procedures. Methods: Based on CBCT confirmation of single oval-shaped canals, one hundred extracted mandibular first premolars were chosen. Using 5.25% NaOCl, the teeth were prepared using the XP Endo Shaper and divided into experimental and control groups. The following were the experimental groups: Group 1 comprised the XP-Endo Finisher, Group 2 the Ultrasonic Activation, Group 3 the Gentle File Finisher Brush, and Group 4 the 27-gauge side-vented needle. To test extrusion, the teeth were placed in a 0.2% agarose gel that contained the pH-sensitive dye m-cresol purple, allowing pixel quantification via ImageJ software (version 1.54i). Results: The XP Endo Finisher featured the most pixels, depicting higher apical extrusion (p < 0.01), followed by the side-vented needle, Gentle File Finisher Brush, and PUI, while the Control Group endured no extrusion. Conclusions: The effective irrigation method for root canal therapy is critical, especially in situations of open apices, resorption, or perforation. According to in vitro experiments, the XP-Endo Finisher has the maximum sodium hypochlorite extrusion, which is determined by parameters such as apical preparation size and irrigation system.
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Affiliation(s)
- Aalisha Parkar
- Department of Conservative Dentistry and Endodontics, Nair Hospital Dental College, Mumbai 400008, India; (A.P.); (K.S.B.)
| | - Kulvinder Singh Banga
- Department of Conservative Dentistry and Endodontics, Nair Hospital Dental College, Mumbai 400008, India; (A.P.); (K.S.B.)
| | - Ajinkya M. Pawar
- Department of Conservative Dentistry and Endodontics, Nair Hospital Dental College, Mumbai 400008, India; (A.P.); (K.S.B.)
| | - Alexander Maniangat Luke
- Department of Clinical Sciences, College of Dentistry, Ajman University, Al-Jruf, Ajman P.O. Box 346, United Arab Emirates;
- Centre of Medical and Bio-Allied Health Science Research (CMBHSR), Ajman University, Al-Jruf, Ajman P.O. Box 346, United Arab Emirates
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Izadi A, Lashkarbolok M, Kazeminejad E, Tavakolinejad Kermani I, Mesri Y. Numerical investigation of injection characteristics on normal saline irrigation quality in curved root canals using computational fluid dynamics. Heliyon 2024; 10:e23773. [PMID: 38192861 PMCID: PMC10772184 DOI: 10.1016/j.heliyon.2023.e23773] [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: 02/26/2023] [Revised: 11/29/2023] [Accepted: 12/13/2023] [Indexed: 01/10/2024] Open
Abstract
Objectives The primary aim of this research was to find the effects of Normal saline injection rate and position on irrigation quality in curved root canals. Methods Computational Fluid Dynamics (CFD) was used to simulate irrigation in root canals. Root canal geometries were obtained by considering the complete shaping of a rotary file in four root groups with 0, 10, 30, and 60° of curvatures. Fluid surface tension, bouncy, gravity, and air entrance were considered in the numerical simulation using Ansys-CFX software. For each root canal, the flow regime and wall shear stresses were calculated at three different syringe plunger speeds, and three different injection locations of a beveled open-ended needle and their effects on the irrigation quality were investigated in this paper. Results Wall shear stress is considered the main parameter determining irrigation quality. It was calculated for all 36 test cases. Injection rate and normal saline accumulating near the apex and their effects on washed area ratio were shown for the test cases. Results showed significant effects of injection characteristics, incredibly faster injection, and deeper needle position on the irrigation quality of curved root canals. Conclusions A higher injection rate and deeper needle position are required to achieve the best irrigation quality and a more washed area ratio in root canals with greater curvature.
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Affiliation(s)
- Arash Izadi
- Dental Research Center, Golestan University of Medical Sciences, Gorgan, Iran
- Department of Endodontics, Faculty of Dentistry, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mohsen Lashkarbolok
- Department of Civil Engineering, Faculty of Engineering, Golestan University, Aliabad Katoul, Iran
| | - Ezatolah Kazeminejad
- Dental Research Center, Golestan University of Medical Sciences, Gorgan, Iran
- Department of Endodontics, Faculty of Dentistry, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Yaser Mesri
- Research Center for Biomedical Engineering, Ferdowsi University of Mashhad, Mashhad, Iran
- Faculty of Dentistry, Golestan University of Medical Sciences, Gorgan, Iran
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Laslami K, Khaldoune S, Sy A, Drouri S, Benkiran I. Apical Extrusion: Is It an Inherent Occurrence During Every Endodontic Treatment? Cureus 2023; 15:e45211. [PMID: 37720124 PMCID: PMC10504573 DOI: 10.7759/cureus.45211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 09/19/2023] Open
Abstract
The aim of this literature review was to analyze all available scientific data on apical extrusion and to identify and associate the possible factors influencing the occurrence of apical extrusion, ranging from the choice of the canal shaping system, the irrigation technique, to the choice of diameter and the apical limit of preparation. A bibliographic search for relevant articles on apical extrusion of debris, irrigants, and bacteria was performed using the following databases: PubMed, Cochrane Library, and ScienceDirect. This search identified articles published between 2010 and 2023 in two languages (French and English). After selective sorting, 25 relevant documents were included. All the studies retained clearly agree on the inherent nature of apical extrusion during endodontic treatment. At the same time, we also understand that the amount of extrusion can be influenced by a number of parameters throughout endodontic therapy. According to this review, despite the undeniable nature of apical extrusion during endodontic therapy, studies with relatable experimental models that approach in vivo conditions are required to establish exploitable conclusions regarding apical extrusion and its prevention.
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Affiliation(s)
- Kaoutar Laslami
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Medicine, University Hassan II, Casablanca, MAR
| | - Salma Khaldoune
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Medicine, University Hassan II, Casablanca, MAR
| | - Aly Sy
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Medicine, University Hassan II, Casablanca, MAR
| | - Sofia Drouri
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Medicine, University Hassan II, Casablanca, MAR
| | - Imane Benkiran
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Medicine, University Hassan II, Casablanca, MAR
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Azizi Mazreah S, Shirvani A, Azizi Mazreah H, Dianat O. Evaluation of irrigant extrusion following the use of different root canal irrigation techniques: A systematic review and meta-analysis. AUST ENDOD J 2023; 49:396-417. [PMID: 35988128 DOI: 10.1111/aej.12678] [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: 05/23/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022]
Abstract
This systematic review investigates whether different irrigation techniques have different effects on irrigant extrusion from mature tooth apices. Articles published between January 2000 and January 2022 were searched in six electronic databases (MEDLINE, Embase, Google Scholar, Web of Science, Scopus and Cochrane) using appropriate keywords. Overall, 2265 articles were screened by their titles and abstracts. Fifty-six full-text articles were selected based on the inclusion criteria. Of them, 17 in vitro studies were included in the systematic review and meta-analysis. The meta-analysis was conducted using the random-effects inverse variance method. The results showed that the negative pressure technique caused a lesser amount (p = 0.00) and frequency (p = 0.00) of extrusion than the open-ended needle irrigation. Sonic and ultrasonic activation caused less amount of extrusion than both open-ended (p = 0.00 or p = 0.01) and closed-ended needle (p = 0.00) irrigation.
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Affiliation(s)
| | - Armin Shirvani
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, Baltimore, Maryland, USA
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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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Ada KS, Shetty S, Jayalakshmi KB, Nadig PL, Manje Gowda PG, Selvan AK. Influence of different irrigant activation methods on apical debris extrusion and bacterial elimination from infected root canals. J Conserv Dent 2023; 26:31-35. [PMID: 36908725 PMCID: PMC10003277 DOI: 10.4103/jcd.jcd_378_22] [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: 06/28/2022] [Revised: 07/28/2022] [Accepted: 08/19/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction The study aimed to determine the apical debris extrusion and microbial elimination from infected root canals after using different irrigant activation methods. Materials and Methods Forty freshly extracted human mandibular premolars were selected and randomly assigned to four groups (n = 10). The teeth were mechanically prepared, sterilized, and inoculated with Enterococcus faecalis for 1 week. Irrigation was done with 3% sodium hypochlorite following conventional syringe irrigation-Group 1, manual dynamic agitation (MDA)-Group 2, passive ultrasonic irrigation (PUI)-UltraX -Group 3, and sonic irrigation (SI)-EndoActivator -Group 4, and the extruded debris were collected using Myers and Montgomery model. The microbial samples were taken from the canals using sterile paper points, cultured and recorded as colonies. The amount of extruded debris was measured by subtracting the final weight of the Eppendorf tube with debris from the initial weight of the tube. Results I. Group 3 showed the least apical debris extrusion (P < 0.05), followed by Groups 2 and 1 and the highest with Group 4. II. Group 3 showed the least colony-forming units (CFUs)/ml, followed by Group 4, and finally, Group 2 showed lesser mean CFUs/ml compared to Group 1 (P < 0.05). Conclusion All the irrigation activation methods were associated with apical debris extrusion, with the PUI system extruding the least amount of debris compared to the other groups. Irrigation activation techniques were beneficial in reducing the microbial load from the infected canals with the PUI system showing a complete elimination of the microbes, followed by SI and MDA.
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Affiliation(s)
- K. Sadia Ada
- Department of Conservative Dentistry and Endodontics, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India
| | - Shibani Shetty
- Department of Conservative Dentistry and Endodontics, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India
| | - K. B. Jayalakshmi
- Department of Conservative Dentistry and Endodontics, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India
| | - Prasanna Latha Nadig
- Department of Conservative Dentistry and Endodontics, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India
| | - P. G Manje Gowda
- Department of Conservative Dentistry and Endodontics, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India
| | - Arul K. Selvan
- Department of Conservative Dentistry and Endodontics, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India
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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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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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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: 0] [Impact Index Per Article: 0] [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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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: 66] [Impact Index Per Article: 33.0] [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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12
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Boutsioukis C, Arias-Moliz MT, Chávez de Paz LE. A critical analysis of research methods and experimental models to study irrigants and irrigation systems. Int Endod J 2022; 55 Suppl 2:295-329. [PMID: 35171506 PMCID: PMC9314845 DOI: 10.1111/iej.13710] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/28/2022]
Abstract
Irrigation plays an essential role in root canal treatment. The purpose of this narrative review was to critically appraise the experimental methods and models used to study irrigants and irrigation systems and to provide directions for future research. Studies on the antimicrobial effect of irrigants should use mature multispecies biofilms grown on dentine or inside root canals and should combine at least two complementary evaluation methods. Dissolution of pulp tissue remnants should be examined in the presence of dentine and, preferably, inside human root canals. Micro-omputed tomography is currently the method of choice for the assessment of accumulated dentine debris and their removal. A combination of experiments in transparent root canals and numerical modeling is needed to address irrigant penetration. Finally, models to evaluate irrigant extrusion through the apical foramen should simulate the periapical tissues and provide quantitative data on the amount of extruded irrigant. Mimicking the in vivo conditions as close as possible and standardization of the specimens and experimental protocols are universal requirements irrespective of the surrogate endpoint studied. Obsolete and unrealistic models must be abandoned in favour of more appropriate and valid ones that have more direct application and translation to clinical Endodontics.
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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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Tanalp J. A critical analysis of research methods and experimental models to study apical extrusion of debris and irrigants. Int Endod J 2022; 55 Suppl 1:153-177. [DOI: 10.1111/iej.13686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- J Tanalp
- Yeditepe University Faculty of Dentistry Department of Endodontics Istanbul Turkey
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Sinha A, Singh R, Agrawal M, Thakur S, Sharma T, Razdan R. Recent root canal irrigation protocol followed by endodontists and postgraduate students of endodontics for root canal therapy in Central India: A survey. THE SAINT'S INTERNATIONAL DENTAL JOURNAL 2022. [DOI: 10.4103/sidj.sidj_7_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Gurawa A, Mohana P, Abraham D, Gupta A, Chauhan P, Singh A, Jala S. Quantitative evaluation of apically extruded debris during root canal preparation with reciprocating single file system, continuous rotary multiple file system and manual technique: An in vitro study. ENDODONTOLOGY 2022. [DOI: 10.4103/endo.endo_167_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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ORMIGA F, AMARAL CCF, VIEIRA FM, RISSO PDA, SILVA ABD, ALMEIDA M, SENA R, FERES-FILHO EJ, GRANJEIRO JM, GOMES JADCP. Ionic concentration in periradicular medium after dissolution of endodontic file fragments: an in vitro study. Braz Oral Res 2022; 36:e015. [DOI: 10.1590/1807-3107bor-2022.vol36.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/09/2021] [Indexed: 11/22/2022] Open
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17
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Ramesh S, Teja K, Choudhari S, Janani K, Jose J, Vasundhara K. A questionnaire-based cross-sectional survey of Indian postgraduates and endodontists on awareness, attitude, and practice of using conventional syringe needle irrigation during root canal treatment. SAUDI ENDODONTIC JOURNAL 2022. [DOI: 10.4103/sej.sej_26_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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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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El-Din SN, Ali MM, Hassan R. Comparison of Apically Extruded Debris Associated with Different Irrigation Techniques after Removal of Intracanal Medicaments. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This study aimed to compare the effect of XP-endo Finisher file (XPF), passive ultrasonic irrigation (PUI) and conventional irrigation technique using side-vented needle (SVN) on the amount of apically extruded debris after the removal of calcium hydroxide Ca(OH)2 and double antibiotic paste (DAP). Materials and Methods: Sixty extracted human mandibular premolars were used. After decronation, all canals were prepared up to the ProTaper Next X4 file (Dentsply Maillefer, Ballaigues, Switzerland). After dryness, teeth were randomly assigned into 2 groups (n=30) according to the Type of intracanal medication used; Ca(OH)2 and DAP then incubated at 37 °C and 100% humidity. After one week, Samples in each group were randomly assigned to 3 subgroups (n=10) according to the method used for medicament removal: XPF, PUI and SVN. Debris extruded during the removal procedure were collected into pre-weighed Eppendorf tubes then left to dry in an incubator at 37°C for 15 days. The amount of extruded debris was assessed with an analytical balance and calculated by subtracting the initial weight from the final weight of the tube. Data were statistically analyzed using Kruskal-Wallis and Mann-Whitney U test. Results: there was no statistically significant difference regarding the amount of apically extruded debris after using the three irrigation techniques in removal of both Ca(OH)2 and DAP (P-value = 0.141, Effect size = 0.160) and (P-value = 0.237, Effect size = 0.073) respectively. Conclusions: Neither XPF nor PUI increase the risk of intracanal medicament extrusion beyond the apex.
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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: 14] [Impact Index Per Article: 4.7] [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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21
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Jäggi M, Magni E, Eggmann F, ElAyouti A, Connert T, Weiger R. Apical Pressure Generated Using Conventional Syringe Irrigation in Immature Teeth-An In Vitro Study. MATERIALS 2021; 14:ma14102580. [PMID: 34063549 PMCID: PMC8156040 DOI: 10.3390/ma14102580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 12/23/2022]
Abstract
This in vitro study aimed to evaluate apical pressure during irrigant delivery with syringe irrigation in immature teeth with an open apical foramen. Conventional syringe irrigation was performed in a 3D-printed immature incisor. A 5 mL syringe combined with 25 G and 30 G cannulas was used. Open-ended and side-vented needle tip designs were assessed. Cannulas were placed at tooth length (TL), TL −1 mm, TL −2 mm, and TL −4 mm. The syringe plunger was moved with a force of 10 N, 20 N, 40 N, and 80 N to simulate clinical conditions. A pressure sensor measured periapical pressures during irrigation. Each experiment was repeated 10 times. Data were analyzed descriptively (maximum, mean, standard deviation, 95% CI) with the critical threshold indicative of extrusion set at 7.64 mbar. 30 G cannulas with both needle tip designs never exceeded the threshold at any TL with a plunger force of 10–40 N. At 80 N, 30 G open-ended cannulas exceeded the threshold in 10%, 30 G side-vented in 20–60% of the measurements. At any TL, 25 G open-ended cannulas and 25 G side-vented cannulas never crossed the threshold with forces of 10–20 N and 10 N, respectively. Consequently, 30 G cannulas with both designs can be recommended for irrigant delivery in immature teeth. 25 G cannulas ought to be used with caution.
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Affiliation(s)
- Marco Jäggi
- Department of Reconstructive Dentistry, University Center for Dental Medicine Basel UZB, University of Basel, 4058 Basel, Switzerland;
| | - Eva Magni
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, 4058 Basel, Switzerland; (E.M.); (T.C.); (R.W.)
| | - Florin Eggmann
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, 4058 Basel, Switzerland; (E.M.); (T.C.); (R.W.)
- Correspondence:
| | - Ashraf ElAyouti
- Division of Endodontology, Department of Conservative Dentistry, School of Dental Medicine, Eberhard Karls University of Tübingen, 72076 Tübingen, Germany;
| | - Thomas Connert
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, 4058 Basel, Switzerland; (E.M.); (T.C.); (R.W.)
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, 4058 Basel, Switzerland; (E.M.); (T.C.); (R.W.)
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22
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Chen B, Shen Y, Ma J, Haapasalo M. Effect of apical size on apical pressure during syringe-needle and multisonic negative pressure irrigation. Odontology 2021; 109:625-631. [PMID: 33403470 DOI: 10.1007/s10266-020-00586-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Abstract
Apical pressure during root canal irrigation is regarded as a key factor affecting the risk of irrigant extrusion. The aim of this study was to examine the effect of apical size on the apical pressure by positive and negative pressure syringe-needle and multisonic negative pressure irrigation. An extracted maxillary first molar with two separate buccal roots, one palatal root and four canals was selected. The roots of the molar were fixed in a specially made apparatus to acquire the apical pressure of the four root canals separately. The apical sizes tested were from sizes 10, 30, 40, 50, 60, 70, 80, 90, 110. Multisonic negative pressure irrigation protocol was as recommended by the manufacturer (45 mL/min), syringe-needle irrigation was done using 30-G side-vented needle 3 mm from the working length at 5 mL/min as a conventional positive pressure irrigation (SNI), and as negative pressure irrigation (NPSNI) using suction. Apical pressure by SNI was measured also at 10 mL/min with an open-ended 30G needle, for the smallest and largest apical sizes. Apical pressures by SNI stayed positive, except when suction was used (NPSNI). The apical pressure by multisonic negative pressure irrigation remained negative in all situations. With increasing apical size, apical pressure by SNI decreased, whereas with multisonic negative pressure irrigation and NPSNI, it was not affected by apical size. Large apical size did not result in higher apical pressure values compared to small apical sizes.
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Affiliation(s)
- Binwen Chen
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Jingzhi Ma
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Markus Haapasalo
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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Nangia D, Nawal RR, Talwar S. Evaluation of apical extrusion and cone-beam computed tomography assessment of irrigant penetration in oval-shaped canals, using XP Endo Finisher and EndoActivator. J Conserv Dent 2021; 23:185-189. [PMID: 33384493 PMCID: PMC7720767 DOI: 10.4103/jcd.jcd_390_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 07/13/2020] [Accepted: 08/10/2020] [Indexed: 12/05/2022] Open
Abstract
Background: Thorough cleaning of the pulp space is a challenging task. The mechanical instrumentation alone is usually not sufficient to completely debride the canals, and therefore, it requires the chemical action of irrigants also to disinfect the difficult to reach areas. Aim: The purpose of this study was to determine apical extrusion and assess irrigant penetration through cone-beam computed tomography (CBCT) for EndoActivator (EA) and XP Endo Finisher (XP). Materials and Methods: Sixty single-rooted mandibular premolars with oval-shaped canals were equally divided into three groups after instrumentation, based on the final irrigation: Group-1 syringe needle (30G Max-I-probe), Group-2 EA, and Group-3 XP. After the final irrigation, the weight of the extruded sodium hypochlorite was calculated. The prepared canals were then irrigated with a radiopaque contrast medium, which was activated according to the group of the sample (Group-1, 2, or 3). The volume of irrigant filled in the canal, especially in the apical third was determined through special tools in CBCT imaging. Statistics: One-way ANOVA test was used to compare the different groups. Results and Conclusion: Significantly more apical extrusion was seen in XP (P < 0.001). Both XP and EA have shown complete penetration of irrigant in the canal (100%).
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Affiliation(s)
- Divya Nangia
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Ruchika Roongta Nawal
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Sangeeta Talwar
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
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24
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Ioannidis K, Batty C, Turner C, Smith D, Deb S, Mannocci F. Ex vivo detection and quantification of apically extruded volatile compounds and disinfection by-products by SIFT-MS, during chemomechanical preparation of infected root canals. Dent Mater 2020; 36:257-269. [DOI: 10.1016/j.dental.2019.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/09/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
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25
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Jezeršek M, Jereb T, Lukač N, Tenyi A, Lukač M, Fidler A. Evaluation of Apical Extrusion During Novel Er:YAG Laser-Activated Irrigation Modality. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2019; 37:544-550. [DOI: 10.1089/photob.2018.4608] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Matija Jezeršek
- Laboratory for Laser Techniques, Faculty of Mechanical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Teja Jereb
- Laboratory for Laser Techniques, Faculty of Mechanical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Nejc Lukač
- Laboratory for Laser Techniques, Faculty of Mechanical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Ana Tenyi
- Department of Endodontics and Restorative Dentistry, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
- Department of Endodontics, University Clinical Centre, Ljubljana, Slovenia
| | | | - Aleš Fidler
- Department of Endodontics and Restorative Dentistry, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
- Department of Endodontics, University Clinical Centre, Ljubljana, Slovenia
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26
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Cai X, Wang XY, Santarcangelo F, Schoeffel GJ, Bergeron BE, Tay FR, Niu LN. Effect of simulated intraosseous sinusoidal pressure on NaOCl extrusion. J Dent 2018; 78:46-50. [PMID: 30077808 DOI: 10.1016/j.jdent.2018.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 07/28/2018] [Accepted: 08/01/2018] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION The present study examined the effects of irrigant flow rate and simulated intraosseous sinusoidal pressure on the rate of NaOCl extrusion from the apical terminus of a faux root canal. METHODS An extrusion setup was designed to enable irrigant extrusion to be opposed by 30 mm Hg simulated intraosseous pressure. The faux canal apex was opposed by atmospheric + 30 mm Hg pressure (experimental) or atmospheric pressure only (control group). Using five irrigant delivery rates (15.6 8.0, 4.0, 3.4 or 3.0 mL/min), the extrusion rates of 2% NaOCl from the faux apex were measured in both groups (n = 16). Data were analysed with two-factor ANOVA and pairwise comparisons at α = 0.05. Correlation between NaOCl delivery rates and extrusion rates in both groups were analysed with the Pearson product-moment procedure. RESULT Irrespective of the presence or absence of simulated sinusoidal pressure, NaOCl extrusion rates were positively-correlated with irrigant flow rates. For the factor "irrigant flow rates", significant differences in NaOCl extrusion rates were identified among all flow rates (p < 0.05), except for the pairwise comparison between 4.0 and 3.4 mL/min in the control. For all irrigant flow rates, NaOCl extrusion rate was significantly lower in the presence of 30 mm Hg simulated sinusoidal pressure than that obtained in the absence of opposing pressure (p < 0.05). CONCLUSION In the presence of 30 mm Hg simulated intraosseous pressure, NaOCl delivered via a side-vented needle inserted to 1 mm short of working length may be prevented from extrusion when its flow rate is ≤ 3.0 mL/min. CLINICAL SIGNIFICANCE When opposed by intraosseous sinusoidal pressure, NaOCl delivered via a side-vented needle inserted to 1 mm short of working length may be prevented from extrusion when its flow rate is ≤ 3.0 mL/min.
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Affiliation(s)
- Xue Cai
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiao-Yan Wang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing, China
| | | | - G John Schoeffel
- Department of Endodontics, The Dental College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Brian E Bergeron
- Department of Endodontics, The Dental College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Franklin R Tay
- Department of Endodontics, The Dental College of Georgia, Augusta University, Augusta, Georgia, USA; Department of Prosthodontics, School of Stomatology, Fourth Military Medical University, Xi'an, China.
| | - Li-Na Niu
- Department of Endodontics, The Dental College of Georgia, Augusta University, Augusta, Georgia, USA; Department of Prosthodontics, School of Stomatology, Fourth Military Medical University, Xi'an, China.
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Zeng C, Meghil MM, Miller M, Gou Y, Cutler CW, Bergeron BE, Niu L, Ma J, Tay FR. Antimicrobial efficacy of an apical negative pressure root canal irrigation system against intracanal microorganisms. J Dent 2018; 72:71-75. [PMID: 29571954 DOI: 10.1016/j.jdent.2018.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/15/2018] [Accepted: 03/18/2018] [Indexed: 10/17/2022] Open
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Uzunoglu-Özyürek E, Karaaslan H, Türker SA, Özçelik B. Influence of size and insertion depth of irrigation needle on debris extrusion and sealer penetration. Restor Dent Endod 2018; 43:e2. [PMID: 29487833 PMCID: PMC5816991 DOI: 10.5395/rde.2018.43.e2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 11/08/2017] [Indexed: 12/28/2022] Open
Abstract
Objectives To determine the effect of size and insertion depth of irrigation needle on the amount of apical extruded debris and the amount of penetration depth of sealer using a confocal laser scanning microscope (CLSM). Materials and Methods Twenty maxillary premolars were assigned to 2 groups (n = 10), according to the size of needle tip, 28 G or 30 G. Buccal roots of samples were irrigated with respective needle type inserted 1 mm short of the working length (WL), while palatal roots were irrigated with respective needle type inserted 3 mm short of the WL. Prepared teeth were removed from the pre-weighed Eppendorf tubes. Canals were filled with F3 gutta-percha cone and rhodamine B dye-labeled AH 26 sealer. Teeth were transversally sectioned at 1 and 3 mm levels from the apex and observed under a CLSM. Eppendorf tubes were incubated to evaporate the irrigant and were weighed again. The difference between pre- and post-weights was calculated, and statistical evaluation was performed. Results Inserting needles closer to the apex and using needles with wider diameters were associated with significantly more debris extrusion (p < 0.05). The position of needles and level of sections had statistically significant effects on sealer penetration depth (p < 0.05 for both). Conclusions Following preparation, inserting narrower needles compatible with the final apical diameter of the prepared root canal at 3 mm short of WL during final irrigation might prevent debris extrusion and improve sealer penetration in the apical third.
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Affiliation(s)
- Emel Uzunoglu-Özyürek
- Department of Endodontics, Hacettepe University Faculty of Dentistry, Ankara, Turkey
| | - Hakan Karaaslan
- Department of Endodontics, Hacettepe University Faculty of Dentistry, Ankara, Turkey
| | - Sevinç Aktemur Türker
- Department of Endodontics, Bülent Ecevit University Faculty of Dentistry, Zonguldak, Turkey
| | - Bahar Özçelik
- Department of Endodontics, Hacettepe University Faculty of Dentistry, Ankara, Turkey
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29
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Yao K, Satake K, Watanabe S, Ebihara A, Kobayashi C, Okiji T. Effect of Laser Energy and Tip Insertion Depth on the Pressure Generated Outside the Apical Foramen During Er:YAG Laser-Activated Root Canal Irrigation. Photomed Laser Surg 2017; 35:682-687. [DOI: 10.1089/pho.2017.4268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Kanako Yao
- Department of Pulp Biology and Endodontics, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Kazuhisa Satake
- Department of Pulp Biology and Endodontics, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Satoshi Watanabe
- Department of Pulp Biology and Endodontics, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Arata Ebihara
- Department of Pulp Biology and Endodontics, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Chihiro Kobayashi
- Oral Diagnosis and General Dentistry Dental Hospital, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Takashi Okiji
- Department of Pulp Biology and Endodontics, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
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30
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Azim AA, Aksel H, Margaret Jefferson M, Huang GTJ. Comparison of sodium hypochlorite extrusion by five irrigation systems using an artificial root socket model and a quantitative chemical method. Clin Oral Investig 2017; 22:1055-1061. [PMID: 28748298 DOI: 10.1007/s00784-017-2187-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 07/18/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This is to compare the volumes of irrigant apically extruded by five irrigation systems in an artificial socket model simulating clinical conditions. MATERIALS AND METHODS Twenty extracted human single-rooted teeth were enlarged to size 40/04 and then embedded in silicone impression material. The root canal space was irrigated with nominal 3% sodium hypochlorite (NaOCl) using standard needle irrigation (SNI) with a 30-gauge notched needle, EndoActivator (EA), XP Endo Finisher (XP Endo), EndoVac (EV), and photon-induced photoacoustic streaming (PIPS). Extruded NaOCl was collected, reacted with taurine to form taurine-monochloramine, and absorbance of taurine-monochloramine was measured at 252 nm using a spectrophotometer. The five irrigation systems were compared with repeated measures ANOVA and pairwise comparisons. RESULTS The EV group had very low extrusion (mean ± SD = 0.12 ± 0.2 μL) and differed significantly from the other four groups (P ≤ 0.001). Larger volumes of irrigant were extruded in the other irrigation groups. There were no significant differences in the extruded volumes among the SNI (7.4 ± 3.4 μL), EA (7.0 ± 6.1 μL), and XP Endo (7.8 ± 4.1 μL) groups (P = 1). The PIPS group had the highest mean extruded volume (12.9 ± 6.8 μL) and differed significantly from SNI (P = 0.030), EV (P < 0.0005), and EA (P = 0.02), but not XP Endo (P = 0.154). CONCLUSION Under the in vitro conditions of this study, irrigant extrusion appears unavoidable unless negative pressure irrigation such as EV is used. PIPS extrudes more irrigant than other systems, while SNI, EA, and XP Endo extrude similar volumes of irrigant. CLINICAL RELEVANCE The findings help clinicians select the optimal irrigation system to avoid irrigant extrusion.
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Affiliation(s)
- Adham A Azim
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, 875 Union Avenue, Laboratory, Cancer Research Building, 19 S. Manassas St. Lab Rm 255, office 256, Memphis, TN, 38163, USA.,Department of Periodontics & Endodontics, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | - Hacer Aksel
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, 875 Union Avenue, Laboratory, Cancer Research Building, 19 S. Manassas St. Lab Rm 255, office 256, Memphis, TN, 38163, USA.,Department of Endodontics, School of Dentistry, Hacettepe University, Ankara, Turkey
| | - M Margaret Jefferson
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, 875 Union Avenue, Laboratory, Cancer Research Building, 19 S. Manassas St. Lab Rm 255, office 256, Memphis, TN, 38163, USA
| | - George T-J Huang
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, 875 Union Avenue, Laboratory, Cancer Research Building, 19 S. Manassas St. Lab Rm 255, office 256, Memphis, TN, 38163, USA.
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Garcia A, Fernandez R, Arias A, de Gregorio C. Efficacy of Different Irrigation Protocols for Removing Gutta-Percha and Sealer Remnants in Artificial Un-instrumented Areas. Eur Endod J 2017; 2:1-6. [PMID: 33403349 PMCID: PMC7757966 DOI: 10.5152/eej.2017.16033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 10/24/2016] [Accepted: 01/31/2017] [Indexed: 11/22/2022] Open
Abstract
Objective: The purpose of this study was to determine the efficacy of different irrigants and irrigation protocols in the removal of gutta-percha and sealer from simulated un-instrumented areas. Methods: Eighty-four uniradicular teeth were used. After standardizing working length (WL) and preparing the glide path, coronal flaring was performed. The instrumentation phase was completed with ProFile rotary instruments up to size #35 LightSpeed LSX. Roots were split into halves: in one of them, a groove was prepared in the apical 6 mm. In the opposite one, 5 depressions were made (at 2, 4, 6, 8 and 10 mm). Irregularities were filled with AH Plus sealer and flowable gutta-percha. The Efficacy of sodium hypochlorite (NaOCl) and chloroform in removal of material and the effect of positive pressure (PP), passive ultrasonic irrigation (PUI) (one or three cycles) and paper points were analysed with the chi-square test. Results: Delivery by PP did not eliminate the obturator material from any artificial depression. Chloroform, when activated, demonstrated a significant linear trend in the amount of gutta-percha removed at all tested levels (P<0.01). The use of paper points after passive delivery of chloroform increased significantly the removal of gutta-percha in the groove and at 4 and 10 mm (P<0.05). Three cycles of PUI and chloroform showed significantly fewer remnants of gutta-percha (P<0.01). Conclusion: Positive pressure was not effective in the removal of obturator materials with any of the tested irrigants. Chloroform delivered by PP in combination with paper points obtained a better cleaning efficacy, although its activation using PUI for three cycles of 20 s showed the best cleanliness.
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Affiliation(s)
- Antonio Garcia
- Department of Endodontics, King Juan Carlos University, Madrid, Spain
| | - Rocio Fernandez
- Department of Endodontics, King Juan Carlos University, Madrid, Spain
| | - Ana Arias
- Department of Endodontics, Complutense University, Madrid, Spain
| | - Cesar de Gregorio
- Department of Endodontics, King Juan Carlos University, Madrid, Spain.,Department of Endodontics, University of Washington, Seattle, USA
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Silva PB, Krolow AM, Pilownic KJ, Casarin RP, Lima RKP, Leonardo RDT, Pappen FG. Apical Extrusion of Debris and Irrigants Using Different Irrigation Needles. Braz Dent J 2017; 27:192-5. [PMID: 27058383 DOI: 10.1590/0103-6440201600382] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 02/16/2016] [Indexed: 11/22/2022] Open
Abstract
This study evaluated the influence of irrigation tip, root canal curvature and final apical diameter on periapical debris and irrigant extrusion during root canal instrumentation. After being classified as mildly or moderately curved, the mesiobuccal root canals of 90 human molars were instrumented. The teeth were allocated into three groups according to the used needle type: a flat open-end needle (Group 1), a side-vented needle (Group 2) or a double side-vented needle (Group 3). The amount of extruded material after instrumentation was calculated for each group. The differences in irrigant and debris extrusion between the experimental groups were analyzed with the Mann-Whitney U test. Irrigation tips and final instrument diameter differences were analyzed with the Kruskal-Wallis test. Multiple groups were compared using the Mann-Whitney U-test with a Bonferroni correction at α=0.05. The amount of extruded material from the double side-vented needle was significantly less than the open-ended flat needle (p=0.008), but there was no difference compared to the side-vented needle (p=0.929). The results showed no effect of root curvature and final apical diameter on the amount of irrigant and debris extrusion (p>0.05). The double side-vented needles generated the least material extrusion to the periapical tissues. Irrigation needle type had the greatest influence on periapical irrigant and debris extrusion and the double side-vented needles may be safely used during endodontic therapy.
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Affiliation(s)
- Paula Barcellos Silva
- Department of Semiology and Clinics, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Angélica Mohnsam Krolow
- Department of Semiology and Clinics, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Katerine Jahnecke Pilownic
- Department of Semiology and Clinics, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Renata Picanço Casarin
- Department of Semiology and Clinics, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Regina Karla Pontes Lima
- Department of Restorative Dentistry, Araraquara Dental School, Universidade Estadual Paulista, Araraquara, SP, Brazil
| | - Renato de Toledo Leonardo
- Department of Restorative Dentistry, Araraquara Dental School, Universidade Estadual Paulista, Araraquara, SP, Brazil
| | - Fernanda Geraldo Pappen
- Department of Semiology and Clinics, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
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Romualdo PC, de Oliveira KMH, Nemezio MA, Küchler EC, Silva RAB, Nelson-Filho P, Silva LAB. Does apical negative pressure prevent the apical extrusion of debris and irrigant compared with conventional irrigation? A systematic review and meta-analysis. AUST ENDOD J 2017; 43:129-137. [DOI: 10.1111/aej.12162] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Priscilla Coutinho Romualdo
- Department of Pediatric Dentistry; School of Dentistry of Ribeirão Preto; University of São Paulo; Ribeirão Preto Brazil
| | | | - Mariana Alencar Nemezio
- Department of Pediatric Dentistry; School of Dentistry of Ribeirão Preto; University of São Paulo; Ribeirão Preto Brazil
| | - Erika Calvano Küchler
- Department of Pediatric Dentistry; School of Dentistry of Ribeirão Preto; University of São Paulo; Ribeirão Preto Brazil
| | - Raquel Assed Bezerra Silva
- Department of Pediatric Dentistry; School of Dentistry of Ribeirão Preto; University of São Paulo; Ribeirão Preto Brazil
| | - Paulo Nelson-Filho
- Department of Pediatric Dentistry; School of Dentistry of Ribeirão Preto; University of São Paulo; Ribeirão Preto Brazil
| | - Lea Assed Bezerra Silva
- Department of Pediatric Dentistry; School of Dentistry of Ribeirão Preto; University of São Paulo; Ribeirão Preto Brazil
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Perez R, Neves AA, Belladonna FG, Silva EJNL, Souza EM, Fidel S, Versiani MA, Lima I, Carvalho C, De-Deus G. Impact of needle insertion depth on the removal of hard-tissue debris. Int Endod J 2016; 50:560-568. [DOI: 10.1111/iej.12648] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 04/07/2016] [Indexed: 12/01/2022]
Affiliation(s)
- R. Perez
- Department of Dental Clinics; Rio de Janeiro State University; Rio de Janeiro Brazil
| | - A. A. Neves
- Department of Pediatric Dentistry and Orthodontics; Federal University of Rio de Janeiro; Rio de Janeiro Brazil
| | - F. G. Belladonna
- Department of Endodontics; Fluminense Federal University; Niterói Rio de Janeiro Brazil
| | - E. J. N. L. Silva
- Department of Endodontics; Grande Rio University; Duque de Caxias Rio de Janeiro Brazil
| | - E. M. Souza
- Department of Dentistry II; Federal University of Maranhão; São Luís Maranhão Brazil
| | - S. Fidel
- Department of Dental Clinics; Rio de Janeiro State University; Rio de Janeiro Brazil
| | - M. A. Versiani
- Department of Restorative Dentistry; Dental School of Ribeirão Preto; University of São Paulo; São Paulo Brazil
| | - I. Lima
- Nuclear Engineering Program; Federal University of Rio de Janeiro; Rio de Janeiro Brazil
| | - C. Carvalho
- Department of Endodontics; Grande Rio University; Duque de Caxias Rio de Janeiro Brazil
| | - G. De-Deus
- Department of Endodontics; Grande Rio University; Duque de Caxias Rio de Janeiro Brazil
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Charara K, Friedman S, Sherman A, Kishen A, Malkhassian G, Khakpour M, Basrani B. Assessment of Apical Extrusion during Root Canal Irrigation with the Novel GentleWave System in a Simulated Apical Environment. J Endod 2016; 42:135-9. [DOI: 10.1016/j.joen.2015.04.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 04/08/2015] [Accepted: 04/10/2015] [Indexed: 12/15/2022]
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Apical pressure created during irrigation with the GentleWave™ system compared to conventional syringe irrigation. Clin Oral Investig 2015; 20:1525-34. [DOI: 10.1007/s00784-015-1632-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 10/12/2015] [Indexed: 10/22/2022]
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Uzunoglu E, Turker SA, Görduysus M. Effects of Different Rotary Files Combined with Different Irrigation Needles on Apically Extruded Debris. Braz Dent J 2015; 26:347-50. [DOI: 10.1590/0103-6440201300166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 06/24/2015] [Indexed: 11/22/2022] Open
Abstract
<p>The aim of this study was to compare the apically extruded debris associated with ProTaper Next and OneShape Apical files using two different irrigation needles, open-ended and closed-ended (Max-I-Probe). Forty-eight mandibular premolars were assigned to four groups (n=12) as follows: Group PTN-SN: Root canal was prepared with ProTaper Next (PTN) and irrigated with open-ended standard needle; Group PTN-MP: Root canal was prepared with PTN and irrigated with Max-I-Probe; Group OSA-SN: Root canal was prepared with OneShape Apical (OSA) and irrigated with open-ended needle; Group OSA-MP: Root canal was prepared with OSA and irrigated with Max-I-Probe. Debris extruded during instrumentation was collected into pre-weighed Eppendorf tubes. After storage in an incubator at 70 °C for 5 days, the Eppendorf tubes were weighed to obtain the final weight with extruded debris. The difference between pre-and post-debris weights was calculated and statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U tests (p<0.05). No statistically significant difference was observed between files and needles regarding amount of apically extruded debris (p>0.05). OneShape Apical and ProTaper Next resulted in extrusion of debris beyond the apical foramen, regardless of needle tip.</p>
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Yost RA, Bergeron BE, Kirkpatrick TC, Roberts MD, Roberts HW, Himel VT, Sabey KA. Evaluation of 4 Different Irrigating Systems for Apical Extrusion of Sodium Hypochlorite. J Endod 2015; 41:1530-4. [PMID: 26143609 DOI: 10.1016/j.joen.2015.05.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 05/16/2015] [Accepted: 05/17/2015] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate NaOCl apical extrusion by using negative apical pressure (EndoVac), sonic agitation (EndoActivator), side-vented needle (Max-i-Probe), and photon induced photoacoustic streaming (PIPS 10 mJ and PIPS 20 mJ) laser irrigation in an in vitro gel model. METHODS Extracted mandibular and maxillary central incisors (n = 18) were prepared to size 35/.04 and 55/.04, respectively. Teeth were mounted in transparent containers with clear acrylic and suspended in a color-changing pH-sensitive gel, creating a closed system. By using a crossover design, each tooth was sequentially irrigated by using 6% NaOCl with each device following manufacturers' recommendations. Each tooth served as its own control. Pre-irrigation and post-irrigation buccal and proximal view photographs served to measure the longest distance of extrusion and were analyzed with ImageJ software. Mean results were analyzed by using Kruskal-Wallis and Dunn post hoc test (P < .05). RESULTS There were no significant differences between EndoVac, EndoActivator, and the passive extrusion groups. The EndoVac and EndoActivator groups produced significantly less extrusion than PIPS irrigation. Max-i-Probe extrusion results were more variable than those of EndoActivator but had no significant difference. Across all irrigation systems, there were no significant differences with respect to apical preparation size. CONCLUSIONS Under the in vitro conditions of this study, no difference was found between the 10 mJ and 20 mJ PIPS laser groups. EndoVac demonstrated significantly less potential for apical extrusion than PIPS and Max-i-Probe, whereas apical preparation size did not significantly affect extrusion of irrigant. The potential for apical extrusion of endodontic irrigants should be a consideration when selecting a system for final irrigation.
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Affiliation(s)
- Ross A Yost
- Keesler Medical Center, Keesler Air Force Base, Mississippi
| | | | | | - Mark D Roberts
- Keesler Medical Center, Keesler Air Force Base, Mississippi
| | | | - Van T Himel
- Louisiana State University, New Orleans, Louisiana
| | - Kent A Sabey
- Louisiana State University, New Orleans, Louisiana
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de Hemptinne F, Slaus G, Vandendael M, Jacquet W, De Moor RJ, Bottenberg P. In Vivo Intracanal Temperature Evolution during Endodontic Treatment after the Injection of Room Temperature or Preheated Sodium Hypochlorite. J Endod 2015; 41:1112-5. [DOI: 10.1016/j.joen.2015.02.011] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 02/03/2015] [Accepted: 02/07/2015] [Indexed: 10/23/2022]
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Tian J, Liang G, Qi W, Jiang H. Odontogenic cutaneous sinus tract associated with a mandibular second molar having a rare distolingual root: a case report. Head Face Med 2015; 11:13. [PMID: 25885921 PMCID: PMC4414428 DOI: 10.1186/s13005-015-0072-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 04/09/2015] [Indexed: 11/29/2022] Open
Abstract
Introduction Odontogenic cutaneous sinus tracts are often misdiagnosed as lesions of non-odontogenic origin, leading to the treatment of patients with unnecessary and ineffective therapies. Sinus tracts of endodontic origin usually respond well to endodontic therapy. However, root canal treatment of mandibular molars with aberrant canal anatomy can be diagnostically and technically challenging. Herein we present a patient with a cutaneous odontogenic sinus tract in the right submandibular area. Case report A 23-year-old Chinese female patient presented with a cutaneous odontogenic sinus tract that was initially misdiagnosed as a sebaceous cyst. The patient had undergone surgical excision and traditional Chinese medical therapy before endodontic consultation. With the aid of cone beam computed tomography (CBCT), it was confirmed that the causative factor of the cutaneous odontogenic sinus tract was chronic periapical periodontitis of the right mandibular second molar, which had a rare and curved distolingual root. The resolution of the sinus tract and apical healing was accomplished following nonsurgical root canal treatment. Conclusion A dental aetiology must be included in the differential diagnosis of cutaneous sinus tracts in the neck and face. Elimination of odontogenic cutaneous sinus tract infection by endodontic therapy results in resolution of the sinus tract without surgical excision or systemic antibiotic therapy. This case report also indicates that CBCT imaging is useful for identifying the tooth involved, ascertaining the extent of surrounding bone destruction and accurately managing the aberrant canal morphology.
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Affiliation(s)
- Jun Tian
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Affiliated Stomatological Hospital, Guangdong Province Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China.
| | - Guobin Liang
- Department of Prosthodontics, Guanghua School of Stomatology, Affiliated Stomatological Hospital, Guangdong Province Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China.
| | - Wenting Qi
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Affiliated Stomatological Hospital, Guangdong Province Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China.
| | - Hongwei Jiang
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Affiliated Stomatological Hospital, Guangdong Province Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China.
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İriboz E, Bayraktar K, Türkaydın D, Tarçın B. Comparison of Apical Extrusion of Sodium Hypochlorite Using 4 Different Root Canal Irrigation Techniques. J Endod 2015; 41:380-4. [DOI: 10.1016/j.joen.2014.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/22/2014] [Accepted: 11/04/2014] [Indexed: 11/26/2022]
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Adorno CG, Fretes VR, Ortiz CP, Mereles R, Sosa V, Yubero MF, Escobar PM, Heilborn C. Comparison of two negative pressure systems and syringe irrigation for root canal irrigation: anex vivostudy. Int Endod J 2015; 49:174-83. [DOI: 10.1111/iej.12431] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 01/23/2015] [Indexed: 12/01/2022]
Affiliation(s)
- C. G. Adorno
- Facultad de Odontología; Universidad Nacional de Asunción; Asunción Paraguay
| | - V. R. Fretes
- Facultad de Odontología; Universidad Nacional de Asunción; Asunción Paraguay
| | - C. P. Ortiz
- Facultad de Odontología; Universidad Nacional de Asunción; Asunción Paraguay
| | - R. Mereles
- Facultad de Odontología; Universidad Nacional de Asunción; Asunción Paraguay
| | - V. Sosa
- Facultad de Odontología; Universidad Nacional de Asunción; Asunción Paraguay
| | - M. F. Yubero
- Departamento de Físico-Química; Facultad de Ciencias Químicas; Universidad Nacional de Asunción; Asunción Paraguay
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van der Sluis L, Boutsioukis C, Jiang LM, Macedo R, Verhaagen B, Versluis M. Root Canal Irrigation. SPRINGER SERIES ON BIOFILMS 2015. [DOI: 10.1007/978-3-662-47415-0_9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Corelation between machines assisted endodontic irrigant agitation and apical extrusion of debris and irrigant: a laboratory study. ScientificWorldJournal 2014; 2014:346184. [PMID: 25386593 PMCID: PMC4214052 DOI: 10.1155/2014/346184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 08/29/2014] [Accepted: 08/29/2014] [Indexed: 12/22/2022] Open
Abstract
Aims. To compare amount of root canal debris and irrigant extruded apically after irrigants agitation using closed and open chambers. Methods and Material. Sixty maxillary central incisors were selected, decoronated, and mounted in preweighed glass vials filled with distilled water. Biomechanical preparation was completed using ProTaper rotary files until number F4 and 1 mL of 3% NaOCl solution after each file use. Samples were randomly divided into closed or open chamber sets which were further subdivided into 6 groups, based on the agitation techniques: no agitation (control), canalBrush, lentulospiral, passive ultrasonic agitation (PUA), EndoActivator, and EndoVac. Canals were irrigated with 1 mL of 17% EDTA and agitated for 30 s and then flushed with 2 mL of distilled water. Apically extruded irrigant was measured and vials were kept in incubator for 5 days at 68°C for drying for weight calculation. Statistical Analysis. Analysis was done using Student's t-test, one-way ANOVA, and post-hoc. Results. All agitation techniques showed apical extrusion of the debris and irrigant. The closed chamber apparatus showed significantly less extrusion of debris and irrigant than open chamber (P < 0.05). Conclusions. EndoVac was found to be the safest agitation system among all test groups with regard to apical extrusion of debris and irrigant.
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Spectrophotometric Determination of Irrigant Extrusion Using Passive Ultrasonic Irrigation, EndoActivator, or Syringe Irrigation. J Endod 2014; 40:1622-6. [DOI: 10.1016/j.joen.2014.03.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/15/2014] [Accepted: 03/18/2014] [Indexed: 12/20/2022]
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Ramamoorthi S, Nivedhitha MS, Divyanand MJ. Comparative evaluation of postoperative pain after using endodontic needle and EndoActivator during root canal irrigation: A randomised controlled trial. AUST ENDOD J 2014; 41:78-87. [PMID: 25195661 DOI: 10.1111/aej.12076] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The purpose of this study was to evaluate and compare the postoperative level of pain after activation of irrigants using EndoActivator with conventional needle irrigation during root canal therapy. In this prospective randomised clinical trial, 72 symptomatic irreversible pulpitis patients were selected. Based on block randomisation after routine root canal preparation, patients were assigned to two groups. In group EN, procedures were performed with endodontic irrigating needle (n = 36) while group EA received activation using EndoActivator (n = 36) in the final irrigation protocol. All the participants were called through phone at 8, 24 and 48 h to analyse pain score using visual analogue scale. Those patients who developed pain were prescribed ibuprofen 200 mg. Pain score and frequency of tablet intake were recorded and statistically analysed. Results showed that group EA resulted in significantly less postoperative pain and analgesics intake than group EN. In conclusion, within the limitations of this study, the activation of irrigants using EndoActivator can be considered an effective method for reducing postoperative pain.
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Affiliation(s)
- Surendar Ramamoorthi
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Saveetha University, Chennai, Tamilnadu, India
| | - Malli Sureshbabu Nivedhitha
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Saveetha University, Chennai, Tamilnadu, India
| | - Madras Jeyaprakash Divyanand
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Saveetha University, Chennai, Tamilnadu, India
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Karatas E, Ozsu D, Arslan H, Erdogan AS. Comparison of the effect of nonactivated self-adjusting file system, Vibringe, EndoVac, ultrasonic and needle irrigation on apical extrusion of debris. Int Endod J 2014; 48:317-22. [DOI: 10.1111/iej.12317] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 05/21/2014] [Indexed: 11/30/2022]
Affiliation(s)
- E. Karatas
- Department of Endodontics; Faculty of Dentistry; Ataturk University; Erzurum Turkey
| | - D. Ozsu
- Department of Endodontics; Faculty of Dentistry; Ataturk University; Erzurum Turkey
| | - H. Arslan
- Department of Endodontics; Faculty of Dentistry; Ataturk University; Erzurum Turkey
| | - A. S. Erdogan
- Department of Endodontics; Faculty of Dentistry; Ataturk University; Erzurum Turkey
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Tanomaru-Filho M, Loiola LED, Miano LM, Chávez-Andrade GM, Guerreiro-Tanomaru JM. Influência do diâmetro foraminal do canal radicular, do tipo e da penetração de agulha, e do fluxo da solução irrigadora na limpeza e na extrusão apical. REVISTA DE ODONTOLOGIA DA UNESP 2014. [DOI: 10.1590/rou.2014.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introdução: A irrigação do canal radicular visa a limpeza e desinfecção do sistema de canais radiculares, sem promover extrusão apical. Objetivo: Avaliar a influência do diâmetro foraminal do canal radicular, da penetração e do tipo de agulha, e do fluxo na limpeza e na extrusão apical da solução irrigadora. Material e método: Doze dentes incisivos inferiores humanos com canal único foram instrumentados e, após ampliação foraminal com diferentes diâmetros (LK #40 e 60), os canais radiculares foram preenchidos com solução de contraste radiológico espessada com propilenoglicol e óxido de zinco. Foram utilizados dois tipos de agulhas de irrigação 27G com diferentes designs (abertura apical ou lateral), dois fluxos correspondentes a 15 ou 25 mL/min, e com penetração das agulhas em duas profundidades (3 e 6 mm aquém do ápice). Antes e após irrigação, os dentes foram radiografados utilizando um sistema radiográfico digital. As áreas do canal radicular antes (preenchido pelo contraste) e após irrigação (remanescente do contraste) foram submetidas à subtração de imagens no programa Adobe Photoshop CS4 e mensuradas por meio do programa Image Tool 3.0, obtendo o percentual de limpeza e de extrusão. Os dados foram analisados por meio dos testes ANOVA e Tukey, com nível de significância de 5%. Resultado: Não houve diferença estatística entre o diâmetro foraminal, o tipo e a profundidade de penetração da agulha, e a velocidade do fluxo de irrigação nos parâmetros limpeza (acima de 97%) e extrusão apical (menor do que 0,38 mm2), com p>0,05. Conclusão: Todos os protocolos de irrigação avaliados proporcionaram limpeza do canal radicular e pequena extrusão apical da solução irrigadora.
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Hacer AKSEL, Sevinc ASKERBEYLI, Cigdem CANBAZOGLU, Ahmet SERPER. Effect of needle insertion depth and apical diameter on irrigant extrusion in simulated immature permanent teeth. Braz Oral Res 2014; 28:1-6. [PMID: 25271966 DOI: 10.1590/1807-3107bor-2014.vol28.0053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/27/2014] [Indexed: 12/23/2022] Open
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Boutsioukis C, Psimma Z, Kastrinakis E. The effect of flow rate and agitation technique on irrigant extrusionex vivo. Int Endod J 2013; 47:487-96. [DOI: 10.1111/iej.12176] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 07/17/2013] [Indexed: 12/19/2022]
Affiliation(s)
- C. Boutsioukis
- Physics of Fluids Group; Faculty of Science and Technology; University of Twente; Enschede
- MESA+ Institute for Nanotechnology; University of Twente; Enschede The Netherlands
| | - Z. Psimma
- Department of Endodontology; Dental School; Aristotle University of Thessaloniki; Thessaloniki
| | - E. Kastrinakis
- Chemical Engineering Department; School of Engineering; Aristotle University of Thessaloniki; Thessaloniki Greece
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