1
|
Koulogiannis A, Walmsley AD, Angeli P, Balabani S. Ultrasonic irrigation flows in root canals: effects of ultrasound power and file insertion depth. Sci Rep 2024; 14:5368. [PMID: 38438434 PMCID: PMC10912427 DOI: 10.1038/s41598-024-54611-x] [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: 09/06/2023] [Accepted: 02/14/2024] [Indexed: 03/06/2024] Open
Abstract
Ultrasonic irrigation during root canal treatment can enhance biofilm disruption. The challenge is to improve the fluid flow so that the irrigant reaches areas inaccessible to hand instrumentation. The aim of this study is to experimentally investigate how the flow field and hydrodynamic forces induced by ultrasonic irrigation are influenced by the ultrasound power and file insertion depth. A root canal phantom was 3D printed and used as a mold for the fabrication of a PDMS channel. An ultrasonic instrument with a #15K-file provided the irrigation. The flow field was studied by means of Particle Image Velocimetry (PIV). The time averaged velocity and shear stress distributions were found to vary significantly with ultrasound power. Their maximum values increase sharply for low powers and up to a critical power level. At and above this setting, the flow pattern changes, from the high velocity and shear stress region confined in the vicinity of the tip, to one covering the whole root canal domain. Exceeding this threshold also induces a moderate increase in the maximum velocities and shear stresses. The insertion depth was found to have a smaller effect on the measured velocity and shear stresses. Due to the oscillating nature of the flow, instantaneous maximum velocities and shear stresses can reach much higher values than the mean, especially for high powers. Ultrasonic irrigation will benefit from using a higher power setting as this does produce greater shear stresses near the walls of the root canal leading to the potential for increased biofilm removal.
Collapse
Affiliation(s)
- A Koulogiannis
- FluME, Department of Mechanical Engineering, University College London (UCL), London, UK
| | - A D Walmsley
- School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - P Angeli
- ThAMes, Department of Chemical Engineering, University College London (UCL), London, UK.
| | - S Balabani
- FluME, Department of Mechanical Engineering, University College London (UCL), London, UK.
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London (UCL), London, UK.
| |
Collapse
|
2
|
Boppré LM, Menezes Savaris J, Catherine Maiola E, Peressoni Vieira-Schuldt D, da Fonseca Roberti Garcia L, da Silveira Teixeira C, Antunes Bortoluzzi E. Can Heated Distilled Water Effectively Prevent Precipitate Formation between NaOCl and CHX? Int J Dent 2024; 2024:6612675. [PMID: 38222303 PMCID: PMC10787650 DOI: 10.1155/2024/6612675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/25/2023] [Accepted: 12/19/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction The present study aimed to investigate the capacity of different irrigation protocols using heated distilled water at 65°C (HDW), in preventing the formation of the brown-orange precipitate observed after the interaction between sodium hypochlorite (NaOCl) and chlorhexidine (CHX). Methods Forty human canines were selected, prepared, and cleaved in two halves. Images of delimited areas in each root canal thirds were obtained through a stereomicroscope (16x and 40x). After reassembly, the teeth were distributed into four groups (n = 10) according to the final irrigation protocol: G1 (no HDW): EDTA + NaOCl + CHX with conventional irrigation (CI); G2 (HDW + CI): EDTA with passive ultrasonic irrigation (PUI) + NaOCl (PUI) + HDW (CI) + CHX (PUI); G3 (HDW + PUI): EDTA + NaOCl + HDW + CHX with PUI; G4 (HDW + CUI): EDTA (PUI) + NaOCl (PUI) + HDW with continuous ultrasonic irrigation (CUI) + CHX (PUI). After irrigation, the teeth were re-separated and images of the same delimited areas were obtained again. Scores were assigned according to the amount of precipitate observed, comparing the initial and final images. The data were submitted to Kruskal-Wallis, Dunn and Friedman statistical tests (α = 5%). Results G1(no HDW) showed the highest scores in the analysis between groups (p < 0.001), with a greater amount of precipitate in the cervical and medium thirds (p < 0.001). The thirds of the other experimental groups did not differ from each other (p > 0.05). Conclusion The intermediate irrigation with heated distilled water at 65°C prevented the formation of brown-orange precipitate, regardless of the use of ultrasonic activation (PUI or CUI).
Collapse
Affiliation(s)
- Letícia Mendes Boppré
- Department of Dentistry-Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Julia Menezes Savaris
- Department of Dentistry-Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Emanuelle Catherine Maiola
- Department of Dentistry-Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | | | - Lucas da Fonseca Roberti Garcia
- Department of Dentistry-Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Cleonice da Silveira Teixeira
- Department of Dentistry-Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Eduardo Antunes Bortoluzzi
- Department of Diagnosis and Oral Health, Division of Endodontics, University of Louisville, Louisville, KY, USA
| |
Collapse
|
3
|
Wigler R, Herteanu M, Wilchfort Y, Kfir A. Efficacy of Different Irrigant Activation Systems on Debris and Smear Layer Removal: A Scanning Electron Microscopy Evaluation. Int J Dent 2023; 2023:9933524. [PMID: 37771362 PMCID: PMC10533223 DOI: 10.1155/2023/9933524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 08/19/2023] [Accepted: 09/02/2023] [Indexed: 09/30/2023] Open
Abstract
Background Irrigation is an essential component of root canal treatment to enable cleaning beyond the reach of mechanical instruments. The study aimed to assess and compare the efficacy of different final irrigation protocols, including sonic- and ultrasonic-powered irrigant-activation systems, on debris and smear layer removal in the coronal, middle, and apical thirds of straight oval root canals. Materials and Methods Straight oval root canals of 60 human mandibular incisors were prepared to size 40.04 and divided into four groups (n = 15) according to the final irrigation protocols: (a) Eddy sonic activation (b) endosonic passive ultrasonic irrigation (PUI), (c) irrisafe PUI, and (d) manual syringe and needle irrigation with no additional activation, which served as control. After the treatment procedures, the roots were split and observed using scanning electron microscopy. The presence of remaining debris and smear layer at the coronal, mid-root, and apical thirds of the canals were evaluated using a score system and statistically analyzed using multinominal models with significance level set at p < 0.05. Results None of the final irrigation protocols completely removed all debris and smear layer from all root canals. When the syringe and needle were used without activation, more debris and smear layer were found in the apical third of the canals. Activation of the final irrigant with each of the three devices significantly reduced the presence of debris in the apical third, compared to the syringe and needle final irrigation, with no difference among the three activation devices. Eddy and irrisafe activation also significantly reduced the residual smear layer in the apical third, compared to syringe and needle alone, while the reduction in the remaining smear layer by endosonic activation did not reach the significance level. Conclusions Removal of debris and smear layer from the apical part of the root canal by syringe and needle irrigation alone may be significantly improved by using sonic or ultrasonic activation of the final irrigant. Endosonic activation was less effective in removal of smear layer from the apical part of the canals compared to the other two activation systems.
Collapse
Affiliation(s)
- Ronald Wigler
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moran Herteanu
- The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Wilchfort
- The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anda Kfir
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Jain S, Patni P, Jain P, Raghuwanshi S, Pandey SH, Tripathi S, Soni A. Comparison of dentinal tubular penetration of Intra-canal heated and Pre-heated sodium hypochlorite through different agitation techniques. J Endod 2023:S0099-2399(23)00235-2. [PMID: 37105500 DOI: 10.1016/j.joen.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION The efficacy of sodium hypochlorite (NaOCl) as an intracanal irrigant is widely debated in endodontic therapy. This study aimed to analyze and compare the penetration abilities of different modes of NaOCl application and assess the impact of various agitation strategies on promoting root canal cleanliness. MATERIALS AND METHODS This study included 168 single-rooted mandibular premolars that were randomly divided into eight groups. The two modes of application of 5% NaOCl evaluated were intracanal heating and preheating, and the agitation strategies included ultrasonic, sonic, and manual dynamic agitations (MDAs). The samples were sectioned and observed at a magnification of 1000× under a scanning electron microscope. RESULTS The analysis of variance test showed a statistically significant difference among the various groups of agitation (P < 0.05). The post hoc Tukey test confirmed that preheated NaOCl with ultrasonic agitation, intracanal-heated NaOCl with sonic agitation, and MDA had significantly higher debris scores of 1, 4, and 5, respectively, in the apical third of the canal. CONCLUSION The results indicated that the combination of intracanal-heated NaOCl and ultrasonic agitation is an effective method for reducing debris in the root canal system. These findings highlight the importance of considering both the mode of application and the agitation strategies when optimizing the use of NaOCl as an intracanal irrigant in endodontic therapy.
Collapse
Affiliation(s)
- Swati Jain
- Sri Aurobindo College of Dentistry, Sri Aurobindo University, Indore, MP, India
| | - Pallav Patni
- Sri Aurobindo College of Dentistry, Sri Aurobindo University, Indore, MP, India.
| | - Pradeep Jain
- Sri Aurobindo College of Dentistry, Sri Aurobindo University, Indore, MP, India
| | - Swadhin Raghuwanshi
- Sri Aurobindo College of Dentistry, Sri Aurobindo University, Indore, MP, India
| | - Sanket Hans Pandey
- Sri Aurobindo College of Dentistry, Sri Aurobindo University, Indore, MP, India
| | - Shubham Tripathi
- Sri Aurobindo College of Dentistry, Sri Aurobindo University, Indore, MP, India
| | - Ankita Soni
- Sri Aurobindo College of Dentistry, Sri Aurobindo University, Indore, MP, India
| |
Collapse
|
5
|
Chu X, Feng S, Zhou W, Xu S, Zeng X. Cleaning efficacy of EDDY versus ultrasonically-activated irrigation in root canals: a systematic review and meta-analysis. BMC Oral Health 2023; 23:155. [PMID: 36932445 PMCID: PMC10024384 DOI: 10.1186/s12903-023-02875-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Ultrasonically-activated irrigation (UAI) is effective in root canal irrigation but may damage canal walls. EDDY is a sonic activation system with flexible working tips that cause no harm to dentinal walls. This review explores the intracanal cleaning efficacy of EDDY compared with UAI in vitro. METHODS The systematic review was registered in the PROSPERO database (CRD42021235826). A literature search was conducted in six electronic databases. In vitro studies that compared the removal of smear layer, debris, soft tissue or microbes in root canals between EDDY and UAI were included. Data extraction and quality assessment were performed. Meta-analyses were conducted on smear layer removal and debris elimination with the standardized mean difference (SMD). Heterogeneity was measured using the I2 test and the Chi2 test. The random-effect model was used when I2 > 50%, or p < 0.1, otherwise the fixed-effect model was applied. The level of significance was set at p < 0.05. RESULTS 19 articles were included in this systematic review and 7 articles were included in meta-analyses. Meta-analyses on smear layer removal showed unimportant differences between EDDY and UAI at any canal third (coronal [SMD = 0.08, 95% confidence interval (95%CI): -0.29 to 0.45; p = 0.44, I2 = 0%]; middle [SMD = 0.02, 95% CI: -0.44 to 0.47; p = 0.94, I2 = 0%]; apical [SMD = 0.01, 95%CI: -0.35 to 0.38; p = 0.70, I2 = 0%]). Meta-analyses on debris removal evaluated by scanning electron microscope (coronal [SMD = 0.03, 95% CI: -0.41 to 0.46; p = 0.27, I2 = 23%]; middle [SMD = -0.24, 95% CI: -0.83 to 0.35; p = 0.80, I2 = 0%]; apical [SMD = 0.24, 95%CI: -0.20 to 0.67; p = 0.36, I2 = 2%]) and micro-CT (SMD = 0.36, 95% CI: -0.67 to 1.40; p = 0.03, I2 = 70%) both found insignificant differences. No meta-analysis was undertaken on soft-tissue removal and disinfection due to the various study designs, but the qualitative analyses implied that EDDY achieved similar performance to UAI in both aspects. CONCLUSIONS Limited evidence indicated that EDDY was comparable to UAI in removing smear layer, debris, soft tissue and microbes ex vivo. Considering UAI may damage canal walls, EDDY might be a substitute for UAI in irrigation activation. But more randomized clinical trials are required to explore the clinical extrapolation of the results in this review.
Collapse
Affiliation(s)
- Xiaojun Chu
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, No 366 Jiangnan Avenue South, Guangzhou, 510280, Guangdong, China
| | - Shuting Feng
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, No 366 Jiangnan Avenue South, Guangzhou, 510280, Guangdong, China
| | - Weiqing Zhou
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, No 366 Jiangnan Avenue South, Guangzhou, 510280, Guangdong, China
| | - Shuaimei Xu
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, No 366 Jiangnan Avenue South, Guangzhou, 510280, Guangdong, China
| | - Xiongqun Zeng
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, No 366 Jiangnan Avenue South, Guangzhou, 510280, Guangdong, China.
| |
Collapse
|
6
|
Park R, Choi M, Seo J, Park EH, Jang SW, Shon WJ, Kim HY, Kim W. Root canal irrigation system using remotely generated high-power ultrasound. ULTRASONICS SONOCHEMISTRY 2022; 90:106168. [PMID: 36137469 PMCID: PMC9493060 DOI: 10.1016/j.ultsonch.2022.106168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/27/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
Root canal treatment is performed to remove the bacteria proliferating in the root canals of a tooth. Many conventional root canal irrigation methods use an instrument inserted into the root canals. However, bacteria removal is often incomplete in the apical region of the root canal, and the treatment carries clinical risks, such as instrument fracture and extrusion of irrigation liquid through the canal apex. We here suggest a novel, remotely generated high-intensity ultrasound irrigation system that exhibits better irrigation performance and a reduced clinical risk. Our device employs powerful ultrasonic waves generated by a transducer placed outside a target tooth. The generated ultrasonic waves are guided to travel into the root canals. In the root canals of the target tooth, acoustic cavitation occurs, and vapor bubbles are created. The dynamic motions of vapor bubbles create remarkable cleaning effects. Using root canal models, we tested the cleaning performance of the proposed system and compared it with other conventional irrigation methods. The results revealed that biofilm in the apical region of the root canal models can be removed exclusively using the proposed system, thus demonstrating an improvement in cleaning performance. We also measured pressure at the apex of the root canals of an extracted tooth while operating the proposed system. Our system exhibited a smaller pressure compared to the syringe irrigation method, thus suggesting a reduced risk of apical extrusion of the irrigation liquid. Since the proposed system operates without inserting instruments into the root canal, it can clean multiple root canals in a tooth simultaneously with a single treatment. The proposed device would be a breakthrough in root canal treatment in terms of irrigation performance, clinical safety, and ease of treatment.
Collapse
Affiliation(s)
- Ryeol Park
- Department of Mechanical Engineering, Sogang University, Seoul 04107, Republic of Korea
| | - Minsu Choi
- Department of Mechanical Engineering, Sogang University, Seoul 04107, Republic of Korea
| | - Jaedeok Seo
- Department of Mechanical Engineering, Sogang University, Seoul 04107, Republic of Korea
| | - Eun Hyun Park
- Department of Conservative Dentistry, Dental Research Institute and School of Dentistry, Seoul National University, Seoul 03080, Republic of Korea.
| | | | - Won-Jun Shon
- Department of Conservative Dentistry, Dental Research Institute and School of Dentistry, Seoul National University, Seoul 03080, Republic of Korea
| | - Ho-Young Kim
- Department of Mechanical Engineering, Seoul National University, Seoul 08826, Republic of Korea.
| | - Wonjung Kim
- Department of Mechanical Engineering, Sogang University, Seoul 04107, Republic of Korea; Institute of Emergent Materials, Sogang University, Seoul 04107, Republic of Korea.
| |
Collapse
|
7
|
Boutsioukis C, Verhaagen B, van der Sluis LWM, Versluis M. Irrigant flow in the root canal during ultrasonic activation: a numerical fluid-structure interaction model and its validation. Int Endod J 2022; 55:938-949. [PMID: 35762040 PMCID: PMC9545492 DOI: 10.1111/iej.13791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 11/26/2022]
Abstract
Aim The aim of the study was (a) to develop a three‐dimensional numerical model combining the oscillation of a tapered ultrasonic file and the induced irrigant flow along with their two‐way interaction in the confinement of a root canal. (b) To validate this model through comparison with experiments and theoretical (analytical) solutions of the flow. Methodology Two partial numerical models, one for the oscillation of the ultrasonic file and another one for the irrigant flow inside the root canal around the file, were created and coupled in order to take into account the two‐way coupled fluid–structure interaction. Simulations were carried out for ultrasonic K‐files and for smooth wires driven at four different amplitudes in air or inside an irrigant‐filled straight root canal. The oscillation pattern of the K‐files was determined experimentally by Scanning Laser Vibrometry, and the flow pattern inside an artificial root canal was analysed using high‐speed imaging together with Particle Image Velocimetry. Analytical solutions were obtained from an earlier study. Numerical, experimental and analytical results were compared to assess the validity of the model. Results The comparison of the oscillation amplitude and node location of the ultrasonic files and of the irrigant flow field showed a close agreement between the simulations, experiments and theoretical solutions. Conclusions The model is able to predict reliably the file oscillation and irrigant flow inside root canals during ultrasonic activation under similar conditions.
Collapse
Affiliation(s)
- C Boutsioukis
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - B Verhaagen
- Physics of Fluids Group, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - L W M van der Sluis
- Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M Versluis
- Physics of Fluids Group, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.,Technical Medical (TechMed) Centre and MESA+ Institute for Nanotechnology, University of Twente, Enschede, The Netherlands
| |
Collapse
|
8
|
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.
Collapse
Affiliation(s)
- Christos Boutsioukis
- Department of EndodontologyAcademic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | | | | |
Collapse
|
9
|
Boutsioukis C, Arias-Moliz MT. Present status and future directions - irrigants and irrigation methods. Int Endod J 2022; 55 Suppl 3:588-612. [PMID: 35338652 PMCID: PMC9321999 DOI: 10.1111/iej.13739] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
Irrigation is considered the primary means of cleaning and disinfection of the root canal system. The purpose of this review was to set the framework for the obstacles that irrigation needs to overcome, to critically appraise currently used irrigants and irrigation methods, to highlight knowledge gaps and methodological limitations in the available studies and to provide directions for future developments. Organization of bacteria in biofilms located in anatomic intricacies of the root canal system and the difficulty to eliminate them is the main challenge for irrigants. Sodium hypochlorite remains the primary irrigant of choice, but it needs to be supplemented by a chelator. Delivery of the irrigants using a syringe and needle and activation by an ultrasonic file are the most popular irrigation methods. There is no evidence that any adjunct irrigation method, including ultrasonic activation, can improve the long‐term outcome of root canal treatment beyond what can be achieved by instrumentation and syringe irrigation. It is necessary to redefine the research priorities in this field and investigate in greater depth the penetration of the irrigants, their effect on the biofilm and the long‐term treatment outcome. New studies must also focus on clinically relevant comparisons, avoid methodological flaws and have sufficiently large sample sizes to reach reliable conclusions. Future multidisciplinary efforts combining the knowledge from basic sciences such as Chemistry, Microbiology and Fluid Dynamics may lead to more effective antimicrobials and improved activation methods to bring them closer to the residual biofilm in the root canal system.
Collapse
Affiliation(s)
- C Boutsioukis
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M T Arias-Moliz
- Department of Microbiology, Faculty of Dentistry, University of Granada, Granada, Spain
| |
Collapse
|
10
|
Retsas A, Dijkstra RJB, van der Sluis L, Boutsioukis C. The effect of the ultrasonic irrigant activation protocol on the removal of a dual-species biofilm from artificial lateral canals. J Endod 2022; 48:775-780. [DOI: 10.1016/j.joen.2022.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/23/2022] [Accepted: 03/12/2022] [Indexed: 12/20/2022]
|
11
|
Natanasabapathy V, Arul B, Srinivasan V, Santosh SS, Vasudevan A, Arockiam S, Namasivayam A, Deivanayagam K, Srinivasan MR. Removal of accumulated hard tissue debris from mesial root of mandibular molars evaluated using micro-CT - a systematic review and network meta-analysis. Evid Based Dent 2021:10.1038/s41432-021-0207-x. [PMID: 34795397 DOI: 10.1038/s41432-021-0207-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/21/2021] [Indexed: 11/09/2022]
Abstract
Aim The aim of this systematic review and network meta-analysis was to identify the best irrigant activation technique (IAT) for the removal of accumulated hard tissue debris (AHTD) from the mesial root of mandibular molars evaluated using micro-CT studies.Methods The research question was based on the PICO format. Four electronic databases - PubMed, Scopus, Embase and Web of Science - were searched for articles up to June 2020. Selected articles were assessed for bias using the Joanna Briggs Institute Critical appraisal tool. The network meta-analysis using a fixed-effects model and SUCRA ranking were performed. The quality of the evidence was assessed using the CINeMA framework.Results Eleven studies were included for qualitative synthesis while seven were included for quantitative synthesis. The risk of bias of all included articles was low. The results based on SUCRA values revealed the IAT shock wave-enhanced emission photoacoustic streaming (100%) resulted in the greatest reduction of the volume of AHTD from mesial roots of mandibular molars. Ranking of the other IATs was as follows: photon-induced photoacoustic streaming (87%), laser-activated irrigation (79.3%), XP EndoFinisher (71.2%), ultrasonically activated irrigation (59.6%), apical negative pressure (42.3%), EasyClean (37.4%), EDDY (26.2%), EndoActivator (24.2%), self-adjusting file (11.6%) and needle irrigation (11.3%).Conclusion None of the IATs rendered the root canals completely free of AHTD. The laser-activated irrigation groups fared better than all other interventions in reducing AHTD from the mesial roots of mandibular molars. The confidence rating ranged from low to high for indirect evidence and moderate to high for mixed evidence. Results must be interpreted with caution due to the laboratory nature of the included studies.
Collapse
Affiliation(s)
- Velmurugan Natanasabapathy
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER), No.1, Alapakkam Main Road, Maduravoyal, Chennai, 600095, Tamil Nadu, India.
| | - Buvaneshwari Arul
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER), No.1, Alapakkam Main Road, Maduravoyal, Chennai, 600095, Tamil Nadu, India
| | - Vignesh Srinivasan
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER), No.1, Alapakkam Main Road, Maduravoyal, Chennai, 600095, Tamil Nadu, India
| | - Sneha Susan Santosh
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER), No.1, Alapakkam Main Road, Maduravoyal, Chennai, 600095, Tamil Nadu, India
| | - Aishwarya Vasudevan
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER), No.1, Alapakkam Main Road, Maduravoyal, Chennai, 600095, Tamil Nadu, India
| | - Selva Arockiam
- Department of Orthodontics, Faculty of Dentistry, Meenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER), No.1, Alapakkam Main Road, Maduravoyal, Chennai, 600095, Tamil Nadu, India
| | - Ambalavanan Namasivayam
- Department of Periodontology and Oral implantology, Faculty of Dentistry, Meenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER), No.1, Alapakkam Main Road, Maduravoyal, Chennai, 600095, Tamil Nadu, India
| | - Kandaswamy Deivanayagam
- Department of Conservative Dentistry & Endodontics, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, 600116, Tamil Nadu, India
| | - M R Srinivasan
- Department of Conservative Dentistry and Endodontics, Sri Venkateswara Dental College and Hospital, Chennai, 600130, Tamil Nadu, India
| |
Collapse
|
12
|
Valencia YM, Vertuan GC, Alcalde MP, Vivan RR, Reis Só MV, Duarte MAH. Effect of Irrigating Agitation after Root End Preparation on the Wall Cleaning and Bond Strength of Calcium Silicate Material in Retrograde Obturation. Eur J Dent 2021; 15:707-713. [PMID: 34303319 PMCID: PMC8630967 DOI: 10.1055/s-0041-1729454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective
This study aimed to evaluate the cleaning efficacy of irrigant activation with a new ultrasonic tip in root-end preparations and to determine its influence on the bond strength of calcium silicate-based material.
Materials and Methods
Maxillary canines were prepared and filled, and their root ends resected. Root-end cavities were ultrasonically prepared and randomly distributed into four groups according to the final irrigation protocols: G1 (ultrasonic irrigation [UI] + saline solution [SS]), G2 (syringe irrigation [SI] + SS), G3 (UI + ethylenediaminetetraacetic acid [EDTA]), and G4 (SI + EDTA). Cleaning efficacy analysis employed 72 specimens (
n
= 18) split longitudinally for imaging of the same areas by scanning electron microscopy (SEM). The percentage of dentinal tubules opened before and after irrigation was used as evaluation parameter. Push-out testing employed 40 specimens (
n
= 10) sectioned apical region perpendicularly, which slice was placed on a testing machine for the bond strength measurement and failure mode was assessed by SEM. The data were statistically analyzed (α ≤ 0.05).
Results
G3 (UI + EDTA) removed the smear layer more effectively, showed the best tubule opening (
p
< 0.05), and presented the highest mean bond strength values (
p
< 0.05). Failure modes were predominantly adhesive, except for the G3 (UI + EDTA) group, in which they were mainly mixed (80%).
Conclusion
The results of this study suggest that EDTA 17% agitation promoted better cleaning and smear layer removal, improving the push-out bond strength of calcium silicate material in retrograde obturation.
Collapse
Affiliation(s)
- Yahir Muñoz Valencia
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Gislene Cristina Vertuan
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Murilo Priori Alcalde
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Rodrigo Ricci Vivan
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Marcus Vinícius Reis Só
- Department of Dentistry, University Federal of the Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marco Antonio Hungaro Duarte
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| |
Collapse
|
13
|
Choi MJ, Kim MA, Choi Y, Neelakantan P, Yu MK, Min KS. A novel three-dimensionally printed model to assess biofilm removal by ultrasonically activated irrigation. Int Endod J 2021; 54:1871-1877. [PMID: 34043827 DOI: 10.1111/iej.13579] [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: 01/15/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 02/05/2023]
Abstract
AIM To apply an innovative three-dimensionally printed tooth model to investigate the efficacy of three ultrasonically activated irrigation (UAI) systems in removing multispecies biofilms from dentine samples. METHODOLOGY Three-dimensionally printed teeth with a curved root canal were fabricated with a standardized slot in the apical third of the root to achieve precision fit of human root dentine specimens. Multispecies biofilms including Enterococcus faecalis, Streptococcus mitis and Campylobacter rectus were developed in the root canal for 21 days. The canals were allocated to be irrigated with 1% sodium hypochlorite (NaOCl) using a syringe and needle or ultrasonically activated NaOCl with a stainless-steel file (Irrisafe), a conventional nickel-titanium (Ni-Ti) file (CK) or a blue heat-treated Ni-Ti file (Endosonic Blue). Infected root canals irrigated with distilled water served as controls. Bacterial reduction was determined by colony-forming unit (CFU) counting (n = 20), whilst biofilms were analysed using confocal laser scanning microscopy (n = 7) and field emission scanning electron microscopy. For CFU counting, the independent two-sample t-test (Welch's t-test) was examined to compare overall bacterial reduction amongst groups. For CLSM analysis, the data were analysed using one-way analysis of variance (ANOVA), followed by the Scheffé post hoc test. The p-values <.05 were considered to indicate statistical significance. RESULTS All groups in which NaOCl was ultrasonically activated had significantly lower CFU values than the syringe-and-needle irrigation and control groups (p < .05). Ultrasonic activation with the stainless-steel file and blue heat-treated Ni-Ti file significantly reduced the biofilm volume compared with other groups (p < .05). Overall, UAI with the blue heat-treated file resulted in the highest antibacterial and biofilm removal efficacy. CONCLUSIONS UAI with different inserts had differential antibiofilm effects. The blue heat-treated Ni-Ti ultrasonic insert resulted in the greatest antibacterial and biofilm removal from dentine in this standardized root canal model.
Collapse
Affiliation(s)
- Min-Ji Choi
- Department of Conservative Dentistry, School of Dentistry, Jeonbuk National University, Jeonju, Korea
| | - Mi-Ah Kim
- Department of Conservative Dentistry, School of Dentistry, Jeonbuk National University, Jeonju, Korea
| | - Yoorina Choi
- Department of Conservative Dentistry, College of Dentistry, Wonkwang University, Iksan, Korea
| | - Prasanna Neelakantan
- Discipline of Endodontology, Department of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Mi-Kyung Yu
- Department of Conservative Dentistry, School of Dentistry, Jeonbuk National University, Jeonju, Korea.,Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea.,Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Kyung-San Min
- Department of Conservative Dentistry, School of Dentistry, Jeonbuk National University, Jeonju, Korea.,Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea.,Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| |
Collapse
|
14
|
Souza MA, Palhano HS, Macci D, Broch GM, Tissiani L, Rauber BF, Cecchin D, Bervian J, de Almeida Gomes BPF, Gabrielli ES. Influence of ultrasonic activation on antimicrobial activity of a new final irrigant containing glycolic acid: An in vitro study. AUST ENDOD J 2021; 47:531-537. [PMID: 33901338 DOI: 10.1111/aej.12517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/19/2021] [Accepted: 04/11/2021] [Indexed: 11/29/2022]
Abstract
This study evaluated the influence of ultrasonic activation (US) on the antimicrobial activity of a new final irrigant containing glycolic acid (GA). Extracted teeth were used, being 70 to counting of colony-forming units (CFUs) and 35 to confocal laser scanning microscopy. Samples were inoculated with Enterococcus faecalis and divided into 7 groups: distilled water + US; 17% EDTA; Qmix; 17% GA; 17% EDTA + US; QMix + US; and 17% GA + US and kept in contact with test solution for 1 min in the groups with or no US. In the CFUs, the highest bacterial reduction was observed in QMix + US group, followed by QMix and GA + US. In the confocal evaluation, the lowest number of viable cells was observed in EDTA + US, with no statistical difference from QMix, QMix + US and GA + US (P > 0.05). The use of US improves the antimicrobial activity of EDTA and GA, being statistically different from the isolated use of these final irrigants in both evaluation tests.
Collapse
Affiliation(s)
| | | | - Dierro Macci
- School of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil
| | | | - Luanda Tissiani
- School of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil
| | | | - Doglas Cecchin
- School of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil
| | - Juliane Bervian
- School of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil
| | | | - Ezequiel Santin Gabrielli
- School of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil.,School of Dentistry of Piracicaba, State University of Campinas, Piracicaba, SP, Brazil
| |
Collapse
|
15
|
Dashtimoghadam E, Johnson A, Fahimipour F, Malakoutian M, Vargas J, Gonzalez J, Ibrahim M, Baeten J, Tayebi L. Vibrational and sonochemical characterization of ultrasonic endodontic activating devices for translation to clinical efficacy. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 109:110646. [PMID: 32228956 DOI: 10.1016/j.msec.2020.110646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 07/13/2019] [Accepted: 01/03/2020] [Indexed: 11/30/2022]
Abstract
Passive activation of endodontic irrigants provides improved canal disinfection, smear layer removal, and better subsequent sealing. Although evidence suggests that passive activating endodontic devices increase the effectiveness of irrigation, no study exists to quantitatively compare and validate vibrational characteristics and cavitation produced by different ultrasonic endodontic devices. The current study aims to compare the efficiency of various commercially available ultrasonic endodontic activating devices (i.e., EndoUltra™, EndoChuck, Irrisafe™, and PiezoFlow®). The passive endodontic activating devices were characterized in terms of tip displacement and cavitation performance using scanning laser vibrometry (SLV) and sonochemical analysis, respectively. The obtained results showed that activator tip displacements and speed correlate to established cavitation thresholds. The EndoUltra™ tip speed was measured to be 14.5 and 28.1 m/s at 45 and 91 kHz, respectively, which is greater than the threshold. The EndoUltra™ was found to be the only device that exceeds the cavitation thresholds (i.e. tip speed and displacement), as evident from laser vibrometry analysis, and subsequently yielded measurable cavitation quantified via sonochemical analysis. All other passive endodontic activation devices, despite ultrasonic oscillation, were unable to produce cavitation.
Collapse
Affiliation(s)
| | | | | | - Mohamadali Malakoutian
- Electrical and Computer Engineering Department, Marquette University, Milwaukee, WI, USA
| | - Jessica Vargas
- Marquette University School of Dentistry, Milwaukee, WI 53233, USA
| | - Jose Gonzalez
- Marquette University School of Dentistry, Milwaukee, WI 53233, USA
| | - Mohamed Ibrahim
- Marquette University School of Dentistry, Milwaukee, WI 53233, USA; Endodontic Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - John Baeten
- Inter Med-Vista Dental, Racine, WI 53404, USA
| | - Lobat Tayebi
- Marquette University School of Dentistry, Milwaukee, WI 53233, USA.
| |
Collapse
|
16
|
Swimberghe RCD, De Clercq A, De Moor RJG, Meire MA. Efficacy of sonically, ultrasonically and laser-activated irrigation in removing a biofilm-mimicking hydrogel from an isthmus model. Int Endod J 2018; 52:515-523. [DOI: 10.1111/iej.13024] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 10/02/2018] [Indexed: 12/29/2022]
Affiliation(s)
- R. C. D. Swimberghe
- Department of Restorative Dentistry and Endodontology; Dental School; Ghent University; Gent Belgium
| | - A. De Clercq
- Department of Restorative Dentistry and Endodontology; Dental School; Ghent University; Gent Belgium
| | - R. J. G. De Moor
- Department of Restorative Dentistry and Endodontology; Dental School; Ghent University; Gent Belgium
| | - M. A. Meire
- Department of Restorative Dentistry and Endodontology; Dental School; Ghent University; Gent Belgium
| |
Collapse
|
17
|
Pereno V, Aron M, Vince O, Mannaris C, Seth A, de Saint Victor M, Lajoinie G, Versluis M, Coussios C, Carugo D, Stride E. Layered acoustofluidic resonators for the simultaneous optical and acoustic characterisation of cavitation dynamics, microstreaming, and biological effects. BIOMICROFLUIDICS 2018; 12:034109. [PMID: 29887932 PMCID: PMC5976496 DOI: 10.1063/1.5023729] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 05/09/2018] [Indexed: 05/22/2023]
Abstract
The study of the effects of ultrasound-induced acoustic cavitation on biological structures is an active field in biomedical research. Of particular interest for therapeutic applications is the ability of oscillating microbubbles to promote both cellular and tissue membrane permeabilisation and to improve the distribution of therapeutic agents in tissue through extravasation and convective transport. The mechanisms that underpin the interaction between cavitating agents and tissues are, however, still poorly understood. One challenge is the practical difficulty involved in performing optical microscopy and acoustic emissions monitoring simultaneously in a biologically compatible environment. Here we present and characterise a microfluidic layered acoustic resonator (μLAR) developed for simultaneous ultrasound exposure, acoustic emissions monitoring, and microscopy of biological samples. The μLAR facilitates in vitro ultrasound experiments in which measurements of microbubble dynamics, microstreaming velocity fields, acoustic emissions, and cell-microbubble interactions can be performed simultaneously. The device and analyses presented provide a means of performing mechanistic in vitro studies that may benefit the design of predictable and effective cavitation-based ultrasound treatments.
Collapse
Affiliation(s)
- V. Pereno
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford OX3 7DQ, United Kingdom
| | - M. Aron
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford OX3 7DQ, United Kingdom
| | - O. Vince
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford OX3 7DQ, United Kingdom
| | - C. Mannaris
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford OX3 7DQ, United Kingdom
| | - A. Seth
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford OX3 7DQ, United Kingdom
| | - M. de Saint Victor
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford OX3 7DQ, United Kingdom
| | - G. Lajoinie
- Physics of Fluids Group, MESA+ Institute for Nanotechnology and MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - M. Versluis
- Physics of Fluids Group, MESA+ Institute for Nanotechnology and MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - C. Coussios
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford OX3 7DQ, United Kingdom
| | - D. Carugo
- Authors to whom correspondence should be addressed: and
| | - E. Stride
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford OX3 7DQ, United Kingdom
| |
Collapse
|
18
|
Dynamic Irrigation Promotes Apical Papilla Cell Attachment in an Ex Vivo Immature Root Canal Model. J Endod 2018; 44:744-750. [PMID: 29550003 DOI: 10.1016/j.joen.2018.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 01/10/2018] [Accepted: 01/20/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The use of dentin preconditioning techniques in regenerative endodontic procedures is currently promising. Several growth factors have been detected on dentin after ultrasonic irrigation with EDTA. This study aimed to evaluate the effects of dynamic irrigation with different solution regimens on apical papilla cell (APC) attachment in an ex vivo immature tooth model. METHODS Various dynamic irrigation techniques, needle irrigation (NI), NI with EndoActivator, and NI with passive ultrasonic irrigation, were used with different solution regimens, normal saline solution (NSS), EDTA, and chlorhexidine digluconate followed by EDTA, in enlarged root canal models where calcium hydroxide-medicated dentin slices were inserted. The initial number of attached fibronectin-positive APCs was counted. Dentin surface morphology was also inspected by using scanning electron microscopy. RESULTS The number of APCs was significantly greater in the dynamic irrigation groups than in the control group (P < .001). Greater APC numbers were observed in the groups in which NSS was used than in those in which EDTA or chlorhexidine digluconate/EDTA was used, when using the same techniques (P < .001). Cell numbers were similar at all levels of the root canals; however, in the ultrasonically supplemented group irrigated with NSS, the number of attached cells was significantly increased at the middle and apical levels (P < .05). CONCLUSIONS The use of dynamic irrigation techniques in an immature tooth model definitely promoted APC attachment to calcium hydroxide-medicated dentin. Furthermore, when NSS was used as a final irrigant, the number of attached cells was significantly increased.
Collapse
|
19
|
Vyas N, Dehghani H, Sammons RL, Wang QX, Leppinen DM, Walmsley AD. Imaging and analysis of individual cavitation microbubbles around dental ultrasonic scalers. ULTRASONICS 2017; 81:66-72. [PMID: 28595164 DOI: 10.1016/j.ultras.2017.05.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/23/2017] [Accepted: 05/23/2017] [Indexed: 06/07/2023]
Abstract
Cavitation is a potentially effective and less damaging method of removing biofilm from biomaterial surfaces. The aim of this study is to characterise individual microbubbles around ultrasonic scaler tips using high speed imaging and image processing. This information will provide improved understanding on the disruption of dental biofilm and give insights into how the instruments can be optimised for ultrasonic cleaning. Individual cavitation microbubbles around ultrasonic scalers were analysed using high speed recordings up to a million frames per second with image processing of the bubble movement. The radius and rate of bubble growth together with the collapse was calculated by tracking multiple points on bubbles over time. The tracking method to determine bubble speed demonstrated good inter-rater reliability (intra class correlation coefficient: 0.993) and can therefore be a useful method to apply in future studies. The bubble speed increased over its oscillation cycle and a maximum of 27ms-1 was recorded during the collapse phase. The maximum bubble radii ranged from 40 to 80μm. Bubble growth was observed when the ultrasonic scaler tip receded from an area and similarly bubble collapse was observed when the tip moved towards an area, corresponding to locations of low pressure around the scaler tip. Previous work shows that this cavitation is involved in biofilm removal. Future experimental work can be based on these findings by using the protocols developed to experimentally analyse cavitation around various clinical instruments and comparing with theoretical calculations. This will help to determine the main cleaning mechanisms of cavitation and how clinical instruments such as ultrasonic scalers can be optimised.
Collapse
Affiliation(s)
- N Vyas
- Physical Sciences of Imaging for Biomedical Sciences (PSIBS) Doctoral Training Centre, College of Engineering & Physical Sciences, University of Birmingham, Birmingham B15 2TT, UK; School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Mill Pool Way, Birmingham B5 7EG, UK
| | - H Dehghani
- School of Computer Science, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - R L Sammons
- School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Mill Pool Way, Birmingham B5 7EG, UK
| | - Q X Wang
- School of Mathematics, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - D M Leppinen
- School of Mathematics, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - A D Walmsley
- School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Mill Pool Way, Birmingham B5 7EG, UK.
| |
Collapse
|
20
|
Robinson JP, Macedo RG, Verhaagen B, Versluis M, Cooper PR, van der Sluis LWM, Walmsley AD. Cleaning lateral morphological features of the root canal: the role of streaming and cavitation. Int Endod J 2017; 51 Suppl 1:e55-e64. [PMID: 28654211 DOI: 10.1111/iej.12804] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/19/2017] [Indexed: 12/15/2022]
Abstract
AIM To investigate the effects of ultrasonic activation file type, lateral canal location and irrigant on the removal of a biofilm-mimicking hydrogel from a fabricated lateral canal. Additionally, the amount of cavitation and streaming was quantified for these parameters. METHODOLOGY An intracanal sonochemical dosimetry method was used to quantify the cavitation generated by an IrriSafe 25 mm length, size 25 file inside a root canal model filled with filtered degassed/saturated water or three different concentrations of NaOCl. Removal of a hydrogel, demonstrated previously to be an appropriate biofilm mimic, was recorded to measure the lateral canal cleaning rate from two different instruments (IrriSafe 25 mm length, size 25 and K 21 mm length, size 15) activated with a P5 Suprasson (Satelec) at power P8.5 in degassed/saturated water or NaOCl. Removal rates were compared for significant differences using nonparametric Kruskal-Wallis and/or Mann-Whitney U-tests. Streaming was measured using high-speed particle imaging velocimetry at 250 kfps, analysing both the oscillatory and steady flow inside the lateral canals. RESULTS There was no significant difference in amount of cavitation between tap water and oversaturated water (P = 0.538), although more cavitation was observed than in degassed water. The highest cavitation signal was generated with NaOCl solutions (1.0%, 4.5%, 9.0%) (P < 0.007) and increased with concentration (P < 0.014). The IrriSafe file outperformed significantly the K-file in removing hydrogel (P < 0.05). Up to 64% of the total hydrogel volume was removed after 20 s. The IrriSafe file typically outperformed the K-file in generating streaming. The oscillatory velocities were higher inside the lateral canal 3 mm compared to 6 mm from WL and were higher for NaOCl than for saturated water, which in turn was higher than for degassed water. CONCLUSIONS Measurements of cavitation and acoustic streaming have provided insight into their contribution to cleaning. Significant differences in cleaning, cavitation and streaming were found depending on the file type and size, lateral canal location and irrigant used. In general, the IrriSafe file outperformed the K-file, and NaOCl performed better than the other irrigants tested. The cavitation and streaming measurements revealed that both contributed to hydrogel removal and both play a significant role in root canal cleaning.
Collapse
Affiliation(s)
- J P Robinson
- Physical Sciences of Imaging in the Biomedical Sciences, University of Birmingham, Birmingham, UK
| | - R G Macedo
- Department of Cariology, Endodontology & Pedodontology, ACTA Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - B Verhaagen
- Physics of Fluids group and MIRA Institute for Biomedical Technology and Technical Medicine and MESA + Institute for Nanotechnology, University of Twente, Enschede, The Netherlands
| | - M Versluis
- Physics of Fluids group and MIRA Institute for Biomedical Technology and Technical Medicine and MESA + Institute for Nanotechnology, University of Twente, Enschede, The Netherlands
| | - P R Cooper
- School of Dentistry, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - L W M van der Sluis
- Center for Dentistry and Oral Hygiene, University Medical Center Groningen, Groningen, The Netherlands
| | - A D Walmsley
- School of Dentistry, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
21
|
Andrade-Junior CV, Batista RM, Marceliano-Alves M, Alves FRF, Silva EJNL. Efficacy of a new Activation Device in Irrigant Penetration Into Simulated Lateral Canals. Eur Endod J 2016; 1:1-4. [PMID: 32566897 PMCID: PMC7299054 DOI: 10.5152/eej.2016.16003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 06/20/2016] [Accepted: 07/31/2016] [Indexed: 11/29/2022] Open
Abstract
Objective: The aim of the present study was to compare the effects of EasyClean (EC) on irrigant delivery into simulated lateral canals using an artificial closed canal system. Passive ultrasonic irrigation (PUI) was used as a reference technique for comparison. Methods: Forty simulated curved root canals manufactured in transparent resin and with simulated lateral canals were instrumented with Reciproc R40 files and randomly assigned to four groups (n=10) according to the irrigant activation technique: PUI group, ECrec group (EC used in reciprocating motion), ECrot group (EC used in rotary motion), and control group (no activation performed). After activation, stereomicroscope images from each block were taken, and irrigant penetration into lateral canals was measured using Adobe Photoshop software. Data were analysed using ANOVA and Tukey’s post hoc test (α=0.05). Results: No penetration was observed in the control group. The ECrec group showed lower penetration than the other group (P<0.05). No differences were observed between the ECrot group and the PUI group (P>0.05). Conclusion: EC used in rotary motion was effective in increasing the penetration of the irrigating solution into simulated lateral canals.
Collapse
Affiliation(s)
- Carlos Vieira Andrade-Junior
- Department of Endodontics, Southwestern Bahia State University (UESB), Jequié, Brazil.,Department of Endodontics, Estácio de Sá University (UNESA), Rio de Janeiro, Brazil
| | - Rafaela M Batista
- Department of Endodontics, Southwestern Bahia State University (UESB), Jequié, Brazil
| | | | | | | |
Collapse
|
22
|
Irrigant flow during photon-induced photoacoustic streaming (PIPS) using Particle Image Velocimetry (PIV). Clin Oral Investig 2015; 20:381-6. [DOI: 10.1007/s00784-015-1562-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 08/04/2015] [Indexed: 10/23/2022]
|
23
|
Layton G, Wu WI, Selvaganapathy PR, Friedman S, Kishen A. Fluid Dynamics and Biofilm Removal Generated by Syringe-delivered and 2 Ultrasonic-assisted Irrigation Methods: A Novel Experimental Approach. J Endod 2015; 41:884-9. [PMID: 25749254 DOI: 10.1016/j.joen.2015.01.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 01/17/2015] [Accepted: 01/24/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Thorough understanding of fluid dynamics in root canal irrigation and corresponding antibiofilm capacity will support improved disinfection strategies. This study aimed to develop a standardized, simulated root canal model that allows real-time analysis of fluid/irrigation dynamics and its correlation with biofilm elimination. METHODS A maxillary incisor with an instrumented root canal was imaged with micro-computed tomography. The canal volume was reconstructed in 3 dimensions and replicated in soft lithography-based models microfabricated from polyethylene glycol-modified polydimethylsiloxane. Canals were irrigated by using a syringe (SI) and 2 ultrasonic-assisted methods, intermittent (IUAI) and continuous (CUAI). Real-time fluid movement within the apical 3 mm of canals was imaged by using microparticle image velocimetry. In similar models, canals were inoculated with Enterococcus faecalis to grow 3-week-old biofilms. Biofilm reduction by irrigation with SI, CUAI, and IUAI was assessed by using a crystal violet assay and compared with an untreated control. RESULTS SI generated higher velocity and shear stress in the apical 1-2 mm than 0-1 and 2-3 mm. IUAI generated consistently low shear stress in the apical 3 mm. CUAI generated consistently high levels of velocity and shear stress; it was the highest of the groups in the apical 0-1 and 2-3 mm. Biofilm was significantly reduced compared with the control only by CUAI (two-sample permutation test, P = .005). CONCLUSIONS CUAI exhibited the highest mechanical effects of fluid flow in the apical 3 mm, which correlated with significant biofilm reduction. The soft lithography-based models provided a novel model/method for study of correlations between fluid dynamics and the antibiofilm capacity of root canal irrigation methods.
Collapse
Affiliation(s)
- Gillian Layton
- Discipline of Endodontics, University of Toronto, Toronto, Ontario, Canada
| | - Wen-I Wu
- Department of Mechanical Engineering, McMaster University, Hamilton, Ontario, Canada
| | | | - Shimon Friedman
- Discipline of Endodontics, University of Toronto, Toronto, Ontario, Canada
| | - Anil Kishen
- Discipline of Endodontics, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
24
|
van der Sluis L, Boutsioukis C, Jiang LM, Macedo R, Verhaagen B, Versluis M. Root Canal Irrigation. SPRINGER SERIES ON BIOFILMS 2015. [DOI: 10.1007/978-3-662-47415-0_9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
25
|
Macedo RG, Robinson JP, Verhaagen B, Walmsley AD, Versluis M, Cooper PR, van der Sluis LWM. A novel methodology providing insights into removal of biofilm-mimicking hydrogel from lateral morphological features of the root canal during irrigation procedures. Int Endod J 2014; 47:1040-51. [PMID: 24397845 DOI: 10.1111/iej.12246] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 01/04/2014] [Indexed: 01/09/2023]
Abstract
AIM To introduce and characterize a reproducible hydrogel as a suitable biofilm mimic in endodontic research. To monitor and visualize the removal of hydrogel from a simulated lateral canal and isthmus for the following: I) Ultrasonic-Activated Irrigation (UAI) with water, ii) UAI with NaOCl and iii) NaOCl without UAI. METHODOLOGY A rheometer was used to characterize the viscoelastic properties and cohesive strength of the hydrogel for suitability as a biofilm mimic. The removal rate of the hydrogel from a simulated lateral canal or isthmus was measured by high-speed imaging operating at frame rates from 50 to 30,000 fps. RESULTS The hydrogel demonstrated viscoelastic behaviour with mechanical properties comparable to real biofilms. UAI enhanced the cleaning effect of NaOCl in isthmi (P < 0.001) and both NaOCl and water in lateral canals (P < 0.001). A greater depth of cleaning was achieved from an isthmus (P = 0.009) than from a lateral canal with UAI and also at a faster rate for the first 20 s. NaOCl without UAI resulted in a greater depth of hydrogel removal from a lateral canal than an isthmus (P < 0.001). The effect of UAI was reduced when stable bubbles were formed and trapped in the lateral canal. Different removal characteristics were observed in the isthmus and the lateral canal, with initial highly unstable behaviour followed by slower viscous removal inside the isthmus. CONCLUSIONS The biofilm-mimicking hydrogel is reproducible, homogenous and can be easily applied and modified. Visualization of its removal from lateral canal anatomy provides insights into the cleaning mechanisms of UAI for a biofilm-like material. Initial results showed that UAI improves hydrogel removal from the accessory canal anatomy, but the creation of stable bubbles on the hydrogel-liquid interface may reduce the cleaning rate.
Collapse
Affiliation(s)
- R G Macedo
- Department of Cariology, Endodontology & Pedodontology, ACTA Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, the Netherlands
| | | | | | | | | | | | | |
Collapse
|