Abstract
The purpose of this ex vivo study was to determine, in "open" and "closed" systems, whether the design has an influence on the penetration length of sodium hypochlorite mixed with a radiopaque contrast medium, measured in millimeters, when delivered using positive pressure (PP) and using sonic (SI) or passive ultrasonic (PUI) activation. Sixty single-rooted teeth were divided into two groups: open and closed systems (n=30). Root canal shaping was performed to a working length of 17 mm. The samples were divided into three sub-groups (n=10) according to irrigant delivery and activation: PP, and SI or PUI activation. By using radiographs, penetration length was measured, and vapor lock was assessed. For the closed group, the penetration distance means were: PP 15.715 (±0.898) mm, SI 16.299 (±0.738) mm and PUI 16.813 (±0.465) mm, with vapor lock occurring in 53.3% of the specimens. In the open group, penetration to 17 mm occurred in 97.6% of the samples, and no vapor lock occurred. Irrigant penetration and distribution evaluation using open and closed systems provide significantly different results. For closed systems, PUI is the most effective in delivering the irrigant to working length, followed by SI.
Highlights
Sonic and ultrasonic irrigant agitation devices have been initially suggested in root canal treatment to enhance debridement after shaping
53.3% of the roots presented with vapor lock overall
NaOCl activation with sonic and ultrasonic means has previously been shown to be more efficient at irrigant replacement at the apical third, by breaking the vapor lock and moving the solutions apically and laterally in closed systems ex vivo [9]
Summary
Sonic and ultrasonic irrigant agitation devices have been initially suggested in root canal treatment to enhance debridement after shaping. Their differences in oscillation frequency reflect on tip movement amplitude and subsequent oscillating pattern, with the latter having higher frequencies (>20 kHz) but lower amplitudes [1]. The clinical significance of irrigants reaching the most apical part of the root canal is related to the fact that the management of teeth with apical periodontitis aims to disrupt the biofilms in this area, as surviving microorganisms are associated with treatment failure [6]. The presence of incompletely treated pulp tissues is suggested as a potential cause of persistent pain in vital cases [7]
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