Influence of different irrigant activation methods on apical debris extrusion and bacterial elimination from infected root canals

Introduction

The study aimed to determine the apical debris extrusion and microbial elimination from infected root canals after using different irrigant activation methods.

Materials and Methods

Forty freshly extracted human mandibular premolars were selected and randomly assigned to four groups (n = 10). The teeth were mechanically prepared, sterilized, and inoculated with Enterococcus faecalis for 1 week. Irrigation was done with 3% sodium hypochlorite following conventional syringe irrigation-Group 1, manual dynamic agitation (MDA)-Group 2, passive ultrasonic irrigation (PUI)-UltraX -Group 3, and sonic irrigation (SI)-EndoActivator -Group 4, and the extruded debris were collected using Myers and Montgomery model. The microbial samples were taken from the canals using sterile paper points, cultured and recorded as colonies. The amount of extruded debris was measured by subtracting the final weight of the Eppendorf tube with debris from the initial weight of the tube.

Results

I. Group 3 showed the least apical debris extrusion (P < 0.05), followed by Groups 2 and 1 and the highest with Group 4. II. Group 3 showed the least colony-forming units (CFUs)/ml, followed by Group 4, and finally, Group 2 showed lesser mean CFUs/ml compared to Group 1 (P < 0.05).

Conclusion

All the irrigation activation methods were associated with apical debris extrusion, with the PUI system extruding the least amount of debris compared to the other groups. Irrigation activation techniques were beneficial in reducing the microbial load from the infected canals with the PUI system showing a complete elimination of the microbes, followed by SI and MDA.

The Sealer Penetration into the Dentinal Tubules: An Appraisal of Different Irrigation Systems: Original Research

INTRODUCTION

A good endodontic sealer aids in a successful root canal treatment. Sealer in turn depends on the thorough irrigation technique and debris removal. Hence, in the present study, we intend to compare the sealer's dispersion into dentinal tubules of the different irrigation systems by confocal laser scanning microscopy (CLSM).

METHODOLOGY

Seventy-six single-rooted, freshly removed human mandibular premolars were taken. They were separated into equal groups as conventional endodontic needle irrigation system, Endovacirrigation, Endoactivator irrigation, and manual dynamic agitation groups. Protaper rotary system was used and obturation was done with gutta-percha. The sealer used was AH Plus labeled with fluorescent dye (0.1% Rhodamine B isothcyanate). Transverse sections from the root apex at the levels of 1 mm, 3 mm, and 5 mm were scanned using CLSM. The sealer's penetration for the depth and the percentage were measured.

RESULTS

We observed that endovac irrigation system showed maximum percentage and depth of sealer's penetration compared to endoactivator, manual dynamic agitation, and conventional methods at 1, 3, and 5 mm levels from the apex.

CONCLUSION

The irrigation systems significantly influence the penetration of the Sealer into root dentinal tubules. When penetration of sealer at different levels, compared to endoactivator, manual dynamic agitation, and conventional method, significant greater levels were attained with the EndoVac system.

Evaluation and comparison on the wettability of three root canal sealers after three different irrigant activation techniques: An in vitro study

Background

Wettability of root canal sealers to the root canal wall plays a significant role in the attainment of a fluid-tight seal.

Aims

This study aimed to evaluate and compare the wettability of three different root canal sealers on the root canal walls after three different irrigant activation techniques using the contact angle meter.

Subjects and Methods

Thirty-six single-rooted mandibular premolars after decoronation and cleaning and shaping up to size #35 were randomly divided into three groups with 12 samples in each group (n = 12) based on the different activation techniques: Group I (passive irrigation with side-vented needle), Group II (manual dynamic agitation), and Group III (passive ultrasonic irrigation). Root segments were split longitudinally and were subdivided into three subgroups based on the root canal sealers tested with four samples in each subgroup (n = 4): Subgroup A (Tubliseal EWT), Subgroup B (AH Plus), and Subgroup C (Endosequence BC sealer). A controlled volume droplet of sealer was placed on each specimen and was subjected to the contact angle meter.

Statistical Analysis

Data were statistically analyzed using the one-way ANOVA and Tukey's post hoc test at a significance level of 0.05 (P < 0.05).

Results

A statistically significant difference was seen among all the groups and subgroups with the highest contact angle value for Group III and Subgroup C and the least value for Group I and Subgroup A.

Conclusions

Passive irrigation with side-vented needle and Tubli-Seal EWT showed better wettability on dentin.

Activated Irrigation vs. Conventional non-activated Irrigation in Endodontics - A Systematic Review

Objective:

Irrigant activation has been claimed to be beneficial in in vitro and clinical studies. This systematic review aims to investigate the clinical efficiency of mechanically activated irrigants and conventional irrigation.

Methods:

A literature search (PROSPERO registration number: CRD42018112595) was undertaken in PubMed, Cochrane and hand search. The inclusion criteria were clinical trials, in vivo/ex vivo on adult permanent teeth involving an active irrigation device and a control group of conventional irrigation. The exclusion criteria were studies done in vitro, animals and foreign language. Adult patients requiring endodontic treatment of permanent dentition and irrigant activation during the treatment were chosen as the participants and intervention respectively.

Results:

After removal of duplicates, 89 articles were obtained, and 72 were excluded as they did not meet the selection criteria. 6 devices (EndoVac, EndoActivator, Ultrasonic, MDA (manual dynamic agitation), CUI (Continuous Ultrasonic Irrigation) and PUI (Passive Ultrasonic Irrigation)) and 6 variables of interest (Post-operative pain, periapical healing, antibacterial efficacy, canal and/or isthmus cleanliness, debridement efficacy and delivery up to working length) were evaluated in the 17 included articles. The risk of bias and quality of the selected articles were moderate. Results showed that mechanical active irrigation reduces post-operative pain. It improved debridement, canal/isthmus cleanliness. It also improved delivery of irrigant up to working length. Bacterial count was more with active irrigation, though not significant. There is no effect on long-term periapical healing.

Conclusion:

It may be concluded that mechanical active irrigation devices are beneficial in reducing post-operative pain and improving canal and isthmus cleanliness during Endodontics.