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Furuncuoğlu F, Uğur Aydın Z, Doğan Çankaya T, Ocak MG. Evaluation of the efficacy of different irrigation activation techniques in removing of calcium hydroxide on teeth with the simulated internal root resorption cavity: a confocal laser scanning microscope analysis. Lasers Med Sci 2024; 39:213. [PMID: 39129047 DOI: 10.1007/s10103-024-04167-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 07/31/2024] [Indexed: 08/13/2024]
Abstract
The aim of this study is to evaluate the effect of different irrigation activation methods on root canal sealer penetration in teeth with simulated internal root resorption (IRR) and calcium hydroxide (CH) applied using a confocal laser scanning microscope (CLSM). 60 incisors with a single root and a single canal were included in the study. IRR cavities were created in the middle third of the root canal, and CH was placed. The samples were randomly divided into 4 groups (n = 15) according to the irrigation activation method to be tested: standard needle irrigation (SNI), sonic activation (EDDY), photon-induced photoacoustic flow (PIPS), and shock wave enhanced emission photoacoustic flow (SWEEPS). After irrigation activation applications, the root canals were obturated. Sections of 1.0 ± 0.1 mm were taken from the apical, middle, and coronal regions of each sample. The penetration area (µm2) and maximum penetration depth (µm) of the root canal sealer were examined by CLSM and analyzed using ImageJ software. Statistical analysis was performed with a one-way ANOVA and post-hoc Tukey test at the P < 0.05 significance level. Among all irrigation activation methods tested, both the penetration area and maximum penetration depth of the root canal sealer were greater in the coronal region than in the apical region (p < 0.05). In the IRR region, there was no difference in terms of maximum penetration depth between PIPS and SWEEPS (p > 0.05), it was highest in SWEEPS (p < 0.05). PIPS and SWEEPS were better than other irrigation activation methods in the penetration of root canal sealer in the resorption areas of teeth with IRR.
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Affiliation(s)
- Fatma Furuncuoğlu
- Faculty of Dentistry, Department of Endodontics, Sakarya University, Sakarya, Turkey
| | - Zeliha Uğur Aydın
- Gülhane Faculty of Dentistry, Department of Endodontics, Health Sciences University, Ankara, Turkey
| | - Tülin Doğan Çankaya
- Faculty of Dentistry, Department of Endodontics, Alanya Alaaddin Keykubat University, Antalya, Turkey.
| | - Mehmet Görkem Ocak
- Faculty of Dentistry, Department of Endodontics, Bolu Abant İzzet Baysal University, Bolu, Turkey
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Meire M, De Moor RJG. Principle and antimicrobial efficacy of laser-activated irrigation: A narrative review. Int Endod J 2024; 57:841-860. [PMID: 38340037 DOI: 10.1111/iej.14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
In the last two decades, the activation of root canal irrigants with pulsed lasers as an adjunct in root canal treatment has become increasingly popular. This narrative review explains the physical basics and the working mechanism of laser-activated irrigation (LAI), explores the parameters influencing LAI efficacy, considers historical evolutions in the field and summarizes laboratory and clinical evidence with emphasis on the antimicrobial action of LAI. Cavitation is the driving force behind LAI, with growing and imploding vapour bubbles around the laser tip causing various secondary phenomena in the irrigant, leading to intense liquid dynamics throughout the underlying root canal. High-speed imaging research has shown that laser wavelength, pulse energy, pulse length and fibre tip geometry are parameters that influence this cavitation process. Nevertheless, this has not resulted in standardized settings for LAI. Consequently, there is significant variability in studies assessing LAI efficacy, complicating the synthesis of results. Laboratory studies in extracted teeth suggest that, with regard to canal disinfection, LAI is superior to conventional irrigation and there is a trend of higher antimicrobial efficacy of LAI compared to ultrasonic activation. Clinical evidence is limited to trials demonstrating similar postoperative pain levels after LAI versus no activation or ultrasonic activation. Clinical evidence concerning the effect of LAI on healing of apical periodontitis as yet is scarce.
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Affiliation(s)
- Maarten Meire
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - Roeland J G De Moor
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
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Myint PYA, Watanabe S, Okiji T. Comparative Effectiveness of Different Er:YAG Laser-Activated Irrigation Systems on Removing Calcium Hydroxide from Simulated Internal Root Resorption Cavities at Different Root Levels. Photobiomodul Photomed Laser Surg 2024; 42:480-487. [PMID: 38836513 DOI: 10.1089/pho.2024.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
Objective: To investigate the effectiveness of Er:YAG laser-activated irrigation (LAI) with a short pulse duration for removing calcium hydroxide (CH) from simulated internal root resorption (IRR) cavities at three root levels. Background: Pulse duration is an important parameter during LAI, which ensures the efficiency of irradiation and the corresponding activation process. Short pulses in the range of a few microseconds enable rapid expansion and successive implosion of irrigants, resulting in distinct fluid movement. There have been few reports on CH removal efficacy from IRR cavities of different LAI systems, including those using short pulse duration. Methods: IRR cavities (1.6 mm diameter) were created at the apical, middle, and coronal root levels in 60 mandibular premolars and filled with a radiopaque CH paste. Samples were assigned to the following irrigation groups (n = 12, each): (1) LAI(P)-F, a prototype laser device that operates with short pulse duration (Morita Manufacturing) with a flat tip; (2) LAI(EA)-F, the ErwinAdverl laser device (Morita Manufacturing) with a flat tip; (3) LAI(EA)-T, the ErwinAdverl laser device with a tapered tip; (4) PIPS-T, the Lightwalker laser device (Fotona) with a tapered tip; and (5) SI, the syringe irrigation group. The laser tips were fixed at the canal entrance. The remaining CH volume and surface area were assessed in IRR cavities using micro-computed tomography and scanning electron microscopy, respectively. Data were statistically analyzed utilizing one-way analysis of variance and Tukey's test at 5% significance level. Results: The LAI(P)-F and PIPS-T groups exhibited the highest CH removal rates at three different levels (p < 0.05). The LAI(EA)-F group had a significantly better efficacy of CH removal compared with the LAI(EA)-T group at the middle level (p < 0.05). Conclusion: The LAI(P)-F and PIPS-T groups demonstrated superior efficiency in removing CH from simulated IRR cavities.
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Affiliation(s)
- Phu Yadanar Aung Myint
- Department of Pulp Biology and Endodontics, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Satoshi Watanabe
- Department of Pulp Biology and Endodontics, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takashi Okiji
- Department of Pulp Biology and Endodontics, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Usta SN, Erdem BA, Gündoğar M. Comparison of the removal of intracanal medicaments used in regenerative endodontics from root canal system using needle, ultrasonic, sonic, and laser-activated irrigation systems. Lasers Med Sci 2024; 39:27. [PMID: 38214804 PMCID: PMC10786972 DOI: 10.1007/s10103-024-03980-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
This study aimed to compare the syringe-needle irrigation (SNI), passive ultrasonic irrigation (PUI), EDDY, and shock wave-enhanced emission photoacoustic streaming (SWEEPS) techniques regarding calcium hydroxide and double antibiotic paste removal from the root canal in regenerative endodontic treatments. Eighty single-rooted human teeth were decoronated and enlarged up to #100 to stimulate the immature tooth model. Root canals were irrigated with 1.5% sodium hypochlorite followed by saline solution according to the regenerative endodontic treatment protocol. Dressed teeth were divided into 2 main groups regarding the used intracanal medicaments. Calcium hydroxide and double antibiotic paste were introduced to the canals, and teeth were stored for 3 weeks. Each medicament group was divided into 4 subgroups according to the activation techniques. Medicaments were removed using a 17% EDTA solution. Teeth were split longitudinally into two parts. The remaining medicaments were evaluated under a stereo microscope with a scoring system. Data were analyzed with the Kruskal-Wallis and Mann-Whitney U tests. Regardless of the used irrigation activation systems, there was no statistically significant difference between the removal of the CH and DAP from the root canal (P>0.05). While SWEEPS had the highest ability regarding the removal of intracanal medicaments, syringe-needle irrigation had the lowest (P<0.05). There was no statistically significant difference between PUI and EDDY (P>0.05). Complete removal of intracanal medicaments could not be achieved with any techniques. SWEEPS technology was more effective in removing intracanal medicaments in regenerative endodontic treatments compared to the sonic and ultrasonic irrigation activation systems.
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Affiliation(s)
- Sıla Nur Usta
- Department of Endodontics, Gulhane Faculty of Dentistry, University of Health Sciences, Ankara, Turkey.
| | - Berat Akın Erdem
- Department of Endodontics, Gulhane Faculty of Dentistry, University of Health Sciences, Ankara, Turkey
| | - Mustafa Gündoğar
- Department of Endodontics, Faculty of Dentistry, University of Medipol, Istanbul, Turkey
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Nasiri K. Management of root resorption in dentistry. J Dent Sci 2023; 18:1427-1428. [PMID: 37404643 PMCID: PMC10316509 DOI: 10.1016/j.jds.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Indexed: 07/06/2023] Open
Affiliation(s)
- Kaveh Nasiri
- Corresponding author. Independent Researcher, Koenigraetzstrasse, Essen 45138, Germany.
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Anatomic Comparison of Contralateral Maxillary Second Molars Using High-Resolution Micro-CT. Symmetry (Basel) 2023. [DOI: 10.3390/sym15020420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
The present study aimed to measure and compare anatomic parameters in contralateral maxillary second molars. A total of 18 intact maxillary second molar pairs (n = 36) extracted from 18 patients were scanned with micro-computed tomography (micro-CT) and then reconstructed. Axial, sagittal, and cross-sectional slices were used to analyze the parameters (lengths, widths, and thicknesses) and evaluate the symmetry of the right and left sides. The number of root canals and their internal patterns were classified following Vertucci’s classification. The number of lateral canals and their locations were also noted. Contralateral second molar pairs demonstrated a high degree of similarity in terms of the linear measurements (lengths, widths, and thicknesses). The root canal anatomy configuration symmetry of mesiobuccal, distobuccal, and palatal roots according to Vertucci’s classification were 41.1%, 88.2%, and 94.4%, respectively. In total, 41.6% of mesiobuccal roots, 2.7% of distobuccal roots, and 30.6% of palatal roots had at least one lateral canal. The apical third (38.7%) was the most frequent location of lateral canals, followed by the middle third (32.3%) of the root. This study provides insight into the anatomy of the root canals of contralateral maxillary second molars, which is valuable for both practitioners and researchers.
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Petričević GK, Katić M, Anić I, Salarić I, Vražić D, Bago I. Efficacy of different Er:YAG laser-activated photoacoustic streaming modes compared to passive ultrasonic irrigation in the retreatment of curved root canals. Clin Oral Investig 2022; 26:6773-6781. [PMID: 35879623 DOI: 10.1007/s00784-022-04637-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/12/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate the efficacy of passive ultrasonic irrigation (PUI) and super short pulse (SSP) and shock wave-enhanced emission photoacoustic streaming (SWEEPS) modes of Er:YAG laser-activated irrigation (LAI) with two different laser tips, in removing filling remnants after conventional retreatment in severely curved root canals. MATERIALS AND METHODS The study sample consisted of 40 extracted molars with curved mesiobuccal root canals. The canals were instrumented with ProTaper Next and filled with an epoxy resin-based sealer and gutta-percha using continuous wave vertical compaction and warm injection back-filling. After retreatment with ProTaper Universal Retreatment system and sodium hypochlorite (NaOCl), all samples were randomly divided into four groups (n = 10) according to the final irrigation technique: PUI, LAI/SSP, SWEEPS/flat-tip, and SWEEPS/radial-tip, using 6 mL of 3% NaOCl for an activation time of 3 × 30 s. The samples were subjected to micro-CT scans after root canal filling, retreatment, and final irrigation. The filling material volume and percentage reduction were calculated. RESULTS All tested irrigation techniques were successful in the elimination of the filling remnants after the retreatment (p < 0.001). The LAI/SSP group showed a higher reduction rate than the SWEEPS/flat-tip group (p = 0.032). No significant differences were found between the other groups (p > 0.05). CONCLUSION All tested techniques improved the removal of filling material during retreatment in curved canals. LAI/SSP showed slightly better results than other techniques. CLINICAL RELEVANCE The study highlights the need for additional activated irrigation after the retreatment of curved root canals. The choice between PUI and LAI is not decisive for success.
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Affiliation(s)
- Gabrijela Kapetanović Petričević
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Gundulićeva 5, 10 000, Zagreb, Croatia
| | - Marko Katić
- Department of Materials, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia
| | - Ivica Anić
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Gundulićeva 5, 10 000, Zagreb, Croatia
| | - Ivan Salarić
- Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Domagoj Vražić
- Department of Periodontology, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivona Bago
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Gundulićeva 5, 10 000, Zagreb, Croatia.
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Koruk D, Basmacı F, Kırmızı D, Aksoy U. The Impact of Laser-Activated and Conventional Irrigation Techniques on Sealer Penetration into Dentinal Tubules. Photobiomodul Photomed Laser Surg 2022; 40:565-572. [DOI: 10.1089/photob.2022.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dilara Koruk
- Department of Endodontics, Faculty of Dentistry, Near East University, Nicosia, Cyprus
| | - Fatma Basmacı
- Department of Endodontics, Faculty of Dentistry, Near East University, Nicosia, Cyprus
| | - Dilan Kırmızı
- Department of Endodontics, Faculty of Dentistry, Near East University, Nicosia, Cyprus
| | - Umut Aksoy
- Department of Endodontics, Faculty of Dentistry, Near East University, Nicosia, Cyprus
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Moon W, Chung SH, Chang J. Sonic irrigation for removal of calcium hydroxide in the apical root canal: A micro-CT and light-coupled tracking analysis. PLoS One 2022; 17:e0268791. [PMID: 35653310 PMCID: PMC9162323 DOI: 10.1371/journal.pone.0268791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 05/08/2022] [Indexed: 11/19/2022] Open
Abstract
Objective This study aimed to evaluate the efficacy of three sonic irrigation systems for removal of calcium hydroxide dressing from the apical root canal. Materials and methods A total of 96 single-rooted teeth in three categories of root canal curvatures (straight: 0–5°, moderate: 6–20°, and severe: > 20°) were allocated to four groups: conventional needle irrigation, EndoActivator, EQ-S, and Vibringe. The root canals were instrumented using Protaper NEXT and filled with calcium hydroxide. After removal of calcium hydroxide, the remaining volume of calcium hydroxide was measured by micro-CT analysis. Data were compared among root canal curvatures and irrigation systems using the Kruskal-Wallis test and Mann-Whitney test (p < .05). The oscillating range of each irrigation system was measured using light-coupled motion tracking. Results The volumes of calcium hydroxide remaining in the canals with severe curvature were significantly higher than in those of straight curvature (p < .05). In the canals of moderate or severe curvature, EQ-S showed the highest removal percentage, followed by EndoActivator, Vibringe, and needle irrigation (p < .05). Light-coupled tracking showed the largest oscillating range in EQ-S (p < .05). Conclusions Sonically activated irrigation systems with a flexible tip can be beneficial for calcium hydroxide intracanal dressing removal in the curved apical canals.
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Affiliation(s)
- Wonjoon Moon
- Department of Dental Biomaterials Science, School of Dentistry and Dental Research Institute, Seoul National University, Jongno-gu, Seoul, Republic of Korea
| | - Shin Hye Chung
- Department of Dental Biomaterials Science, School of Dentistry and Dental Research Institute, Seoul National University, Jongno-gu, Seoul, Republic of Korea
| | - Juhea Chang
- National Dental Care Center for Persons with Special Needs, Seoul National University Dental Hospital, Jongno-gu, Seoul, Republic of Korea
- * E-mail:
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