Apical Negative Pressure Irrigation Research Articles

Outcome of nonsurgical management of large cyst-like periapical lesions using a modified apical negative pressure irrigation system: a case series study

ObjectiveTo assess the effectiveness of a self-constructed modified apical negative pressure irrigation (ANPI) system employing commonly used clinical instruments in nonsurgical root canal therapy (NSRCT) for large cyst-like periapical lesions (LCPLs).MethodsFrom 2017 to 2022, 35 patients diagnosed with LCPLs (5-15 mm) via preoperative clinical and radiographic evaluations of endodontic origin underwent NSRCT combined with ANPI. These patients were subjected to postoperative clinical and radiographic follow-up at 3 months, 6 months, 1 year, 2 years, 3 years, and 4 years, with a CBCT scan specifically conducted at 6-month follow-up. Through the reconstruction of three-dimensional cone beam computed tomography (CBCT) data, an early prognosis was facilitated by monitoring changes in lesion volume. Various treatment predictors—including sex, type of treatment, lesion size, preoperative pain, jaw, type of teeth involved, sealer extrusion, and the number of root canals—were meticulously analyzed. The evaluation of post-treatment outcomes leveraged both clinical observations and radiographic data collected during the follow-up periods. The Kruskal‒Wallis test and one-way ANOVA were also conducted to determine the independent factors influencing treatment outcomes. A significance level of 5% was established.ResultsThirty-five teeth from 35 patients with a median age of 28 years (range 24–34) were treated; the median follow-up duration was 19 months (range 12–26). The overall success rate was 91.4%, with a median lesion reduction of 77.0% (range 54.2–96.4%) at 6 months. Patients under 30 years of age exhibited a significantly greater success rate than older patients did (100.0% vs. 80.0%, p = 0.037). Other factors, such as sex, jaw, treatment type, preoperative pain, cyst size, tooth location, sealer extrusion, and the number of roots, did not significantly impact treatment outcomes.ConclusionsDespite limitations related to the observational case-series study design and relatively small sample size, our findings suggest that utilizing the ANPI in the NSRCT for LCPLs may hold promise. The notably higher success rate in patients younger than 30 years is worth noting.

Management of symptomatic irreversible pulpitis using irrigation agitation techniques in anterior teeth.

Endodontic pain, a common complication after root canal treatment, affects 2.5% to 60% of patients. Therefore, it is of interest to compare apical negative pressure irrigation (EndoVac) with conventional needle irrigation to assess their impact on postoperative pain in permanent anterior teeth with symptomatic irreversible pulpitis. Fifty patients were randomly assigned to either the EndoVac or needle irrigation group. Pre and post-operative pain levels were assessed using a Visual Analog Scale and the amount of Ibuprofen taken was recorded. At 12-, 24-, and 48-hour intervals, the EndoVac group reported significantly less pain than the needle irrigation group. The needle irrigation group also required more Ibuprofen. The apical negative pressure irrigation system (EndoVac) resulted in significantly less postoperative pain and reduced the need for analgesic medication than the conventional needle irrigation protocol.

Application of apical negative pressure irrigation in the nonsurgical treatment of radicular cysts: A case report

Application of apical negative pressure irrigation in the nonsurgical treatment of radicular cysts: A case report

Comparative Efficacy of Different Irrigant Activation Techniques for Irrigant Delivery Up to the Working Length of Mature Permanent Teeth: A Systematic Review and Meta-Analysis

This systematic review aims to establish whether various irrigant activation techniques (IATs) result in greater penetration of irrigant up to the working length. The MEDLINE, Scopus and Cochrane Library electronic databases were searched to determine the difference in irrigant penetration depth in the main canal following the use of manual dynamic activation (MDA), sonic irrigation (SI), passive ultrasonic irrigation (PUI), and apical negative pressure irrigation technique (ANP) in comparison with conventional needle irrigation technique (CNI) in mature permanent teeth. Meta-analysis was performed for straight canals as well as curved canals in addition to subgroup analyses for a) Individual IATs in comparison with CNI, b) Comparison of PUI v ANP and SI v ANP in the straight canals, c) comparison of different IATs performed in straight and curved canals. The outcome was presented as effect size: standardized mean difference (SMD) and percentage difference (% diff) of irrigant penetration up to the working length (WL) alongside 95% confidence intervals using chi-square analysis. Of the 840 records screened, 20 studies were included in the systematic review and 17 studies were included in the meta-analysis. It revealed IATs had significant improvement in irrigant delivery up to the WL in straight (% diff: 51.94%, 95% CI: 39.20-64.67%) and curved canals (SMD: 1.08, 95% CI: 0.64-1.52) over CNI. The subgroup analysis revealed ANP was the most effective and significant technique followed by PUI, SI and MDA techniques in straight canals (% diff: 91.70%, 95% CI: 75.63-107.77%) and curved canals (SMD: 1.45, 95% CI: 0.77-2.13). IATs improve irrigant penetration when compared to CNI technique. In both straight and curved canals, ANP is the most effective in delivering the irrigant up to the WL followed by PUI, SI and MDA techniques. Hence adaptation of recent IATs in routine endodontic practice is recommended. (EEJ-2022-03-036).

Evaluation of the Efficacy of Different Irrigation Systems on the Removal of Root Canal Smear Layer: A Scanning Electron Microscopic Study

Irrigation represents a crucial step in endodontics for bacteria disinfection and smear layer removal. Several irrigation strategies have been proposed, although their effects are controversial. This study aims to assess the comparison of four different irrigation systems on the smear layer removal utilizing scanning electron microscopy (SEM). Forty sound monoradicular teeth were collected and casually allocated into four groups (n = 10): Group A, conventional irrigation; Group B, IrriFlex irrigation; Group C, ultrasonic irrigation system; Group D, apical negative pressure irrigation. After chemo-mechanical preparation and longitudinal root separation, the three root thirds were analyzed by SEM. Micrographs were carried out at ×2000 to analyze the smear layer residual in each third of the root canal. Statistically significant differences were found between Group A and Group D (p < 0.05). Groups B and C showed satisfactory results in the coronal and middle thirds, while Group D was the only system that achieved satisfactory results in the apical third. However, the complete smear layer removal in the root canal was never achieved with any of the four systems tested. In conclusion, among the four tested irrigation systems, the greatest efficacy on smear layer removal was reached by Group D.

Effectiveness of Different Irrigant Activation Systems on Smear Layer Removal: A Scanning Electron Microscopic Study.

The aim of this study was to evaluate the effectiveness of smear layer removal after the use of different irrigation methods (passive ultrasonic irrigation (PUI), continuous ultrasonic irrigation (CUI), apical negative pressure irrigation and conventional irrigation) using scanning electron microscopy (SEM) as an analytical tool. A total of 100 single-canal teeth were decoronated and randomly divided into five groups (n = 20) according to the irrigation method used: conventional irrigation with front outlet syringe, conventional irrigation with lateral outlet syringe, apical negative pressure irrigation (EndoVac), PUI with Irrisafe and CUI with ProUltra PiezoFlow ultrasonic irrigation needle. Root canal preparation was performed with the ProTaper Gold system up to the F4 instrument, and 5.25% NaOCl was used as an irrigant. After chemical-mechanical preparation, the roots were split longitudinally, and the coronal, middle and apical thirds were examined. SEM digital photomicrographs were taken at ×1000 magnification to evaluate the amount of smear layer in each root canal third; CUI significantly removed more smear layer than any other irrigant activation protocol (p < 0.05); CUI was more effective in removing the smear layer than the other irrigation protocols. However, none of the irrigation protocols were able to produce root canals completely free from smear layer.

Calcium Hydroxide Removal Using Four Different Irrigation Systems: A Quantitative Evaluation by Scanning Electron Microscopy

This study compares conventional endodontic needle irrigation, passive ultrasonic irrigation, apical negative pressure irrigation, and mechanical activation to remove calcium hydroxide from single straight root canals. Eighty-four mandibular premolars were prepared in a crown-down manner up to size #40. Two teeth represented a negative control, and another two served as a positive control. Calcium hydroxide paste was placed inside root canals. The remaining eighty samples were analyzed based on the activation techniques, and the cleanliness of the canals was quantified using Fiji’s software on 500× magnified SEM backscattered electron micrographs. Considering the whole canal, all instruments showed better performance than conventional endodontic needle irrigation in removing calcium hydroxide (p &lt; 0.05). Irrisafe and XP-endo Finisher could remove a significantly higher amount of calcium hydroxide than Endovac (p &lt; 0.05). Irrisafe and XP-endo Finisher have been able to remove more calcium hydroxide than EndoVac.

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.

In Vitro Assessment of Intracanal Calcium Hydroxide Removal Using Various Irrigation Systems: An SEM Study

The aim of this research was to assess the effectiveness of three different irrigation systems in elimination of calcium hydroxide [Ca(OH)2]from root canals. This in vitro research included ninety recently extracted mandibular premolar teeth with a solitary root. The sample teeth were subjected to disinfection employing sodium hypochlorite at 5.25%. The root canal preparation was performed followed by placement of premixed Ca(OH)2 within every canal. The sample teeth were then randomly allocated into one of the three experimental groups (each comprising 30 samples) as follows: Group 1, NaviTip FX irrigation system; group 2, Vibringe sonic irrigation system; and group 3, EndoVac apical negative pressure irrigation system. Following the preparation, each of the sample teeth was examined beneath a scanning electron microscope (SEM) at a magnification of 1000×. An intragroup comparative analysis revealed that the highest Ca(OH)2 elimination was seen at middle third (0.82 ± 0.09, 0.30 ± 0.11) in NaviTip FX irrigation system and Vibringe sonic irrigation system, respectively. Higher Ca(OH)2 was eliminated at the apical third (0.26 ± 0.02) by the EndoVac irrigation system. At coronal third, maximum Ca(OH)2 removal was seen in EndoVac irrigation system (0.49 ± 0.03). A statistically significant difference was noted amid Vibringe sonic irrigation and EndoVac irrigation systems. The intergroup evaluation of Ca(OH)2 elimination at coronal, middle, and apical third showed a statistically significant difference between NaviTip FX irrigation and Vibringe sonic irrigation as well as between NaviTip FX irrigation and EndoVac irrigation at a p value of 0.001. The difference between EndoVac irrigation and Vibringe sonic irrigation was not statistically significant. Amid the limitations of this research, this research concludes that none among the irrigation methods employed could totally eliminate the Ca(OH)2 off the root canals. Nevertheless, EndoVac apical negative pressure irrigation has slightly superior potential in eliminating Ca(OH)2 from the root canals in comparison with Vibringe sonic irrigation as well as the NaviTip FX irrigation system. Even though the Ca(OH)2 is largely suggested as medicament, its elimination at the point of canal obturation is likewise significant and complex as any remaining portion may avoid sealer diffusion inside the dentinal tubules, consequently substantially escalating the apical leakage of endodontically treated teeth.

In Vitro Comparative Evaluation of Effectiveness of Sodium Hypochlorite with Conventional Irrigation Method versus EndoVac and Ultrasonic Irrigation in the Elimination of Enterococcus faecalis from Root Canals.

ABSTRACTAim:The aim of this study was to compare the decrease in bacterial population in the root canals with 2.5% sodium hypochlorite (NaOCl) and three irrigation systems: Conventional Needle Irrigation, Passive Ultrasonic Irrigation, and EndoVac Apical Negative Pressure Irrigation systemMaterials and Methods:Access open was carried out in 48 extracted single-rooted maxillary and mandibular human premolar teeth. The canals were instrumented 1 mm short of apical foramen up to No. 50 size file; irrigated and apical foramen was sealed with cyanoacrylate. The teeth were mounted in plaster and autoclaved for 20 min at 121°C. The plaster blocks containing the teeth were inoculated with Enterococcus faecalis and incubated at 37°C for 24 h. The specimens divided randomly into four groups (n = 12) depending on the type of irrigation system used: Group 1: Conventional Irrigation Needle, Group 2: Ultrasonic system, Group 3: EndoVac Negative Pressure Irrigation system used with 2.5% NaOCl, and Group 4: Control group, normal saline irrigation. The normal saline is used as control. The samples were collected using 45 size sterile paper points and quantitative bacterial assessment was carried out by seeding each dilution on plates containing brain heart infusion broth. Then, incubated at 37°C for 7 days and colony-forming units were counted. Data obtained were statistically analyzed.Results:Statistically, EndoVac irrigation systems were more effective in reducing the number of bacteria than the other irrigation systems.Conclusion:EndoVac irrigation system was more effective in reducing bacterial numbers in infected root canals than the other two irrigation systems.

COMPARISON OF DEBRIDEMENT EFFICACY AND PERIAPIACL REPAIR USING APICAL NEGATIVE PRESSURE IRRIGATION VERSUS SYRINGE IRRIGATION- A SYSTEMATIC REVIEW

Irrigation is considered an indispensable part of root canal treatment as it fortifies the cleaning and disinfection of areas of the root canal system that have been inadequately influenced by instruments. The aim of this systematic review was to collate published data on the two modes of irrigation i.e., conventional irrigation and apical negative pressure irrigation (ANP) for cleaning and shaping of the canals and to compare their efficacy in debridement and periapical tissue repair. The electronic databases PubMed and Google Scholar were searched in this review using specific inclusion and exclusion criteria. The search was performed in June 2018 and updated in March 2019. Among 1481 studies, five studies satisfied the eligibility criteria and were included in the review to be analysed. These studies compared the effectiveness of ANP method against syringe irrigation in removing debris within the root canal system and their effect in periapical tissue repair, including: different types of irrigation methods, debris removal during cleaning and shaping, and updating studies of their effect in periodontal and periapical repair. The compiled data observed that ANP was more efficient in removing the debris and offered a greater advantage that should lead to wider acceptance among dentists for effective results compared to different irrigation systems. However, more clinical trials with standardized protocol and defined clinical, radiographic, and histopathological outcomes with longer follow-up periods are warranted.

Effectiveness of Combination Irrigant Technique for Debris Removal in Simulated Canal Irregularities: An in vitro Study

Aim: To evaluate the debridement efficacy of different irrigation systems in simulated canal irregularities. Study Design and Setting: About sixty maxillary central incisors were selected and after chemomechanical preparation were split longitudinally into two halves. Each groove and depression were filled with dentine debris mixed with 2.5 % NaOCl to simulate a situation where dentine debris accumulates in the un-instrumented extensions of the root canal. Materials and Methods: The specimens were randomly divided into 4 experimental groups as follows: Group I - Conventional Needle Irrigation, Group II - Apical Negative Pressure Irrigation (EndoVac), Group III - Passive Ultrasonic Irrigation and Group IV - Combination Irrigation (EV+PUI). 9 ml of 2.5 % NaOCl, 9 ml of 17 % EDTA and 9 ml of saline was used for the final irrigation protocol. Images were taken before and after irrigation using PRIMA DNT surgical microscope with digital camera. Statistical Analysis: The intergroup and individual comparison of percentage reduction of debris in groove and depressions were carried out by using Kruskal-Wallis and Mann-Whitney U tests respectively. The intergroup comparison for different scoring criteria was compared using Pearson’s chi-square tests. Differences were considered statistically significant at P value &lt; 0.05. Results: The combination group, EV group and PUI group showed better removal of debris in Groove and Depressions than Conventional needle irrigation group. The Combination group had significant reduction of debris at 2 mm level when compared to all the other groups. Conclusion: The effectiveness of this combination irrigant delivery system for smear layer removal and antibacterial efficacy have to be evaluated further in future clinical studies

Investigation of different sodium hypochlorite volumes, concentrations and times of irrigation in endodontic therapy: a systematic review

Investigation of different sodium hypochlorite volumes, concentrations and times of irrigation in endodontic therapy: a systematic review

There are probably no important differences in postoperative pain levels between positive and negative pressure irrigation during root canal treatment of mandibular molars

Topçuoğlu HS, Topçuoğlu G, Arslan H. The effect of apical positive and negative pressure irrigation methods on postoperative pain in mandibular molar teeth with symptomatic irreversible pulpitis: a randomized clinical trial [published online ahead of print June 20, 2018]. J Endod. https://doi.org/10.1016/j.joen.2018.04.019.

The Effect of Apical Positive and Negative Pressure Irrigation Methods on Postoperative Pain in Mandibular Molar Teeth with Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial

IntroductionThis study compared the effect of conventional needle irrigation (positive pressure) and the EndoVac system (Discus Dental, Culver City, CA) (negative pressure) on postoperative pain in mandibular molar teeth with symptomatic irreversible pulpitis. MethodsOne hundred sixteen patients with symptomatic irreversible pulpitis were selected. Teeth were randomly assigned to 2 groups according to the irrigation methods performed during root canal preparation. In group 1, root canal irrigation was performed using a syringe and a 31-G side-port needle (NaviTip; Ultradent, South Jordan, UT). In group 2, the EndoVac system was used for irrigation. Teeth were then obturated with gutta-percha and a resin-based sealer using the cold lateral compaction technique. The presence of postoperative pain was assessed after 6, 24, 48, and 72 hours and 1 week. ResultsAt 6-, 24-, and 48-hour time intervals, group 1 patients reported more intense postoperative pain than patients in group 2 (P < .05). There was no significant difference between the 2 groups at the other time intervals (P > .05), and in both groups the intensity of postoperative pain decreased over time. ConclusionsApical positive pressure irrigation caused greater postoperative pain after endodontic therapy of mandibular molar teeth with symptomatic irreversible pulpitis compared with the apical negative pressure irrigation system.

Antimicrobial efficacy of an apical negative pressure root canal irrigation system against intracanal microorganisms

ObjectivesThe effect of irrigation time on the antimicrobial efficacy of an apical negative pressure irrigation system was examined in vitro, followed by validation of the antimicrobial effect in vivo using the identified optimal irrigation time. MethodsFor the in vitro experiment, 44 extracted premolars were decoronated, instrumented, autoclaved and inoculated with Enterococcus faecalis (ATCC 29212) for 21 days. Four teeth were used as positive control, without irrigation. Each of the remaining 40 teeth was irrigated with 2.5% NaOCl, delivered via the EndoVac MacroCannula for 10 s, and subsequently via the EndoVac MicroCannula for 15, 30, 45, 60 or 90 s per canal, respectively (N = 8). After irrigation, microbial samples were collected, transferred to BHI broth and incubated for counting of bacterial colony forming units (CFUs). Based on the in vitro results, 8.25% NaOCl was delivered via the EndoVac MicroCannula for 60 s, during root canal treatment of 20 human subjects presented with apical periodontitis. Microbial samples retrieved in vivo prior to canal instrumentation (S0), after chemomechanical debridement (S1) and after irrigation with EndoVac (S2) were cultured in an anaerobic chamber for 7 days for CFU evaluation. ResultsCompared with the control, irrigation significantly reduced bacterial populations (p < .05). Irrigation delivery via the EndoVac demonstrated improved antibacterial efficacy with increased irrigation time (p < .05). Samples retrieved from canals after NaOCl delivery in vivo with the EndoVac for 60 s were all culture-negative. ConclusionsMicrobial elimination may be achieved with 8.25% NaOCl delivered via the EndoVac apical negative pressure irrigation device for 60 s. Clinical significanceWith the use of the EndoVac apical negative pressure irrigant delivery system, optimal elimination of the intracanal bacterial load can only be achieved when sodium hypochlorite is delivered via the MicroCannula for at least 60 s per canal.

Orthodontic Movement after Regenerative Endodontic Procedure: Case Report and Long-term Observations

IntroductionAlthough regenerative treatment approaches in teeth with incomplete root formation and pulp necrosis have become part of the suggested therapeutic endodontic spectrum, little is known about the effect of orthodontic movement in the tissue that has been regenerated. Furthermore, as the number of adults undergoing orthodontic treatment increases, there is an increasing need to investigate the changes that these tissues may undergo during orthodontic movement. Here we describe the alterations observed after the application of orthodontic forces in a case of an apically root-fractured necrotic immature root that had been managed with regenerative endodontic procedures in the past. MethodsA 9-year-old male patient was referred after suffering the third incidence of trauma in the anterior maxilla. Radiographic evaluation revealed a periapical rarefaction associated with an apically root-fractured immature central incisor. Clinical evaluation revealed a buccal abscess and grade 3 tooth mobility. Periodontal probing was within normal limits. The tooth was accessed and disinfected by using apical negative pressure irrigation of 6% NaOCl. Intracanal dentin conditioning was achieved by using 17% EDTA for 5 minutes. A blood clot was induced from the periapical area, and calcium silicate–based cement was placed in direct contact with the blood clot at the same visit. The composite resin restoration was accomplished in the same appointment. Results and ConclusionsRecall radiographic examination after 24 months revealed healing of the periapical lesion and signs of continuous root development despite the apical root fracture. Clinical evaluation revealed normal tooth development, normal mobility, and a resolving buccal infection. The tooth was subjected to orthodontic treatment because of Class II division 1 malocclusion with an overjet of 11 mm. After completion of the orthodontic treatment, 5.5 years after the initial intervention, the radiographic image revealed marked remodeling of the periapical tissues and repair of the apical fractures, and the buccal infection had resolved completely.

Does apical negative pressure prevent the apical extrusion of debris and irrigant compared with conventional irrigation? A systematic review and meta-analysis.

The aim of this study was to evaluate if apical negative pressure (ANP) irrigation prevents the apical extrusion of debris and irrigant compared with conventional needle irrigation through a systematic review and meta-analysis. A computer search of dental literature was performed using four different databases. A combination of the terms 'apical negative pressure', 'endovac', 'apical extrusion', 'extrusion' and 'endodontics' was used. Studies that used extracted human teeth with a mature apex and that evaluated the apical extrusion of debris and/or irrigating solution were included. After an evaluation of the full studies according to the eligibility criteria, eight studies were critically analysed and subjected to quality assessment and risk of bias. Only four studies that evaluated extrusion of irrigant were considered as having high methodological quality and were subjected to a meta-analysis. Studies evaluating extrusion of debris did not have sufficient methodological quality to be subjected to the meta-analysis. The forest plot indicated that ANP irrigation prevents the risk of irrigant extrusion compared with conventional irrigation (OR 0.07 [95%CI 0.02-0.20]; P < 0.00001). This systematic review and meta-analysis showed that ANP prevents the apical extrusion of irrigant. There is no evidence if this type of irrigation prevents the extrusion of debris.

Continuous Apical Negative-Pressure Ultrasonic Irrigation (CANUI): A new concept for activating irrigants.

Background: Irrigation of the root canal system is an essential step in the endodontic treatment. The aim of this article is to introduce continuous apical negative-pressure ultrasonic irrigation (CANUI), a new irrigation concept, and compare the characteristics of this new technique with current devices for activating the irrigant. Material and Methods: CANUI is designed for cleaning and disinfecting the root canal system. The device consists of a tube inside another tube that allows the continuous ultrasonic exchange of fresh irrigant, as the irrigant is simultaneously aspirated apically. The coronal and apical tubes are 0.75 and 0.3 mm in diameter, respectively. It is composed of a nickel-titanium microcannula suitable for the working length of curved canals. Results: The CANUI technique has the advantages of apical negative pressure (to avoid apical extrusion of the irrigant) and continuous ultrasonic irrigation (continuous refreshment of the irrigant and forced introduction into the canal ramifications). Conclusions: The CANUI technique could improve the irrigation technique of dentists to reach more disinfection in endodontic treatments. Key words:Apical negative pressure, continuous ultrasonic irrigation, irrigation in curved canals, irrigation systems.

New Technologies to Improve Root Canal Disinfection.

Effective irrigant delivery and agitation are prerequisites to promote root canal disinfection and debris removal and improve successful endodontic treatment. This paper presents an overview of the currently available technologies to improve the cleaning of the endodontic space and their debridement efficacy. A PubMed electronic search was conducted with appropriate key words to identify the relevant literature on this topic. After retrieving the full-text articles, all the articles were reviewed and the most appropriate were included in this review. Several different systems of mechanical activation of irrigants to improve endodontic disinfection were analysed: manual agitation with gutta-percha cones, endodontic instruments or special brushes, vibrating systems activated by low-speed hand-pieces or by sonic or subsonic energy, use of ultrasonic or laser energy to mechanically activate the irrigants and apical negative pressure irrigation systems. Furthermore, this review aims to describe systems designed to improve the intracanal bacterial decontamination by a specific chemical action, such as ozone, direct laser action or light-activated disinfection. The ultrasonic activation of root canal irrigants and of sodium hypochlorite in particular still remains the gold standard to which all other systems of mechanical agitation analyzed in this article were compared. From this overview, it is evident that the use of different irrigation systems can provide several advantages in the clinical endodontic outcome and that integration of new technologies, coupled with enhanced techniques and materials, may help everyday clinical practice.