Accumulated Hard-tissue Debris Research Articles

Root canal curvature influences uncontrolled removal of dentin and cleaning efficacy after ultrasonic activation.

This study evaluated the correlation between root canal curvature and the effects of ultrasonic irrigation in the following parameters: volume of uncontrolled dentin removal (UDRVol), maximum depth of dentin defects, removal of accumulated hard tissue debris (AHTD), and canal transportation in prepared curved root canals. Twenty-four human permanent mandibular molars were divided into two groups according to root canal curvature: moderate curvature (MC: mean 25°); and severe curvature (SC: mean 48°). The specimens were scanned using an X-ray microcomputed scanner (Skyscan 1172) before and after cleaning and shaping and after the final irrigation protocol with ultrasonic irrigation. There was a moderate correlation between the degree of root canal curvature and the volume of remaining AHTD (p<0.05) and between the degree of root canal curvature and maximum depth of defects due to uncontrolled removal of dentin (p<0.05). The teeth in the SC group had a greater maximum depth of defects on the dentin wall in the apical third than the teeth in the MC group (p <0.05). Both groups had a significant reduction of AHTD in all canal thirds, but the amount of remaining AHTD in the middle and apical thirds and the whole canal was significantly greater in the SC than in the MC group (p <0.05). Canal transportation was not influenced by the canal curvature in all thirds (p >0.05). This study concluded that root canal curvature affects significantly the uncontrolled removal of dentin and remaining AHTD volume after the final irrigation protocol with ultrasonic irrigation.

Accumulated Hard Tissue Debris and Root Canal Shaping Profiles Following Instrumentation with Gentlefile, One Curve, and Reciproc Blue

IntroductionThis laboratory study aimed to evaluate the accumulated hard tissue debris (AHTD) and shaping performance following root canal instrumentation with a novel stainless steel rotary system (Gentlefile; MedicNRG, Kibbutz Afikim, Israel) compared with two single-file nickel-titanium instruments of different kinematics through micro–computed tomography (micro-CT) analysis. MethodsThirty isthmus-containing mesial roots of human mandibular molars with a curvature of 15°–35° were scanned with micro-CT at an isotropic resolution of 12 μm and randomly assigned to three groups (n = 10) according to the instruments used for canal preparation: Gentlefile (GF; #23/.04), One Curve (OC; #25/.06; Micro-Mega, Besancon, France), and Reciproc Blue R25 (RB; #25/.08; VDW, Munich, Germany). The AHTD, unprepared canal surface area, volume changes, surface area changes, and transportation were evaluated by comparing preoperative and postoperative micro-CT images. In addition, the time required for canal preparation was recorded. Data were statistically analyzed using the one-way analysis of variance (ANOVA) test or the Kruskal-Wallis test at a significance level of 5%. ResultsNo significant differences were observed in the percentage of AHTD or in the unprepared canal surface area between the three groups (P > .05). The RB group demonstrated a significantly greater percentage increase in volume and surface area than the GF group (P < .05). The GF and OC groups showed significantly less transportation at 3 mm from the apex than the RB group (P < .001). The OC group required significantly less time for instrumentation than the RB and GF groups (P < .05). ConclusionsInstrumentation with GF (#23/.04), OC, and RB yielded similar levels of AHTD and unprepared surface area in isthmus-containing curved canals. GF achieved this with less dentin removal and apical transportation, at the expense of a longer preparation time.

Effect of preparation size on the removal of accumulated hard-tissue debris from the mesial root canal system of mandibular molars using SWEEPS technology

ObjectivesThis study assessed the influence of preparation size on the efficacy of shock wave–enhanced emission photoacoustic streaming (SWEEPS) and conventional irrigation (CI) on removal of accumulated hard tissue debris (AHTD) from isthmus-containing mandibular molars using micro-computed tomographic analysis.Materials and methodsSixty extracted mandibular molars with two mesial canals connected by an isthmus were selected. Canals were shaped with Mtwo instruments (VDW, Munich, Germany) up to sizes 25/.06, 40/.04 or 40/.06 (n = 20), and specimens were distributed into 2 final irrigation groups (n = 10): SWEEPS and CI. Roots were scanned at a resolution of 10.5 µm before and after preparation and final irrigation. Data sets were co-registered, and the percentage reduction of AHTD calculated for each specimen was statistically compared using analysis of variance with a of 5% significance level.ResultsThe preparation size did not significantly influence the percentage reduction of AHTD (p < 0.05), whereas the final irrigation technique had a significant effect on debris removal (p < 0.05). A significant reduction of AHTD was achieved after final irrigation in all groups (p < 0.05); however, SWEEPS was associated with a significantly greater percentage reduction of debris than CI (p < 0.05). None of the specimens presented a completely clean isthmus.ConclusionsRemoval of AHTD was not significantly affected by the preparation size. SWEEPS was associated with significantly less debris than CI.Clinical relevanceSWEEPS performed significantly better than CI regarding the removal of AHTD from isthmus-containing mandibular molars irrespective of the preparation size.

Micro-CT Evaluation of Different Root Canal Irrigation Protocols on the Removal of Accumulated Hard Tissue Debris: A Systematic Review and Meta-Analysis.

Accumulated hard tissue debris (AHTD) is an inevitable by-product during endodontic treatment and is difficult to remove completely using traditional syringe and needle irrigation (SNI). Adjunctive irrigation is proposed to assist the clean-up of AHTD. This systematic review and meta-analysis aimed to evaluate the AHTD removal efficacy of different root canal irrigation devices using micro-computed tomography (Micro-CT). A literature search was carried out within the main scientific databases until 20 June 2022. All results were screened with detailed eligibility criteria. Eleven studies were included for analysis. SNI, passive ultrasonic irrigation (PUI), negative pressure systems, sonically activated irrigation (SAI), mechanical-activated system and laser-activated irrigation (LAI) were assessed. PUI is superior to SNI for debris removal and LAI has better AHTD removal performance than PUI. The negative pressure system and mechanical-activated system were proved to be less effective. Registration: PROSPERO (CRD42021273892).

XP-endo Finisher effectively reduces hard-tissue debris accumulated in root canals with isthmus after preparation with a reciprocating file system.

This study compared the accumulated hard-tissue debris (AHTD) after preparation with WaveOne Gold (WOG) to XP-endo Shaper (XPS), without and with a supplementary step using XP-endo Finisher (XPF) using clinically applicable irrigation. Twenty-four mesial roots with two canals and single foramen were micro-CT-scanned and matched. Scans were also taken after preparation with WOG or XPS, and after XPF. Irrigation with 2.5% NaOCl (total: 17 ml per canal) and 17% EDTA (2.5ml per canal) was performed using a 30ga Max-I-Probe needle placed up to the working length. Morphological parameters were calculated and compared within and among groups. XPF significantly reduced unprepared area within XPS and WOG groups, and AHTD within WOG (p< 0.05). There were no significant differences between WOG and XPS after preparation and after XPF (p> 0.05). In conclusion, WOG and XPS produced a similar volume of AHTD, but the supplementary step with XPF decreased the AHTD in the WOG group.

Removal of Accumulated Hard Tissue Debris (AHTD) from Root Canals with an Electric Current Device: A MicroCT Preliminary Report

In modern endodontics, removal of accumulated hard tissue debris (AHTD) from root canals is requested. In the last decade, different irrigating solutions and activation methods have been successfully tested. Sonic activation has been shown to be effective in the removal of AHTD. Electric current has been tested before in restorative dentistry, but not in endodontics. An experimental electric current delivering device was compared in the removal of AHTD, using microCT analyses. Fifteen single-rooted teeth were shaped with TruNatomy system endodontic files and divided into three groups: negative control group: specimens underwent no activation; EA group: specimens were activated with EndoActivator (EA); EB group: specimens were activated with ElectroBond (EB). The 2D images, 3D images and morphometric analysis from the microCT showed a statistically significant increased AHTD removal when EB was used. Results of the present preliminary study showed that the irrigant activation with ElectroBond is encouraging when compared to EndoActivator along the entire root canal system. The AHTD was significantly statistically reduced, validating the clinical use of electric fields in endodontics.

Removal of accumulated hard tissue debris from mesial root of mandibular molars evaluated using micro-CT - a systematic review and network meta-analysis.

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.

Unprepared surface areas, accumulated hard tissue debris, and dentinal crack formation after preparation using reciprocating or rotary instruments: a study in human cadavers.

This study using contralateral teeth from human cadavers assessed the amount of unprepared wall surface areas (USA), accumulated hard tissue debris (AHTD), and dentinal crack formation after root canal preparation using either reciprocating or rotary instruments. Incisors with a single root canal from 11 human mandibles had their root canals prepared with Reciproc or Mtwo. Each contralateral tooth was treated with one of the test instruments in order to create matched pairs. Micro-CT scans were taken before and after preparation to instrument sizes 40 and 50 in both groups. USA and AHTD were evaluated in the full canal length or the apical portion only. Crack formation was also evaluated in the full root length. After size 40, no significant differences in USA and AHTD were observed in the full canal length (P > .05). Separate analysis of the apical 4-mm canal revealed no difference in AHTD, but significantly more USA with Mtwo than Reciproc (P < .05). After size 50, the amount of USA was similar between groups both in the full canal and in the apical canal (P > .05). More AHTD were observed in the full canal after using Mtwo size 50 (P < .05), but no difference occurred in the apical canal only (P > .05). Intragroup analyses showed a significant decrease of USA and a significant increase of AHTD when preparation size increased from 40 to 50 (P < .05). In teeth without any pre-existing detectable dentinal defect (n = 38), crack formation occurred in 4 teeth, 2 from each preparation system. Reciproc instrument size 40 resulted in more prepared areas in the apical canal than Mtwo instrument of the same size. However, the amount of AHTD did not differ between them at this file size. Canal enlargement to size 50 prepared more walls but created more debris. Dentinal defects were produced after preparation with both systems.

Influence of ultraconservative access cavities on instrumentation efficacy with XP-endo Shaper and Reciproc, filling ability and load capacity of mandibular molars subjected to thermomechanical cycling.

To evaluate the influence of ultraconservative access cavities (UltraAC) on canal shaping and filling ability and load capacity of mandibular molars after root canal preparation with XP-endo Shaper (XP) or Reciproc (RC), under simulated clinical conditions. Traditional access cavities (TradAC) were used for comparison. Forty extracted mandibular molars were scanned by micro-computed tomographic and, based on similar anatomical features, were divided into four groups (n=10), according to the type of access cavity and canal instrumentation protocol: TradAC/RC, TradAC/XP, UltraAC/RC and UltraAC/XP. All root canal procedures were performed with the teeth placed in a dental mannequin. Teeth were scanned after root canal instrumentation and filling. Unprepared canal area, dentine removed, accumulated hard tissue debris (AHTD), canal transportation, presence of voids and filling material remnants within the pulp chamber were analysed. After restorative procedures, the teeth were subjected to thermomechanical cycling and to a load capacity test. Statistical analyses were performed using two-way anova test, considering the randomized blocks design (P<0.05). The percentage of unprepared canal area was significantly lower in TradAC groups when compared to UltraAC groups (P<0.05), regardless of the instrument used. The UltraAC/XP group had significantly lower percentage of root dentine removed when compared to other groups (P<0.05). UltraAC/XP and TradAC/XP groups had significantly lower percentages of AHTD than UltraAC/RC and TradAC/RC groups (P<0.05). Regarding canal transportation, in the MB root canals, the TradAC/XP group had significantly lower values than other groups (P<0.05). In general, in ML and distal root canals, TradAC/XP and UltraAC/XP groups had significantly lower values of canal transportation when compared to other groups (P<0.05). Moreover, the UltraAC/RC had the greatest canal transportation values in MB and distal canals. The UltraAC groups had significantly greater percentages of voids and volume of remaining root filling material within the pulp chamber after cleaning procedures than TradAC groups (P<0.05). There was no difference in the load capacity amongst groups (P<0.05). The UltraAC/XP and UltraAC/RC groups had significantly greater areas of unprepared canal walls, significantly more voids and volume of root filling material remnants within the pulp chamber after canal filling. UltraAC/XP was associated with significantly less root dentine removal and significantly more AHTD whilst TradAC/XP had overall significantly less canal transportation. No differences were observed in the load capacity amongst groups.

Preparation Ability of ProTaper Next and XP-endo Shaper Instruments in Isthmus-containing Root Canal System

ABSTRACT Aim and objective This research compares the abilities of the preparation of ProTaper Next (PTN; Dentsply-Maillefer) and XP-endo Shaper (XPS; FKG, Switzerland) files in mesial canals of lower molars with separate binary canals and one foramen with isthmus connection using μCT imaging. Materials and methods The comparison showed 20 roots matched according to the similarities in preoperative canal volume, specimen length, and root curvature using preoperative scans, and then they were indiscriminately separated into two groups and prepared either with PTN or XPS instruments. After chemomechanical preparation, the roots were resubmitted to postoperative scans. Results There was no variance in instrument systems for the volume of removed dentine, surface area as well as the amount of accumulated debris in the isthmus region (p &gt;0.05). Change in canal surface area and amount of accumulated hard tissue debris (AHTD) was more in the PTN group for total root canal space (p &lt;0.05). PTN instruments increased surface area in a shorter period. Conclusion: Both instrument systems with different design and metallurgic properties had reached the desired volume in different periods; however, neither technique was able to fully prepare the isthmus-containing mesial roots of lower molars. How to cite this article Sarıkahya M, Alaçam T. Preparation Ability of ProTaper Next and XP-endo Shaper Instruments in Isthmus-containing Root Canal System. Cons Dent Endod J 2020;5(2):28–35.

Effect of passive ultrasonic irrigation on hard tissue debris removal: a systematic review and meta-analysis.

Accumulated hard tissue debris (AHTD) in root canal irregularities may negatively impact adequate root canal disinfection. In light of this, the efficacy of passive ultrasonic irrigation (PUI) to reduce AHTD has been largely studied in in vitro studies, which have adopted different analytic methods of varying accuracy to determine the extent of AHTD more correctly. Therefore, the aim of this study was to compare how well PUI and non-activated irrigation (NAI) systems perform in reducing AHTD during final irrigation protocols, based exclusively on studies whose analyses used microCT scanning. A systematic search of the studies published up to April 2020 was performed using MeSH terms and free terms, in the following databases: PubMed, Scopus, Web of Science, BVS (Lilacs and BBO) and Embase. The inclusion criteria consisted of laboratory studies that evaluated the amount of AHTD, and compared PUI with NAI protocols using microCT analysis. The risk of bias in the selected studies was assessed critically by two reviewers. A meta-analysis was performed using the RevMan software program (P<0.05), and included studies providing the standardized mean difference (SMD), using a fixed effect model, and adopting a confidence interval of 95%. In all, 3495 studies were identified, three of which met the inclusion criteria. All three were considered as having a low risk of bias. The meta-analysis comparing the ability of PUI and NAI protocols to remove hard tissue debris showed a higher percentage of AHTD reduction (P<0.01) for PUI, with a confidence interval of 1.41 [0.79, 2.02]. The heterogeneity among the studies was 82% (I2). Considering the limitations of the present study, this systematic review and meta-analysis showed that PUI was more effective than NAI in removing hard tissue debris, based exclusively on studies that used microCT scanning to provide a more precise analysis of the two techniques used. The findings presented in the present study reinforce the concept that PUI can increase residue removal and improve the cleanliness of the root canal in endodontic treatments.

Characterization of the differential efficacy of austenitic vs martensitic NiTi rotary files in non-surgical root canal retreatment: a micro-CT analysis.

Aim: Our study aims to characterize the differential efficacy of martensitic and austenitic files in root canal retreatment regarding defiling ability, debris management and morphometric features. Materials and methods: A total of 10 human premolar teeth with two separate fully formed roots were selected, prepared with BioRace system (BR) up to a size BR2 (0.04/25). Root canals were filled and then divided according to the file type into two groups (n = 10). Two geometrically identical files have been used with the only difference between them is heat treatment; One Curve (OC) martensitic and One Shape (OS) austenitic. Preoperative and postoperative Micro-CT scans were done for all the samples, and the percent volume of residual filling materials was calculated. Canals reshaping and remaining debris in the canals were assessed by calculating the volume of the canals before and after retreatment using Micro-CT software. Results: The percentages of removed filling materials were similar between both groups (97.2% OC vs 97.8% OS). OS was significantly faster than OC (P < 0.05). Retreatment procedure did not significantly change volume, structure model index, surface area, and canal curvature. OS group transported the canals more than OC at the apical third (P < 0.05). There were no significant differences between both groups concerning un-instrumented surface area and accumulated hard tissue debris (AHTD) (P > 0.05). Conclusion: Under the circumstances of this study, neither file systems could completely remove the filling materials. However, OC resulted in less transportation than OS in the apical one third (P < 0.05). Also, OC resulted less AHTD than OS but with no statistical difference.

Antimicrobial activity, toxicity and accumulated hard-tissue debris (AHTD) removal efficacy of several chelating agents.

To evaluate the antimicrobial, toxicity and cleaning effectiveness of ethylenediaminetetraacetic acid (EDTA) and maleic acid (MA) alone and combined with cetrimide (CTR). Cytotoxic and genotoxic effects were assessed on Chinese hamster cells V79 using the MTT, clonogenic and micronucleus assays, respectively. The bacterial inhibitory and bactericidal concentrations (MIC and MBC, respectively) were determined on a strain of Enterococcus faecalis. Antimicrobial tests were performed on a biofilm model after treatment with the chelating agents by using a biofilm eradication concentration (MBEC) and confocal laser scanning microscope (CLSM) assays. Quantification of cell biomass and percentage of live and dead cells in the biomass were assessed for each group. The percentage reduction of accumulated hard-tissue debris (AHTD) after root canal preparation and final irrigation protocols was evaluated by micro-CT. Statistical tests of one-way analysis of variance (anova), Bonferroni test, Kruskal-Wallis test, Dunn's multiple comparison test and Wilcoxon matched-pairs signed-rank tests were used. Cetrimide alone as well as in combination with EDTA and MA at dilutions of 1/10 and 1/100 was significantly more toxic as compared to untreated controls (P<0.001). All tested mixtures were nontoxic at a dilution of 1/1000. EDTA retained a weak inhibitory and bactericidal effect against planktonic cells, whilst MA inhibited cells growth and killed 99.9% of the cells when diluted. CTR revealed the most prominent effect, being inhibitory and bactericidal, also when diluted. Cetrimide alone or combined with EDTA was able to remove, respectively, 40% (P<0.01) and 60% (P<0.001) of the entire biomass after 1min. Conversely, MA alone and in combination with CTR did not have a significant effect on biomass reduction. After final irrigation, the AHTD volume was significantly decreased in all groups (P<0.05). EDTA+CTR and MA+CTR were associated with a significant reduction in the percentage of AHTD on the entire root canal compared to the same solutions without surfactant. 7% MA was less cytotoxic in comparison with 17% EDTA. The addition of cetrimide to EDTA and MA removed accumulated hard-tissue debris effectively from the canal walls and increased their antimicrobial activity when compared to the same solutions without detergents.

The influence of the addition of surfactants to sodium hypochlorite on the removal of hard tissue debris.

To evaluate the effect of the addition of surfactants to sodium hypochlorite (NaOCl) on the removal of accumulated hard tissue debris (AHTD), before and after final irrigation with 17% EDTA, from mesial canals of mandibular molars through microcomputed tomographic (micro-CT) analysis. Thirty moderately curved mandibular mesial roots with Vertucci type II canal configuration were selected and scanned in a micro-CT device at an isotropic resolution of 22.9μm. The specimens were assigned to three groups (n=10) with respect to the root length, degree of curvature of the mesial root, volume and 3D anatomy of the root canals according to the irrigating solution used during root canal preparation: 2.5% NaOCl and 0.1% Benzalkonium Chloride, 2.5% NaOCl and 0.1% Tween 80 and 2.5% NaOCl without additives. The root canals were instrumented up to Reciproc R25 instrument. Then, the specimens were scanned again after canal preparation and after final irrigation with 17% EDTA, and the registered data sets were examined to evaluate the percentage of AHTD. For comparison between the different groups before and after using 17% EDTA, the Kruskal-Wallis test was used with a significance level of 5%. For comparison between the same groups before and after using 17% EDTA, the Wilcoxon test was used with a significance level of 5%. None of the irrigant solutions tested was able to completely eliminate hard tissue debris from mesial canals of mandibular molars. There were no significant differences in the percentage of AHTD amongst the different irrigation solutions (P>0.05). Final irrigation with 17% EDTA significantly reduced the percentage of AHTD (P<0.05), without differences amongst the groups (P>0.05). The addition of surfactants to NaOCl did not affect the removal of AHTD from mesial canals of extracted mandibular molars. Final irrigation with 17% EDTA significantly improved AHTD removal.

Micro-computed tomographic evaluation of smear layer and accumulated hard tissue debris removal.

Background:The isthmus and irregularities present in the root canal system are potential areas for debris accumulation areas and therefore the seach for devices and solutions to improve cleaning of these areas is of utmust importance. This study evaluated, by micro–computed tomography, the efficiency of 37% phosphoric acid solution with that of 17% EDTA in the removal of smear layer and accumulated hard tissue debris (AHTD) after canal preparation.Methods and Materials:Twenty-six mesial roots of mandibular molars were subjected to microtomographic scanning using the SkyScan 1173 X-ray microtomograph at a resolution of 14,97 µm. The canals were prepared using Reciproc R40 instruments, 6% NaOCl and EndoVac System® to irrigation/aspiration. After instrumentation, the specimens were divided into two groups: 37% phosphoric acid solution or 17% EDTA.Results:The results demonstrated that 37% phosphoric acid was significantly more effective in removing smear layer and AHTD than 17% EDTA (Mann-Whitney, P <0.05). It was shown that both 37% phosphoric acid and 17% EDTA are effective agents in the removal of smear layer and debris, but better results were obtained with the use of 37% phosphoric acid.Conclusion:The results suggest that this solution can be a potential alternative to remove smear layer after root canal preparation.

Micro-CT study on the removal of accumulated hard-tissue debris from the root canal system of mandibular molars when using a novel laser-activated irrigation approach.

To compare the efficacy of ultrasonically activated irrigation (UAI), photon-induced photoacoustic streaming (PIPS) and shock wave enhanced emission photoacoustic streaming (SWEEPS) activation for the removal of accumulated hard-tissue debris (AHTD) from the root canal system of mandibular molars when assessed using microcomputed tomography (micro-CT). A total of 30 mandibular first and second molars with joining mesial root canals containing an isthmus and a single distal canal were subjected to three micro-CT scans (before and after canal instrumentation and after final irrigation) at a resolution of 15μm. Mesial canals were prepared up to aProTaper F3 rotary file, and distal canals were prepared up to aProTaper F4 rotary file. Teeth were randomly assigned to three groups according to the irrigant activation method (n=10): the UAI group, the PIPS group and the SWEEPS group. The final irrigation procedures were performed using a total of 15.5mL of 1% NaOCl for each tooth with an activation time of 3×30s. After three-dimensional model reconstruction and volumetric measurement of root canals, the percentage reduction (%Rd) of AHTD was calculated. The %Rd of AHTD was analysed statistically using one-way analysis of variance and nonparametric tests at a significance level of 5%. There were no significant differences between the three groups in terms of canal volume before or after instrumentation, or the volume of debris after canal preparation (P>0.05). In the mesial canals, irrigation with SWEEPS reduced the overall debris by 84.31%, which was significantly more than the reduction associated with PIPS and UAI (58.79% and 50.27%, respectively). In the distal canals, the %Rd of AHTD was significantly different between PIPS and SWEEPS and between UAI and SWEEPS (P<0.05), but was not significantly different between PIPS and UAI groups (P>0.05). The SWEEPS was associated with a greater %Rd of AHTD than the PIPS and UAI groups. SWEEPS was associated with significantly less debris compared than PIPS and UAI, especially in isthmus-containing mesial roots. None of the activation techniques completely removed debris from root canal systems.

Efficacy of 3 Supplementary Irrigation Protocols in the Removal of Hard Tissue Debris from the Mesial Root Canal System of Mandibular Molars

IntroductionInstrumentation of the mesial root canal system of mandibular molars may hinder disinfection by packing hard tissue debris within the isthmuses. The removal of accumulated hard tissue debris (AHTD) by 3 supplemental irrigation systems, 2 ultrasonically activated and 1 multisonic, was assessed with micro–computed tomographic imaging. MethodsTwenty-four extracted mandibular molars with 2 mesial canals connected by an isthmus and converging to a single foramen were selected. After preparation of the mesial canals with WaveOne Gold instruments (Dentsply Maillefer, Ballaigues, Switzerland), anatomically matched specimens were assigned to 3 final irrigation protocols (n = 8): intermittent ultrasonic (IU) with an ultrasonically energized 200-μm wire (Irrisafe; Satelec, Bordeaux, France), continuous ultrasonic (CU) with an ultrasonic irrigation needle (ProUltra PiezoFlow, Dentsply Maillefer), and GentleWave (GW) system (Sonendo Inc, Laguna Hills, CA). Specimens were scanned (SkyScan 1176; Bruker-microCT, Kontich, Belgium) at 17.18-μm pixel size before and after preparation and irrigation protocols. Data sets were coregistered, and the percentage reduction of AHTD calculated within the canals and isthmus for each specimen was statistically compared using 1-way analysis of variance and post hoc Tukey tests with a 5% significance level. ResultsThe mean percentage reduction of AHTD in canals and isthmuses was significantly higher for GW (96.4% and 97.9%, respectively) than for CU (80.0% and 88.9%, respectively) (P < .05). AHTD reduction for IU (91.2% and 93.5%, respectively) did not differ significantly from GW and CU (P > .05). ConclusionsGW achieved greater efficacy in the removal of AHTD from the mesial root canal system of mandibular molars compared with CU but not IU. The efficacy of CU and IU was comparable.

Evaluation of several instrumentation techniques and irrigation methods on the percentage of untouched canal wall and accumulated dentine debris in C-shaped canals.

To evaluate the effect of instrumentation using Reciproc Blue (RB; VDW, Munich, Germany) and XP-endo Shaper (XP-S; FKG Dentaire, La Chaux-deFonds, Switzerland) systems on the area of untouched canal wall (AUCW), accumulated hard-tissue debris (AHTD) and the efficacy of three irrigation protocols on percentage reductions (red%) of AHTD within C-shaped canals of mandibular molars. Seventy mandibular molars with C-shaped canals were scanned, matched and assigned to two shaping groups (n=35): RB and XP-S. Following instrumentation, specimens were triple-matched with respect to the amount of remaining debris and assigned to three irrigation subgroups (n=10): syringe-and-needle irrigation (SNI), XP-endo Finisher (XP-F; FKG Dentaire) and passive ultrasonic irrigation (PUI). The AUCW% and AHTD% after instrumentation and the red% of AHTD after irrigation were calculated from micro-computed tomography. Data were analysed using comparisons for two groups (RB vs. XP-S) or multiple subgroups followed by pairwise comparison procedures (SNI vs. XP-F vs. PUI) at α=0.05. For RB and XP-S, 33.04% and 30.45%, respectively, of the canal wall remained untouched (P>0.05). For both groups, the apical third had larger AUCW% than the coronal third (P<0.05). Instrumentation with RB left more debris (2.8%) than XP-S (1.1%) (P<0.05). The PUI and XP-F subgroups had higher mean red% of AHTD than the SNI subgroup; the difference was significant for RB (P<0.05) but not for XP-S. Both RB and XP-S systems were associated with similar AUCW after instrumenting C-shaped canals. RB left significantly greater levels of AHTD compared with XP-S. PUI and XP-F irrigation removed more debris than SNI when using the RB system.

Micro-CT evaluation of sonically and ultrasonically activated irrigation on the removal of hard-tissue debris from isthmus-containing mesial root canal systems of mandibular molars.

To evaluate the efficacy of sonically and ultrasonically activated irrigation on removal of accumulated hard-tissue debris (AHTD) in mesial root canal systems of mandibular molars using micro-computed tomographic (micro-CT) analysis. Forty mesial roots of mandibular molars with two independent canals joined apically by an isthmus (Vertucci type II) were selected. The root canals were instrumented using Reciproc R25 instruments, and specimens were scanned at a resolution of 10.5μm. Subsequently, n=10 roots were assigned to each of the four final irrigation groups such that the group means and variances were almost identical: sonically activated irrigation with EndoActivator (EA) or EDDY (ED), ultrasonically activated irrigation (UAI) and manual irrigation without activation (MI). The final irrigation procedures were performed using a total of 5mL 1% NaOCl and 5mL 15% EDTA per canal over 5 min with activation time of 4×20 s. Reconstructed data sets were coregistered, and the mean percentage reduction of AHTD after final irrigation was compared statistically between groups using analysis of variance at a significance level set at 5%. A significant reduction of AHTD was achieved after final irrigation in all groups (P<0.05), ranging from 44.1% to 66.8%. The vol% of debris after irrigation was 3.7±1.9% for EA, 3.3±2.3% for ED, 2.1±1.6% for UAI and 4.4±2.3% for MI, with no significant difference between groups (P>0.05). None of the final irrigation protocols completely removed AHTD from mesial root canal systems in extracted human mandibular molars. Sonically and ultrasonically activated irrigation performed no better compared to manual irrigation.

Micro-CT comparison of XP-endo Finisher and passive ultrasonic irrigation as final irrigation protocols on the removal of accumulated hard-tissue debris from oval shaped-canals.

To compare the effectiveness of the XP-endo Finisher instrument and passive ultrasonic irrigation (PUI) as final irrigation protocols on the removal of accumulated hard-tissue debris (AHTD) from oval-shaped canals using micro-computed tomographic (micro-CT) analysis. Twenty mandibular incisors were anatomically pair-matched based on similar morphological dimensions (length, volume, aspect ratio, and configuration) through micro-CT analysis, prepared with Reciproc R25 instrument, scanned again, and assigned to one of the two experimental groups (n = 10), according to the final irrigation protocol: XP-endo Finisher and PUI. After the final irrigation protocols, the specimens were rescanned and the registered datasets were examined to quantify the amount of AHTD. Data were statistically analyzed using Student's t test with a significance level of 5%. The final irrigation protocols were highly similar in terms of volumetric percentage reduction of AHTD (P = 1.000). XP-endo Finisher and PUI showed the same effectiveness on the removal of AHTD. None of the tested final irrigation protocols completely removed the AHTD from oval-shaped root canals. AHTD may be considered clinically relevant because it could harbor bacterial contents away from the disinfection procedures. Both final irrigation protocols were effective on the removal of AHTD.