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da Rosa AF, Fischer BV, Dias-Junior LCDL, Serique AVC, Bortoluzzi EA, Teixeira CDS, da Fonseca Roberti Garcia L. Effectiveness of different supplementary protocols for remaining filling material removal in endodontic reintervention: an integrative review. Odontology 2024; 112:51-73. [PMID: 37561273 DOI: 10.1007/s10266-023-00845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
The aim of this study was to perform an integrative review to identify the most effective supplementary protocols used after filling material (FM) removal and root canal reinstrumentation, during endodontic reintervention. The literature search was performed on the electronic databases PubMed and Latin American and Caribbean Health Sciences Literature (LILACS), using a combination of specific scientific descriptors. Selection criteria accepted articles published in English, Spanish and Portuguese languages, up to August 2021, involving in vitro and ex vivo studies. After applying the eligibility criteria, 46 articles were included for qualitative analysis. The tool for qualitative analysis of quasi-experimental studies of the Joanna Briggs Institute was used to determine the risk of bias of the included articles. The selected articles provided important data regarding the following supplementary protocols: sonic and ultrasonic activation of the irrigating solution; the use of ultrasonic inserts, XP-endo system instruments, and photon-induced photoacoustic streaming for mechanical debridement; and new devices as GentleWave system, and the self-adjusting file. Overall, all supplementary protocols demonstrated efficacy in removing the remaining FM. The implementation of various supplementary protocols can effectively remove the remaining FM from the root canal walls, although complete removal is not always achieved. However, it was not possible to determine the most effective protocol. Conversely, their association can enhance remaining FM removal. Remaining FM attached to root canal walls hinders proper chemical-mechanical preparation during endodontic reintervention. Supplementary protocols optimize the remaining FM removal, enhancing cleaning and disinfection of root canal.
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Affiliation(s)
- Amanda Freitas da Rosa
- Department of Dentistry - Endodontics Division, Health Sciences Centre, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, CEP, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - Bruna Venzke Fischer
- Department of Dentistry - Endodontics Division, Health Sciences Centre, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, CEP, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - Luiz Carlos de Lima Dias-Junior
- Department of Dentistry - Endodontics Division, Health Sciences Centre, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, CEP, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - Anna Victoria Costa Serique
- Department of Dentistry - Endodontics Division, Health Sciences Centre, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, CEP, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - Eduardo Antunes Bortoluzzi
- Department of Diagnosis & Oral Health, Endodontics Division, University of Louisville, Louisville, KY, USA
| | - Cleonice da Silveira Teixeira
- Department of Dentistry - Endodontics Division, Health Sciences Centre, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, CEP, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - Lucas da Fonseca Roberti Garcia
- Department of Dentistry - Endodontics Division, Health Sciences Centre, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, CEP, Florianópolis, Santa Catarina, 88040-900, Brazil.
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Solakoğlu E, Topçuoğlu HS, Düzgün S. Effect of different final irrigation agitation techniques on root canal dentin tubule penetration of nanoparticle calcium hydroxide dressing. AUST ENDOD J 2023; 49 Suppl 1:447-454. [PMID: 37144660 DOI: 10.1111/aej.12765] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 04/05/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Abstract
This study is aimed to assess the efficacy of different final irrigation agitation techniques on dentin tubule penetration of nanoparticle calcium hydroxide (NCH) dressing. Ninety-six extracted upper incisors were shaped up to #40file. Then, Four experimental groups were formed according to the final irrigation procedure: conventional needle irrigation (CNI), manual dynamic agitation (MDA), sonic agitation (SA) and ultrasonic irrigant agitation (UIA). According to the intracanal drug used, these groups were divided into two subgroups: calcium hydroxide (CH) and NCH. Prepared CH preparations were labelled with Rhodamine B, and CH or NCH were placed in root canals. In the UIA group, both CH and NCH had the highest penetration depth and percentage compared to the other groups (p < 0.05). The penetration depth and percentage of NCH in the UIA and SA groups were significantly higher than in the CH groups (p < 0.05). UIA is more effective than other groups in increasing dentinal tubule penetration of CH and NCH.
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Affiliation(s)
| | | | - Salih Düzgün
- Department of Endodontics, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
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Gomes BPFA, Aveiro E, Kishen A. Irrigants and irrigation activation systems in Endodontics. Braz Dent J 2023; 34:1-33. [PMID: 37909632 PMCID: PMC10642269 DOI: 10.1590/0103-6440202305577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 11/03/2023] Open
Abstract
Root canal infections are typically polymicrobial and involve strong bacterial interactions. The goal of endodontic treatment is to remove infected content from the root canal system to allow the healing of a pre-existing periapical lesion or to prevent infection of the periradicular tissues. Instrumentation alone is not capable of touching all of the root canal walls. Therefore, the irrigation process is an essential step in the endodontic treatment. However, due to the complex anatomy of the root canal system, this cleaning is very challenging. Although syringe and needle irrigation associated with the use of chemical substances is still the most used method, it does not guarantee optimal cleaning of the root canals. As a result, not only alternative irrigating substances but also numerous activation systems - which are technologies that aim to optimize the action of irrigating substances, both chemically and physically - have been developed. This work aimed to review the characteristics of both classic and current alternatives of irrigating substances and irrigation activation systems.
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Affiliation(s)
- Brenda P. F. A. Gomes
- Department of Restorative Dentistry, Division of Endodontics,
Piracicaba Dental School - State University of Campinas, UNICAMP, Brazil
| | - Emelly Aveiro
- Department of Restorative Dentistry, Division of Endodontics,
Piracicaba Dental School - State University of Campinas, UNICAMP, Brazil
| | - Anil Kishen
- Department of Dentistry, University of Toronto, Canada
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Adl A, Razavian A, Eskandari F. The efficacy of EndoActivator, passive ultrasonic irrigation, and Ultra X in removing calcium hydroxide from root canals: an in-vitro study. BMC Oral Health 2022; 22:564. [DOI: 10.1186/s12903-022-02626-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/28/2022] [Indexed: 12/04/2022] Open
Abstract
Abstract
Background
This study aimed to compare the efficacy of EndoActivator, passive ultrasonic irrigation, and Ultra X in removing calcium hydroxide from the artificial grooves in root canal walls.
Methods
The root canals of 50 extracted human maxillary incisors were instrumented by using the ProTaper rotary system up to #F4 (size 40/0.06 ProTaper) and the teeth were split longitudinally. Lateral grooves were created in the apical and coronal parts of one half and the middle part of the other half. Calcium hydroxide paste was applied to the grooves and the root halves were reassembled. After seven days, the calcium hydroxide was removed from the canal by using one of the EndoActivator, passive ultrasonic irrigation, and Ultra X devices; one group went without irrigation (control group). The CH remnants in the grooves were scored at 20× magnification. The data were analyzed by using the Kruskal–Wallis, Dunn’s post hoc, and Friedman tests. P < 0.05 was considered to be statistically significant.
Results
No statistically significant difference existed among the experimental groups at the coronal and middle grooves (P > 0.05). However, Ultra X was significantly more effective than passive ultrasonic irrigation at the apical grooves (P = 0.023).
Conclusion
Within the limitations of this study, Ultra X can be reported to remove the calcium hydroxide from the apical third more efficiently than passive ultrasonic irrigation.
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Kaloustian MK, Hachem CE, Zogheib C, Nehme W, Hardan L, Rached P, Kharouf N, Haikel Y, Mancino D. Effectiveness of the REvision System and Sonic Irrigation in the Removal of Root Canal Filling Material from Oval Canals: An In Vitro Study. Bioengineering (Basel) 2022; 9:bioengineering9060260. [PMID: 35735503 PMCID: PMC9219995 DOI: 10.3390/bioengineering9060260] [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: 05/17/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to evaluate the effectiveness of the Endostar REvision system (Poldent, Warsaw, Poland) in the removal of filling materials from oval root canals using sonic irrigation as an additional cleaning method. Thirty human-extracted mandibular premolars with oval canals were prepared using the ProTaper Universal system (Dentsply Maillefer, Ballaigues, Switzerland) up to instrument F1 (20/.07), and then filled by the continuous wave vertical compaction technique using pulp canal sealer EWT (Sybron Dental Specialties, Orange, CA, USA). The teeth were randomly divided into two groups (n = 15) according to the instrumentation system and the additional cleaning method, as follows: REvision (30/.08, 25/.06) with EQ-S sonic activation (Meta Biomed, Chungcheongbuk-do, Korea), REvision (30/.08, 25/.06) without additional activation. All specimens were sectioned longitudinally at 3 and 7 mm from the apex, and analyzed using digital microscopy (KEYENCE, Osaka, Japan) to measure the total area of the residual obturation materials, followed by SEM analysis. The data on the percentage of remaining filling material were analyzed by Kruskal−Wallis one-way Analysis of Variance on ranks. None of the retreatment protocols completely removed the filling material from the root canals (p > 0.05); the retreatment technique using sonic activation showed statistically less residual filling materials than the retreatment technique using irrigants without activation at the coronal third (p < 0.05), whilst no significant difference was found between both tested groups at the apical and middle thirds (p > 0.05). The REvision system showed promising results in the removal of filling materials from oval canals.
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Affiliation(s)
- Marc Krikor Kaloustian
- Department of Endodontics, Faculty of Dentistry, Saint Joseph University, Beirut 1107 2180, Lebanon; (M.K.K.); (C.Z.); (W.N.)
| | - Claire El Hachem
- Department of Pediatric Dentistry, Faculty of Dentistry, Saint Joseph University, Beirut 1107 2180, Lebanon;
| | - Carla Zogheib
- Department of Endodontics, Faculty of Dentistry, Saint Joseph University, Beirut 1107 2180, Lebanon; (M.K.K.); (C.Z.); (W.N.)
| | - Walid Nehme
- Department of Endodontics, Faculty of Dentistry, Saint Joseph University, Beirut 1107 2180, Lebanon; (M.K.K.); (C.Z.); (W.N.)
| | - Louis Hardan
- Department of Restorative Dentistry, School of Dentistry, Saint-Joseph University, Beirut 1107 2180, Lebanon;
| | - Pamela Rached
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, Strasbourg University, 67000 Strasbourg, France; (P.R.); (Y.H.); (D.M.)
| | - Naji Kharouf
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, Strasbourg University, 67000 Strasbourg, France; (P.R.); (Y.H.); (D.M.)
- Department of Endodontics, Faculty of Dental Medicine, Strasbourg University, 67000 Strasbourg, France
- Correspondence: ; Tel.:+33-66752-2841
| | - Youssef Haikel
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, Strasbourg University, 67000 Strasbourg, France; (P.R.); (Y.H.); (D.M.)
- Department of Endodontics, Faculty of Dental Medicine, Strasbourg University, 67000 Strasbourg, France
- Pôle de Médecine et Chirurgie Bucco-Dentaire, Hôpital Civil, Hôpitaux Universitaires, 67000 Strasbourg, France
| | - Davide Mancino
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, Strasbourg University, 67000 Strasbourg, France; (P.R.); (Y.H.); (D.M.)
- Department of Endodontics, Faculty of Dental Medicine, Strasbourg University, 67000 Strasbourg, France
- Pôle de Médecine et Chirurgie Bucco-Dentaire, Hôpital Civil, Hôpitaux Universitaires, 67000 Strasbourg, France
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Jirathanyanatt T, Ponsri S. Treatment outcome and prognostic factors of orthograde retreatment: A retrospective study. J Int Soc Prev Community Dent 2022; 12:442-448. [DOI: 10.4103/jispcd.jispcd_26_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 01/17/2022] [Accepted: 07/19/2022] [Indexed: 11/04/2022] Open
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Coaguila-Llerena H, Gaeta E, Faria G. Outcomes of the GentleWave system on root canal treatment: a narrative review. Restor Dent Endod 2022; 47:e11. [PMID: 35284323 PMCID: PMC8891464 DOI: 10.5395/rde.2022.47.e11] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/03/2021] [Accepted: 08/17/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Hernán Coaguila-Llerena
- Department of Restorative Dentistry, Araraquara School of Dentistry, São Paulo State University - UNESP, Araraquara, SP, Brazil
| | - Eduarda Gaeta
- Department of Restorative Dentistry, Araraquara School of Dentistry, São Paulo State University - UNESP, Araraquara, SP, Brazil
| | - Gisele Faria
- Department of Restorative Dentistry, Araraquara School of Dentistry, São Paulo State University - UNESP, Araraquara, SP, Brazil
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Güven Y, Ali A, Arslan H. Efficiency of Endosonic Blue, Eddy, Ultra X and Endoactivator in the removal of calcium hydroxide paste from root canals. AUST ENDOD J 2021; 48:32-36. [PMID: 34939722 DOI: 10.1111/aej.12608] [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: 05/16/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/27/2022]
Abstract
We investigated the efficiency of Endosonic Blue, EDDY, Ultra X and EndoActivator in removing calcium hydroxide from artificially created apical grooves in root canal walls. In Materials and Methods: A total of 60 single-root maxillary central incisors, root canals were created and the roots were divided into two longitudinal parts. In the most suitable root piece, artificial grooves were created in the apical section and filled with calcium hydroxide. Calcium hydroxide in the grooves was removed using EDDY, Ultra X, Endosonic Blue or EndoActivator, and the remnants in the grooves were examined under a stereomicroscope. EDDY and Ultra X removed significantly more calcium hydroxide than Endosonic Blue and EndoActivator. The performance of EDDY and Ultra X or Endosonic Blue and EndoActivator was comparable. Therefore, EDDY and Ultra X are more effective than Endosonic Blue and EndoActivator in removing calcium hydroxide from apical grooves in root canal walls. No technique could achieve complete calcium hydroxide removal.
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Affiliation(s)
- Yahya Güven
- Department of Endodontics, Faculty of Dentistry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Afzal Ali
- Department of Conservative Dentistry and Endodontics, Pacific Dental College and Hospital, Udaipur, India
| | - Hakan Arslan
- Dental Faculty Department of Endodontics, Medeniyet University, Istanbul, Turkey
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Ajina MA, Shah PK, Chong BS. Critical analysis of research methods and experimental models to study removal of root filling materials. Int Endod J 2021; 55 Suppl 1:119-152. [PMID: 34674279 DOI: 10.1111/iej.13650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 12/14/2022]
Abstract
Despite enjoying high favourable outcome rates, root canal treatment is not always successful. Root canal retreatment is a widely practised option for managing a non-healing root treated tooth. A basic distinction between retreatment and initial treatment is the requirement to remove the existing root filling material occupying the root canal space. Only then, can the technical deficiencies and possible causes of failure be addressed. Hence, the successful removal of the root filling material is critical to achieving the objectives of retreatment. Many different materials and techniques have been used for root canal filling, which have been documented in a plethora of studies; these are mainly laboratory studies investigating the removal of root filling materials. To help guide future research, which may then better inform clinical practice in relation to retreatment procedures, the focus of this narrative review is on the research methods and experimental models employed to study the removal of root filling materials. The current available literature demonstrates great variation in the research methodologies used to study the removal of root filling material, including direct visualization by splitting tooth samples or clearing, three-dimensional radiographic imaging including using microcomputed tomography or cone-beam computed tomography, and a combination of these techniques. Depending on the research method employed, variation also exists in quantification of root filling material removal; these include measurements of surface area, volume or weight, and criteria-based (semi-quantitative) assessment. Experimental models, using human teeth or resin models, differ with respect to standardization techniques and replication of the clinical scenario including initial sample preparation, canal filling, allocation and technical aspects of retreatment procedures. Future models should replicate, as closely as possible, the clinical scenario. Currently, microcomputed tomography provides a highly detailed, non-invasive and non-destructive method of objectively assessing and quantifying root filling removal.
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Affiliation(s)
- Mahdi A Ajina
- Institute of Dentistry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Pratik K Shah
- Institute of Dentistry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Bun San Chong
- Institute of Dentistry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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