Abstract
This study evaluated the effectiveness of NiTi ultrasonic tips for Enterococcus faecalis (E. faecalis) biofilm removal in simulated complex root canals. Sixty root canal models consisting of a 30-degree curved main canal and two lateral canals were constructed from polydimethylsiloxane and incubated with E. faecalis. Irrigants in root canals were activated using a manual syringe (SI), a stainless steel (SS) instrument, a nickel-titanium (Ni-Ti) ultrasonic instrument, or a sonic instrument (EA). Instruments of SI, SS, and NiTi-9 groups were placed 9 mm from the apex, whereas those in NiTi-2 and EA groups were placed 2 mm from the apex. The efficacy of each method was determined as the ratio of fluorescence concentration before and after activation. In the apical curved canal, the highest efficacy was found in the NiTi-2 group (99.40%), followed by SI (84.25%), EA (80.38%), SS (76.93%), and NiTi-9 (67.29%) groups. In lateral canals 1 and 2, the efficacy was the highest in the NiTi-2 group and the lowest in the SI group. The NiTi ultrasonic instrument could effectively remove biofilms in the curved canal and lateral canals. This instrument should be introduced close to the working length. An up-and-down motion of the activation instrument is recommended.
Highlights
Disinfection of the root canal system is essential for successful endodontic treatment
We evaluated NiTi ultrasonic tips’ effectiveness in a simulated curved root canal model made with a PDMS microfluidic chip
The biofilm removal was less effective in the EA group than in the NiTi-2 group, the ultrasonic activation method was more effective than the sonic activation using an Endoactivator meaning that the ultrasonic activation method was more effective than the sonic activation using an device; this finding is consistent with previous studies [13,14,31]
Summary
Disinfection of the root canal system is essential for successful endodontic treatment. Disinfection is limited when using mechanical instrumentation alone because of anatomic complexities in root canal systems, such as curvatures, fins, grooves, isthmus, and lateral canals [1,2]. There is an increasing awareness of the importance of antimicrobial irrigants when cleaning these systems. Sodium hypochlorite (NaOCl) is a commonly used irrigating solution with a broad spectrum of antimicrobial actions and has the ability to dissolve both necrotic and vital pulp tissues [3]. A recent study reported that irrigants affect operative torque during root canal instrumentation [4]. The operative torque means that the amount of torque needed by the rotary instrument to reach the root apex, and NaOCl reduces operative torque during the treatment. A syringe irrigation method with NaOCl has some limitations, including the stagnation of the irrigant and vapor lock [5,6]
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