1
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Monteiro LPB, Guerreiro MYR, Belladonna FG, de Lima CO, da Silva EJNL, da Silva Brandão JM. Can the addition of surfactants to NaOCl irrigation impact on the percentage of voids of root canal filling? AUST ENDOD J 2024; 50:260-266. [PMID: 38243635 DOI: 10.1111/aej.12829] [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: 09/28/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 01/21/2024]
Abstract
This study evaluated the impact of canal irrigation using surfactants associated to NaOCl on the percentage of voids of root canal filling through micro-computed tomographic (micro-CT) analysis. 27 mandibular mesial roots with Vertucci type II canal configuration with isthmus were selected and scanned in a micro-CT device. The specimens were assigned to three groups (n = 9), according to the irrigation solution during instrumentation: 2.5% NaOCl without additives (control), 2.5% NaOCl with 0.1% Benzalkonium Chloride and 2.5% NaOCl with 0.1% Tween 80. After obturation, the specimens were rescanned, and the percentage of voids were calculated. Data were analysed using one-way ANOVA with a significance level of 5%. The percentage of voids were similar among the groups (p > 0.05). None of the specimens showed completely voids-free areas. The addition of surfactants to NaOCl irrigation did not improve the quality of root canal filling of mandibular mesial root canals.
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Affiliation(s)
| | | | | | - Carolina Oliveira de Lima
- Department of Endodontics, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Department of Endodontics, Juiz de Fora Federal University, Governador Valadares, Brazil
| | - Emmanuel João Nogueira Leal da Silva
- Department of Endodontics, Fluminense Federal University, Niterói, Brazil
- Department of Endodontics, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Department of Endodontics, Grande Rio University, Duque de Caxias, Brazil
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2
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Rito Pereira M, Silva G, Semiao V, Martins JNR, Silverio V, Pascoal-Faria P, Duarte I, Alves N, Ginjeira A. Syringe irrigation in confluent canals: A sequential computational fluid dynamics assessment. AUST ENDOD J 2024; 50:40-51. [PMID: 37849412 DOI: 10.1111/aej.12805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 08/18/2023] [Accepted: 10/07/2023] [Indexed: 10/19/2023]
Abstract
This study aims to assess the influence of root canal preparation, irrigation needle design and its placement depth in the irrigation flow of confluent canals during syringe irrigation. A mandibular molar presenting two confluent canals in its mesial root was sequentially prepared and scanned by micro-computed tomography after mechanical preparation up to ProTaper Next system sizes X2 (25/.06v), X3 (30/.07v) and X4 (40/.06v). In each of the root canal preparation models, a side-vented and an open-ended needle at 5, 3 and 2 mm from the working length were included, and irrigation flow was assessed by a validated computational fluid dynamics model. The results revealed that the irrigant flowed out of the confluent canals mainly through the canal that did not have the needle. Apical penetration and renewal of the irrigant were most efficiently achieved with the use of a 30G open-ended needle and a 30/.07v preparation.
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Affiliation(s)
- Mário Rito Pereira
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Almada, Portugal
| | - Goncalo Silva
- IDMEC, Department of Mechatronics, Universidade de Évora, Évora, Portugal
| | - Viriato Semiao
- IDMEC, Instituto Superior Técnico, Departamento de Engenharia Mecânica, Universidade de Lisboa, Lisboa, Portugal
| | - Jorge N R Martins
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
| | - Vania Silverio
- Instituto de Engenharia de Sistemas e Computadores - Microsistemas e Nanotecnologias, INESC MN, Lisboa, Portugal
- Department of Physics, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - Paula Pascoal-Faria
- Mathematics Department of the School of Technology and Management (ESTG) and Centre for Rapid and Sustainable Product Development (CDRSP) from the Polytechnic of Leiria, Marinha Grande, Portugal
| | - Isabel Duarte
- Department of Mechanical Engineering, Centre for Mechanical Technology and Automation (TEMA), University of Aveiro, Aveiro, Portugal
- LASI - Intelligent Systems Associate Laboratory, Guimarâes, Portugal
| | - Nuno Alves
- Centre for Rapid and Sustainable Product Development, Instituto Politécnico de Leiria, Marinha Grande, Portugal
| | - António Ginjeira
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
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3
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Silva WO, Amoroso-Silva P, Olivares P, Alcalde MP, Alves FRF, Marceliano-Alves MF. Enhancing debris removal in curved canals: a comparative evaluation of XP-endo Finisher and Passive Ultrasonic Irrigation. Clin Oral Investig 2023; 27:7523-7529. [PMID: 37910237 DOI: 10.1007/s00784-023-05342-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/14/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES The study aimed to compare the efficacy of XP-endo Finisher and Passive Ultrasonic Irrigation (PUI) in removing hard tissue debris from curved canals. MATERIALS AND METHODS Thirty-four mandibular molars with Vertucci's type II mesial canals were scanned in microcomputed tomography before and after preparation with HyFlex EDM, and accumulated hard tissue debris was quantified. Subsequently, the teeth were randomly divided into two groups according to the supplementary procedure: PUI with the Ultra-X insert or XP-endo Finisher. After the intervention, the specimens underwent another scanning. Two separate analyses were conducted, one for the total canal and another for the isthmus area. Unpaired and paired T-tests were used for inter- and intergroup comparisons, with a significance level set at 5%. RESULTS Both supplementary methods reduced the amount of debris compared to the initial volume. Remarkably, the XP-endo Finisher achieved a significantly higher percentage of debris removal (71% for the total canal and 74% for the isthmus areas) compared to PUI (41% for the total canal and 52% for the isthmus area) (P < 0.05). CONCLUSIONS Both supplementary approaches reduced the amount of hard tissue debris from canal preparation, still XP-endo Finisher showed a higher reduction compared to PUI (p < 0.05). CLINICAL RELEVANCE None of the supplementary methods rendered canals completely free of hard tissue debris. However, the supplementary approach with XP-endo Finisher resulted in lower levels of hard tissue debris than PUI in curved canals with isthmuses.
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Affiliation(s)
- Warley Oliveira Silva
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
- Federal University of Valley of Jequitinhonha and Mucuri (UFVJM), Diamantina, Brazil
| | - Pablo Amoroso-Silva
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
| | - Patrícia Olivares
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
| | - Murilo Priori Alcalde
- Faculty of Dentistry of Bauru, Department of Dentistry, Endodontics and Dental Materials, University of São Paulo, Bauru, SP, Brazil
| | - Flávio Rodrigues Ferreira Alves
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
- Department of Endodontics and Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Av. Abílio Augusto Távora, 2134, Nova Iguaçu, RJ, 26260-045, Brazil
| | - Marília Fagury Marceliano-Alves
- Department of Endodontics and Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Av. Abílio Augusto Távora, 2134, Nova Iguaçu, RJ, 26260-045, Brazil.
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4
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Poly A, Marques F, Lee J, Setzer FC, Karabucak B. XP-endo Finisher effectively reduces hard-tissue debris accumulated in root canals with isthmus after preparation with a reciprocating file system. AUST ENDOD J 2023; 49:279-286. [PMID: 35980742 PMCID: PMC10091117 DOI: 10.1111/aej.12676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022]
Abstract
This study compared the accumulated hard-tissue debris (AHTD) after preparation with WaveOne Gold (WOG) to XP-endo Shaper (XPS), without and with a supplementary step using XP-endo Finisher (XPF) using clinically applicable irrigation. Twenty-four mesial roots with two canals and single foramen were micro-CT-scanned and matched. Scans were also taken after preparation with WOG or XPS, and after XPF. Irrigation with 2.5% NaOCl (total: 17 ml per canal) and 17% EDTA (2.5 ml per canal) was performed using a 30ga Max-I-Probe needle placed up to the working length. Morphological parameters were calculated and compared within and among groups. XPF significantly reduced unprepared area within XPS and WOG groups, and AHTD within WOG (p < 0.05). There were no significant differences between WOG and XPS after preparation and after XPF (p > 0.05). In conclusion, WOG and XPS produced a similar volume of AHTD, but the supplementary step with XPF decreased the AHTD in the WOG group.
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Affiliation(s)
- Ane Poly
- Proclin Department, School of Dentistry, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Department of Endodontics, College of Dentistry, Texas A&M University, Dallas, TX, USA
| | - Fernando Marques
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Josh Lee
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
- School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - Frank C. Setzer
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Bekir Karabucak
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
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5
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Rödig T, Westbomke V, Haupt F, Münster M, Baxter S. Effect of preparation size on the removal of accumulated hard-tissue debris from the mesial root canal system of mandibular molars using SWEEPS technology. Clin Oral Investig 2023; 27:2787-2796. [PMID: 36642725 PMCID: PMC10264281 DOI: 10.1007/s00784-023-04862-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 01/06/2023] [Indexed: 01/17/2023]
Abstract
OBJECTIVES This study assessed the influence of preparation size on the efficacy of shock wave-enhanced emission photoacoustic streaming (SWEEPS) and conventional irrigation (CI) on removal of accumulated hard tissue debris (AHTD) from isthmus-containing mandibular molars using micro-computed tomographic analysis. MATERIALS AND METHODS Sixty extracted mandibular molars with two mesial canals connected by an isthmus were selected. Canals were shaped with Mtwo instruments (VDW, Munich, Germany) up to sizes 25/.06, 40/.04 or 40/.06 (n = 20), and specimens were distributed into 2 final irrigation groups (n = 10): SWEEPS and CI. Roots were scanned at a resolution of 10.5 µm before and after preparation and final irrigation. Data sets were co-registered, and the percentage reduction of AHTD calculated for each specimen was statistically compared using analysis of variance with a of 5% significance level. RESULTS The preparation size did not significantly influence the percentage reduction of AHTD (p < 0.05), whereas the final irrigation technique had a significant effect on debris removal (p < 0.05). A significant reduction of AHTD was achieved after final irrigation in all groups (p < 0.05); however, SWEEPS was associated with a significantly greater percentage reduction of debris than CI (p < 0.05). None of the specimens presented a completely clean isthmus. CONCLUSIONS Removal of AHTD was not significantly affected by the preparation size. SWEEPS was associated with significantly less debris than CI. CLINICAL RELEVANCE SWEEPS performed significantly better than CI regarding the removal of AHTD from isthmus-containing mandibular molars irrespective of the preparation size.
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Affiliation(s)
- Tina Rödig
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Valerie Westbomke
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Franziska Haupt
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Marc Münster
- Endopur, Clinic for Endodontology, Frankfurt, Germany
| | - Steffi Baxter
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
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6
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de Mattos de Araujo BM, Cruz ATG, Piasecki L, Webber M, Carneiro E, Westphalen VPD, da Silva Neto UX. Micro-CT evaluation of four final irrigation protocols on hard-tissue debris removal from mesial roots of mandibular molars containing isthmus. Clin Oral Investig 2022; 26:6121-6128. [PMID: 35650363 DOI: 10.1007/s00784-022-04561-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/21/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate by means of microcomputed tomography (micro-CT), the efficacy of four final irrigation protocols in the removal of hard-tissue debris (HTD) in mesial roots of mandibular molars containing isthmus. MATERIALS AND METHODS Forty standardized mesial roots of extracted mandibular molars presenting isthmus were selected. The root canals were prepared and randomly divided into 4 groups (n = 10): EA, EndoActivator (Dentsply Sirona); EC, Easy Clean (Easy Dental Equipment, Belo Horizonte, Brazil); XPF, XP-Endo Finisher (FKG Dentaire, La Chaus-de Fonds, Switzerland); and PUI, passive ultrasonic irrigation using Irrisafe tip (Satelec Acteon, Merignac, France). Each final irrigation protocol was performed in two cycles (60 s), using, respectively, 2.5% sodium hypochlorite and 17% EDTA. Micro-CT scans were obtained pre-operatory, post-preparation, and post-irrigation. The percentage of HTD reduction was calculated. Data was analyzed statistically (ANOVA and Kruskal-Wallis, significance set at 5%). RESULTS The percentage of HTD reduction was greatest for the XPF group (77.92%), followed by EA (62.92%), PUI (47.48%), and EC (32.65%). Statistical differences (p < .05) were found between XPF and EC only. A significant difference (p < .05) was found between XPF and EC in all thirds and between PUI and EC in the middle third. CONCLUSIONS XPF, EA, and PUI were similarly effective in HTD reduction. However, none of the evaluated protocols was able to completely remove all the debris. CLINICAL RELEVANCE Final irrigation protocols aim to clean the canal complexities that are not addressed by the shaping procedures. Micro-CT allowed to assess the removal of hard-tissue debris in the isthmus and canals of mandibular molars.
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Affiliation(s)
| | | | - Lucila Piasecki
- Department of Periodontics & Endodontics, University at Buffalo, Buffalo, NY, USA.
| | - Mariel Webber
- Department of Periodontics & Endodontics, University at Buffalo, Buffalo, NY, USA
| | - Everdan Carneiro
- Department of Dentistry, School of Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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7
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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: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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-computed 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)
- Christos Boutsioukis
- Department of EndodontologyAcademic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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8
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A Novel Digital Technique to Analyze the Wear of CM-Wire NiTi Alloy Endodontic Reciprocating Files: An In Vitro Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063203. [PMID: 35328891 PMCID: PMC8951034 DOI: 10.3390/ijerph19063203] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 12/10/2022]
Abstract
The present study seeks to describe a novel digital measurement technique for analyzing the wear volume of controlled memory (CM)-wire NiTi alloy endodontic reciprocating files after clinical use. Material and Methods: Ten CM-wire NiTi endodontic reciprocating files were randomly used in ten first upper molar teeth within four root canals. The CM-wire NiTi alloy endodontic reciprocating files were subjected to preoperative and postoperative micro-computed tomography (micro-CT) scans to obtain accurate digital imaging and communication on medicine (DICOM) digital files, which were segmented using intensity-based thresholding and an exclusive OR (XOR) logical operation (Boolean algebra logical operator) to obtain a mask of the location to localize and quantify the wear volume of the CM-wire NiTi alloy endodontic reciprocating files. Gage repeatability and reproducibility statistical analysis was applied to assess the reproducibility and repeatability of this measurement technique. Results: The analysis showed a repeatability and reproducibility of 0.00% for the digital measurement technique used to analyze the wear volume of CM-wire NiTi alloy endodontic reciprocating files after clinical use. Wear was mostly identified at the tip and cutting edges of the CM-wire NiTi alloy endodontic reciprocating files. Conclusions: This novel digital measurement technique is a repeatable, reproducible, and accurate method of quantifying the wear volume of CM-wire NiTi alloy endodontic reciprocating files after clinical use.
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9
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Barbosa AFA, Lima COD, Sassone LM, Fares RD, Fidalgo TKDS, Silva EJNL. Effect of passive ultrasonic irrigation on hard tissue debris removal: a systematic review and meta-analysis. Braz Oral Res 2021; 35:e123. [PMID: 34878078 DOI: 10.1590/1807-3107bor-2021.vol35.0123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/15/2021] [Indexed: 12/22/2022] Open
Abstract
Accumulated hard tissue debris (AHTD) in root canal irregularities may negatively impact adequate root canal disinfection. In light of this, the efficacy of passive ultrasonic irrigation (PUI) to reduce AHTD has been largely studied in in vitro studies, which have adopted different analytic methods of varying accuracy to determine the extent of AHTD more correctly. Therefore, the aim of this study was to compare how well PUI and non-activated irrigation (NAI) systems perform in reducing AHTD during final irrigation protocols, based exclusively on studies whose analyses used microCT scanning. A systematic search of the studies published up to April 2020 was performed using MeSH terms and free terms, in the following databases: PubMed, Scopus, Web of Science, BVS (Lilacs and BBO) and Embase. The inclusion criteria consisted of laboratory studies that evaluated the amount of AHTD, and compared PUI with NAI protocols using microCT analysis. The risk of bias in the selected studies was assessed critically by two reviewers. A meta-analysis was performed using the RevMan software program (P<0.05), and included studies providing the standardized mean difference (SMD), using a fixed effect model, and adopting a confidence interval of 95%. In all, 3495 studies were identified, three of which met the inclusion criteria. All three were considered as having a low risk of bias. The meta-analysis comparing the ability of PUI and NAI protocols to remove hard tissue debris showed a higher percentage of AHTD reduction (P<0.01) for PUI, with a confidence interval of 1.41 [0.79, 2.02]. The heterogeneity among the studies was 82% (I2). Considering the limitations of the present study, this systematic review and meta-analysis showed that PUI was more effective than NAI in removing hard tissue debris, based exclusively on studies that used microCT scanning to provide a more precise analysis of the two techniques used. The findings presented in the present study reinforce the concept that PUI can increase residue removal and improve the cleanliness of the root canal in endodontic treatments.
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Affiliation(s)
- Ana Flávia Almeida Barbosa
- Universidade do Estado do Rio de Janeiro - UERJ, School of Dentistry, Department of Endodontics, Rio de Janeiro, RJ, Brazil
| | - Carolina Oliveira de Lima
- Universidade do Estado do Rio de Janeiro - UERJ, School of Dentistry, Department of Endodontics, Rio de Janeiro, RJ, Brazil
| | - Luciana Moura Sassone
- Universidade do Estado do Rio de Janeiro - UERJ, School of Dentistry, Department of Endodontics, Rio de Janeiro, RJ, Brazil
| | - Raissa Dias Fares
- Universidade do Estado do Rio de Janeiro - UERJ, School of Dentistry, Department of Preventive and Community Dentistry, Rio de Janeiro, RJ, Brazil
| | - Tatiana Kelly da Silva Fidalgo
- Universidade do Estado do Rio de Janeiro - UERJ, School of Dentistry, Department of Preventive and Community Dentistry, Rio de Janeiro, RJ, Brazil
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10
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Examination of Irrigant Flow on a Tooth With Internal Root Resorption by Using a Computational Fluid Dynamics Model. Eur Endod J 2021; 6:177-182. [PMID: 34650013 PMCID: PMC8461487 DOI: 10.14744/eej.2021.29290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: This study investigated the flow of an endodontic irrigant in a single-rooted tooth with internal root resorption (IRR). Methods: A simulation of a prepared central incisor with internal root resorption was created and irrigation with a 30-G needle was performed. The fluid pattern of the irrigant was evaluated using a Computational Fluid Dynamics model. In addition, the effects of the needle-insertion depth in the root canal and the size of root resorption on the fluid flow and the wall shear stress (WSS) values were assessed. The IRR was placed immediately below the canal orifice. Results: Inadequate irrigant washout was observed inside the resorption cavity when the needle was positioned 1 mm from the working length while placing the needle slightly above the resorption cavity resulted in significant irrigant circulation inside the resorption cavity. Moreover, when the needle was placed slightly above the defect, the calculated WSS values in the resorption cavity walls were significantly higher (approximately 20 times higher in every case). In cases where the needle was placed 1 mm from the working length, the average and maximum WWS values were between 3 Pa and 51 Pa, while in cases where the needle was placed coronal to the IRR, the values were between 55 Pa and 528 Pa. The radius of the resorption cavity did not affect the irrigant flow patterns. Conclusion: During the endodontic treatment of cases with internal root resorption, complementary irrigations with the needle tip placed slightly above the resorption cavity should be followed to better debride the root canal.
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11
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Sarwar H, Qazi F, Ahmed S, Abidi Y, Naeem M, Shabbir J, Khurshid Z. Efficacy of Handpiece Mounted Continuous Irrigation System for the Removal of Residual Pulpal Debris During Root Canal Preparation. Eur J Dent 2021; 15:551-556. [PMID: 33975373 PMCID: PMC8382463 DOI: 10.1055/s-0041-1726160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective
The removal of residual pulpal debris (RPD) from the root canal walls, especially in necrotic teeth is important for successful endodontic outcome. The aim of this study was to evaluate the RPD removal efficacy of handpiece mounted continuous irrigation with simultaneous root canal preparation from the apical third of root canals as compared to conventional syringe irrigation (SI).
Materials and Methods
Ninety extracted teeth were randomly divided into three groups: SI; handpiece mounted continuous irrigation (CI); and both syringe and continuous irrigation (CI+SI). After root canal preparation, roots were sectioned at 1 (a), 3 (b) and 5 (c) mm from apex and prepared for Hematoxylin-Eosin staining. Sections were microscopically examined for presence of RPD.
Statistical Analysis
Intergroup difference in average percentage of RPD at different root levels was calculated by using analysis of variance test (ANOVA). Tuckey test was used for pairwise comparison.
Results
ANOVA showed significant difference between all three groups (
p
< 0.05). SI group showed a significantly higher percentage of RPD as compared with CI and CI+ SI groups at all root levels (
p
< 0.01). At root level a, CI showed a significantly higher percentage of RPD as compared with CI+SI (
p
< 0.01).
Conclusion
Handpiece mounted CI during rotary instrumentation showed a significant reduction in RPD as compared with conventional syringe irrigation. This technique was found to be an effective method for an enhanced root canal debridement.
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Affiliation(s)
- Huma Sarwar
- Department of Operative Dentistry & Endodontics, Dr. Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan.,Department of Periodontology, Dr Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
| | - Fazal Qazi
- Department of Operative Dentistry & Endodontics, Dr. Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan.,Department of Periodontology, Dr Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
| | - Shahbaz Ahmed
- Department of Operative Dentistry & Endodontics, Dr. Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan.,Department of Periodontology, Dr Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
| | - Yawar Abidi
- Department of Operative Dentistry & Endodontics, Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Meshal Naeem
- Department of Operative Dentistry & Endodontics, Dr. Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan.,Department of Periodontology, Dr Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
| | - Juzer Shabbir
- Department of Operative Dentistry & Endodontics, Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Zohaib Khurshid
- Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Al Ahsa, Saudi Arabia
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Souza EM, Campos MG, Rosas Aguilar R. Mapping the periapex anatomical pattern of teeth involved in sodium hypochlorite accidents: a cross-sectional quasi-experimental study. Int Endod J 2021; 54:1212-1220. [PMID: 33826773 DOI: 10.1111/iej.13528] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/05/2021] [Indexed: 12/30/2022]
Abstract
AIM To determine the anatomical reasons for sodium hypochlorite (NaOCl) accidents by testing whether this mishap is likely to occur in cases where the anatomical apex of the teeth fenestrates the overlying buccal cortical alveolar bone, allowing NaOCl to gain direct access to buccal soft tissues. METHODOLOGY Following a cross-sectional, nonrandomized design, 13 patients who suffered unintentional NaOCl accidents whilst undergoing root canal treatment were included. After remission of symptoms, the root canals were fully irrigated with an innocuous radiopaque solution (saline diluted Claritrast 300) and subsequently CBCT scanned to create a 3D-map of the periapex and tracking of the irrigant pathway throughout the periapical tissues. An extra group of five control patients, who underwent root canal treatment with no NaOCl accident, was also CBCT-scanned after irrigation with the tracking radiopaque solution. The anatomical relationship of the cortical bone and the root apex, as well as the distribution of irrigation solution in the periapical tissue, was associated with patients undergoing a NaOCl accident or not, using a Fisher's exact test. RESULTS The frequency of teeth with apical cortical fenestration was significantly higher in the NaOCl accident-positive group, compared to the negative (P < 0.001). All 13 accident-positive patients had an anatomical apex in direct contact with the buccal soft tissue via fenestration of the overlying cortical bone and direct contact of the foramen with the soft tissues. The radiopaque solution was distributed in the soft tissue in these cases. In contrast, accident-negative patients had no fenestration of the buccal cortical bone and the anatomical root apex was within the cancellous bone or within a bone-confined periapical lesion. The radiopaque solution was also found in the cancellous bone or the periapical lesion, but patients had no manifestations of a NaOCl accident. CONCLUSION This quasi-experimental cross-sectional clinical study suggests that, in addition to the presence of the extruded NaOCl solution, a patent foramen that fenestrates the cortical bone merging into the mucosal tissue might constitute a risk for the clinical manifestation of a NaOCl accident. Preoperative 3D scans aid in anticipating when an accident is likely to occur.
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Affiliation(s)
- E M Souza
- Department of Dentistry II, Federal University of Maranhão, São Luís, Brazil
| | - M G Campos
- Department of Endodontics, Escuela Nacional de Estudios Superiores UNAM, León, Mexico
| | - R Rosas Aguilar
- Department of Endodontics, Escuela Nacional de Estudios Superiores UNAM, León, Mexico
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Silva EJNL, Guerreiro MYR, Belladonna FG, Monteiro LPB, Lima CO, Brandão JMS. Response to the letter to the editor‐ Is EDTA the protagonist for the enhancement of accumulated hard tissue debris removal from root canals? Int Endod J 2020; 53:1456-1457. [DOI: 10.1111/iej.13358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- E. J. N. L. Silva
- Department of Endodontics Fluminense Federal University Niterói Rio de JaneiroBrazil
- Department of Endodontics State University of Rio de Janeiro Rio de Janeiro Rio de JaneiroBrazil
- Department of Endodontics Grande Rio University Duque de Caxias Rio de JaneiroBrazil
| | | | - F. G. Belladonna
- Department of Endodontics Fluminense Federal University Niterói Rio de JaneiroBrazil
| | | | - C. O Lima
- Department of Endodontics State University of Rio de Janeiro Rio de Janeiro Rio de JaneiroBrazil
| | - J. M. S. Brandão
- Department of Endodontics Federal University of Pará Belém Brazil
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14
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Linden D, Boone M, De Bruyne M, De Moor R, Versiani MA, Meire M. Adjunctive Steps for the Removal of Hard Tissue Debris from the Anatomic Complexities of the Mesial Root Canal System of Mandibular Molars: A Micro–Computed Tomographic Study. J Endod 2020; 46:1508-1514. [DOI: 10.1016/j.joen.2020.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 11/30/2022]
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15
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Liu L, Shen C, Ye W, Yao H, Peng Q, Cui Y, Khoo BC. Investigation of an Improved Side-Vented Needle and Corresponding Irrigation Strategy for Root Canal Therapy with CFD Method. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 195:105547. [PMID: 32480193 DOI: 10.1016/j.cmpb.2020.105547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/21/2020] [Accepted: 05/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE This research aimed to present an improved side-vented needle and explore its availability as well as the corresponding irrigation strategy. METHODS A CFD model was used to simulate the irrigant flow in a simplified prepared round root canal with an apical delta respectively with different needles for irrigation. The needle types include flat end-tip needle, original side-vented needle, and improved side-vented needle. Different insertion depths and inlet velocities were contrastively studied, as well as the gap size between the bulb at the end tip of the improved side-vented needle and the root canal. The study includes a total of 13 schemes. Velocity, pressure, and shear stress in the root canal were measured to contrast the internal flow-field details and irrigation efficiencies between different schemes. RESULTS Poor irrigation replacement appeared in the schemes without enough needle insertion no matter which kind of needle has been used, though relatively lower pressure emerged at the apical foramen. On the contrary, deepening needle insertion not only brings better irrigant replacement but also higher apical foramen pressure. The original side-vented needle tends to make lower pressure at the apical foramen and simultaneously worse irrigant replacement as compared to the flat end-tip needle. The fluid entering the apical anatomy part deceases a lot as the original side-vented needle was replaced by the improved one. The scheme using the improved side-vented needle with gap size ratio and inlet velocity respectively equaling 5.0% and 5.50m/s can be considered the best one. CONCLUSIONS The improved side-vented needle can ensure acceptable irrigant replacement performance without leading to a high-pressure level at the apical foramen. The gap between the bulb and the wall of the root canal is very crucial for the pressure at the apical. The ideal irrigation strategy is ensuring the gap equals zero. However, it is a little hard to realize during the whole procedure of the root canal preparation except the final step. Consequently, another strategy that keeping the value of gap size ratio as small as possible such as less than 15% and simultaneously ensuring lower-velocity coming fluid, is necessary in the non-final irrigation.
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Affiliation(s)
- Lei Liu
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, China; State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China
| | - Chenlu Shen
- The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Weijia Ye
- The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Hua Yao
- The First Affiliated Hospital, Zhejiang University, Hangzhou, China.
| | - Qiao Peng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yongdong Cui
- Department of mechanical engineering, National University of Singapore, Singapore
| | - Boo Cheong Khoo
- Department of mechanical engineering, National University of Singapore, Singapore
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Silva EJNL, Oliveira VB, Silva AA, Belladonna FG, Prado M, Antunes HS, De‐Deus G. Effect of access cavity design on gaps and void formation in resin composite restorations following root canal treatment on extracted teeth. Int Endod J 2020; 53:1540-1548. [DOI: 10.1111/iej.13379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022]
Affiliation(s)
- E. J. N. L. Silva
- Department of Endodontics Grande Rio University Duque de CaxiasBrazil
- Department of Endodontics Fluminense Federal University NiteróiBrazil
| | - V. B. Oliveira
- Department of Endodontics Grande Rio University Duque de CaxiasBrazil
| | - A. A. Silva
- Department of Endodontics Grande Rio University Duque de CaxiasBrazil
| | - F. G. Belladonna
- Department of Endodontics Fluminense Federal University NiteróiBrazil
| | - M. Prado
- Department of Endodontics Veiga de Almeida University Rio de Janeiro Brazil
| | - H. S. Antunes
- Department of Endodontics Grande Rio University Duque de CaxiasBrazil
| | - G. De‐Deus
- Department of Endodontics Fluminense Federal University NiteróiBrazil
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17
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Barbosa AFA, Silva EJNL, Coelho BP, Ferreira CMA, Lima CO, Sassone LM. The influence of endodontic access cavity design on the efficacy of canal instrumentation, microbial reduction, root canal filling and fracture resistance in mandibular molars. Int Endod J 2020; 53:1666-1679. [DOI: 10.1111/iej.13383] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 12/17/2022]
Affiliation(s)
- A. F. A. Barbosa
- Department of Endodontics School of Dentistry State University of Rio de Janeiro (UERJ) Rio de JaneiroBrazil
| | - E. J. N. L. Silva
- Department of Endodontics School of Dentistry State University of Rio de Janeiro (UERJ) Rio de JaneiroBrazil
- Department of Endodontics School of Dentistry Grande Rio University (UNIGRANRIO) Rio de Janeiro Brazil
| | - B. P. Coelho
- Department of Endodontics School of Dentistry State University of Rio de Janeiro (UERJ) Rio de JaneiroBrazil
| | - C. M. A. Ferreira
- Department of Endodontics School of Dentistry State University of Rio de Janeiro (UERJ) Rio de JaneiroBrazil
| | - C. O. Lima
- Department of Endodontics School of Dentistry State University of Rio de Janeiro (UERJ) Rio de JaneiroBrazil
| | - L. M. Sassone
- Department of Endodontics School of Dentistry State University of Rio de Janeiro (UERJ) Rio de JaneiroBrazil
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18
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Rover G, Lima CO, Belladonna FG, Garcia LFR, Bortoluzzi EA, Silva EJNL, Teixeira CS. Influence of minimally invasive endodontic access cavities on root canal shaping and filling ability, pulp chamber cleaning and fracture resistance of extracted human mandibular incisors. Int Endod J 2020; 53:1530-1539. [DOI: 10.1111/iej.13378] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/09/2020] [Accepted: 07/29/2020] [Indexed: 01/11/2023]
Affiliation(s)
- G. Rover
- Department of Dentistry Federal University of Santa Catarina Florianópolis SCBrazil
| | - C. O. Lima
- Department of Endodontics State University of Rio de Janeiro Rio de JaneiroRJBrazil
| | - F. G. Belladonna
- Department of Endodontics Fluminense Federal University NiteróiRJBrazil
| | - L. F. R. Garcia
- Department of Dentistry Federal University of Santa Catarina Florianópolis SCBrazil
| | - E. A. Bortoluzzi
- Department of Dentistry Federal University of Santa Catarina Florianópolis SCBrazil
| | - E. J. N. L. Silva
- Department of Endodontics State University of Rio de Janeiro Rio de JaneiroRJBrazil
- Department of Endodontics Fluminense Federal University NiteróiRJBrazil
- Department of Endodontics Grande Rio University Duque de Caxias RJ Brazil
| | - C. S. Teixeira
- Department of Dentistry Federal University of Santa Catarina Florianópolis SCBrazil
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19
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Uzunoglu-Özyürek E, Dik Güzel C, Dogan Buzoglu H. Effect of different irrigation methods in the presence of a separated instrument: an in vitro study. Acta Odontol Scand 2020; 78:409-416. [PMID: 32105162 DOI: 10.1080/00016357.2020.1733076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: The aim of this study was to evaluate the effect of different irrigation methods on sodium hypochlorite (NaOCl)/debris extrusion and dentinal tubule penetration of 2.5% NaOCl in the presence of an apically separated instrument.Materials and methods: Sixty root canals of freshly extracted mandibular single-rooted premolars were chemomechanically prepared up to ProTaper F2. Manual needle irrigation (30-gauge/side-vented) with 2.5% NaOCl was performed between files and a smear layer was removed with 17% ethylenediaminetetraacetic acid. Three mm of notched ProTaper F3 files were separated in the apical third of the roots. Samples were then randomly divided according to the final irrigation systems as follows: EndoActivator, EndoVac, manual needle irrigation, passive ultrasonic activation, and RinsEndo. Samples were mounted to Eppendorf tubes and root canals were irrigated with 3-mL Rhodamine B-labelled 2.5% NaOCl, which was applied using one of the above-mentioned methods. The extruded NaOCl/debris weight was calculated by extracting pre-irrigation weights of tubes from post-irrigation ones. Samples embedded in acrylic resin were sectioned transversely in 1-mm thicknesses at apical 1- and 3-mm levels. NaOCl's penetration depth and percentage into the dentinal tubules were evaluated with the aid of a confocal laser scanning microscope. Data were analysed statistically with Kruskal-Wallis and post hoc Siegel-Castellan tests (p < .05).Results: EndoVac significantly decreased the extruded NaOCl/debris compared to RinsEndo, passive ultrasonic activation, and EndoActivator in the presence of a separated instrument (p < .05). The penetrability of NaOCl significantly increased with the use of RinsEndo and EndoVac compared to the remaining groups (p < .05).Conclusion: In the presence of an irretrievable separated instrument, it could be suggested that devices with apical negative pressure such as EndoVac may improve the penetrability of irrigation solutions to the apical part of the root while preserving periapical tissues from NaOCl/debris extrusion.
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Affiliation(s)
- Emel Uzunoglu-Özyürek
- Department of Endodontics, Faculty of Dentistry, University of Hacettepe, Ankara, Turkey
| | | | - Hatice Dogan Buzoglu
- Department of Endodontics, Faculty of Dentistry, University of Hacettepe, Ankara, Turkey
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20
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Guerreiro MYR, Belladonna FG, Monteiro LPB, Lima CO, Silva EJNL, Brandão JMS. The influence of the addition of surfactants to sodium hypochlorite on the removal of hard tissue debris. Int Endod J 2020; 53:1131-1139. [PMID: 32294253 DOI: 10.1111/iej.13307] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/07/2020] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the effect of the addition of surfactants to sodium hypochlorite (NaOCl) on the removal of accumulated hard tissue debris (AHTD), before and after final irrigation with 17% EDTA, from mesial canals of mandibular molars through microcomputed tomographic (micro-CT) analysis. METHODOLOGY Thirty moderately curved mandibular mesial roots with Vertucci type II canal configuration were selected and scanned in a micro-CT device at an isotropic resolution of 22.9 μm. The specimens were assigned to three groups (n = 10) with respect to the root length, degree of curvature of the mesial root, volume and 3D anatomy of the root canals according to the irrigating solution used during root canal preparation: 2.5% NaOCl and 0.1% Benzalkonium Chloride, 2.5% NaOCl and 0.1% Tween 80 and 2.5% NaOCl without additives. The root canals were instrumented up to Reciproc R25 instrument. Then, the specimens were scanned again after canal preparation and after final irrigation with 17% EDTA, and the registered data sets were examined to evaluate the percentage of AHTD. For comparison between the different groups before and after using 17% EDTA, the Kruskal-Wallis test was used with a significance level of 5%. For comparison between the same groups before and after using 17% EDTA, the Wilcoxon test was used with a significance level of 5%. RESULTS None of the irrigant solutions tested was able to completely eliminate hard tissue debris from mesial canals of mandibular molars. There were no significant differences in the percentage of AHTD amongst the different irrigation solutions (P > 0.05). Final irrigation with 17% EDTA significantly reduced the percentage of AHTD (P < 0.05), without differences amongst the groups (P > 0.05). CONCLUSIONS The addition of surfactants to NaOCl did not affect the removal of AHTD from mesial canals of extracted mandibular molars. Final irrigation with 17% EDTA significantly improved AHTD removal.
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Affiliation(s)
- M Y R Guerreiro
- Department of Endodontics, Federal University of Pará, Belém, Brazil
| | - F G Belladonna
- Department of Endodontics, Fluminense Federal University, Niterói, Brazil
| | - L P B Monteiro
- Department of Endodontics, Federal University of Pará, Belém, Brazil
| | - C O Lima
- Department of Endodontics, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - E J N L Silva
- Department of Endodontics, Fluminense Federal University, Niterói, Brazil.,Department of Endodontics, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Endodontics, Grande Rio University, Duque de Caxias, Brazil
| | - J M S Brandão
- Department of Endodontics, Federal University of Pará, Belém, Brazil
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21
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Kouno A, Watanabe S, Hongo T, Yao K, Satake K, Okiji T. Effect of Pulse Energy, Pulse Frequency, and Tip Diameter on Intracanal Vaporized Bubble Kinetics and Apical Pressure During Laser-Activated Irrigation Using Er:YAG Laser. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2020; 38:431-437. [PMID: 32364877 DOI: 10.1089/photob.2019.4739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: Er:YAG laser-activated irrigation (LAI) is an effective method of root canal cleaning, but irrigant extrusion from the apical foramen has been a concern. We aimed to analyze the effects of pulse energy, pulse frequency, and laser tip diameter on intracanal vapor bubble kinetics and periapical pressure generation during LAI with Er:YAG laser. Background: Irrigant vapor bubble kinetics are one of indices of root canal cleaning efficacy. However, few studies have compared laser pulse conditions to vapor bubble kinetics, in relation to periapical pressure. Methods: A plastic root canal model (apical diameter 0.50 mm, 6% taper, 20 mm long) was filled with distilled water, and LAI with Er:YAG laser (Erwin AdvErl Unit; 30, 50, or 70 mJ; 10, or 20 pulses per second; laser tip R200T or R600T) was performed with the end of the tip fixed at 15 mm from the root apex. The number, maximum diameter, and velocity of vapor bubbles were analyzed by high-speed video imaging. Pressure generated outside the apical foramen was measured with a pressure sensor. Results: Vapor bubble count and maximum diameter increased significantly with pulse energy, pulse frequency, and tip diameter. Vapor bubble velocity increased significantly with pulse frequency, but not with pulse energy or tip diameter. Periapical pressure increased significantly with pulse energy, pulse frequency, and tip diameter. Conclusions: The pulse frequency was the single factor that significantly affected all the examined parameters (the number, diameter, and velocity) of vapor bubble kinetics together with the periapical pressure.
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Affiliation(s)
- Akira Kouno
- Division of Oral Health Sciences, Department of Pulp Biology and Endodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Satoshi Watanabe
- Division of Oral Health Sciences, Department of Pulp Biology and Endodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tomoyuki Hongo
- Division of Oral Health Sciences, Department of Pulp Biology and Endodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kanako Yao
- Division of Oral Health Sciences, Department of Pulp Biology and Endodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kazuhisa Satake
- Division of Oral Health Sciences, Department of Pulp Biology and Endodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takashi Okiji
- Division of Oral Health Sciences, Department of Pulp Biology and Endodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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22
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Aragão AC, Pintor AVB, Marceliano-Alves M, Primo LG, Silva ASDS, Lopes RT, Neves ADA. Root canal obturation materials and filling techniques for primary teeth: In vitro evaluation in polymer-based prototyped incisors. Int J Paediatr Dent 2020; 30:381-389. [PMID: 31811738 DOI: 10.1111/ipd.12604] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/20/2019] [Accepted: 12/02/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Achieving a void-free root canal filling is a challenge in current clinical pulpectomy practice. AIM To compare filling effectiveness and internal voids of root filling materials and obturation techniques in resin-prototyped primary incisors by micro-CT. DESIGN Fifty prototypes were instrumented and randomly divided (n = 10) according to the filling materials (Vitapex® , ZOE, Calcicur® , Feapex, and Calen® -ZO) and obturation technique: lentulo or pressure syringe (n = 5). The specimens were micro-CT scanned (pixel size = 7.83 μm) and reconstructed, and the total volume of filled canal (%FC) and internal voids (%IV) of the bulk filling material was calculated. Kruskal-Wallis and Mann-Whitney tests were used to detect differences and interactions among groups. RESULTS Calen® -ZO, Vitapex® , and ZOE showed similar %FC. Calcicur® showed lower %FC compared with Calen® -ZO, Vitapex® , and ZOE (P < .05) but similar to Feapex. No statistically significant differences in %FC between lentulo or pressure syringe were disclosed. Regarding %IV, Vitapex® , and Calen® -ZO performed better with syringe, although Calcicur® was better with lentulo. The number of voids in the obturation bulk was similar among materials, but always lower (P < .05) in syringe filled specimens. CONCLUSION Vitapex® , Calen® -ZO, and ZOE outperformed Calcicur® and Feapex in %FC and if the syringe technique is used, %IV of the obturation bulk and presence of defects was lower.
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Affiliation(s)
- Amanda Carneiro Aragão
- Department of Pediatric Dentistry and Orthodontics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andréa Vaz Braga Pintor
- Department of Pediatric Dentistry and Orthodontics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Laura Guimarães Primo
- Department of Pediatric Dentistry and Orthodontics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Ricardo Tadeu Lopes
- Laboratory for Nuclear Engineering, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Aline de Almeida Neves
- Department of Pediatric Dentistry and Orthodontics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Paediatric Dentistry, King's College London, London, UK
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Liu YJ, Yang WD, Wang WM, Zhu YN, Lin ZT, Zhu M. Relationship between canal morphology and isthmus in mesio-buccal roots of maxillary first molars in 9- to 12-year-old children: An in-vivo cone-beam computed tomography analysis. Arch Oral Biol 2020; 112:104645. [PMID: 31991228 DOI: 10.1016/j.archoralbio.2019.104645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/23/2019] [Accepted: 12/23/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVES This study aims to analysis the distribution of root canal isthmuses (RCIs), and its relationship with canal morphology in the mesio-buccal roots of maxillary first molars in children aged 9-12 in a Chinese sub-population. METHODS 494 healthy, untreated maxillary first molars with fully developed mesio-buccal roots were examined. Cone-beam computed tomography (CBCT) scans were acquired as part of diagnosis and treatment plannings unrelated to the present study. The images were evaluated to identify the canal morphology of mesio-buccal roots according to Vertucci's classification. A map-reading strategy was used to identify RCIs. RESULTS In mesio-buccal roots, the most common canal morphology was type Ⅳ (38.5 %). The frequency of type I (1.6 %) was much lower than adults. RCIs were found in 92.5 % mesio-buccal roots. The RCIs which began in the cervical third and ended in the middle third (CT-MT) (31.0 %) had the highest frequency. In type III, the RCIs which began and ended in the middle third (MT-MT) (30.3 %) were most common. For type V, 30.8 % RCIs began in the cervical third and ended in the apical third (CT-AT). No significant differences were found between sexes and sides (P > 0.05). CONCLUSIONS For children aged 9-12, the frequency of type I canals was much lower in mesio-buccal roots of maxillary permanent first molars, while the frequency of RCIs was higher than adults, especially in the apical third. The distribution of RCIs had its own characteristics in each canal type, closely related to the structures.
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Affiliation(s)
- Ya-Jing Liu
- Department of Endodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210008, China
| | - Wei-Dong Yang
- Department of Endodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210008, China.
| | - Wen-Mei Wang
- Department of Oral Mucosa Diseases, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210008, China
| | - Ya-Nan Zhu
- Department of Endodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210008, China
| | - Zi-Tong Lin
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210008, China
| | - Min Zhu
- Department of Endodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210008, China
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Rödig T, Koberg C, Baxter S, Konietschke F, Wiegand A, Rizk M. Micro-CT evaluation of sonically and ultrasonically activated irrigation on the removal of hard-tissue debris from isthmus-containing mesial root canal systems of mandibular molars. Int Endod J 2019; 52:1173-1181. [PMID: 30773661 DOI: 10.1111/iej.13100] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 02/13/2019] [Indexed: 01/23/2023]
Abstract
AIM To evaluate the efficacy of sonically and ultrasonically activated irrigation on removal of accumulated hard-tissue debris (AHTD) in mesial root canal systems of mandibular molars using micro-computed tomographic (micro-CT) analysis. METHODOLOGY Forty mesial roots of mandibular molars with two independent canals joined apically by an isthmus (Vertucci type II) were selected. The root canals were instrumented using Reciproc R25 instruments, and specimens were scanned at a resolution of 10.5 μm. Subsequently, n = 10 roots were assigned to each of the four final irrigation groups such that the group means and variances were almost identical: sonically activated irrigation with EndoActivator (EA) or EDDY (ED), ultrasonically activated irrigation (UAI) and manual irrigation without activation (MI). The final irrigation procedures were performed using a total of 5 mL 1% NaOCl and 5 mL 15% EDTA per canal over 5 min with activation time of 4 × 20 s. Reconstructed data sets were coregistered, and the mean percentage reduction of AHTD after final irrigation was compared statistically between groups using analysis of variance at a significance level set at 5%. RESULTS A significant reduction of AHTD was achieved after final irrigation in all groups (P < 0.05), ranging from 44.1% to 66.8%. The vol% of debris after irrigation was 3.7 ± 1.9% for EA, 3.3 ± 2.3% for ED, 2.1 ± 1.6% for UAI and 4.4 ± 2.3% for MI, with no significant difference between groups (P > 0.05). CONCLUSIONS None of the final irrigation protocols completely removed AHTD from mesial root canal systems in extracted human mandibular molars. Sonically and ultrasonically activated irrigation performed no better compared to manual irrigation.
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Affiliation(s)
- T Rödig
- Department for Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
| | - C Koberg
- Department for Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
| | - S Baxter
- Department for Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
| | - F Konietschke
- Institute of Biometry and Clinical Epidemiology, Charité - University Medical Center Berlin, Berlin, Germany
| | - A Wiegand
- Department for Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
| | - M Rizk
- Department for 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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Silva EJNL, Carvalho CR, Belladonna FG, Prado MC, Lopes RT, De-Deus G, Moreira EJL. Micro-CT evaluation of different final irrigation protocols on the removal of hard-tissue debris from isthmus-containing mesial root of mandibular molars. Clin Oral Investig 2018; 23:681-687. [DOI: 10.1007/s00784-018-2483-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 05/02/2018] [Indexed: 11/27/2022]
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Uzunoglu-Özyürek E, Karaaslan H, Türker SA, Özçelik B. Influence of size and insertion depth of irrigation needle on debris extrusion and sealer penetration. Restor Dent Endod 2018; 43:e2. [PMID: 29487833 PMCID: PMC5816991 DOI: 10.5395/rde.2018.43.e2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 11/08/2017] [Indexed: 12/28/2022] Open
Abstract
Objectives To determine the effect of size and insertion depth of irrigation needle on the amount of apical extruded debris and the amount of penetration depth of sealer using a confocal laser scanning microscope (CLSM). Materials and Methods Twenty maxillary premolars were assigned to 2 groups (n = 10), according to the size of needle tip, 28 G or 30 G. Buccal roots of samples were irrigated with respective needle type inserted 1 mm short of the working length (WL), while palatal roots were irrigated with respective needle type inserted 3 mm short of the WL. Prepared teeth were removed from the pre-weighed Eppendorf tubes. Canals were filled with F3 gutta-percha cone and rhodamine B dye-labeled AH 26 sealer. Teeth were transversally sectioned at 1 and 3 mm levels from the apex and observed under a CLSM. Eppendorf tubes were incubated to evaporate the irrigant and were weighed again. The difference between pre- and post-weights was calculated, and statistical evaluation was performed. Results Inserting needles closer to the apex and using needles with wider diameters were associated with significantly more debris extrusion (p < 0.05). The position of needles and level of sections had statistically significant effects on sealer penetration depth (p < 0.05 for both). Conclusions Following preparation, inserting narrower needles compatible with the final apical diameter of the prepared root canal at 3 mm short of WL during final irrigation might prevent debris extrusion and improve sealer penetration in the apical third.
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Affiliation(s)
- Emel Uzunoglu-Özyürek
- Department of Endodontics, Hacettepe University Faculty of Dentistry, Ankara, Turkey
| | - Hakan Karaaslan
- Department of Endodontics, Hacettepe University Faculty of Dentistry, Ankara, Turkey
| | - Sevinç Aktemur Türker
- Department of Endodontics, Bülent Ecevit University Faculty of Dentistry, Zonguldak, Turkey
| | - Bahar Özçelik
- Department of Endodontics, Hacettepe University Faculty of Dentistry, Ankara, Turkey
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28
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Virdee SS, Seymour DW, Farnell D, Bhamra G, Bhakta S. Efficacy of irrigant activation techniques in removing intracanal smear layer and debris from mature permanent teeth: a systematic review and meta-analysis. Int Endod J 2017; 51:605-621. [PMID: 29178166 DOI: 10.1111/iej.12877] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/16/2017] [Indexed: 12/21/2022]
Abstract
AIMS To establish whether irrigant activation techniques (IATs) result in greater intracanal smear layer and debris removal than conventional needle irrigation (CNI). METHODOLOGY Six electronic databases were searched to identify scanning electron microscopy studies evaluating smear layer and/or debris removal following the use of manual dynamic activation (MDA), passive ultrasonic irrigation (PUI), sonic irrigation (SI) or apical negative pressure (ANP) IATs in mature permanent teeth. Meta-analyses were performed for each canal segment (coronal, middle, apical and apical 1 mm) in addition to subgroup analyses for individual IATs with respect to CNI. Outcomes were presented as standardized mean differences (SMD) alongside 95% confidence intervals (95% CI) and chi-squared analysis. RESULTS From 252 citations, 16 studies were identified. The meta-analyses demonstrated significant improvements in coronal (SMD: 1.15, 95% CI: 0.72-1.57 / SMD: 0.54, 95% CI: 0.29-0.80), middle (SMD: 1.30, 95% CI: 0.59-2.53 / SMD: 0.8, 95% CI: 0.58-1.13) and apical thirds (SMD: 1.22, 95% CI: 0.83-1.62 / SMD: 1.86, 95% CI: 0.76-2.96) for smear layer and debris removal, respectively. In the apical 1 mm IATs improved cleanliness; however, differences were insignificant (SMD: 1.15, 95% CI: -0.47-2.77). Chi-squared analysis revealed heterogeneity scores of 79.3-92.8% and 0.0-93.5% for smear layer and debris removal, respectively. CONCLUSIONS IATs improve intracanal cleanliness across a substantial portion of the canal, and therefore, their use is recommended throughout root canal preparation. However, current data is too heterogeneous to compare and identify superiority of an individual technique highlighting the need to standardize experimental protocols and develop a more representative research model to investigate the in vivo impact of IATs on clinical outcomes and periapical healing following root canal treatment.
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Affiliation(s)
- S S Virdee
- Department of Restorative Dentistry, Birmingham Dental Hospital, Birmingham, UK
| | - D W Seymour
- Department of Restorative Dentistry, York Hospital, York, UK
| | - D Farnell
- Department of Dentistry, Cardiff University School of Dentistry, Cardiff, UK
| | - G Bhamra
- Department of Restorative Dentistry, Cardiff University Dental Hospital, Cardiff, UK
| | - S Bhakta
- Department of Restorative Dentistry, Leeds Dental Institute, Leeds, UK
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Rover G, Belladonna FG, Bortoluzzi EA, De-Deus G, Silva EJNL, Teixeira CS. Influence of Access Cavity Design on Root Canal Detection, Instrumentation Efficacy, and Fracture Resistance Assessed in Maxillary Molars. J Endod 2017; 43:1657-1662. [DOI: 10.1016/j.joen.2017.05.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/09/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
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30
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Verstraeten J, Jacquet W, De Moor RJG, Meire MA. Hard tissue debris removal from the mesial root canal system of mandibular molars with ultrasonically and laser-activated irrigation: a micro-computed tomography study. Lasers Med Sci 2017; 32:1965-1970. [DOI: 10.1007/s10103-017-2297-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 07/27/2017] [Indexed: 11/28/2022]
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31
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Chen N, Wang J, Mucelli A, Zhang X, Wang C. Electro-Acupuncture is Beneficial for Knee Osteoarthritis: The Evidence from Meta-Analysis of Randomized Controlled Trials. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2017; 45:965-985. [DOI: 10.1142/s0192415x17500513] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Knee osteoarthritis (KOA) is a common chronic degenerative disease of the elderly. Electro-acupuncture (EA) is considered as a beneficial treatment for KOA, but the conclusion is controversial. This systematic review compiled the evidence from 11 randomized controlled trials to objectively assess the effectiveness and safety of EA for KOA. Eight databases including PubMed, Cochrane Library, Clinic trials, Foreign Medical Literature Retrial Service (FMRS), Science Direct, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), and Wanfang Data were extensively searched up to 5 July 2016. The outcomes included the evaluation of effectiveness, pain and physical function. Risk of bias was evaluated according to the Cochrane risk of bias tool. Eleven RCTs with 695 participants were included. Meta-analysis indicated that EA was more effective than pharmacological treatment (RR [Formula: see text] 1.14; 95% CI [Formula: see text] 1.01,1.28; [Formula: see text]) and manual acupuncture (RR [Formula: see text] 1.12; 95% CI [Formula: see text] 1.02,1.22; [Formula: see text]). Also, EA had a more significant effect in reducing the pain intensity (SMD [Formula: see text]; 95% CI [Formula: see text]; [Formula: see text]) and improving the physical function in the perspective of WOMAC (MD [Formula: see text]; 95% CI [Formula: see text], 5.56; [Formula: see text]) and LKSS (pharmacological treatment: MD [Formula: see text]; 95% CI [Formula: see text], 6.64; [Formula: see text]). Furthermore, these studies implied that EA should be performed for at least 4 weeks. Conclusively, the results indicate that EA is a great opportunity to remarkably alleviate the pain and improve the physical function of KOA patients with a low risk of adverse reaction. Therefore, more high quality RCTs with rigorous methods of design, measurement and evaluation are needed to confirm the long-term effects of EA for KOA.
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Affiliation(s)
- Na Chen
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing 210023, P. R. China
| | - Jing Wang
- The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing 210023, P. R. China
| | - Attilio Mucelli
- School of Economics “Giorgio Fuà”, Polytechnic University of Marche, Ancona 60121, Italy
| | - Xu Zhang
- Jiangsu Collaborative Innovation Center of Traditional, Chinese Medicine Prevention and Treatment of Tumor, Nanjing 210023, P. R. China
| | - Changqing Wang
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing 210023, P. R. China
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