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Donnermeyer D, Dust PC, Schäfer E, Bürklein S. Comparative Analysis of Irrigation Techniques for Cleaning Efficiency in Isthmus Structures. J Endod 2024; 50:644-650.e1. [PMID: 38382735 DOI: 10.1016/j.joen.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION This study aimed to evaluate the removal of a biofilm-mimicking hydrogel from isthmus structures in a simulated complex root canal system consisting of 2 curved root canals by Laser-activated irrigation (LAI, AdvErl Evo, Morita) and mechanical activation techniques. METHODS A 3D-printed root canal model with 2 parallel root canals (60°-curvature, radius 5 mm, dimension 25/.06) with a total length of 20 mm connected via isthmuses (2.5 × 0.4 × 0.2 mm) at 5 mm and 8 mm from the apical endpoint and with lateral canals (diameter 0.2 mm) in all directions at 2, 5, and 8 mm from the apex was filled with a colored biofilm-mimicking hydrogel. Irrigation protocols under continuous irrigation with distilled water (3 × 20s per root canal; 3 ml/20s; n = 20) included conventional needle irrigation (=NI); manual agitation (=MA, gutta-percha point 25/.06); EndoActivator (=SAI-EA, 25/.04); EDDY (=SAI-E, 25/.04); ultrasonically-activated irrigation (=UAI) and LAI (Er:YAG-laser; P400FL tip at canal entrance; 25pps, 50 mJ, 300μs). Removal of the hydrogel was determined as a percentage via standardized photos through a microscope. Statistical analysis was performed using Kruskal-Wallis and Conover tests (P = .05). RESULTS Laser-activated irrigation (LAI) was associated with the greatest removal of hydrogel from the entire root canal system (P < .05), followed by SAI-E. No significant differences were reported for the coronal isthmus between LAI, SAI-E, NI, and MA (P > .05), but inferior results for SAI-EA and UAI (P < .05). In the apical isthmus, all techniques outperformed UAI (P < .05), with LAI, SAI-E, and NI showing the best results (P < .05). CONCLUSIONS Laser-activated irrigation (LAI) was superior to other irrigation techniques in the entire root canal system. SAI-E and NI performed comparable to LAI in the isthmuses.
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Affiliation(s)
- David Donnermeyer
- Department of Periodontology and Operative Dentistry, University of Münster, Münster, Germany
| | - Patricia Claire Dust
- Department of Periodontology and Operative Dentistry, University of Münster, Münster, Germany
| | - Edgar Schäfer
- Central Interdisciplinary Ambulance in the School of Dentistry, University of Münster, Münster, Germany
| | - Sebastian Bürklein
- Central Interdisciplinary Ambulance in the School of Dentistry, University of Münster, Münster, Germany.
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Wigler R, Srour Y, Wilchfort Y, Metzger Z, Kfir A. Debris and Smear Layer Removal in Curved Root Canals: A Comparative Study of Ultrasonic and Sonic Irrigant Activation Techniques. Dent J (Basel) 2024; 12:51. [PMID: 38534274 DOI: 10.3390/dj12030051] [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: 10/23/2023] [Revised: 01/30/2024] [Accepted: 02/23/2024] [Indexed: 03/28/2024] Open
Abstract
The aim of this study was to compare the cleaning efficacy of three irrigant activation devices with a control of non-activated syringe and needle irrigation in curved root canals. Sixty human curved roots were endodontically prepared and divided into four groups (n = 15) with similar root curvature distributions. Final irrigation using 4% NaOCl was performed with a syringe and needle (30-G) alone, or with Eddy sonic powered irrigation system (polymeric tip #0.25/0.06), Endosonic ultrasonic activation (polymeric tip #0.25/0.03), or Irrisafe ultrasonic activation (stainless-steel tip, #0.25/0.00). SEM was used to evaluate cleaning efficacy, employing five-score systems for debris and smear layer. While no significant difference in debris removal was observed between Endosonic or Irrisafe activation and non-activated irrigation, Eddy sonic powered irrigation system significantly improved debris removal in the apical third of curved root canals. Smear layer removal was effective in coronal and mid-root sections for all groups but less so in the apical third. Thus, Eddy sonic powered irrigation system demonstrated higher efficacy in removing debris from the apical third of curved root canals compared with non-activated syringe and needle irrigation. However, all three irrigant activation systems exhibited no difference from the non-activated control in smear layer removal.
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Affiliation(s)
- Ronald Wigler
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | | | - Yuval Wilchfort
- The Goldschleger School of Dental Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Zvi Metzger
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Anda Kfir
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
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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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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: 84] [Impact Index Per Article: 42.0] [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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Chaniotis A, Ordinola Zapata R. Present status and future directions -Management of curved and calcified root canals. Int Endod J 2022; 55 Suppl 3:656-684. [PMID: 35106792 DOI: 10.1111/iej.13685] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 12/01/2022]
Abstract
Root canal curvature and calcification introduce factors that increase the risk of procedural accidents during root canal treatment. The inability to achieve patency to the apical third, asymmetrical dentine removal leading to transportation, perforation and instrument fracture inside the curved trajectories are some of the procedural problems that might jeopardize the management of intraradicular infection and result in poor treatment outcomes. In fact, curved and constricted canals introduce such complexity that total instrumentation concepts and specially designed instruments have been developed to deal with the challenge. This narrative review seeks to provide and consolidate the principles necessary for understanding the dynamics of curved and constricted canal management and to improve the understanding for future developments in this field.
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Affiliation(s)
- Antonis Chaniotis
- Private practice, National and Kapodistrian University of Athens, Dental School, Athens, Greece
| | - Ronald Ordinola Zapata
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA
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Zhou J, Liu T, Guo L. Effectiveness of XP-Endo Finisher and passive ultrasonic irrigation on intracanal medicament removal from root canals: a systematic review and meta-analysis. BMC Oral Health 2021; 21:294. [PMID: 34107959 PMCID: PMC8191128 DOI: 10.1186/s12903-021-01644-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/27/2021] [Indexed: 01/07/2023] Open
Abstract
Background XP-Endo Finisher (XPF) and passive ultrasonic irrigation (PUI) are commonly used in intracanal medicament removal. The effectiveness of these two techniques needs to be compared, and evidence-based research should be conducted. Methods A comprehensive literature search was conducted in PubMed, Web of Science, Embase, Cochrane Library, and Google Scholar up to December 20th, 2020. The outcomes of the included trials were pooled into the Cochrane Collaboration’s Review Manager 5.3 software. Cochrane’s risk-of-bias tool 2.0 was applied to assess the risk of bias. Results Nine articles were included in this systematic review and processed for data extraction, and eight studies were identified for meta-analysis. In general, the use of PUI showed better medicament removal effectiveness than XPF (odds ratio [OR]: 3.09; 95% confidence interval [CI], 1.96–4.86; P < 0.001). PUI was also significantly more efficient than XPF in the apical third (OR: 3.42; 95% CI, 1.32–8.84; P = 0.01). For trials using sodium hypochlorite (NaOCl) alone, PUI was also significantly more effective than XPF on intracanal medicaments removal (OR: 5.23; 95% CI, 2.79–9.82; P < 0.001). However, there was no significant difference between PUI and XPF when NaOCl and ethylenediaminetetraacetic acid (EDTA) were used in combination (OR: 1.51; 95% CI, 0.74–3.09; P = 0.26). In addition, for studies whose intracanal medicament periods were two weeks, the effectiveness of PUI was statistically better than the XPF (OR: 7.73; 95% CI, 3.71–16.07; P < 0.001). Nevertheless, for trials whose intracanal medicament time was one week or over two weeks, no differences between the XPF and PUI were found (OR: 1.54; 95% CI, 0.74–3.22; P = 0.25) (OR: 1.42; 95% CI, 0.44–4.61; P = 0.56). Conclusions The meta-analysis is the first study to quantitatively compare the effectiveness of XPF and PUI techniques on intracanal medicaments removal. With rigorous eligibility criteria, the study only included high-quality randomised controlled trials. The study indicated that PUI might be superior over XPF techniques for removing intracanal medicaments from artificial standardized grooves and cavities in the root canal system. The anatomical areas, irrigation protocol, and intracanal medicaments time may influence the cleaning efficacy. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01644-7.
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Affiliation(s)
- Jiani Zhou
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, 56 Lingyuanxi Road, Guangzhou, 510055, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Tingjun Liu
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, 56 Lingyuanxi Road, Guangzhou, 510055, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Lihong Guo
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, 56 Lingyuanxi Road, Guangzhou, 510055, China. .,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
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Castelo-Baz P, Lozano FJR, Ginzo-Villamayor MJ, Vila RM, Seoane-Romero J, Martín-Cruces J, Martín-Biedma B. Efficacy of continuous apical negative ultrasonic irrigation (CANUI) in penetration of simulated lateral canals in extracted teeth. Sci Rep 2021; 11:10908. [PMID: 34035414 PMCID: PMC8149429 DOI: 10.1038/s41598-021-90430-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/15/2021] [Indexed: 02/08/2023] Open
Abstract
The aim of this study was to evaluate the efficacy of continuous apical negative ultrasonic irrigation into simulated lateral canals and the apical third in straight and curved root canals. Two simulated lateral canals were created 2, 4 and 6 mm from the working length in 120 single-rooted teeth (6 canals/tooth, n = 360 straight, n = 360 curved). The teeth were randomly divided into 3 experimental groups: positive pressure irrigation (PPI) (n = 20); passive ultrasonic irrigation (PUI) (n = 20); continuous apical negative ultrasonic irrigation (CANUI) (n = 20). 20% Chinese ink was added to a 5% sodium hypochlorite solution and delivered into the root canals. The results showed a significantly higher (P < 0.05) penetration of irrigant into the lateral canals and up to working length in the CANUI group for straight and curved roots. CANUI improves penetration into the lateral canals and up to the working length of the cleared teeth in straight and curved roots.
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Affiliation(s)
- Pablo Castelo-Baz
- Facultad de Odontología, University of Santiago de Compostela, Entrerríos Street, No. 15702, Santiago de Compostela, Spain.
| | | | - María J Ginzo-Villamayor
- Facultad de Odontología, University of Santiago de Compostela, Entrerríos Street, No. 15702, Santiago de Compostela, Spain
| | - Ramón Miguéns Vila
- Facultad de Odontología, University of Santiago de Compostela, Entrerríos Street, No. 15702, Santiago de Compostela, Spain
| | - Juan Seoane-Romero
- Facultad de Odontología, University of Santiago de Compostela, Entrerríos Street, No. 15702, Santiago de Compostela, Spain
| | - José Martín-Cruces
- University of Murcia, Murcia, Spain.,Universidad Internacional de Catalunya, Barcelona, Spain
| | - Benjamín Martín-Biedma
- Facultad de Odontología, University of Santiago de Compostela, Entrerríos Street, No. 15702, Santiago de Compostela, Spain
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Efficacy of different irrigation technique in simulated curved root canals. Lasers Med Sci 2021; 36:1317-1322. [PMID: 33624186 DOI: 10.1007/s10103-021-03263-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/31/2021] [Indexed: 01/14/2023]
Abstract
The aim of this study was to assess the influence of the canal curvature on the efficacy of sonically, ultrasonically, and laser-activated irrigation in removing a biofilm-mimicking hydrogel (BMH) from simulated canal irregularities. Transparent resin blocks containing a curved root canal (40° or 60°) were used as test models. A 4-mm groove at 1 mm from the apex was filled with BMH. Five different irrigation procedures were performed (n=20): needle irrigation (NI), EndoActivator (EA), Eddy, ultrasonically activated irrigation (UAI) (Irrisafe), and laser-activated irrigation (LAI) using a pulsed erbium laser (PIPS approach). All protocols were executed for 3×20s. Images of the groove were taken before and after irrigation, and the percentage BMH removal was calculated using image analysis software. In the 40° canal curvature model, the highest BMH removal was observed for UAI (99.9%), yielding a significantly better removal than that of EA (57.2%) and NI (53.8%), but not of LAI (96.8%) and Eddy (99.4%). In the 60° canal curvature model, UAI removed 99.5%, which resulted in significantly greater hydrogel removal than all other groups (P < 0.05). The difference between LAI (82.5%) and Eddy (78.1%) was not statistically significant, but both were more effective than EA (13.5%) and NI (7.3%). Canal curvature negatively affects the cleaning efficacy of different irrigation methods. The effect was most pronounced for the sonic techniques, while this was not the case for UAI. This could be ascribed to the prebent ultrasonic tip. Despite the position of the laser tip at the orifice level, fluid streaming during LAI resulted in substantial BMH removal beyond the curve.
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Efficacy of a Nickel-Titanium Ultrasonic Instrument for Biofilm Removal in a Simulated Complex Root Canal. MATERIALS 2020; 13:ma13214914. [PMID: 33142941 PMCID: PMC7662333 DOI: 10.3390/ma13214914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/25/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023]
Abstract
This study evaluated the effectiveness of NiTi ultrasonic tips for Enterococcus faecalis (E. faecalis) biofilm removal in simulated complex root canals. Sixty root canal models consisting of a 30-degree curved main canal and two lateral canals were constructed from polydimethylsiloxane and incubated with E. faecalis. Irrigants in root canals were activated using a manual syringe (SI), a stainless steel (SS) instrument, a nickel-titanium (Ni-Ti) ultrasonic instrument, or a sonic instrument (EA). Instruments of SI, SS, and NiTi-9 groups were placed 9 mm from the apex, whereas those in NiTi-2 and EA groups were placed 2 mm from the apex. The efficacy of each method was determined as the ratio of fluorescence concentration before and after activation. In the apical curved canal, the highest efficacy was found in the NiTi-2 group (99.40%), followed by SI (84.25%), EA (80.38%), SS (76.93%), and NiTi-9 (67.29%) groups. In lateral canals 1 and 2, the efficacy was the highest in the NiTi-2 group and the lowest in the SI group. The NiTi ultrasonic instrument could effectively remove biofilms in the curved canal and lateral canals. This instrument should be introduced close to the working length. An up-and-down motion of the activation instrument is recommended.
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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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Eggmann F, Vokac Y, Eick S, Neuhaus KW. Sonic irrigant activation for root canal disinfection: power modes matter! BMC Oral Health 2020; 20:102. [PMID: 32276625 PMCID: PMC7147034 DOI: 10.1186/s12903-020-01088-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/25/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Sonic irrigant activation has gained widespread popularity among general dentists and endodontists alike in recent years. This in vitro study aimed to evaluate the impact of three power modes of a sonic activation device (EDDY) on its antimicrobial effectiveness in infected root canals. METHODS The root canals of straight, human roots (n = 120) were prepared to size 40/.06. In a short-term infection experiment, the root canals were inoculated with different microbial species for three days. The following irrigation protocols, using 4 ml of normal saline as irrigant, were performed: negative control, manual rinsing, sonic irrigant activation at power modes "low", "medium" and "high". In a second, long-term experiment, testing the same irrigation protocols, inoculation lasted 21 days and sodium hypochlorite was used as irrigant. Sequential infection control samples were assessed using culture assays. The statistical analysis included one-way analysis of variance of log10-scaled counts of colony-forming units (CFU) with post-hoc comparisons using Bonferroni corrections and Chi2 tests (α = 0.05). RESULTS In the short-term experiment, the sonic irrigation protocols decreased the number of CFUs by 1.88 log10 units compared with the negative control (p < 0.001). The power modes "medium" and "high" achieved the most effective reduction of the microbial load. In the long-term experiment, microbial regrowth occurred after 7 days unless the device was used at its highest power setting. CONCLUSIONS The power modes of the sonic irrigation device have a significant impact on the effectiveness for endodontic disinfection. The sonic irrigation device should always be used at the highest power setting in order to maximize its antimicrobial effectiveness.
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Affiliation(s)
- Florin Eggmann
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine, UZB, University of Basel, Mattenstrasse 40, CH-4056, Basel, Switzerland.
| | | | - Sigrun Eick
- Laboratory of Oral Microbiology, Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Klaus W Neuhaus
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine, UZB, University of Basel, Mattenstrasse 40, CH-4056, Basel, Switzerland.,Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Bern, Switzerland
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12
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Ultrasonic Irrigant Activation during Root Canal Treatment: A Systematic Review. J Endod 2019; 45:31-44.e13. [PMID: 30558797 DOI: 10.1016/j.joen.2018.09.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/05/2018] [Accepted: 09/16/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The aim of this study was to systematically review the evidence on the cleaning and disinfection of root canals and the healing of apical periodontitis when ultrasonic irrigant activation is applied during primary root canal treatment of mature permanent teeth compared with syringe irrigation. METHODS An electronic search was conducted of the Cochrane Library, Embase, LILACS, PubMed, SciELO, and Scopus databases using both free-text key words and controlled vocabulary. Additional studies were sought through hand searching of endodontic journals and textbooks. The retrieved studies were screened by 2 reviewers according to predefined criteria. The included studies were critically appraised, and the extracted data were arranged in tables. RESULTS The electronic and hand search retrieved 1966 titles. Three clinical studies and 45 in vitro studies were included in this review. Ultrasonic activation did not improve the healing rate of apical periodontitis compared with syringe irrigation after primary root canal treatment of teeth with a single root canal. Conflicting results were reported by the in vitro microbiological studies. Ultrasonic activation was more effective than syringe irrigation in the removal of pulp tissue remnants and hard tissue debris based on both clinical and in vitro studies. Ultrasonic activation groups were possibly favored in 13 studies, whereas syringe irrigation groups may have been favored in 3 studies. CONCLUSIONS The level of the available evidence was low, so no strong clinical recommendations could be formulated. Future studies should focus on the antimicrobial effect and healing of apical periodontitis in teeth with multiple root canals.
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Haupt F, Meinel M, Gunawardana A, Hülsmann M. Effectiveness of different activated irrigation techniques on debris and smear layer removal from curved root canals: a SEM evaluation. AUST ENDOD J 2019; 46:40-46. [PMID: 30907051 DOI: 10.1111/aej.12342] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2019] [Indexed: 02/01/2023]
Abstract
This study evaluates the effectiveness of different activated irrigation techniques on removal of debris and smear layer from curved root canals. Ninety mandibular molars with a root canal curvature between 20 and 40 degrees were assigned to 4 groups (n = 20): syringe irrigation (SI), passive ultrasonic activation (PUI), sonic activation with EDDY (ED) or EndoActivator (EA) and a control group. Mesiobuccal root canals were prepared to size 40, 0.04 and irrigated with NaOCl (3%) according to the respective technique. Roots were split longitudinally and subjected to scanning electron microscopic analysis. Presence of debris and smear layer was evaluated using 5-grade scoring systems with 200× and 1000× magnification, respectively. Data were analysed with nonparametric analysis for ordinal longitudinal data (α = 5%). Activation of the irrigant significantly improved smear layer removal (P < 0.05). Regarding debris, only activation with EA and ED was significantly more effective than SI (P < 0.05). No activation technique was able to eliminate debris and smear layer completely from curved root canals.
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Affiliation(s)
- Franziska Haupt
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
| | - Michael Meinel
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
| | - Asanka Gunawardana
- Department of Mathematical Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Michael Hülsmann
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
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De-Deus G, Belladonna FG, de Siqueira Zuolo A, Perez R, Carvalho MS, Souza EM, Lopes RT, Silva EJNL. Micro-CT comparison of XP-endo Finisher and passive ultrasonic irrigation as final irrigation protocols on the removal of accumulated hard-tissue debris from oval shaped-canals. Clin Oral Investig 2018; 23:3087-3093. [PMID: 30417226 DOI: 10.1007/s00784-018-2729-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/22/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the effectiveness of the XP-endo Finisher instrument and passive ultrasonic irrigation (PUI) as final irrigation protocols on the removal of accumulated hard-tissue debris (AHTD) from oval-shaped canals using micro-computed tomographic (micro-CT) analysis. METHODS Twenty mandibular incisors were anatomically pair-matched based on similar morphological dimensions (length, volume, aspect ratio, and configuration) through micro-CT analysis, prepared with Reciproc R25 instrument, scanned again, and assigned to one of the two experimental groups (n = 10), according to the final irrigation protocol: XP-endo Finisher and PUI. After the final irrigation protocols, the specimens were rescanned and the registered datasets were examined to quantify the amount of AHTD. Data were statistically analyzed using Student's t test with a significance level of 5%. RESULTS The final irrigation protocols were highly similar in terms of volumetric percentage reduction of AHTD (P = 1.000). CONCLUSIONS XP-endo Finisher and PUI showed the same effectiveness on the removal of AHTD. None of the tested final irrigation protocols completely removed the AHTD from oval-shaped root canals. CLINICAL RELEVANCE AHTD may be considered clinically relevant because it could harbor bacterial contents away from the disinfection procedures. Both final irrigation protocols were effective on the removal of AHTD.
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Affiliation(s)
- Gustavo De-Deus
- Department of Endodontics, Fluminense Federal University, Av. Henrique Dodsworth 85 Apto 808 - Lagoa, Niterói, Rio de Janeiro, RJ, 22061-030, Brazil.
| | - Felipe Gonçalves Belladonna
- Department of Endodontics, Fluminense Federal University, Av. Henrique Dodsworth 85 Apto 808 - Lagoa, Niterói, Rio de Janeiro, RJ, 22061-030, Brazil
| | - Arthur de Siqueira Zuolo
- Department of Endodontics, Fluminense Federal University, Av. Henrique Dodsworth 85 Apto 808 - Lagoa, Niterói, Rio de Janeiro, RJ, 22061-030, Brazil
| | - Renata Perez
- Department of Endodontics, Fluminense Federal University, Av. Henrique Dodsworth 85 Apto 808 - Lagoa, Niterói, Rio de Janeiro, RJ, 22061-030, Brazil
| | - Marco Simões Carvalho
- Department of Endodontics, Fluminense Federal University, Av. Henrique Dodsworth 85 Apto 808 - Lagoa, Niterói, Rio de Janeiro, RJ, 22061-030, Brazil
| | - Erick Miranda Souza
- Department of Dentistry II, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - Ricardo Tadeu Lopes
- Nuclear Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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Nagendrababu V, Jayaraman J, Suresh A, Kalyanasundaram S, Neelakantan P. Effectiveness of ultrasonically activated irrigation on root canal disinfection: a systematic review of in vitro studies. Clin Oral Investig 2018; 22:655-670. [DOI: 10.1007/s00784-018-2345-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/15/2018] [Indexed: 12/01/2022]
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Rodrigues CT, Duarte MAH, Guimarães BM, Vivan RR, Bernardineli N. Comparison of two methods of irrigant agitation in the removal of residual filling material in retreatment. Braz Oral Res 2017; 31:e113. [PMID: 29267674 DOI: 10.1590/1807-3107bor-2017.vol31.0113] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 11/23/2017] [Indexed: 12/16/2022] Open
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Schiavotelo TCL, Coelho MS, Rasquin LC, Rocha DGP, Fontana CE, Bueno CEDS. Ex-vivo Smear Layer Removal Efficacy of Two Activated Irrigation Techniques After Reciprocating Instrumentation in Curved Canals. Open Dent J 2017; 11:512-519. [PMID: 29238411 PMCID: PMC5712658 DOI: 10.2174/1874210601711010512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/28/2017] [Accepted: 09/14/2017] [Indexed: 01/10/2023] Open
Abstract
Introduction: This study aimed to compare the effectiveness of two activated irrigation techniques in removing the smear layer after single-file reciprocating instrumentation in curved canals. Materials and Methods: Sixty distobuccal roots of maxillary molars were standardized to create a closed system, and then instrumented using WaveOne Primary (Dentsply Maillefer, Ballaigues, Switzerland) instruments. Fifty-four specimens were randomly distributed into 3 groups for final irrigation: Non-activated irrigation, passive ultrasonic irrigation (PUI), and EndoActivator (EA;Dentsply Maillefer, Tulsa, USA) irrigation. All specimens received 3 mL of 17% EDTA for 1 minute, followed by irrigation with 6 mL of 2.5% NaOCl. The apical, middle and cervical thirds of the specimens were analyzed using scanning electronic microscopy (SEM), and the amount of remaining smear layer on the canal walls was rated by three examiners using a five-category scoring system. Kendall’s concordance coefficient was used to assess inter-rater agreement. Kruskal-Wallis and Mann-Whitney (Bonferroni) tests were used to compare the scores. Results: Kendall’s concordance coefficient was ≥ 0.7, indicating an excellent level of agreement between the raters. No statistically significant difference in irrigation techniques efficacy for removal of the smear layer (p=0.061) was found for the apical third. The scores attributed to the specimens irrigated with the EA system were significantly lower than those of the other groups in the cervical and middle thirds (p< 0.05). Conclusions: The efficacy of the EA system in removing the smear layer in the cervical and middle thirds of root canals instrumented with reciprocating motion was significantly higher than that of either PUI or non-activated irrigation. Both EA and PUI performed similarly in apical third.
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Affiliation(s)
| | - Marcelo Santos Coelho
- Department of Endodontics, School of Dentistry and Medicine, São Leopoldo Mandic University, Campinas, SP, Brazil
| | - Luis Cardoso Rasquin
- Department of Integrated Clinical Dentistry and Diagnostics, School of Dentistry, Federal University of Bahia, Salvador, BA, Brazil
| | - Daniel Guimarães Pedro Rocha
- Department of Endodontics, School of Dentistry and Medicine, São Leopoldo Mandic University, Campinas, SP, Brazil
| | - Carlos Eduardo Fontana
- Department of Endodontics, School of Dentistry and Medicine, São Leopoldo Mandic University, Campinas, SP, Brazil.,Department of Endodontics, School of Dentistry and Medicine, Pontificia Universidade Católica de Campinas, Campinas, SP, Brazil
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Castelo-Baz P, Varela-Patiño P, Ruíz-Piñón M, Abella F, Miguéns-Vila R, Martín-Biedma B. Continuous Apical Negative-Pressure Ultrasonic Irrigation (CANUI): A new concept for activating irrigants. J Clin Exp Dent 2017. [PMID: 28638557 PMCID: PMC5474336 DOI: 10.4317/jced.53836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Irrigation of the root canal system is an essential step in the endodontic treatment. The aim of this article is to introduce continuous apical negative-pressure ultrasonic irrigation (CANUI), a new irrigation concept, and compare the characteristics of this new technique with current devices for activating the irrigant.
Material and Methods: CANUI is designed for cleaning and disinfecting the root canal system. The device consists of a tube inside another tube that allows the continuous ultrasonic exchange of fresh irrigant, as the irrigant is simultaneously aspirated apically. The coronal and apical tubes are 0.75 and 0.3 mm in diameter, respectively. It is composed of a nickel-titanium microcannula suitable for the working length of curved canals.
Results: The CANUI technique has the advantages of apical negative pressure (to avoid apical extrusion of the irrigant) and continuous ultrasonic irrigation (continuous refreshment of the irrigant and forced introduction into the canal ramifications).
Conclusions: The CANUI technique could improve the irrigation technique of dentists to reach more disinfection in endodontic treatments.
Key words:Apical negative pressure, continuous ultrasonic irrigation, irrigation in curved canals, irrigation systems.
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Affiliation(s)
- Pablo Castelo-Baz
- PhD, DDS, University of Santiago de Compostela, Facultad de Odontología, Entrerríos Street, no number. 15702, Santiago de Compostela
| | - Purificación Varela-Patiño
- PhD, University of Santiago de Compostela, Facultad de Odontología, Entrerríos Street, no number. 15702, Santiago de Compostela
| | - Manuel Ruíz-Piñón
- PhD, University of Santiago de Compostela, Facultad de Odontología, Entrerríos Street, no number. 15702, Santiago de Compostela
| | | | - Ramón Miguéns-Vila
- DDS, University of Santiago de Compostela, Facultad de Odontología, Entrerríos Street, no number. 15702, Santiago de Compostela
| | - Benjamín Martín-Biedma
- PhD, University of Santiago de Compostela, Facultad de Odontología, Entrerríos Street, no number. 15702, Santiago de Compostela
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Nakamura VC, Pinheiro ET, Prado LC, Silveira AC, Carvalho APL, Mayer MPA, Gavini G. Effect of ultrasonic activation on the reduction of bacteria and endotoxins in root canals: a randomized clinical trial. Int Endod J 2017; 51 Suppl 1:e12-e22. [PMID: 28439928 DOI: 10.1111/iej.12783] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/20/2017] [Indexed: 02/01/2023]
Abstract
AIM This randomized clinical trial aimed to compare the effectiveness of ultrasonic activation with that of nonactivated irrigation on the removal of bacteria and endotoxin from root canals. METHODOLOGY Fifty patients with necrotic pulps and asymptomatic apical periodontitis were randomly allocated into two groups according to the final irrigation protocol after root canal preparation: Group UI - ultrasonic irrigation (n = 25) and Group NI - needle irrigation (n = 25). The root canals were medicated with calcium hydroxide for 14 days. Microbiological sampling was performed before (S1) and after the root canal preparation (S2), after the irrigation protocols (S3) and after the removal of the intracanal medication (S4). Total bacteria counts were determined by qPCR and the endotoxin levels by the limulus amebocyte lysate assay. Intragroup analyses were performed using the Wilcoxon test for related samples, whereas intergroup analyses were performed using the Mann-Whitney U-test (P < 0.05). RESULTS All S1 samples were positive for bacteria, with median numbers of 1.49 × 106 and 8.55 × 105 bacterial cells for the UI and NI groups, respectively. This number significantly decreased in S2 samples (UI: 1.41 × 104 ; NI: 3.53 × 104 ; both with P < 0.001). After final irrigation protocols, there was a significant decrease in bacterial load from S2 to S3 samples in both groups (UI: 4.29 × 103 ; NI: 1.08 × 104 ; P < 0.01). Intergroup analysis revealed a significant difference between irrigation methods regarding bacterial counts in S3 samples (P < 0.05). In contrast, no significant differences were observed between groups for endotoxin levels (P > 0.05). CONCLUSIONS Ultrasonic activation was more effective than nonactivated irrigation for reducing the number of bacteria but not the endotoxin levels in root canals of teeth with apical periodontitis.
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Affiliation(s)
- V C Nakamura
- Discipline of Endodontic, Department of Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - E T Pinheiro
- Discipline of Endodontic, Department of Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - L C Prado
- Discipline of Endodontic, Department of Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - A C Silveira
- Discipline of Endodontic, Department of Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - A P L Carvalho
- Discipline of Endodontic, Department of Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - M P A Mayer
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - G Gavini
- Discipline of Endodontic, Department of Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
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20
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Neuhaus KW, Liebi M, Stauffacher S, Eick S, Lussi A. Antibacterial Efficacy of a New Sonic Irrigation Device for Root Canal Disinfection. J Endod 2016; 42:1799-1803. [PMID: 27780580 DOI: 10.1016/j.joen.2016.08.024] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/22/2016] [Accepted: 08/25/2016] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Passive ultrasonic irrigation (PUI) is the most widespread method used to activate irrigation solutions. Concerns have been raised that PUI is less effective in curved root canals and is not passive at all. Our aim was to compare a novel passive sonic irrigation (PSI) device (6000 Hz) with PUI and manual irrigation (MI) with respect to their efficiency in removing different endodontic microorganisms from curved and straight root canals. METHODS We performed 2 experiments as follows. In a 3-day infection model, we included 8 groups of single or dual microbial species that were rinsed with 0.9% sodium chloride using PSI, PUI, or MI. Colony-forming units (CFUs) were counted after incubation, and log10 transformations were performed for statistical comparisons. In a 21-d infection model, we tested the same irrigation protocols on 4 groups of microorganisms and used 1.5% sodium hypochlorite as an irrigant. Infection control samples were taken at day 0, 3, 5, and 7 after treatment and were subsequently reincubated. RESULTS Using sodium chloride as an irrigant, the amount of reduction in CFUs compared with the negative control was approximately 3 log10 units for PSI at 6000 Hz, 2 log10 units for PUI, and 1 log10 unit for MI. PSI reduced the microorganism CFUs significantly better than PUI. Using sodium hypochlorite led to a significant reduction in microorganism CFUs even with MI. After 3 days, compared with MI, microorganism regrowth significantly reduced after PSI and PUI treatment, but in these groups, in at least half of the samples, microorganisms were detectable after 7 days. CONCLUSIONS PSI at 6000 Hz might be at least equal to PUI with respect to reduction of the microbial load in curved and straight root canals.
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Affiliation(s)
- Klaus W Neuhaus
- Department of Preventive, Restorative and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland.
| | - Melanie Liebi
- Department of Preventive, Restorative and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Simone Stauffacher
- Department of Preventive, Restorative and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Sigrun Eick
- Laboratory of Oral Microbiology, Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Adrian Lussi
- Department of Preventive, Restorative and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
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Castelo-Baz P, Varela-Patiño P, Cantatore G, Domínguez-Perez A, Ruíz-Piñón M, Miguéns-Vila R, Martín-Biedma B. In vitro comparison of passive and continuous ultrasonic irrigation in curved root canals. J Clin Exp Dent 2016; 8:e437-e441. [PMID: 27703613 PMCID: PMC5045692 DOI: 10.4317/jced.53023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 02/17/2016] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The efficacy of endodontic irrigation procedures can be compromised by the complexity of the root canal system. Delivering irrigants to the apical third of curved canals presents a particular challenge to endodontists. This study compared the effects of two ultrasonic irrigation techniques on the penetration of sodium hypochlorite into the main canal and simulated lateral canals of curved roots in extracted teeth. MATERIAL AND METHODS Two sets of simulated lateral canals were created at 2, 4, and 6 mm from the working length in 60 single-rooted teeth (6 canals/tooth, n = 360 canals). The teeth were randomly divided into three experimental irrigation groups: group 1 (n = 20), positive pressure irrigation (PPI); group 2 (n = 20), passive ultrasonic irrigation (PUI); and group 3 (n = 20), continuous ultrasonic irrigation (CUI). To assess the irrigation solution penetration, 20% Chinese ink (Sanford Rotring GmbH, Hamburg, Germany) was added to a 5% sodium hypochlorite solution and delivered into the curved root canals. The penetration of contrast solution into the simulated lateral canals was scored by counting the number of lateral canals (0-2) penetrated to at least 50% of the total length. RESULTS The CUI group showed significantly higher (P < 0.05) irrigant penetration into the lateral canals and into the apical third of the main canals. The PPI group showed significantly lower sodium hypochlorite penetration (P < 0.001) into the main and lateral canals compared with that in the CUI and PUI groups. Significantly higher irrigant penetration was observed in the PUI group than the PPI group. CONCLUSIONS Using CUI as the final rinse significantly increased the penetration of irrigant solution into the simulated lateral canals and apical third of curved roots. Key words:Continuous ultrasonic irrigation, curved root canals, passive ultrasonic irrigation, positive pressure irrigation, root canal irrigation.
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Investigation of the Efficacy of Passive Ultrasonic Irrigation Versus Irrigation with Reciprocating Activation: An Environmental Scanning Electron Microscopic Study. J Endod 2016; 42:659-63. [DOI: 10.1016/j.joen.2016.01.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 01/19/2016] [Accepted: 01/21/2016] [Indexed: 11/20/2022]
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Cachovan G, Schiffner U, Altenhof S, Guentsch A, Pfister W, Eick S. Comparative antibacterial efficacies of hydrodynamic and ultrasonic irrigation systems in vitro. J Endod 2015; 39:1171-5. [PMID: 23953293 DOI: 10.1016/j.joen.2013.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 04/26/2013] [Accepted: 06/29/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION To ensure root canal treatment success, endodontic microbiota should be efficiently reduced. The in vitro bactericidal effects of a hydrodynamic system and a passive ultrasonic irrigation system were compared. METHODS Single-rooted extracted teeth (n = 250) were contaminated with suspensions of Enterococcus faecalis ATCC 29212, mixed aerobic cultures, or mixed anaerobic cultures. First, the antibacterial effects of the hydrodynamic system (RinsEndo), a passive ultrasonic irrigation system (Piezo smart), and manual rinsing with 0.9% NaCl (the control) were compared. Colony-forming units were counted. Second, the 2 systems were used with 1.5% sodium hypochlorite (NaOCl) alone or NaOCl + 0.2% chlorhexidine (CHX). The colony-forming units in the treated and untreated roots were determined during a period of 5 days. RESULTS Both irrigation systems reduced bacterial numbers more effectively than manual rinsing (P < .001). With NaCl, ultrasonic activated irrigation reduced bacterial counts significantly better than hydrodynamic irrigation (P = .042). The NaOCl + CHX combination was more effective than NaOCl alone for both systems (P < .001), but hydrodynamic irrigation was more effective with NaOCl + CHX than the passive ultrasonic irrigation system. CONCLUSIONS Both irrigation systems, when combined with NaOCl + CHX, removed bacteria from root canals.
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Affiliation(s)
- Georg Cachovan
- Department of Restorative and Preventive Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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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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Yeung W, Raldi DP, Cunha RS, Mello I. Assessment of smear layer removal protocols in curved root canals. AUST ENDOD J 2014; 40:66-71. [PMID: 25244220 DOI: 10.1111/aej.12038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study sought to assess if the final rinse protocol interferes with the smear layer removal in the apical area of curved canals. Sixty-four extracted human mandibular molars with curved mesial roots were instrumented with rotary files and divided into six experimental groups for final rinse: 1EDTA (syringe irrigation with 1 mL of 17% ethylenediaminetetraacetic acid (EDTA) ), 5EDTA (syringe irrigation with 5 mL of 17% EDTA), 1EDTA-P (syringe irrigation with 1 mL of 17% EDTA + pumping with gutta-percha point), 5EDTA-P (syringe irrigation with 5 mL of 17% EDTA + pumping with gutta-percha point), 1EDTA-EA (syringe irrigation with 1 mL of 17% EDTA + EndoActivator) and 5EDTA-EA (syringe irrigation with 5 mL of 17% EDTA + EndoActivator). Final rinsing was carried out over 3 min. The specimens were split lengthwise and observed under a scanning electron microscope using a score criterion. Comparison among the groups showed statistically significant difference only between the 5EDTA-EA group and the other groups (Kruskal-Wallis and Dunn's post-hoc tests, P < 0.05). The combination of 5 mL of 17% EDTA and 3 mL of 2.5% sodium hypochlorite (NaOCl) with the EndoActivator removed smear layer from the apical area of curved root canals more effectively than the other protocols used.
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Affiliation(s)
- William Yeung
- Private Practice, Vancouver, British Columbia, Canada
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26
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Verhaagen B, Boutsioukis C, van der Sluis LWM, Versluis M. Acoustic streaming induced by an ultrasonically oscillating endodontic file. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2014; 135:1717-30. [PMID: 25234972 DOI: 10.1121/1.4868397] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Ultrasonically activated irrigation is an advanced dental technique for irrigation of the root canal system during a root canal treatment. The basic cleaning mechanism is a result of acoustic streaming induced by an oscillating file, leading to mixing of the irrigant and pressure and shear stresses on the walls of the root canal. Here the induced acoustic streaming, pressure, and shear stress are investigated in a two-dimensional cross-section of the root canal, using a combination of theory, numerical predictions, and experimental validation through high-speed particle tracking velocimetry. Acoustic streaming theory describes very well the flow induced by an ultrasonically oscillating endodontic file. It consists of an oscillatory component, which is dominant near the file, and a steady component, or jet, along the axis of oscillation. The importance of the oscillatory component for both the pressure and the shear stress is apparent, as it is two to three orders of magnitude higher than the steady component. A confinement affects the formation of the steady jets; meanwhile the oscillatory velocities and associated pressure and shear stress are increased. Previous work considering only the steady component of the flow therefore, underestimated the hydrodynamic effects induced by ultrasonic files.
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Affiliation(s)
- B Verhaagen
- Physics of Fluids group and MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500AE Enschede, The Netherlands
| | - C Boutsioukis
- Department of Cariology, Endodontology, Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), Gustav Mahlerlaan 3004 1081LA Amsterdam, The Netherlands
| | - L W M van der Sluis
- Center for Dentistry and Oral Hygiene, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands
| | - M Versluis
- Physics of Fluids group and MIRA Institute for Biomedical Technology and Technical Medicine and MESA Institute for Nanotechnology, University of Twente, P.O. Box 217, 7500AE Enschede, The Netherlands
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Fruchi LDC, Ordinola-Zapata R, Cavenago BC, Hungaro Duarte MA, Bueno CEDS, De Martin AS. Efficacy of reciprocating instruments for removing filling material in curved canals obturated with a single-cone technique: a micro-computed tomographic analysis. J Endod 2014; 40:1000-4. [PMID: 24935552 DOI: 10.1016/j.joen.2013.12.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 12/10/2013] [Accepted: 12/13/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the efficacy of nickel-titanium reciprocating instrument techniques and passive ultrasonic irrigation (PUI) for retreatment in curved canals and obturated with correspondent single cones. METHODS Twenty molars were selected with mesial-buccal canals with curvatures between 20° and 40°, and they were instrumented with a Reciproc R25 instrument (VDW, Munich, Germany) in a reciprocating motion and obturated with single cones and AH Plus sealer (Dentsply Maillefer, Ballaigues, Switzerland). The teeth were divided into 2 groups (n = 10) according to the instrument used for the removal of filling material: group 1: Reciproc R25 instrument and group 2: WaveOne Primary instrument (Dentsply Maillefer). The analysis of the remnant filling material was made through micro-computed tomographic imaging after the use of reciprocating instruments and again after the use of PUI with xylene. The effective time of retreatment was registered. RESULTS The filling material of the root canal was efficiently removed (P < .05) for both groups. The percentage of removal of filling materials was 93% for the Reciproc group and 92% for the WaveOne group. There were no statistical significant differences (P > .05) between the groups in relation to the removal of filling material ability and the time needed for the procedure. The effective time for the removal of filling material was 78.7 seconds and 89.5 seconds for the Reciproc and WaveOne groups, respectively. CONCLUSIONS It was concluded that both instruments efficiently but not completely removed the filling material from inside the root canals. The use of xylene with PUI increased the removal of filling material a little, but it was not statically significant.
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Affiliation(s)
- Lincoln de Campos Fruchi
- Postgraduate Program in Endodontics, São Leopoldo Mandic Dental Research Center, Campinas, São Paulo, Brazil.
| | - Ronald Ordinola-Zapata
- Department of Endodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | - Bruno Cavalini Cavenago
- Department of Endodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | | | | | - Alexandre Sigrist De Martin
- Postgraduate Program in Endodontics, São Leopoldo Mandic Dental Research Center, Campinas, São Paulo, Brazil
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28
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Boutsioukis C, Verhaagen B, Walmsley AD, Versluis M, Sluis LWM. Measurement and visualization of file‐to‐wall contact during ultrasonically activated irrigation in simulated canals. Int Endod J 2013; 46:1046-55. [DOI: 10.1111/iej.12097] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 02/19/2013] [Indexed: 12/14/2022]
Affiliation(s)
- C. Boutsioukis
- Physics of Fluids Group Faculty of Science and Technology University of Twente EnschedeThe Netherlands
- MESA+ Institute for Nanotechnology University of Twente EnschedeThe Netherlands
| | - B. Verhaagen
- Physics of Fluids Group Faculty of Science and Technology University of Twente EnschedeThe Netherlands
- MIRA Institute for Biomedical Technology and Technical Medicine University of Twente Enschede The Netherlands
| | - A. D. Walmsley
- School of Dentistry College of Medical and Dental Sciences University of Birmingham Birmingham UK
| | - M. Versluis
- Physics of Fluids Group Faculty of Science and Technology University of Twente EnschedeThe Netherlands
- MESA+ Institute for Nanotechnology University of Twente EnschedeThe Netherlands
- MIRA Institute for Biomedical Technology and Technical Medicine University of Twente Enschede The Netherlands
| | - L. W. M. Sluis
- Department of Conservative Dentistry and Endodontics Paul Sabatier University Toulouse France
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29
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Malki M, Verhaagen B, Jiang LM, Nehme W, Naaman A, Versluis M, Wesselink P, van der Sluis L. Irrigant Flow beyond the Insertion Depth of an Ultrasonically Oscillating File in Straight and Curved Root Canals: Visualization and Cleaning Efficacy. J Endod 2012; 38:657-61. [DOI: 10.1016/j.joen.2012.02.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 02/09/2012] [Accepted: 02/09/2012] [Indexed: 10/28/2022]
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