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Palanisamy R, Anirudhan S, Roja RJS, Koshy M. Comparison of ultrasonic versus side-vented needle irrigation for reductions in bacterial growth and postoperative pain: A randomized controlled trial. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2023; 26:616-620. [PMID: 38292745 PMCID: PMC10823969 DOI: 10.4103/jcde.jcde_61_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/07/2023] [Accepted: 09/21/2023] [Indexed: 02/01/2024]
Abstract
Background Postoperative pain affects 16%-25% of root canal therapy patients. The irrigating system and irrigants used should reduce bacterial load without irrigant extrusion beyond the root canal apex, potentially reducing postoperative pain and discomfort. Aim This study aims to compare the effects of passive ultrasonic irrigation and side-vented needle irrigation on postoperative pain and bacterial load in single-rooted teeth with pulp necrosis. Materials and Methods Eighty patients with pulpal necrosis in single-rooted teeth were randomly categorized into two groups (n = 40 each): Group A (side-vented needle irrigation) and Group B (passive ultrasonic irrigation). Bacterial samples were collected using sterile paper points after initial access cavity preparation (S1) and standard endodontic instrumentation + irrigation (S2). Bacterial growth was assessed on MacConkey and blood agar. Pain was recorded 30 min preoperatively and 6, 12, 24, and 48 h postoperatively. Statistical Analysis Used Chi-square test, independent t-test and paired t-test. Results Irrigation with Irrisafe tips showed increased number of bacteria-free samples and a significant reduction in postoperative pain (at the 6 and 12 h time-points) when compared to side-vented needle. Conclusions Passive ultrasonic irrigation with Irrisafe tips may be more effective than side-vented needle irrigation in reducing postoperative pain and intracanal bacterial load in patients undergoing endodontic treatment.
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Affiliation(s)
- Revathi Palanisamy
- Department of Conservative Dentistry and Endodontics, Sri Ramakrishna Dental College and Hospital, Dr. TNMGRM University, Coimbatore, Tamil Nadu, India
| | - Subha Anirudhan
- Department of Conservative Dentistry and Endodontics, Sri Ramakrishna Dental College and Hospital, Dr. TNMGRM University, Coimbatore, Tamil Nadu, India
| | - R. Jaya Shree Roja
- Department of Conservative Dentistry and Endodontics, Sri Ramakrishna Dental College and Hospital, Dr. TNMGRM University, Coimbatore, Tamil Nadu, India
| | - Minu Koshy
- Department of Conservative Dentistry and Endodontics, Sri Ramakrishna Dental College and Hospital, Dr. TNMGRM University, Coimbatore, Tamil Nadu, India
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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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3
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Advances in the Role of Sodium Hypochlorite Irrigant in Chemical Preparation of Root Canal Treatment. BIOMED RESEARCH INTERNATIONAL 2023; 2023:8858283. [PMID: 36685672 PMCID: PMC9859704 DOI: 10.1155/2023/8858283] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 01/15/2023]
Abstract
Irrigation of root canal system is of great significance to the success of endodontic treatment, where sodium hypochlorite (NaOCl) is the most widely used irrigant in chemical preparation. NaOCl functions by eliminating bacterial biofilms and dissolving organic tissue, which may vary according to several factors such as the microbiology of root canal infection and the concentration of the irrigant. It has been proposed that the effectiveness of NaOCl could be enhanced via several methods, including heating the irrigant, applying in conjunction with certain reagents, or activating by agitation techniques. Despite its antibacterial and tissue-dissolving capacities, NaOCl should be used with caution to avoid detrimental effect due to its cytotoxicity and negative effect on dentin properties. In this narrative review, we discussed the factors that affect the properties of NaOCl, the methods to improve its efficacy, and the side effects that might occur in clinical practice.
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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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Chalub LO, Nunes GP, Ferrisse TM, Strazzi-Sahyon HB, Dos Santos PH, Gomes-Filho JE, Cintra LTA, Sivieri-Araujo G. Postoperative pain in root canal treatment with ultrasonic versus conventional irrigation: a systematic review and meta-analysis of randomized controlled trials. Clin Oral Investig 2022; 26:3343-3356. [DOI: 10.1007/s00784-022-04386-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/11/2022] [Indexed: 11/03/2022]
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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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7
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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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Sinha N, Asthana G, Parmar G, Langaliya A, Shah J, Kumbhar A, Singh B. Evaluation of Ozone Therapy in Endodontic Treatment of Teeth with Necrotic Pulp and Apical Periodontitis: A Randomized Clinical Trial. J Endod 2021; 47:1820-1828. [PMID: 34562501 DOI: 10.1016/j.joen.2021.09.006] [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: 08/02/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The aim of this study was to compare the effect of different application techniques of ozone on the prevalence of postendodontic pain in patients undergoing single-visit root canal treatment. METHODS hundred eight patients with necrotic pulp in single-rooted teeth and apical periodontitis participated in the trial. A standard single-visit endodontics protocol was followed with 5.25% sodium hypochlorite and rotary nickel-titanium files. After shaping and cleaning, patients were randomly allocated into the following groups: group 1 (n = 21), ozone treatment with no activation (NA); group 2 (n = 22), ozone treatment with manual dynamic activation (MDA); group 3, (n = 21), ozone treatment with passive ultrasonic activation (PUA); group 4 (n = 23), ozone treatment with sonic activation (SA); and group 5 (n = 21), no ozone treatment (the control group). Patient levels of discomfort were recorded at 6 different time intervals using the visual analog scale (VAS). Comparison of the mean difference between the groups and time intervals was performed using 2-way analysis of variance followed by a post hoc Bonferroni test. The level of significance was set at 5%. RESULTS VAS scores were highest for the control > NA > MDA > SA > PUA groups. A statistically significant reduction in VAS scores was observed in the PUA and SA groups in comparison with the NA, control, and MDA groups. Timewise comparison showed a highly significant decline in VAS scores at all time intervals (P < .001). CONCLUSIONS Ultrasonic and sonic activation of ozone resulted in less pain in patients undergoing single-visit endodontics compared with no ozone treatment.
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Affiliation(s)
- Nidhi Sinha
- Department of Conservative Dentistry and Endodontics, Pacific Dental College and Hospital, Udaipur, Rajasthan, India.
| | - Geeta Asthana
- Department of Conservative Dentistry and Endodontics, Government Dental College, Ahmedabad, Gujarat, India
| | - Girish Parmar
- Department of Conservative Dentistry and Endodontics, Government Dental College, Ahmedabad, Gujarat, India
| | - Akshayraj Langaliya
- Department of Conservative Dentistry and Endodontics, Ahmedabad Municipal Dental College, Ahmedabad, Gujarat, India
| | - Jinali Shah
- Department of Conservative Dentistry and Endodontics, Ahmedabad Municipal Dental College, Ahmedabad, Gujarat, India
| | - Aravind Kumbhar
- Department of Conservative Dentistry and Endodontics, Ahmedabad Municipal Dental College, Ahmedabad, Gujarat, India
| | - Bijay Singh
- Department of Prosthodontics, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
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Uğur Aydın Z, Erdönmez D, Ateş MO, Doğan T. Efficacy of different irrigation activation systems on bacterial extrusion. AUST ENDOD J 2021; 47:137-142. [PMID: 32820601 DOI: 10.1111/aej.12432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 06/21/2020] [Accepted: 07/26/2020] [Indexed: 01/19/2023]
Abstract
The purpose of this study was to evaluate the quantity of extruded bacteria following with EndoVac, EDDY, EndoActivator (EA) and standard needle irrigation (SNI). Ninety teeth with a single root and canal were included in this study. Fifteen teeth were selected as the negative control group to confirm sterilization. Seventy-five teeth were contaminated with Enterococcus faecalis (E. faecalis) for 4 weeks. Teeth were prepared and divided into five groups (n:15): EndoVac, EDDY, EA, SNI and positive control groups. The extruded bacteria were cultured for bacterial quantification. The counts of extruded bacteria were lower in the EndoVac group compared to the EDDY group (P˂ 0.05). The counts of extrusion bacteria were not different in EA and SNI groups compared to EDDY and EndoVac groups (P > 0.05). Within the limits of this study, EndoVac was found to be more reliable irrigation systems than EDDY in terms of the bacterial extrusion.
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Affiliation(s)
- Zeliha Uğur Aydın
- Department of Endodontics, Faculty of Dentistry, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Demet Erdönmez
- Department of Biology, Faculty of Arts and Science, Aksaray University, Aksaray, Turkey
| | - Melis Oya Ateş
- Department of Endodontics, Faculty of Dentistry, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Tülin Doğan
- Department of Endodontics, Faculty of Dentistry, Bolu Abant Izzet Baysal University, Bolu, Turkey
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Panariello BHD, Kindler JK, Spolnik KJ, Ehrlich Y, Eckert GJ, Duarte S. Use of electromagnetic stimulation on an Enterococcus faecalis biofilm on root canal treated teeth in vitro. Sci Rep 2021; 11:8306. [PMID: 33859338 PMCID: PMC8050066 DOI: 10.1038/s41598-021-87922-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/30/2021] [Indexed: 12/02/2022] Open
Abstract
Root canal disinfection is of utmost importance in the success of the treatment, thus, a novel method for achieving root canal disinfection by electromagnetic waves, creating a synergistic reaction via electric and thermal energy, was created. To study electromagnetic stimulation (EMS) for the disinfection of root canal in vitro, single rooted teeth were instrumented with a 45.05 Wave One Gold reciprocating file. Specimens were sterilized and inoculated with Enterococcus faecalis ATCC 29,212, which grew for 15 days to form an established biofilm. Samples were treated with 6% sodium hypochlorite (NaOCl), 1.5% NaOCl 1.5% NaOCl with EMS, 0.9% saline with EMS or 0.9% saline. After treatments, the colony forming units (CFU) was determined. Data was analyzed by Wilcoxon Rank Sums Test (α = 0.05). One sample per group was scored and split for confocal laser scanning microscopy imaging. There was a significant effect with the use of NaOCl with or without EMS versus 0.9% saline with or without EMS (p = 0.012 and 0.003, respectively). CFUs were lower when using 0.9% saline with EMS versus 0.9% saline alone (p = 0.002). Confocal imaging confirmed CFU findings. EMS with saline has an antibiofilm effect against E. faecalis and can potentially be applied for endodontic disinfection.
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Affiliation(s)
- Beatriz H D Panariello
- Department of Cariology, Operative Dentistry and Dental Public Health, Indiana University School of Dentistry (IUSD), 1121 W Michigan St, DS406, Indianapolis, IN, 46202, USA
| | - Justin K Kindler
- Department of Endodontics, Indiana University School of Dentistry (IUSD), Indianapolis, IN, 46202, USA
| | - Kenneth J Spolnik
- Department of Endodontics, Indiana University School of Dentistry (IUSD), Indianapolis, IN, 46202, USA
| | - Ygal Ehrlich
- Department of Endodontics, Indiana University School of Dentistry (IUSD), Indianapolis, IN, 46202, USA
| | - George J Eckert
- Department of Biostatistics, Indiana University School of Medicine, Indiana University School of Dentistry (IUSD), Indianapolis, IN, 46202, USA
| | - Simone Duarte
- Department of Cariology, Operative Dentistry and Dental Public Health, Indiana University School of Dentistry (IUSD), 1121 W Michigan St, DS406, Indianapolis, IN, 46202, USA.
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Liapis D, De Bruyne MAA, De Moor RJG, Meire MA. Postoperative pain after ultrasonically and laser-activated irrigation during root canal treatment: a randomized clinical trial. Int Endod J 2021; 54:1037-1050. [PMID: 33595920 DOI: 10.1111/iej.13500] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 12/18/2022]
Abstract
AIM To compare the intensity of postoperative pain after primary root canal treatment of asymptomatic teeth when using ultrasonically (UAI) or laser-activated irrigation (LAI). METHODOLOGY In this superiority randomized clinical trial (ClinicalTrials.gov ID: NCT03981237) with parallel design, fifty-six patients with an asymptomatic tooth in need of primary root canal treatment were enrolled. After chemo-mechanical canal preparation using rotary instruments and NaOCl irrigation, teeth were randomly assigned to two groups and patients were blinded to the final irrigation protocol. In the UAI group (n = 28), 60s activation with an Irrisafe tip was done per canal. In the LAI group (n = 28), NaOCl was activated with a pulsed Er:YAG (2940 nm) laser, equipped with a conical tip, with settings of 50 µs, 20 mJ at 15 Hz for 60 s. Patients recorded their pain intensity 6, 24, 48 and 72 h after treatment on a 100 mm visual analogue scale (VAS), as well as their analgesic consumption. Pain levels and incidence were compared across groups using the Mann-Whitney U-test and chi-square test. RESULTS Overall, mean postoperative pain intensity was low, with the majority of patients having no or minimal pain 24 h postoperatively. At 6 h postoperatively, pain intensity and incidence were significantly higher in the UAI group compared to the LAI group (P < 0.05). For the other time intervals, no significant differences in postoperative pain incidence or intensity were found. The frequency of analgesic intake did not differ significantly between the two groups. Neither of the activation methods resulted in any adverse effects. CONCLUSIONS Ultrasonically and laser-activated irrigation resulted in low and comparable levels of postoperative pain in asymptomatic patients receiving primary root canal treatment.
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Affiliation(s)
- D Liapis
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - M A A De Bruyne
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - R J G De Moor
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - M A Meire
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
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Elnaggar SE, El Backly RM, Zaazou AM, Morsy Elshabrawy S, Abdallah AA. Effect of different irrigation protocols for applications in regenerative endodontics on mechanical properties of root dentin. AUST ENDOD J 2020; 47:228-235. [PMID: 33314440 DOI: 10.1111/aej.12457] [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: 01/06/2020] [Revised: 09/02/2020] [Accepted: 10/21/2020] [Indexed: 11/29/2022]
Abstract
The objective of this study was to evaluate the effect of different concentrations of NaOCl with and without passive ultrasonic irrigation (PUI) on mechanical properties of human dentin for applications in regenerative endodontics (RE). Sixty single-rooted teeth were sectioned into 2 halves (n = 120). Dentin bars were produced from one half for flexural strength and the other half was used for microhardness. Specimens were randomly assigned into 10 groups: G1 and G2 (control): distilled water for 30 and 60 min, respectively; G3: 1.5%NaOCl for 30 min; G4:1.5%NaOCl for 60 min; G5: 1.5%NaOCl + PUI for 30 min; G6: 1.5%NaOCl + PUI for 60 min; G7: 5.25%NaOCl for 30 min; G8: 5.25%NaOCl for 60 min; G9: 5.25%NaOCl + PUI for 30 min; G10: 5.25%NaOCl + PUI for 60 min. An increase in NaOCl concentration showed highly significant reduction in mechanical properties. There was no significant difference between 1.5% NaOCl and control group except for specimens treated with PUI for 60 min. NaOCl in concentrations recommended for RE did not have a significant effect on mechanical properties of dentin. However, PUI with increased irrigation time might have an effect even with low NaOCl concentration.
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Affiliation(s)
- Semha E Elnaggar
- Endodontics, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Rania M El Backly
- Endodontics, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Ashraf Mamdouh Zaazou
- Endodontics, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.,Department of Endodontics, Faculty of Dentistry, King AbdulAziz University, Jeddah, Saudi Arabia
| | - Sonia Morsy Elshabrawy
- Dental Biomaterials Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Amr Ahmed Abdallah
- Endodontics, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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İnce Yusufoglu S, Keskin NB, Saricam E, Bozkurt DA. Comparison of apical debris extrusion using EDDY, passive ultrasonic activation and photon-initiated photoacoustic streaming irrigation activation devices. AUST ENDOD J 2020; 46:400-404. [PMID: 32881182 DOI: 10.1111/aej.12429] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 06/13/2020] [Accepted: 07/26/2020] [Indexed: 12/13/2022]
Abstract
The study aimed to determine the effect of different irrigation activation systems on the amount of apical debris extrusion in mandibular molar teeth with curved root canals. Sixty extracted mandibular molar teeth were instrumented with HyFlex EDM system and divided into four groups according to irrigation techniques: passive ultrasonic irrigation (PUI), EDDY, photon-initiated photoacoustic streaming (PIPS) and manual irrigation (MI). After the final irrigation, the extruded irrigants were collected into Eppendorf tubes of known weights. The amount of extruded debris was obtained by subtracting the weight from the initial weight of the tube. The Kruskal-Wallis test was used for statistical analysis. EDDY caused significantly more debris extrusion than the other irrigation activation systems (P < 0.001). PUI caused less apical debris extrusion but there was no statistical difference between PUI, PIPS and MI (P > 0.05). The EDDY activation system was associated with the highest amount of debris extrusion in curved root canals.
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Affiliation(s)
- Selen İnce Yusufoglu
- Faculty of Dentistry, Department of Endodontics, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Neslihan Büsra Keskin
- Faculty of Dentistry, Department of Endodontics, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Esma Saricam
- Faculty of Dentistry, Department of Endodontics, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Durmus Alperen Bozkurt
- Faculty of Dentistry, Department of Endodontics, Konya Necmettin Erbakan University, Konya, Turkey
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Activated Irrigation vs. Conventional non-activated Irrigation in Endodontics - A Systematic Review. Eur Endod J 2020; 4:96-110. [PMID: 32161895 PMCID: PMC7006592 DOI: 10.14744/eej.2019.80774] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 09/17/2019] [Indexed: 11/20/2022] Open
Abstract
Objective: Irrigant activation has been claimed to be beneficial in in vitro and clinical studies. This systematic review aims to investigate the clinical efficiency of mechanically activated irrigants and conventional irrigation. Methods: A literature search (PROSPERO registration number: CRD42018112595) was undertaken in PubMed, Cochrane and hand search. The inclusion criteria were clinical trials, in vivo/ex vivo on adult permanent teeth involving an active irrigation device and a control group of conventional irrigation. The exclusion criteria were studies done in vitro, animals and foreign language. Adult patients requiring endodontic treatment of permanent dentition and irrigant activation during the treatment were chosen as the participants and intervention respectively. Results: After removal of duplicates, 89 articles were obtained, and 72 were excluded as they did not meet the selection criteria. 6 devices (EndoVac, EndoActivator, Ultrasonic, MDA (manual dynamic agitation), CUI (Continuous Ultrasonic Irrigation) and PUI (Passive Ultrasonic Irrigation)) and 6 variables of interest (Post-operative pain, periapical healing, antibacterial efficacy, canal and/or isthmus cleanliness, debridement efficacy and delivery up to working length) were evaluated in the 17 included articles. The risk of bias and quality of the selected articles were moderate. Results showed that mechanical active irrigation reduces post-operative pain. It improved debridement, canal/isthmus cleanliness. It also improved delivery of irrigant up to working length. Bacterial count was more with active irrigation, though not significant. There is no effect on long-term periapical healing. Conclusion: It may be concluded that mechanical active irrigation devices are beneficial in reducing post-operative pain and improving canal and isthmus cleanliness during Endodontics.
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The Effect of Different Irrigation Agitation Techniques on Postoperative Pain in Mandibular Molar Teeth with Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial. J Endod 2018; 44:1451-1456. [DOI: 10.1016/j.joen.2018.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/11/2018] [Accepted: 06/15/2018] [Indexed: 12/21/2022]
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16
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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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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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Toljan I, Bago I, Jurič, Anić I. Eradication of Intracanal Enterococcus Faecalis Biofilm by Passive Ultrasonic Irrigation and RinsEndo System. Acta Stomatol Croat 2016; 50:14-22. [PMID: 27688422 DOI: 10.15644/asc50/1/3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
AIM The aim of the study was to compare the antimicrobial efficacy of three irrigation techniques after the use of standardized volume of NaOCl and with standardized time and irrigation. METHODOLOGY Forty-eight single rooted teeth were inoculated with an Enterococcus faecalis suspension for 24 h. The remaining six canals served as negative controls. The 36 root canals were randomly distributed into three experimental groups; group 1, conventional syringe irrigation; group 2, automated-dynamic irrigation (RinsEndo); group 3, passive ultrasonic irrigation (PUI). In the first protocol, the standardized volume of 3% NaOCl (20 mL) was used and in the second protocol, and standardized irrigation time (45 seconds) was used. Samples from root canals were cultured and the colony-forming units (CFUs) were counted. RESULTS When the volume of the irrigant was standardized, RinsEndo was more effective than PUI (p<0.01). When the irrigation time was standardized, there were no significant differences between any irrigation techniques (p>0.05). The RinsEndo group had the highest percentage of minimal counts of E. faecalis CFUs. CONCLUSIONS RinsEndo was more effective than PUI only when the volume of the irrigant was standardized. However, the RinsEndo provided higher bacterial reduction in both protocols when using the least amount of the irrigant and providing longer contact time.
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Affiliation(s)
| | - Ivona Bago
- Private Dental Polyclinic, Zagreb, Croatia
| | - Jurič
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Croatia
| | - Ivica Anić
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Croatia
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Iandolo A, Iandolo G, Malvano M, Pantaleo G, Simeone M. Modern technologies in Endodontics. GIORNALE ITALIANO DI ENDODONZIA 2016. [DOI: 10.1016/j.gien.2015.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Helvacıoğlu Kıvanç B, Deniz Arısu H, Yanar NÖ, Silah HM, İnam R, Görgül G. Apical extrusion of sodium hypochlorite activated with two laser systems and ultrasonics: a spectrophotometric analysis. BMC Oral Health 2015; 15:71. [PMID: 26112918 PMCID: PMC4482037 DOI: 10.1186/s12903-015-0056-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 06/08/2015] [Indexed: 02/06/2023] Open
Abstract
Background The aim of the present study was to compare the effect of ultrasonically or laser (Nd:YAG or diode) activated irrigation on the irrigating solution extrusion compared to non-activated syringe irrigation. Methods Extracted mandibular premolar teeth (n = 48) with single canals were instrumented. The teeth were secured through the lid of an Eppendorf tube filled with 1.0 mL distilled water to collect the apically extruded irrigating solution. The teeth were randomly divided into four groups: non-activated syringe irrigation, diode laser, Nd:YAG laser and passive ultrasonic irrigation (PUI) using 2 % NaOCl. The irrigating solution extruded through the apical foramen was collected in the Eppendorf tube and evaluated by a chemical reaction with using a spectrophotometer. The data was analyzed using one-way ANOVA and Tukey’s post hoc test (α = 0.05). Results All the groups showed apically extruded irrigating solution. There were significant differences among the groups (p < 0.05). Nd:YAG laser activated irrigation showed greater extrusion (p < 0.05), while the non-activated syringe irrigation showed less extrusion (p < 0.05). Only the difference between diode laser and PUI was not statistically significant (p > 0.05). Conclusion Within the limitations of this in vitro study, the researchers concluded that non-activated syringe irrigation caused less apically extruded irrigating solution than PUI and LAI using Nd:YAG or diode lasers.
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Affiliation(s)
- Bağdagül Helvacıoğlu Kıvanç
- Gazi University Faculty of Dentistry Department of Endodontics, 8. Cadde 82. Sokak, 06510, Emek-Ankara, Turkey.
| | - Hacer Deniz Arısu
- Gazi University Faculty of Dentistry Department of Restorative Dentistry, Ankara, Turkey.
| | - Nazlı Özge Yanar
- Gazi University Faculty of Dentistry Department of Endodontics, 8. Cadde 82. Sokak, 06510, Emek-Ankara, Turkey.
| | - Hülya Mercan Silah
- Bilecik Şeyh Edebali University Faculty of Art & Science Department of Chemistry, Bilecik, Turkey.
| | - Recai İnam
- Gazi University Faculty of Art & Science Department of Chemistry, Ankara, Turkey.
| | - Güliz Görgül
- Gazi University Faculty of Dentistry Department of Endodontics, 8. Cadde 82. Sokak, 06510, Emek-Ankara, Turkey.
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