Conventional Syringe Irrigation Research Articles

Efficacy of Different Irrigation Activation Techniques on Dentinal Tubule Penetration of the Novel AH-Plus Bioceramic Sealer

This study aimed to assess the penetration of AH-Plus (AHP) and AH-Plus Bioceramic (AHPB) sealers into dentinal tubules subsequent to different irrigation activation protocols. One hundred fifty teeth were divided into five groups according to the final irrigation protocol: conventional syringe irrigation (CSI), EndoActivator (EA), passive ultrasonic irrigation (PUI), Er,Cr:YSGG laser, and SWEEPS. Then, the teeth were divided into two subgroups (n = 15) according to the canal sealer type. The maximum penetration depth (MPD) point and percentage of the sealer were evaluated using confocal laser scanning microscopy. Then, the data were statistically analyzed. The highest MPD values were observed in the SWEEPS groups, while the lowest value was in the CSI groups. Considering the effect of the sealer type and irrigation protocol interaction, there was a significant difference between the Er,Cr:YSGG laser, and EA groups for the AHPB sealer (p < 0.05), while it was insignificant for the AHP sealer (p > 0.05). The AHP and AHPB sealers statistically presented similar penetration properties. Laser-activated irrigation presented a higher sealer penetration compared to the other techniques.

Effect of different irrigation activation systems using continuous chelating irrigation protocol on the removal of smear layer in the apical third of root canals: An in vitro scanning electron microscope study

Aim: Continuous chelation is a novel irrigation regimen popular as a single solution for irrigation of the root canal system during root canal therapy, especially for the removal of the smear layer. This study aimed to compare the effectiveness of three different irrigation activation systems in removing the smear layer from the apical third in single-rooted mandibular premolars using a scanning electron microscope (SEM). Methods: Fifty-six extracted single-rooted mandibular premolars were decoronated, and canals prepared till #30/0.09, with Chloroquick (3% NaOCl + 9% HEBP) as the working solution. Teeth were randomly divided into four groups based on the final irrigant activation protocol; Group A - (control group) conventional syringe irrigation with a 30-gauge single-side vented needle. Group B - (passive ultrasonic irrigation method) passive ultrasonic irrigation (PUI) with #20-Irrisafe ultrasonic files activated for 1 min. Group C - (sonic activation) EndoActivator system using the yellow tip (#20/0.04) activated for 1 min. Group D - Tornado Disinfection Kit using GF-brush for 20–30 s as per manufacturer’s instructions. The canals were dried, samples were hemi-sectioned, and the amount of remaining smear layer was scored according to the Tabrizizadeh criteria (2015) with SEM images at ×2500 by two blinded operators. The collected data were analyzed statistically using the Chi-square test (P < 0.05). Results: The results showed statistically significant differences in terms of smear removal among the groups (P < 0.05) with the Gentlefile group performing better, followed by PUI, EndoActivator, and the conventional group. Conclusion: Within the limitations of the study, continuous chelation with Gentlefile activation could be a viable and efficient protocol for the removal of the smear layer from the apical third of root canals.

Comparative Analysis of Conventional, Sonic and Laser Activated Irrigation Methods on Fracture Resistance of Endodontically Treated Roots: An in vitro Study

Objective: To compare the effect of different irrigation activation methods on the fracture strength of endodontically treated roots.
 Methods: Sixty extracted single-rooted mandibular premolars with single canals were used. The specimens were instrumented with ProTaper Next rotary instruments up to size X3 and were randomly split into four groups (n=15) according to final irrigation procedures: Group I: Conventional syringe irrigation with distilled water, Group II: Conventional syringe irrigation with NaOCl and EDTA, Group III: Sonic-activated irrigation with EndoActivator and Group IV: Laser-activated irrigation with Er-Cr: YSGG. Using a single-cone technique, root canals were obturated with gutta-percha and AH Plus root canal sealer. All samples were embedded in self-curing acrylic resin and subjected to axial forces by mechanical compression testing in a universal testing machine at 1 mm/min until fracture occurred. The data were evaluated statistically by using analysis of variance (one-way ANOVA) (P < 0.05).
 Results: Conventional syringe irrigation with distilled water showed the highest mean value of fracture resistance and Laser-activated irrigation with Er, Cr: YSGG showed the lowest mean value of fracture resistance. In general, statistical analyses showed a non-significant difference between all tested groups (P > 0.05). 
 Conclusions: The fracture resistance of roots treated endodontically was found to be unaffected by different activation methods. However, Laser-activated irrigation with Er-Cr: YSGG resulted in the greatest reduction of fracture resistance in comparison to the other groups.

Investigating the effect of Er,Cr:YSGG laser agitation of sodium hypochlorite on the removal of mature biofilm in the complex root canal systems using atomic force microscopy.

Endodontic infections caused by remaining biofilm following disinfection with chemical fluids encourage secondary bacterial infection; hence, employing laser pulses to activate the fluids is advised to improve microbial biofilm clearance. This study investigated the performance of Er,Cr:YSGG laser in photon-induced photoacoustic streaming (PIPS) agitation of 5.25% sodium hypochlorite (NaOCl) to enhance the removal of mature Enterococcus faecalis (E. faecalis) biofilms in complex root canal systems. The mesial roots of the lower first and second molars were separated and inoculated with E. faecalis bacteria for 30 days. The roots were irrigated with 5.25% NaOCl, some of them were agitated with passive ultrasonic irrigation (PUI), and the other roots were agitated by Er,Cr:YSGG laser using PIPS at 60 µs/pulse, 5 Hz, and 0.25, 0.5, 0.75, 1, and 1.25 W. An atomic force microscope (AFM) was used as a new method to obtain the results in the isthmus area; the results that have been obtained from each group were compared with each other. ANOVA was utilized to compare the means of the test groups. Based on the AFM and SEM analyses, laser agitation and passive ultrasonic activation groups have shown higher antimicrobial efficacy than the conventional syringe irrigation group (P<0.05). Based on the findings of this investigation, the agitation of 5.25% NaOCl solution by Er,Cr:YSGG laser in PIPS at (60 µs/pulse, 5 Hz, 1.25 W) offers better mature bacterial biofilm removal in the mesial root of lower human molars than the same irrigant with syringe irrigation and passive ultrasonic activation technique.

Effect of Ultrasonic Irrigation Combined with Epoxy Resin Paste in Single Visit Root Canal Treatment in Chronic Pulpitis.

To determine the clinical efficacy of ultrasonic irrigation combined with epoxy resin-based sealer in single visit root canal treatment of chronic pulpitis. Randomised controlled trial. Place and Duration of the Study: Department of Stomatology, Hefei BOE Hospital, Hefei, China, from March 2019 to December 2021. Ninety patients with chronic pulpitis, comprising 104 affected teeth, were enrolled. Using a random number table, they were divided into Group A (n = 30, 35 teeth), Group B (n = 30, 35 teeth), and the control group (n = 30, 34 teeth). All underwent single visit root canal treatment. Group A received ultrasonic irrigation followed by sealing with epoxy resin-based paste; Group B had conventional syringe irrigation followed by the same sealing; the control group had syringe irrigation and closure with zinc oxide-eugenol paste. Pain during treatment, posttreatment clinical outcomes, and differences in inflammatory markers (IL-4, IL-6, hs-CRP), and quality of life (QOL) scores pre- and posttreatment over two months were observed. After the treatment, improvement rates for Groups A, B, and the control group were 91.4%, 65.7%, and 61.7%, respectively. Pain occurrence rates were 6.7%, 30.0%, and 36.7%, respectively. Group A outperformed both Group B and the control group in improvement and pain incidence with statistical significance (p<0.016). Posttreatment, Group A had lower IL-4, IL-6, hs-CRP levels than Groups B and the control group (p<0.05), and had higher scores for sleep, mood, and appetite (p<0.05). Ultrasonic irrigation combined with epoxy resin-based paste yields better results for chronic pulpitis treatment, reducing postoperative pain, mitigating inflammation levels, and enhancing quality of life. Chronic pulpitis, Ultrasonic irrigation, Epoxy resin paste, Root canal treatment, Therapeutic effect.

FARKLI İRRİGASYON SİSTEMLERİNİN KANAL İÇİ İLAÇLARIN UZAKLAŞTIRILMASINA ETKİSİNİN İNCELENMESİ

Objectives: This study aimed to evaluate the effects of different irrigation systems on the removal of intracanal medicament used in regenerative endodonti treatment. Materials and Methods: Following standardized preparation to obtain an immature tooth model, modified triple antibiotic paste (mTAP) consisting of metronidazole, ciprofloxacin and clindamycin was applied to the root canals of single-rooted human maxillar teeth and waited for three weeks. A total of 50 teeth with standardized preparation and intracanal medicament were randomly divided into five groups according to the irrigation method to be applied (n=10); Group 1: Conventional Syringe Irrigation (CSI), Group 2: Passive Ultrasonic Irrigation (PUI), Group 3: EndoActivator (EA), Group 4: EndoVac (EV) Group 5: Nd:YAG laser (LSR). Following the removal of the mTAP with different irrigation systems, the teeth were divided along their bukko-lingual axis. The impact roots were examined under the stereomicroscope with the 4-grade scoring scale for the presence of residual intracanal medicaments. Scores for coronal, middle and apical regions of each root were recorded. Results: In terms of total scores, PUI group showed higher intracanal medicament removal efficacy compared to the other groups (p&amp;lt;0.05). In the intra-group comparison of the root canal third, less intracanal medicament was found in the apical third (p &amp;lt;0.05). The highest intracanal medicament removal efficacy was found in PUI and LSR groups in the coronal third, PUI group in the middle third, and PUI and EV groups in the apical third (p&amp;lt;0.05). Conclusions: Intracanal medicament removal scores were significanlty associated with irrigation system. PUI showed statistically significantly higher intracanal medicament removal efficiency than other irrigation methods. While there was no difference between the coronal and middle thirds, statistically significantly less intracanal medicament removal was found in the apical third compared to the other regions.

Evaluation of Postoperative Pain with Endoactivator and Conventional Syringe Irrigation in Single Rooted Teeth

Numerous irrigant activation devices have been produced that may affect the postoperative pain in addition to manual activation techniques during the final irrigation operation. Objective: To evaluate the postoperative pain after using EndoActivator and conventional syringe irrigation protocol in single rooted teeth. Methods: Patients 18-60 years old with either gender who had symptomatic or asymptomatic apical periodontitis in single-rooted teeth with irreversible pulpitis were included in the study. Fifty patients were randomly chosen and divided into two groups i.e Experimental (EndoActivator irrigation) and control (Conventional needle). Post-operative pain was assessed using a VAS at 24 hours, 3 days, and 7 days. Results: Male patients were 13 (52.0%) and 10 (40.0%) and female patients were 12 (48.0%) and 15 (60.0%) with mean age of 33.68 ± 10.13 and 33.64 ± 12.34 years in group A and group B respectively. Post-operative assessment of pain at 24hrs was: no pain 9 (36.0%) and 7 (28.0%), mild pain 10 (40.0%) and 11 (44.0%), moderate pain 6 (24.0%) and 4 (16.0%) patients, severe pain 0 (0.0%) and 3 (12.0%), on day 3rd: no pain 17 (68.0%) and 13 (52.0%), mild pain 7 (28.0%) and 11 (44.0%). moderate pain 1 (4.0%) and 1 (4.0%) and on day 7th no pain 23 (92.0%) and 23 (92.0%) and mild pain 2 (8.0%) and 2 (8.0%) patients in group A and group B respectively. Conclusions: There was no significant difference in effectiveness of both irrigation systems

Evaluating the effect of different irrigation activation techniques on the dentin tubules penetration of two different root canal sealers by laser scanning confocal microscopy.

The aim of this study is to evaluate the effect of different irrigation activation techniques on the dentin tubules penetration of two different sealers by confocal laser scanning microscope (CLSM). A hundred premolar teeth were used in this study. The root canals were shaped and irrigated with 5% NaOCl and 17% EDTA using the following final irrigation activation techniques in each group; Group1: Conventional Syringe Irrigation (CSI), Group2: Passive Ultrasonic Irrigation (PUI), Group3: Apical Negative Pressure (EndoVac), Group4: Er:YAG laser and Group5: Er,Cr:YSGG laser. Then the teeth were separated two subgroups according to sealers (AH-Plus and Totalfill-BC). Horizontal sections were obtained at 2, 5, 8 mm distance of apex. Images were obtained with CLSM and the penetration areas of sealers were calculated with four different dentin tubule penetration assessment techniques. The data were statistically analyzed with Kruskal Wallis and Mann Whitney U tests. No significant difference was observed between the sealers (p > .05). EndoVac, Er:YAG and Er,Cr:YSGG laser activation groups were observed to have a significantly higher mean penetration depth, penetration percentage and penetration area than the Control group. There was a significant difference between all regions in all penetration parameters (p < .05). While the use of resin or bioceramic-based root canal sealers did not affect dentin tubule penetration, the use of activation techniques positively affect the dentin tubule penetration. The average tubule penetration and penetration area assessment techniques are suitable methods for the investigation of dentinal tubule penetration. It can be stated that the use of resin or bioceramic based root canal sealers does not affect dentin tubule penetration and the use of irrigation activation techniques during removal of the smear layer positively affects dentinal tubule penetration. In addition, it has been determined that the average tubule penetration and penetration area assessment techniques are suitable methods for the investigation of dentinal tubule penetration.

Effect of irrigation systems on the bond strength of calcium-silicate-based cement used as pulp barrier in regenerative endodontic treatment

This study aimed to evaluate the effects of irrigation systems on the bond strength of Biodentine, used as a pulp barrier in regenerative endodontic treatment (RET), to the root canal dentin. Following standardized preparation to obtain an immature tooth model, a modified triple antibiotic paste (mTAP) consisting of metronidazole, ciprofloxacin, and clindamycin was applied to the root canals. Teeth were randomly divided into five groups according to the irrigation system (n = 10): Group 1, Conventional Syringe Irrigation (CSI); Group 2, Passive Ultrasonic Irrigation (PUI); Group 3, EndoActivator (EA); Group 4, EndoVac (EV); and Group 5, Nd:YAG laser (LSR). After removing the mTAP from the root canals, parallel sections of 1 mm thickness were obtained, with three sections per tooth. Biodentine was applied to the obtained sections, and a push-out test was performed. The data were recorded in MPa, and images of the fracture types were examined. There was no significant difference between the PUI and EV groups (p > 0.05), and their respective values, (4.43 ± 0.63) and (4.37 ± 0.47), were greater than those of the other groups (p < 0.05). Although the push-out bond strength of the LSR group was higher than those of the EA and CSI groups, there was no difference between EA and CSI groups (p > 0.05). The irrigation system type had a significant effect on the push-out bond strength of Biodentine to the root canal dentin in the RET. PUI and EV groups had significantly higher bond strength values than the other groups.

Efficacy of different irrigation agitation systems in the removal of root canal sealers from artificial standardised grooves.

The present study aims to assess the efficacy of different irrigation agitation systems in removing calcium silicate-based sealers from artificial standardised apical grooves. After the root canal instrumentation of 96 teeth, artificial apical grooves were created in half of each root. The samples were divided into two main groups according to the sealer type (AH Plus Jet [APJ] and Sure-Seal Root™ [SSR]) (n=48). The root halves were then reassembled and divided into four experimental groups based on the final irrigation technique used: Conventional Syringe Irrigation (CSI), Ultrasonic Irrigant Agitation (UIA), Sonic Agitation (SA) and Manual Dynamic Agitation (MDA). The roots were then dissembled to assess the amount of root canal sealer. UIA significantly removed more of SSR sealer than CSI, MDA and SA while there was no statistical difference between CSI, MDA, SA and UIA groups in the APJ group. None of the irrigation agitation systems used had completely removed the APJ and SSR sealers. However, UIA was more effective in removing SSR sealer from the standardised apical groove than were CSI, MDA and SA.

Effect of irrigation protocols on smear layer removal, bond strength and nanoleakage of fiber posts using a self-adhesive resin cement.

This study aimed to investigate the effect of the application method of 2% chlorhexidine (CHX) and its influence on the adhesion of fiberglass posts cemented with a self-adhesive resin cement. Sixty human mandibular premolars were endodontically treated and divided into 5 groups (n = 12), according to the canal irrigant and its application method: 2 groups with conventional syringe irrigation (CSI)-2.5% sodium hypochlorite (NaOCl) (control) and 2% CHX- and 3 groups with 2% CHX irrigation/activation-by passive ultrasonic irrigation (PUI), Easy Clean file, and XP-Endo Finisher file. Two roots per group were evaluated for smear layer (SL) removal by scanning electron microscopy. For other roots, fiber posts were luted using a self-adhesive resin cement. The roots were sectioned into 6 slices for push-out bond strength (BS) (7/group) and nanoleakage (NL) (3/group). Data from SL removal were submitted to Kruskal-Wallis and Student-Newman-Keuls tests (α = 0.05). Data from BS and NL were evaluated by 2-way analysis of variance and Tukey's test (α = 0.05). For SL removal and BS, the CHX irrigation/activation promoted better values than CSI with CHX (p < 0.05), but it was not significantly different from CSI with NaOCl (p > 0.05). For NL, the lowest values were obtained by the chlorhexidine irrigation/activation groups (p < 0.05). Active 2% CHX irrigation can be used to improve the post space cleaning and adhesion before fiber post cementation with self-adhesive resin cements.

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

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

Comparison of vapor bubble kinetics and cleaning efficacy of different root canal irrigation techniques in the apical area beyond the fractured instrument

Background/purposeIntracanal fractured instruments hamper adequate root canal disinfection. The aim of this study was to evaluate vapor bubble kinetics and cleaning efficacy of different irrigation techniques in the apical area beyond the fractured instrument. Materials and methodsSixty curved root canal models, in which a 3-mm fragment of a #20 K-file or a WaveOne Gold Primary (WOG) instrument was intentionally separated at 3 mm from the apical foramen, were irrigated with laser-activated irrigation with photon-induced photoacoustic streaming (LAI-PIPS; 20 mJ/15 Hz), laser-activated irrigation using an Er:YAG laser unit (LAI; 30 mJ/20 Hz), or ultrasonic-activated irrigation (UAI) for 5 s. Vapor bubble velocity and counts were analyzed using high-speed video imaging. To evaluate canal wall cleanliness, 40 canals of extracted human teeth with an intentionally separated 3-mm WOG fragment in the canal at 3 mm from the apical foramen were irrigated with LAI-PIPS, LAI, UAI or conventional syringe irrigation, using 17% EDTA (30 s, two cycles), saline (30 s), and 3% NaOCl (30 s, three cycles) as irrigants. Debris and smear layer on the apical canal wall beyond the fractured instrument were scored using scanning electron microscopy. ResultsLAI-PIPS and LAI demonstrated higher vapor bubble counts than UAI. The WOG fragment permitted higher bubble velocity and count than the K-file fragment. LAI-PIPS and LAI showed better debris and smear removal than the other techniques. ConclusionLAI and LAI-PIPS demonstrated higher vaporized bubble kinetics and better cleaning efficacy in the apical area, even in the presence of a fractured instrument.

Evaluation of root-canal isthmus debridement efficacy of 3 kinds of activated irrigation technique.

This study aimed to compare the capabilities of sonic, ultrasonic, and laser-activated irrigation for debris removal in the root canal isthmus. A total of 32 human maxillary first premolars with root canal isthmus were prepared by Reciproc Blue, and were randomly divided into four groups (n=8, each group). The groups were subsequently subjected to different regimens as follows: the conventional syringe group (control group) was irrigated by No.27 side opening syringe, the sonic group with EDDY connected pneumatic motor, the ultrasonic group with IRRI Safe connected to a ultrasonic P5 handle, and the laser group with Er:YAG laser device connected to a 9 mm fiber tip for 20 s in each root canal. The first and last four samples in each group were irrigated for 80 and 120 s, respectively. All samples were fixed, decalcified, embedded, sectioned, and stained with hematoxylin-eosin. Image J software was used for measurement analysis of the isthmus and canal debridement efficacy, and SPSS 25.0 was utilized for statistical analysis of all data. The isthmus debridement efficacy of conventional syringe irrigation, sonic, ultrasonic, and laser groups after 80 s irrigation were 30.91%±3.14%, 52.22%±0.31%, 83.77%±5.64%, and 77.97%±7.97%, respectively. The isthmus debridement efficacy of the three experimental groups were better than the conventional syringe irrigation group (P<0.05). The isthmus debridement efficacies of ultrasonic and laser groups after 80 s were better than that of the sonic group (P<0.01, P<0.05). However, no significant difference was observed between the ultrasonic and laser groups. The isthmus debridement efficacy of conventional syringe irrigation, sonic, ultrasonic, and laser groups after 120 s were 75.72%±2.38%, 85.66%±4.42%, 88.07%±4.09%, and 89.12%±3.63%, respectively. The isthmus debridement efficacies of the three experimental groups were better than that of the conventional syringe irrigation group (P<0.05), but no significant difference was observed among the groups (P>0.05). The root canal debridement efficacy among the four groups also exhibited no significant difference (P>0.05). The debridement efficacies of the root canal and isthmus after 120 s irrigation were better than those after 80 s irrigation (P<0.01, P<0.001). Ultrasonic, sonic, and laser-activated irrigation have better results in removing debris from the isthmus than conventional syringe irrigation. The isthmus debridement efficacy of sonic- and laser-activated irrigation are slightly better than that of ultrasonic activated irrigation. The debridement efficacies of 120 s irrigation are better than those of 80 s irrigaion.

Farklı irrigasyon tekniklerinin kalsiyum hidroksit uzaklaştırma etkinliğinin Bilgisayarlı Sıvı Filtrasyon methodu kullanılarak mikrosızıntılarının değerlendirilmesi

Aim: To compare the efficiency of sonic irrigation, passive ultrasonic irrigation, and conventional syringe irrigation (CI) in removing pure and injectable calcium hydroxide (CH) from the root canals of mandibular second premolars by measuring the probable microleakage of residual CH particles in root canal obturation using computerized liquid filtration (CLF). Materials and Methods: Eighty instrumented mandibular second premolars were categorized into three experimental groups (n = 20 each) based on the irrigation method used for removing CH and a control group (n = 20) in which CH was not used. Each experimental group was divided into two equal groups (pure and injectable CH). After 1 week, CH was removed from the root canals, and the teeth were obturated. CLF measurements were performed 1 week after obturation. Nonparametric variables between two groups were compared using the Mann-Whitney U test, and the Kruskal-Wallis test was used to compare more than two groups. The significance level was set at p &amp;lt; 0.05. Results: All experimental groups showed higher leakage values than the control group. The highest leakage values were evident in the CI group, and the lowest leakage values were found in the sonic (EDDY) irrigation group. No significant differences were detected among the different forms of CH. Conclusions: None of the analyzed techniques could completely remove CH from root canals, resulting in higher leakage values. Sonic irrigation with EDDY was the best in removing CH from root canals.

Comparative evaluation of machine assisted irrigation activation technique and conventional syringe irrigation on postoperative pain in patients undergoing endodontic treatment: A Systematic review and meta-analysis

Objective: This systematic review and meta-analysis aimed to assess whether machine- assisted agitation resulted in less postoperative pain (PP) compared with syringe irrigation with needle alone in adult patients undergoing root canal treatment. Methodology: PICO strategy was used to electronically search key terms in the PubMed, Science Direct, Cochrane Library, Google Scholar and Wiley Online databases up to 2021 for randomized control trials (RCTs) with an observation period of at least 6 hours. The bias risk for RCTs was assessed using the Cochrane risk of bias tool. Meta-analysis was performed using RevMan 5.4 (RevMan 5.4, The Nordic Cochrane Centre, Copenhagen). Results: A total of 9 studies (for systematic review) including 1075 patients with a 565/530 male to female ratio and a mean age of 40.5 years met the inclusion criteria. Out of 9, 6 studies were selected for the meta-analysis. Meta-analysis of the 6 studies indicated that overall, the use of machine-assisted irrigation technique showed better postoperative pain reduction than conventional syringe irrigation. Conclusion: Overall, machine-assisted irrigation causes reduction in postoperative pain compared to conventional syringe irrigation.

The Impact of Laser-Activated and Conventional Irrigation Techniques on Sealer Penetration into Dentinal Tubules.

Objective: The present study was aimed at comparing the efficacy of 1-hydroxyethylidene-1, 1-diphosphonic acid (HEDP) and ethylenediaminetetraacetic acid (EDTA) by using various final irrigation techniques on penetration of sealer. Background: Traditional irrigation of root canals with a syringe limits the ability of sealer penetration. Various irrigants and activation techniques, including sonic and ultrasonic devices and various kinds of lasers, have been introduced to improve penetration of sealers into dentinal tubules. Methods: One hundred mandibular premolars were selected. Final irrigation was performed with HEDP or EDTA by conventional syringe irrigation (CI), EndoActivator (EA), passive ultrasonic irrigation (PUI), photon-induced photoacoustic streaming (PIPS), and shock wave-enhanced emission photoacoustic streaming (SWEEPS) methods (n = 10). After obturation of root canals with the EndoSequence BC Sealer, samples were evaluated using a confocal laser scanning microscope (CLSM), which enabled measurement of the maximum depth, percentage, and penetration area. Tests performed for analysis included the Kruskal-Wallis H and Mann-Whitney U tests. Results: In the EA method, the penetration percentage achieved using HEDP was significantly higher than EDTA at both sections (p < 0.05). Irrespective of the final irrigation solution employed, the PUI, PIPS, and SWEEPS techniques exhibited greater tubule penetration values compared with the CI and EA techniques (p < 0.05). Conclusions: HEDP and EDTA showed similar effects on the amount of penetrated sealer into the dentinal tubules, and the PUI, PIPS and SWEEPS methods provided enhanced EndoSequence BC Sealer penetration compared with the CI and EA methods. This study was approved by the Near East University institutional review board (#2020/86-1225).

Effect of Ultrasonic and Diode Laser Irrigation Activation on Post-operative Pain and Microbial Reduction in Single Visit Endodontic Treatment of Necrotic Mandibular Molars

Aim: To clinically evaluate the effect of continuous ultrasonic and diode laser 810 wave length irrigation activation techniques on postoperative pain and bacterial reduction in single visit endodontic treatment of mandibular molars.&#x0D; Material and methods: Forty patients requiring root canal treatment therapy for necrotic mandibular molars teeth were included in this study with age ranges between 20 and 45 years. In all cases, single visit endodontic treatment was carried out using Revo-S rotary file system in crown down sequence. NaOCl 2.5% irrigation solution was used during treatment. Patients were randomly and equally assigned into two groups according to irrigation technique. Group (1): conventional syringe irrigation and group (2): continuous ultrasonic irrigation. Each group was subdivided into two sub groups (n = 10); subgroup 1A (conventional syringe irrigation with no laser), subgroup 1B (conventional syringe irrigation with diode laser), subgroup 2A (continuous ultrasonic irrigation with no laser) and subgroup 2B (continuous ultrasonic irrigation with diode laser).&#x0D; Postoperative pain evaluation was done using Visual Analogue Scale (VAS) at 6, 12, 24, 36, 48 hours and 7 days postoperatively. Microbiological detection of bacterial reduction was done by taking Samples (S1 and S2) for bacterial cultures. S1 after finishing access cavity and before mechanical preparation and S2 after finishing mechanical preparation and irrigation activation and before obturation. Samples were cultured on blood agar and determined as colony forming units (CFU/mL). Microbiological bacterial reduction was calculated accordingly. Statistical analyses were analyzed using the Mann-Whitney U test. The significance level was set at p &lt; 0.05.&#x0D; Results: In all sub groups, postoperative pain decreased by time in all time intervals but pain was significantly lower in subgroup (2B) (continuous ultrasonic irrigation with diode laser) than subgroup (1A) (conventional syringe irrigation with no laser) in all time interval. Microbiological results showed the highest bacterial reduction was in subgroup (2B) (continuous ultrasonic irrigation with diode laser) and least bacterial reduction was in subgroup (1A) (conventional syringe irrigation with no laser).&#x0D; Conclusion: Using diode laser and continuous ultrasonic irrigation activation techniques as adjunctive methods showed improvement in postoperative pain records and enhanced bacterial reduction in root canal therapy.&#x0D; Keywords: Continuous ultrasonic irrigation, diode laser 810, post-operative pain, bacterial reduction, single visit endodontic treatment.

Comparative clinical evaluation of conventional syringe irrigation, endoactivator and endovac in reducing the microbial count from infected root canal

Root canal decontamination is a crucial step in achieving endodontic success. For this, absolute eradication of microbes from root canal is of paramount importance. This in vivo study aimed at comparing the Conventional, EndoActivator and EndoVac irrigation system in reducing intracanal bacterial load. 70 necrotic, single rooted teeth having chronic periapical lesions were selected for endodontic therapy and randomly assigned into three groups. Group 1 – 20 teeth treated using Conventional needle irrigation. Group 2 – 20 teeth treated using EndoActivator system. Group 3– 20 teeth treated using EndoVac system. After the surface disinfection, access opening was done. Groupwise irrigation with NaOCl (VISHAL DENTOCARE PVT.LTD.) and EDTA (AMMDENT CANALARGE) was done with each canal in between instrumentation. Data were obtained by culturing bacterial samples of root canal before and after chemomechanical preparation under both aerobic and anaerobic conditions and CFU was counted. Statistical analysis - Paired‘t’ test was used for intragroup comparisons while ANOVA test followed by the “post hoc Games Howell test” for intergroup comparisons. Significant post-operative reduction in bacterial colony counts was seen with all the groups. EndoVac group had significantly higher mean log reduction in CFU counts than Conventional group.

Effect of Er:YAG laser irrigation with different etching modes on the push-out bond strength of fiber posts to the root dentine

The objective of this study was to evaluate the effect of Er:YAG laser irrigation on the push-out bond strength of fiber posts to the root dentine. Sixty extracted human mandibular first premolars were collected and decoronated. The residual roots received endodontic treatment. The treated roots were randomly divided into three groups according to different irrigation protocols: group LAI (Er:YAG laser–activated irrigation), group PUI (passive ultrasonic irrigation, positive control), and group CSI (conventional syringe irrigation, negative control) (n = 20). Each group was divided into two subgroups, either total-etching modes or self-etching modes (n = 10). After fiber post restoration, all roots were sectioned into seven 1.0-mm-thick slices. The slices received a push-out test by a universal test machine. The resin tag on the segments’ bonding interfaces was observed by scanning electron microscope. There were significant differences in the effects of the irrigation method, bonding modes, and root regions on the push-out bond strength among the groups (p < 0.05). The specimens with Er:YAG laser–activated irrigation and self-etching mode showed significantly the highest bonding strength (p < 0.001). The lengths and densities of resin tags in group PUI or group LAI with self-etching modes were longer than those in group CSI with total-etching modes. The laser-activated irrigation with self-etching modes improved the bond strength of fiber post to root dentine compared to the passive ultrasonic irrigation or conventional syringe irrigation with total or self-etching modes.