EndoVac System Research Articles

Comparative Evaluation of Efficacy of Endodontic Irrigant Delivery to Working Length using Conventional Needle Syringe, Endovac and Self-Adjusting File System on Prepared Mesiobuccal Canal of Mandibular First Molar by using Radiographic Contrast Media: An In Vivo Study

Comparative Evaluation of Efficacy of Endodontic Irrigant Delivery to Working Length using Conventional Needle Syringe, Endovac and Self-Adjusting File System on Prepared Mesiobuccal Canal of Mandibular First Molar by using Radiographic Contrast Media: An In Vivo Study

P191 MINIMALLY-INVASIVE ESOPHAGECTOMY IN TREATMENT FOR ESOPHAGEAL DISEASES

Abstract Aim to study the benefits of the mini-invasive approach. Background & Methods 115 esophagectomies were performed for the period from 2015 to 2018. Gastric conduit in 84 patients, colon - 2 and small intestine - 29. The study included 65 patients after I.Lewis, McKeown or transhiatal esophagectomy, who was performed esophageal replacement with gastric conduit. The first group consisted of 44 patients after open esophagectomy; second group - 21 patients after MIE (minimally invasive esophagectomy): included 8 patients - thoraco-laparoscopic McKeown surgery, 1 patient - laparoscopic transhiatal esophagectomy with anastomosis on the neck, 9 patients – hybrid minimally invasive I.Lewis surgery (laparoscopy+thoracotomy), and 3 patients – minimally invasive thoraco-laparoscopic I.Lewis surgery. The average age of patients was 53 years (13-64). 55 patients (84.6%) with esophageal cancer and 10 patients (15.4%) with benign strictures of the esophagus. There were anastomosis on the neck in 28 patients (43%) and intrathoracic anastomosis in 37 patients (57%). Results In the first group the average operative time was 286 minutes (240-370 min.), the average volume of blood loss was 345 ml (100-600 ml), the length of in-hospital stay was 15 days (9-29), complications: anastomosis leakage - 1 patient on the 5th postoperative day - EndoVAC system was used with a defect closure after 18 days; 1 patient - adhesive intestinal obstruction (relaparotomy, separation of adhesions). In the second group the average operative time was 400 min (370-480 min.), blood loss - 100 ml (50-200 ml), the length of in-hospital stay - 10 days (8-16), complications in 1 patient - acute strangulation with intestinal obstruction. There was no mortality in both groups. Conclusions The application of MIE helps to reduce the severity of postoperative pain, the length of in-hospital stay and intraoperative blood loss. This procedure should be performed in specialized hospitals with experience in miniinvasive surgery and esophageal surgery.

Effect of intracanal cryotherapy on the fracture resistance of endodontically treated teeth

Objective: The aim of this study is to evaluate the effect of intracanal cryotherapy on the fracture resistance of endodontically treated teeth.Materials and methods: Sixty single-rooted maxillary lateral incisor teeth with single root canals were selected and randomly divided into two groups (n = 30). The specimens were immersed in distilled water, which was heated to 37 °C during the procedures. The root canals were chemomechanically prepared up to the apical size of 50 and assigned to either the control group or the cryotherapy group. The specimens in the cryotherapy group were irrigated with 20 mL sterile cold (2.5 °C) saline solution, which was delivered with an EndoVac system for 5 min, whereas the specimens in the control group received a sterile saline solution at room temperature. The fracture resistance of the specimens was then tested with a universal testing machine. The data was analyzed using the independent sample t test with a 5% significance threshold.Results: The fracture strength of the specimens in the intracanal cryotherapy group was significantly lower than that of the control group (p< .05).Conclusions: Application of intracanal cryotherapy as a final irrigant reduced the vertical fracture resistance of prepared roots when compared to the control group.

Effect of different irrigation solutions and techniques on push-out bond strength of resin-based sealer

Aim To evaluate the effect of irrigation solutions [sodium hypochlorite (NaOCl), chlorhexidine (CHX), and normal physiological saline] and different irrigation techniques (conventional needle, EndoVac, and CanalBrush) on push-out bond strength of AH Plus resin-based sealer. Materials and methods Ninety mandibular freshly extracted premolars were selected and divided into three groups according to the irrigation solutions; group I: 5.25% NaOCl, group II: 2% CHX, group III: normal physiological saline solution. Then each group was subdivided into three subgroups according to the irrigation techniques; subgroup A: 27 G side beveled needle, subgroup B: EndoVac irrigating system, subgroup C: medium-sized CanalBrush (30/0.04). Root canals of all groups were prepared using ProTaper Universal Ni-Ti rotary system up to file F4 (40/0.06) and filled by single cone technique using AH Plus sealer. 2 mm thick horizontal sections from the coronal, middle and apical thirds of each root were sliced for the push-out bond strength measurement and tested using universal testing machine. Data were analyzed using one-way analysis of variance in a level of significance (P ≤ 0.05). Results The highest mean push-out bond strength values were recorded for EndoVac system followed by CanalBrush and Needle in all groups and at all root canal levels. In comparison of irrigation solutions in needle subgroup; the highest values were recorded for CHX and least for NaOCl at coronal and middle root levels. While in the apical section, the highest and least mean push-out bond strength values were recorded for CHX and saline respectively. Regarding EndoVac and CanalBrush; the highest push-out bond strength values were recorded for CHX followed by saline and NaOCl at all root canal levels. Conclusions Whenever root canal obturation using AH Plus sealer, it is preferred to use 2% CHX solution throughout and after instrumentation via EndoVac system for improved bond strength. The coronal sections showed higher bond strength than middle and apical sections.

Evaluation of the Antibacterial Effect of Apple Vinegar as a Root Canal Irrigant Using Endovac Irrigation System

Purpose: This study aimed to evaluate the antibacterial effect of Apple Vinegar as a root canal irrigant using Endovac irrigation System. Materials and Methods: for this study, 60 extracted human teeth were used. After their decapitation, they were instrumented using Universal ProTaper rotary files up to size F4 then separated into 2 set of groups according to the solution used in irrigation; Group A1: irrigated with 5.25 NaOCl Group A2: irrigated with Apple vinegar (30 specimens in each group). We then subdivided each group into 2 subgroups according to the technique used for irrigation; Subgroup A: using conventional irrigation and Subgroup B: using Endovac irrigation system. Samples were sterilized and inoculated with Enterococcus faecalis (ATCC29212) for 48 hrs. After irrigation, microbial samples were collected, transferred to nutrient agar and incubated for counting of bacterial colony forming units (CFUs). The significance level was P≤ 0.05. Results: There was a statistically significant difference among the tested groups and subgroups in the mean scores of bacterial counts. Concerning the irrigating devices, there was statistically significant difference between conventional irrigation and Endovac system as Endovac showed higher antibacterial effect than conventional irrigation (P ≤ 0.05). Apple vinegar showed statistical significant difference with Endovac system subgroup than conventional irrigation (P ≤ 0.05). Conclusion: Endovac irrigation system was effective in eradication of E. faecalis from the root canals using either NaOCl or Apple vinegar.

The effect of negative pressure on the antibacterial effect of herbal irrigant (An in vitro study)

Purpose: This study aimed to evaluate the antibacterial effect of Green tea as a root canal irrigant using Endovac irrigation System. Materials and Methods: for this study, 60 extracted human teeth were used. After their decapitation, they were instrumented using Universal ProTaper rotary files up to size F4 then separated into 2 set of groups according to the solution used in irrigation; Group A1: irrigated with 5.25% NaOCl Group A2: irrigated with Green tea (30 specimens in each group). We then subdivided each group into 2 subgroups according to the technique used for irrigation; Subgroup A: using conventional irrigation and Subgroup B: using Endovac irrigation system. Samples were sterilized and inoculated with Enterococcus faecalis(ATCC29212) for 48 hrs. After irrigation, microbial samples were collected, transferred to nutrient agar and incubated for counting of bacterial colony forming units (CFUs). The significance level was P≤ 0.05. Results: There was a statistically significant difference among the tested groups and subgroups in the mean scores of bacterial counts. Concerning the irrigating devices, there was statistically significant difference between conventional irrigation and Endovac system as Endovac showed higher antibacterial effect than conventional irrigation (P ≤ 0.05). Green tea showed statistical significant difference with Endovac system subgroup than conventional irrigation (P ≤ 0.05). Conclusion Endovac irrigation system was effective in eradication of E. faecalis from the root canals using either NaOCl or Green tea.

Comparative Evaluation of the Efficacy of Irrigation Delivery Systems on Enterococcus faecalis

Attaining a sterile root canal system is important since microorganisms can cause persistent inflammation in the periradicular tissues. Objectives: This study sought to evaluate the efficacy of two irrigation delivery systems; the EndoVac and semiconductor diode laser irradiation with 5.25% sodium hypochlorite and 2% chlorhexidine. Methods: Fifty teeth were disinfected according to the Occupational Safety and Health Administration regulations. The teeth were then instrumented, followed by inoculation with bacterial strains of Enterococcus faecalis (ATCC 29212). The teeth were randomly assigned to five groups, Group I: Control group; Group II: Teeth irrigated with 5.25% NaOCl + Endovac; Group III: Teeth irrigated with 2% Chlorhexidine + Endovac; Group IV: Teeth irrigated with 5.25% NaOCl + laser irradiation; and Group V: Teeth irrigated with 2% Chlorhexidine laser irradiation. All samples were incubated on Muller–Hilton media plates for a period of 24 h. We determined the colony-forming units and analyzed them statistically using Fisher’s exact test. Results: Laser irradiation completely disinfected the root canal system. The EndoVac system produced significant disinfection but was comparatively less effective than laser irradiation. Conclusion: Laser irradiation had a significantly greater bactericidal effect than the EndoVac system, used in conjunction with sodium hypochlorite and chlorhexidine.

Efficacy of Chitosan as Root Canal Irrigant in Removing Smear Layer in Curved Root Canals Using Endovac Irrigation System (SEM Study)

Purpose: This study aimed to evaluate the efficacy of Chitosan as root canal irrigant with Endovac irrigation system in removing smear layer of curved root canal walls using Scanning Electron Microscope (SEM). Materials and Methods: Fifty extracted human first mandibular molars were selected with curved mesiobuccal root (20o-35o). Samples were instrumented with Universal ProTaper rotary files till size F4 then divided into 2 main experimental groups according to the final rinse used; Group I: irrigated with 17 % EDTA Group II: irrigated with 0.2% chitosan acetate and control group, irrigated with sterile saline (10 samples). Each group was further subdivided into 2 subgroups according to the irrigating technique used; Subgroup A: using conventional needle irrigation and Subgroup B: using Endovac irrigation system. Samples were grooved longitudinally and smear layer was evaluated using SEM at the coronal, middle and apical root canal levels. The significance level was set at P≤ 0.05. Results: There was a statistically significant difference among the tested groups and the control group in the mean scores of smear layer at all root canal levels and no significant difference between irrigants used. Concerning the irrigating devices, there was no statistical significant difference between conventional irrigation and Endovac system at the coronal and apical root canal levels while at the middle level, 0.2% chitosan showed statistical significant difference with Endovac system subgroup than conventional irrigation(P ≤ 0.05). Conclusion Endovac irrigation system was effective in smear layer removal from curved root canals using either 0.2% Chitosan acetate or 17 % EDTA as finalrinse.

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.

Depth and percentage of resin-based sealer penetration inside the dentinal tubules using EndoVac, EndoActivator, Navi tip FX irrigation system: A confocal laser scanning microscope study.

Aim:This in vitro study was conducted to evaluate the effect of EndoVac, EndoActivator, and Navy Tip FX irrigation system on lateral depth and percentage of sealer penetration into the dentinal tubules using confocal laser scanning microscope.Materials and Methods:Forty recently extracted single-rooted mandibular premolars were taken and root canal treatment was performed using three different irrigation system, that is, EndoVac, EndoActivator, and Navi tip FX. The samples were divided into 4 groups according to the irrigation system used: Control or conventional needle (Group I), Navi Tip FX (Group II), EndoActivator (Group III), and EndoVac (Group IV). All teeth were obturated using AH Plus sealer labeled with fluorescent rhodamine B dye. The teeth were sectioned at coronal (5 mm), middle (3 mm), and apical 3rd (1 mm) from the apex. Total percentage and maximum depth of sealer penetration were measured using confocal laser scanning microscopy. The data were evaluated statistically using Kruskal–Wallis test with a 95% confidence level (P = 0.01).Results:EndoVac resulted in more sealer penetration then EndoActivator and Navi Tip FX irrigation system. Endoactivator resulted in more sealer penetration in comparison to Navi Tip FX.Conclusion:Percentage and depth of sealer penetration were more at apical and middle 3rd with Endovac system followed by Endoactivator and Navi tip FX system.

Evaluation of Intracanal Calcium Hydroxide Removal with Different Techniques: A Scanning Electron Microscope Study

This study aimed to evaluate the efficacy of Intracanal calcium hydroxide removal with different techniques. Seventy-five freshly extracted, non-carious, single canalled lower first premolars, having anatomic characteristics similar to each other, extracted for the orthodontic purpose were collected. After the root canal preparation, Calcium hydroxide was placed into the working length using lentulo spiral instrument till the medicament was visible at the apex. The specimens were segregated into three groups; Group 1: Rotary Files, Group 2: EndoVac system and Group 3: Ultrasonics. The evaluation was done with SEM in the coronal and apical third of the roots with a magnification of 1000x. The statistical analysis was done using statistical packages for social sciences (SPSS) software, version 20.0 for Windows (SPSS Inc., Chicago, IL). A p-value of less than 0.05 was considered significant statistically. Maximum removal of Ca(OH)2 was analyzed in the EndoVac system (2.90 ± 0.12) followed by the rotary files (1.76 ± 0.26) and least was seen with Ultrasonics (1.32 ± 0.14). The p-value of 0.001 was seen between the coronal and apical third with the EndoVac system which is statistically significant. The significant difference statistically was observed between Rotary Files vs. Ultrasonics at apical third and with the EndoVac system vs. Ultrasonics at coronal third as well as at the apical third with p-value 0.001. It can be concluded that the EndoVac technique was effective in removing Ca(OH)2 medicament from the coronal and apical third of the root canal significantly. Calcium hydroxide removal before the obturation was of priority as the Ca(OH)2 remnants have a negative impact of the ability for sealing the obturation material. Therefore, having a complete knowledge regarding the effective technique is much important.

Effectiveness of different irrigation devices on the smear layer removal in the apical portion of curved root canals: A scanning electron microscopy study

Aim: The aim of this study is to evaluate the smear layer removal efficiency of Max-I-Probe, EndoActivator, and EndoVac at three different levels in the apical portion of curved root canals. Materials and Methods: Mandibular molars with angles of root curvature between 25 and 40 degrees were selected and divided into three groups. The specimens were instrumented to size 35/0.04. Group 1 received conventional irrigation with Max-I-Probe needle; Group 2 and Group 3 were irrigated with EndoActivator and EndoVac, respectively. Following shaping and cleaning, the roots were observed under scanning electron microscope for smear layer at three levels (1 mm, 3 mm, and 5 mm from working length). One-way analysis of variance was calculated and to find the exact significance among the groups a post hoc test, i.e., Bonferroni test was performed. Results: The level of significance was set as P Conclusions: The application of EndoVac system could enhance smear layer removal at the apical portion of curved canals.

FESEM evaluation of smear layer removal using different irrigant activation methods (EndoActivator, EndoVac, PUI and LAI). An in vitro study.

This study was to compare the efficacy of EndoActivator, EndoVac, PUI, and LAI methods in removing the smear layer from root canals. Eighty single-rooted mandibular premolars were decoronated to a standardized length of 15mm. Specimens were shaped to ProTaper F4 (Dentsply Maillefer) and irrigated with 5.25% NaOCl at 37°C. Teeth were divided into six groups (two control groups [n=10] and four test groups [n=15]) according to the final irrigation activation/delivering technique (sonic irrigation [EndoActivator], passive ultrasonic irrigation [PUI], negative apical pressure [EndoVac], and laser activated irrigation [LAI]). Root canals were then split longitudinally and observed with field emission scanning electron microscopy to evaluate the presence of smear layer at 1, 3, 5, and 8mm from the apex. Scores were analyzed by Kruskal-Wallis and Mann-Whitney U tests. The EndoActivator was significantly more efficient than PUI, LAI, and control groups in removing the smear layer at 3, 5, and 8mm from the apex. The EndoVac System removed statistically significantly more smear layer than all groups at 1mm from the apex. At 5mm from the apex, EndoActivator and EndoVac removed more smear layer than LAI and control groups. At 5 and 8mm from the apex, PUI and EndoVac did not differ statistically, but both performed statistically better than the control groups. In our study, none of the activation/delivery systems completely removed the smear layer from the root canal walls; nevertheless, EV and EA showed, respectively, statistically significant better results at 1, 3, 5, and 8mm and 3, 5, and 8mm from the apex.

EVALUATION OF ANTIBACTERIAL EFFECT OF DIODE LASER 980 NM, ENDOVAC AND PASSIVE ULTRASONIC IRRIGATION DURING FINAL IRRIGATION

Aim: The purpose of this study is to evaluate the antibacterial effect of Diode laser 980 nm, EndoVac and passive ultrasonic irrigation ex vivo. Methods: One hundred and five maxillary central incisors were standardized to 15mm in length. All samples were prepared using Protaper Universal rotary nickel titanium system till size # F4 then contaminated with E. faecalis. The irrigation protocol used was 2.5% sodium hypochlorite followed by 17% EDTA. Samples were randomly divided into 5 groups (n= 20) according to the irrigant activation method. LAI group, Diode laser 980nm. API group, EndoVac system. PUI group, passive ultrasonic activation. The positive control group, in which the irrigating solution was not activated and the negative control group in which the samples were not subjected to irrigation or activation. Residual bacteria were collected with sterile paper point, plated onto BHI media and incubated (37 °C, 48 h) to determine the colony-forming units (CFU mL-1). Data were analyzed using one-way ANOVA followed by performance of Tukey post hoc tests. Significance was set at p < 0.05. Scanning electron microscopy was used to investigate the changes in biofilm. Results: There was a statistically significant reduction in the mean numbers of colony-forming units among all groups. However, none of the activation methods was able to kill E. faecalis biofilm completely. The LAI group behaved most effectively among all groups.Conclusion: The adjunctive use of 980nm laser is an effective method for bacterial reduction after chemo-mechanical instrumentation of the root canal.

Comparison of the EndoVac system and conventional needle irrigation on removal of the smear layer in primary molar root canals.

This study aimed to compare the EndoVac system and conventional needle irrigation in removing smear layer (SR) from primary molar root canals. Fifty extracted human primary second molar roots were instrumented up to an apical size of 0.04/35 and randomly divided into two main groups; Group 1: EndoVac system (n = 25) and Group 2: Conventional needle irrigation (n = 25) and three subgroups (a) NaOCl + ethylenediaminetetraacetic acid (EDTA) (n = 20) (b) ozonated water (OW) + EDTA (n = 20) and (c) saline (control, n = 10). After a standardized final irrigation protocol performed for all teeth, scanning electron microscope images were taken at ×1000 magnification for each thirds of each root canal. Data were analyzed by the weighted kappa, Kruskal-Wallis, and Wilcoxon signed rank tests. EndoVac was more effective than conventional needle in the removal of SR from the apical third of the root canal system (P < 0.05). The OW + EDTA regimen provided similar SR removal compared with NaOCl + EDTA. EndoVac has better performance than conventional needle irrigation in the removal of the SR in the apical thirds of the primary molar root canals. As a final irrigation regimen, the OW + EDTA regimen is as effective as the NaOCl + EDTA regimen.

Comparison of different agitation methods for the removal of calcium hydroxide from the root canal: Scanning electron microscopy study.

Aim:This ex vivo study compared the efficiency of different irrigations systems to remove calcium hydroxide from root canal walls, especially from the apical third by using scanning electron microscopy (SEM).Materials and Methods:Eighty-four single-rooted teeth were divided into 4 groups of 20 teeth each, according to different irrigation protocols using a 30-gauge slot-tipped needle, ultrasonic irrigation system, erbium-doped yttrium aluminum garnet laser (Er: YAG) laser, and EndoVac system. The rest 4 teeth were used as control groups (2 positive and 2 negative control groups). After coronal access, all teeth were instrumented by Protaper Next rotary files (Dentsply-Maillefer, Ballaigues, Switzerland) up to size X3, followed an irrigation protocol and filled with pure calcium hydroxide powder mixed with saline. Teeth were stored in an incubator for 7 days, and then, calcium hydroxide was removed using 3 techniques: Manually (Group 1), by ultrasonic irrigation (Group 2), by laser Er: YAG and x-pulse tip (Group 3), and by EndoVac system (Group 4). The teeth of control groups were instrumented as the experimental groups; no removal technique was applied in positive group, whereas in negative one, the root canals were left empty. Teeth were sectioned longitudinally and observed under SEM Results were statistically analyzed with the Kruskal–Wallis Test and Mann–Whitney Test.Results:The results showed a significant difference between laser and the other three groups in coronal and middle root third, but no statistic difference in apical third.Conclusion:Laser improved the removal of calcium hydroxide in comparison with conventional techniques.

A Comparative Evaluation of Smear Layer Removal Using Apical Negative Pressure (EndoVac), Sonic Irrigation (EndoActivator) and Er:YAG laser -An In vitro SEM Study.

BackgroundThis study aimed to compare the smear layer removing efficacy of the EndoActivator, EndoVac and Er:YAG laser in extracted mandibular premolars, at the apical, middle and coronal third of root canal, through scanning electron microscopy.Material and Methods40 extracted mandibular premolars were decoronated to a standardized length of 12 mm. Specimens were shaped to ProTaper F4 size and irrigated with 5.25% sodium hypochlorite at 370C between instrumentation. Teeth were divided into four groups (n=10), one control (needle irrigation) and three experimental, according to the irrigant activation technique used i.e. sonic irrigation (EndoActivator), apical negative pressure (EndoVac) or laser (Er:YAG). The final irrigants used were 10ml,17% ethylenediaminetetraacetic acid (EDTA) and 10ml, 5.25% sodium hypochlorite. Root canals were then split longitudinally and observed under a scanning electron microscope. The presence of smear layer at the apical, middle and coronal third of root canal was evaluated. Scores were analyzed by Kruskal-Wallis and Mann-Whitney U tests. Intraexaminer and interexaminer reliability were determined by Kappa test.ResultsThe EndoVac system was significantly more effective in removing debris from the apical third than all other groups. EndoActivator performed better than laser at the apical third. All three experimental groups (EndoVac, EndoActivator, and laser) were better than needle irrigation at the middle and apical third. At the coronal third, no significant difference was seen between the four groups.ConclusionsNone of the activation systems completely removes the smear layer from the dentine walls; nevertheless, EndoVac is significantly better in removing debris from the apical third of canal. Key words:EndoVac, EndoActivator, Er:YAG laser, smear layer, scanning electron microscopy.

Efficiency of Different Endodontic Irrigation and Activation Systems in Removal of the Smear Layer: A Scanning Electron Microscopy Study.

Introduction:This in vitro study was designed to evaluate and compare different endodontic irrigation and activation systems for removal of the intracanal smear layer. Methods and Materials:Forty recently extracted, non-carious human intact single rooted premolars were selected and divided into five groups (n=10) according to the root canal irrigation systems; syringe and needle irrigation (CTR), sonic irrigation, passive ultrasonic irrigation (PUI) and EndoVac irrigation system. All groups were prepared to #40 apical size with K-files. Each sample was subjected to final irrigation by using four different irrigation/activation systems. After splitting the samples, one half of each root was selected for examination under scanning electron microscope (SEM). The irrigation systems were compared using the Fisher's exact test with the level of significance set at 0.05.Results:The four groups did not differ from each other in the coronal and mid-root parts of the canal. In the apical part of the canal none of the methods could completely remove all the smear layer but EndoVac system showed significantly better removal of smear layer and debris than the other methods. Conclusion:Within the limitations of the present study, the EndoVac system cleaned the apical part of the canal more efficiently than sonic, ultrasonic and syringe and needle irrigation.

The Use of Different Irrigation Techniques to Decrease Bacterial Loads in Healthy and Diabetic Patients with Asymptomatic Apical Periodontitis.

BACKGROUND:Diabetes mellitus is a multisystem disease which weakens the human’s immunity. Subsequently, it worsens the sequelae of apical periodontitis by raising a fierce bacterial trait due to the impaired host response.AIM:This study aimed to estimate bacterial reduction after using different irrigation techniques in systemically healthy and diabetic patients with asymptomatic apical periodontitis.MATERIAL AND METHODS:Enterococcus faecalis, Peptostreptococcus micros, and Fusobacterium necleatum bacteria were chosen, as they are the most common and prevailing strains found in periodontitis. Bacterial samples were retrieved from necrotic root canals of systemically healthy and diabetic patients, before and after endodontic cleaning and shaping by using two different irrigation techniques; the conventional one and the EndoVac system. Quantitive polymerase chain reaction (qPCR) was utilised to detect the reduction in the bacterial count.RESULTS:The EndoVac irrigation system was effective in reducing bacteria, especially Peptostreptococcus micros in the diabetic group when compared to conventional irrigation technique with a statistically significant difference.CONCLUSION:The EndoVac can be considered as a promising tool in combination with irrigant solution to defeat the bacterial colonies living in the root canal system. Additional studies ought to be done to improve the means of bacterial clearance mainly in immune-compromised individuals.

Supplementary Steps for Removing Hard Tissue Debris from Isthmus-containing Canal Systems

IntroductionThe purpose of this ex vivo study was to evaluate the percentage reduction of accumulated hard tissue debris (AHTD) in the mesial root canal system of mandibular molars under different final irrigation regimens by means of micro–computed tomographic imaging. MethodsSixty curved mesial roots of mandibular molars with 2 independent canals joint apically by an isthmus (Vertucci type II) were selected. Specimens were scanned at a resolution of 12.5 μm, anatomically matched, and distributed into 3 groups (n = 20) according to the preparation protocol: Self-Adjusting File (SAF; ReDent Nova, Ra'anana, Israel), Reciproc (VDW GmbH, Munich, Germany), and Revo-S (Micro-Mega, Besançon, France) systems. Then, each group was subdivided into 2 subgroups (n = 10) according to the final irrigation protocol with the SAF or EndoVac system (Discus Dental, Culver City, CA). The percentage volume and percentage reduction of AHTD after root canal preparation and final irrigation protocols were statistically compared using 1-way analysis of variance, the paired sample and the independent Student's t tests. The level of significance was set at 5%. ResultsWithin groups, the mean percentage volume was significantly reduced after the final irrigation procedures in either the SAF (from 1.52%–1.78% to 1.01%–1.20%) or EndoVac (from 2.11%–2.23% to 1.31%–1.52%) subgroups (P < .05). In the experimental groups, the mean percentage reduction of AHTD ranged from 29.15%–39.90% after the irrigation protocols, with no statistical difference between groups (P > .05). ConclusionsNone of the irrigation approaches succeeded in rendering the mesial root canal system free of AHTD. A similar percentage reduction of AHTD was achieved after final irrigation protocols using either the SAF or EndoVac system.