Irrigation Activation Techniques Research Articles

Comparative analysis of the effectiveness of modern irrigants activation techniques in the process of mechanical root canal system treatment (Literature review)

Development of apical periodontitis is the most common complication of unsuccessful endodontic treatment. Cleaning the root canal system is a crucial stage and the main factor for a successful endodontic protocol. Inability to remove debris from inaccessible branches of the root canal system, especially from the apical region, leads to and increases the risk of secondary infection. Selection of the optimal method for activating irrigants remains a current issue. According to the results of several studies, none of the individual irrigation activation techniques allows achieving ideal cleanliness in the root canal, but the use of laser, sonic, multisonic, and ultrasonic activation significantly improves the quality of cleaning and provides a prolonged antimicrobial effect by enhancing the diffusion of intracanal antiseptics, their hydrolytic and antibacterial effectiveness, which will eventually ensure maximum adhesion of filling materials. This, in turn, indicates the absence of a unified protocol that would provide stable irrigation efficiency and long-term results in endodontic treatment. The use of a protocol with combined activation of irrigants remains an open question among clinicians and scientists.

Evaluation of Residual Root Canal Sealer Removal Efficacy of Different Irrigation Activation Techniques by Confocal Laser Microscopy Analysis

Objective: The purpose of this study was to use confocal laser microscopy analysis to evaluate the effectiveness of conventional needle irrigation (CNI), EndoActivator (EA), and EDDY during endodontic retreatment.
 Methods: This study included 45 maxillary incisor teeth with a single root and canal. Root canals were prepared with ProTaper Universal files (Dentsply Sirona, Ballaigues, Switzerland) and obturated with labeled sealer mixed with 0.1% Rhodamine B and gutta percha according to single cone techniques. Initial root canal filling material was removed using ProTaper Universal Retreatment files and F4 files. Teeth randomly were divided into 3 groups (n = 15) depending on the activation technique: CNI, EA (Dentsply, Tulsa Dental Specialties, Tulsa, OK), and EDDY (VDW, Munich, Germany). Confocal laser microscopy was used to evaluate the penetration area, depth, and percentage of the residual sealer in the apical, middle, and coronal sections after irrigation activation.
 Results: In all sections, the EDDY group had a lower penetration area of residual sealer than the CNI group (P< .05). In comparison to the coronal section, the penetration percentage of the CNI and EA groups was lower in the apical section (P< .05). In the CNI group, the penetration depth was higher at the coronal section than at the apical and middle sections (P< .05), and it was higher at the coronal section than at the apical section.
 Conclusion: Within the limitations of this study, none of the activation systems tested could completely remove the residual sealer. However, the lowest residual sealer was seen after using EA and EDDY.

Effectiveness of Different Irrigation Techniques on Post Space Smear Layer Removal: SEM Evaluation

Background: Effective debris and smear layer removal affects post-cementation and bond strength. Aim: The aim was to compare the effectiveness of debris and smear layer removal using standard irrigation and activated irrigation with heated EDTA. Moreover, an irrigant activation technique was chosen in the current research, employing the ultrasonic activation of an EDTA solution after being heated directly inside the post space preparation. Materials and Methods: 30 single-rooted human mandibular premolar teeth were used in the current study to test the proposed techniques. First, the teeth were cut to have standardised roots 18 mm in length and prepared endodontically, and then the post space was carried out on all the samples. Then the specimens were randomly distributed into three study groups according to the post space irrigation technique. In detail, the groups were group 1, where a 3D cleaning technique was used; group 2, where the traditional irrigation with EDTA was applied; and group 3, where only saline as an irrigant was used. The third group was considered the control group. Next, the teeth were segmented and analysed via scanning electron microscopy (SEM). The magnification was used to evaluate and score the smear layer and debris. Statistical analysis was undertaken using the classic statistical software package (SPSS, version 28.0; SPSS IBM, Armonk, NY, USA). Then, the data were interpreted with a non-parametric analysis of variance (Kruskal–Wallis ANOVA) among the experiment groups. The significance level was decided as p < 0.05. In addition, statistically significant (p < 0.05) lower mean smear layer and debris scores were found in both the examination groups compared to the control group. Results: group 1 demonstrated better results compared to group 2 in terms of cleaning the dentinal walls. Conclusions: The current research concluded that the EDTA 3D cleaning technique is an effective irrigation technique for clearing debris and smear layers in the post space. Future research, such as on push-out bond strength, should be used to verify this research’s conclusions. Key findings: The use of ultrasonically activated heated EDTA improved the smear layer removal. The use of the 3D cleaning technique resulted in better post space cleaning.

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 Different Irrigation Activation and Condensation Techniques on the Marginal Adaptation of White MTA

Effect of Different Irrigation Activation and Condensation Techniques on the Marginal Adaptation of White MTA

Cleaning Efficacy of Different Final Irrigation Activation Techniques

Cleaning Efficacy of Different Final Irrigation Activation Techniques

Cleaning Efficacy of Different Final Irrigation Activation Techniques

Cleaning Efficacy of Different Final Irrigation Activation Techniques

Postoperative Pain After Using Passive Ultrasonic Irrigation and EasyClean Device, Irrigation Activation Techniques: A Randomized Clinical Trial

IntroductionThis randomized clinical trial aimed to compare postoperative pain after the use of 2different irrigation activation techniques: passive ultrasonic irrigation and the EasyClean device. MethodsSixty-six single-rooted teeth diagnosed with asymptomatic pulp necrosis and apical periodontitis were randomly assigned to 2experimental groups (n = 33), which differed in the irrigation activation technique. Postoperative pain levels were assessed after 24, 48, and 72 hours using a verbal rating scale; the ibuprofen intake amount was recorded at the same time intervals. Data were analyzed using Student's t-test, Mann–Whitney U and Fisher's exact tests, with a significance level of 5%. ResultsPostoperative pain levels and analgesic intake frequency were not significantly different across the 2irrigation activation techniques (P > .05). The frequencies obtained in relation to the prevalence of postoperative pain were 3.1-25.8% for all participants of the 2studied groups. ConclusionThe irrigation activation techniques of passive ultrasonic irrigation and the EasyClean device were found to be equivalent in terms of postoperative pain and analgesic intake.

Assessment of debris extrusion on using step-wise irrigant activation versus conventional activation in different access designs: An ex-vivo study

Introduction: A successful endodontic therapy mainly depends on the effective chemomechanical debridement. The present study assessed the effect of different activation modes on debris extrusion in different access cavity designs. Materials and Methods: Freshly extracted 168 maxillary premolars were collected. They were allocated into two groups (n = 84) (Group I: Traditional Endodontic Access (TEA) and Group II: Contracted Endodontic Access (CEA)). These groups were further subgrouped (n = 28) based on the activation protocol used (Subgroup A, D: Manual irrigation with no activation, Subgroup B, E: Conventional activation (CA), and Subgroup C, F: Step-wise irrigant activation). Each tooth specimen was inserted into Eppendorf for debris collection. The canals were instrumented using HyFlex CM rotary files to 0.04 taper. The irrigation was specific to the experimental subgroups, which was done by a single operator. Following the experimental irrigation, the collected debris was weighted using an analytical balance. The collected data were statistically analyzed. Results: Statistical significant debris extrusion was seen with TEA (P &lt; 0.05). Among the subgroups, step-wise irrigant activation technique showed significant (P &lt; 0.05) debris extrusion. Conclusion: CEA showed less debris extrusion when the CA technique was used for irrigation.

Antimicrobial effectiveness of different irrigation activation techniques on teeth with artificial internal root resorption and contaminated with Enterococcus faecalis: a confocal laser scanning,icroscopy analysis.

This study aimed to compare the antibacterial efficacy of standard needle irrigation (SNI), EDDY, passive ultrasonic irrigation (PUI), photon-induced photoacoustic streaming (PIPS), and shock wave enhanced emission photoacoustic streaming (SWEEPS) activation on the teeth with simulated internal root resorption (IRR) and contaminated with Enterococcus faecalis (E. faecalis) using confocal laser scanning microscopy (CLSM) analyses. A total of 79 human maxillary central incisors with a single canal were selected. The canals were accessed, and then, the roots were split in the bucco-lingual direction. Artificial IRR cavities (depth of 0.8mm and a diameter of 1.6mm) were prepared using round burs and 20% nitric acid in the middle region of the root halves. The root halves were reconstructed with cyanoacrylate glue, and the canals were contaminated with a culture of E. faecalis for 30days. Root canal preparation was performed using the ProTaper Next rotary files up to X5 and 2.5% NaOCl irrigation. Teeth were randomly assigned to five groups according to the irrigation activation method (n = 15): SNI, EDDY, PUI, PIPS, and SWEEPS. The final irrigation procedures were performed using a total of 6mL of 2.5% NaOCl for each tooth with an activation time of 3 × 30s. The canals were stained with LIVE/DEAD BacLight dye and analyzed with CLSM to determine the percentages of dead bacteria in the biofilm. Two-way ANOVA and post hoc Tukey tests were used for statistical analysis (P < .05). None of the irrigation activation methods tested provided 100% bacterial elimination. There was no significant difference between the irrigation activation methods tested in terms of the percentage of dead bacteria (P > 0.05). In irrigation activation methods other than PIPS, there was no significant difference in the percentage of dead bacteria between the coronal, middle, and apical regions of the roots (P > 0.05). A higher percentage of dead bacteria was found in the middle region compared to the apical region in the PIPS (P < 0.05). Within the limitations of this study, SII, EDDY, PUI, PIPS, and SWEEPS have a similar antimicrobial effect on the teeth with IRR and contaminated with E. faecalis.

Efficacy of different irrigant activation techniques for cleaning root canal anastomosis

ObjectiveThis study compared in vitro the anastomosis cleaning efficacy of different irrigant activation techniques at different levels; control group non-activation (NA), passive ultrasonic irrigation (PUI) using Irrisafe, and EDDY sonic activation.MethodsSixty anastomosis-containing mesial roots of mandibular molars were mounted in resin, sectioned at 2, 4, and 6 mm from the apex. Then reassembled and instrumented in a copper cube. For the irrigation technique roots were randomly divided into 3 groups (n = 20): group 1: NA, group 2: Irrisafe, group 3: EDDY. Stereomicroscopic images of anastomoses were taken after instrumentation and after irrigant activation. ImageJ program was used to calculate the percentage of anastomosis cleanliness. The percentage of cleanliness was calculated before and after final irrigation within each group and were then compared using paired t-tests. Intergroup and intragroup analyses were performed to compare between different activation techniques at the same root canal level (2, 4 and 6 mm) (intergroup) and to evaluate if each technique had different cleanliness efficacy according to the root canal level (intragroup) using one-way analysis of variance and post hoc tests (p < 0.05).ResultsAll three irrigation techniques significantly improved anastomosis cleanliness (p < 0.001). Both activation techniques were significantly better than the control group at all levels. Intergroup comparison revealed that EDDY significantly achieved the best overall anastomosis cleanliness. The difference between EDDY and Irrisafe was significant in favor to EDDY at 2 mm and insignificant at 4 and 6 mm. The intragroup comparison showed that improvement in anastomosis cleanliness (i2-i1) in the needle irrigation without activation group (NA) was significantly higher in the apical 2 mm level compared to the 4 & 6 levels. While the difference in anastomosis cleanliness improvement (i2-i1) between levels in both Irrisafe and EDDY groups was insignificant.ConclusionsIrrigant activation improves anastomosis cleanliness. EDDY was the most efficient in cleaning anastomoses located in the critical apical part of the root canal.Clinical relevanceCleaning and disinfection of the root canal system followed by apical and coronal sealing is the key for healing or prevention of apical periodontitis. Remnants of debris and microorganisms retained within the anastomoses (isthmuses), or other root canal irregularities may lead to persistent apical periodontitis. Proper irrigation and activation are essential for cleaning root canal anastomoses.

CURRENT TRENDS IN THE USE OF IRRIGANT ACTIVATION TECHNIQUES AMONGST ENDODONTIST AND GENERAL DENTISTS IN CENTRAL INDIA - A KNOWLEDGE AND PRACTICE BASED SURVEY

Aim - To assess the knowledge and practice of Irrigant Activation Techniques amongst Endodontist and General Dentists in Central India. Materials And Methods - In this online survey a questionnaire consisting of 14 closed ended questions was distributed among Dental Health Care Professionals including Endodontists and General Dentists. Total 202 Responses were collected through google forms. The questionnaire included questions that are focused on Irrigation activation technique based on the knowledge and practice. All statistical analysis was doing using Statistical Packages of Social Science SPSS version 21 and p value less the 0.05 was considered statistically signicant. Results - The usage of irrigation activation technique was more in Endodontists as compared to general dentist. Our data indicated that 94.5% of respondents use sodium hypochlorite (NaOCl) as the primary endodontic irrigant. 85.1% participants use manual dynamic agitation. 55.7% of our respondents aim to remove the smear layer during the endodontic treatment . The mean knowledge score was signicantly high among Endodontists as compared to the General dentists. (p&lt;0.05) Conclusions - The knowledge and attitude of Endodontists &amp; General dentist is largely positive towards use of Irrigant Activation Technique (IAT) in Central India

Comparative analysis of reduction in pain scores after single visit root canal treatment using endodontic irrigation protocols, namely, Conventional needle irrigation, PUI, PIPS and SWEEPS: A randomized control trial.

To assess the effects of different irrigation activation systems on postoperative pain using a Visual Analog Scale (VAS), using new laser irrigation activation system shock wave-enhanced emission photoacoustic streaming (SWEEPS), photon-induced photoacoustic streaming (PIPS), passive ultrasonic irrigation activation techniques, compared with the conventional irrigation (CI) method. Sixty patients suffering from symptomatic irreversible pulpitis in maxillary or mandibular molars were enrolled and randomly assigned to four different irrigation activation groups (n = 15) after chemomechanical root canal preparation. Preoperative and postoperative pain scores were recorded using VAS. The data were collected and subjected to statistical analysis using IBM SPSS 20.0 software at a level of significance being 0.05. We observed that mean pain scores decreased with time in all patients in all groups. The decrease in pain score was found to be statistically significant (P < 0.05) among both the genders in Group 3 (PIPS) and Group 4 (SWEEPS). Postoperatively, pain scores decreased significantly using Group 4 (SWEEPS), followed by Group 3 (PIPS), Group 2 (ultrasonic activation), and Group 1 (conventional needle irrigation). No significant relation was observed statistically between pain scores and age groups among all groups, except for preoperative score in Group 3 and age groups. Postoperative scores were lower in laser-activated irrigation systems as compared to the other activation systems. The highest pain scores were observed in case of CI method, at pre- and post-operative periods.

Evaluating the Effectiveness of Different Irrigant Activation Techniques in Removing the Smear Layer and Opening the Dentinal Canals: A Scanning Electron Microscopic Study.

Background Although irrigation is one of the most important stages during root canal treatment, it is not possible to guarantee the entry of irrigants to all the areas in the root canal, especially in the apical third. Therefore, the activation of irrigants can stimulate and help the irrigants to access hard-to-reach places within the root canal system. Therefore, this study aimed to evaluate the opening of the dentinal canals with scanning electron microscopy (SEM) using different irrigant activation techniques, such as intracanal heating activation, sonic activation, and ultrasonic activation, along the walls of the root canals in the coronal, middle, and apical thirds. Methodology The study sample consisted of 36 single-canal premolars, which were randomly divided into the following three equal groups according to the method of activation used: group 1 (n = 12), which involved heating activation inside the root canals, group 2 (n = 12), which involved sonic activation, and group 3 (control; n = 12), which involved ultrasonic activation. Afterward, dental crowns were cut to standardize the working length by 18 mm and were then prepared using the ProTaper Next system up to size X2. Moreover, the irrigant was activated for each group separately, and the teeth were extracted and prepared for SEM. Three images were taken for each sample (i.e., coronal third, middle third, and apical third) at ×2,000 magnification. Data were analyzed using the Mann-Whitney U test. Results When studying the removal of the smear layer and the opening of the dentinal canal under ×2,000 magnification, there were no statistically significant differences in the coronal and middle third between the three studied groups. However, statistically significant differences were found in the apical third, where the ultrasonic activation group was the best, followed by the sonic activation group, and the heating activation group. Conclusions All methods of activation were effective in removing the smear layer and opening the dentinal canals with the advantage of ultrasonic activation in the rest of the groups.The intracanal heating irrigant activation proved to be similar to the effectiveness ofsonic activation and close to ultrasonic activation.

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).

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.

Порівняльний аналіз ефективності сучасних методів активації іригантів у протоколі хемо-механічної обробки системи кореневого каналу (огляд літератури)

Resume. Development of apical periodontitis is the most common complication of unsuccessful endodontic treatment. Cleaning the root canal system is a crucial stage and the main factor for a successful endodontic protocol. Inability to remove debris from inaccessible branches of the root canal system, especially from the apical region, leads to and increases the risk of secondary infection. Selection of the optimal method for activating irrigants remains a current issue. According to the results of several studies, none of the individual irrigation activation techniques allows achieving ideal cleanliness in the root canal, but the use of laser, sonic, multisonic, and ultrasonic activation significantly improves the quality of cleaning and provides a prolonged antimicrobial effect by enhancing the diffusion of intracanal antiseptics, their hydrolytic and antibacterial effectiveness, which will eventually ensure maximum adhesion of filling materials. This, in turn, indicates the absence of a unified protocol that would provide stable irrigation efficiency and long-term results in endodontic treatment. The use of a protocol with combined activation of irrigants remains an open question among clinicians and scientists. Key words: endodontics, root canal, irrigation, activation, Sodium hypochlorite, smear layer, debris, ultrasonic, sonic activation, laser, Gentlewave, SAF (Self-Adjusting File), XP-Endo Finisher.

Comparison of apical extrusion of sodium hypochlorite in immature teeth after needle irrigation, ultrasonic irrigation, EDDY, Er:YAG, and diode lasers.

This study aimed to assess the apical extrusion of sodium hypochlorite in immature teeth caused by needle irrigation, ultrasonic irrigation, EDDY, Er:YAG, and diode lasers. Seventy-five human maxillary anterior teeth were selected. After the apical 3mm of the roots was resected, the canal lumen was enlarged with #2 to #5 Gates-Glidden burs. The teeth were fixed to the lid of a flat-sided clear plastic container, and the plastic containers were filled with 0.2% agarose gel containing 1mL of 0.1% m-cresol purple. Then, the specimens were allocated into five groups according to the irrigation activation techniques: needle irrigation, ultrasonic irrigation, EDDY, Er:YAG laser, and diode laser. The apical extrusion of sodium hypochlorite caused the color change in the gel. The containers were digitally photographed, and the percentage of pixels of irrigant extrusion (the color change) in each photograph was calculated. The diode laser group showed a significantly lower percentage of pixels than needle irrigation, EDDY, and Er:YAG laser (p < 0.05). The irrigant extrusion value of the ultrasonic irrigation group was significantly lower than that of the EDDY and Er:YAG laser groups (p < 0.05). There was no significant difference between the other groups (p > 0.05). All the groups caused irrigant extrusion in the immature teeth. The diode laser and ultrasonic irrigation caused less sodium hypochlorite extrusion than EDDY and Er:YAG laser. The needle irrigation showed more irrigant extrusion than the only diode laser group.

Evaluation of Postoperative Pain Following Sonic and Ultrasonic Root Canal Irrigation Activation Protocols in Patients with Non-vital Teeth Associated with Apical Periodontitis (Randomized Clinical Trial

Aim: Evaluate the degree of postoperative pain in patients with necrotic teeth with symptomatic apical periodontitis in mandibular first molar teeth at 6, 12, 24, 48 and 72 hrs time interval after using different irrigation activation techniques in single-visit endodontic treatment. Material and Methods: Seventy-eight patients diagnosed with necrotic mandibular first molar with symptomatic apical periodontitis were randomly allocated into 1 of 3 separate groups (n=26); Navitip group (control), EndoUltra group, or Eddy group. After a single visit root canal treatment and a specific method of agitation, depending on each group, the patients were given a questionnaire on which the patient would mark the degree of pain in a scale from 0 to 10 at 6, 12, 24, 48, 72 hours and 7 days post-obturation. Data were statistically analyzed with a significance level of P≤0.05. Results: EndoUltra ultrasonic agitation and Eddy sonic agitation as a final irrigation protocol showed significantly lower pain values than the control group, but there was no significant difference in pain values between the experimental groups. Conclusion: There was significantly less pain associated with EndoUltra ultrasonic and Eddy sonic agitation compared to Navitip irrigation

The efficiency of different irrigation activation techniques in the removal of calcium silicate-based endodontic sealer from artificially created groove.

This study evaluated the removal of a calcium silicate-based sealer (EndoSeal MTA) with needle irrigation (NI), passive ultrasonic irrigation (PUI), XP-endo Finisher (XPF) and EDDY. A total of 56 human mandibular premolars were instrumented up to size 40.04 taper. The roots were separated longitudinally, and grooves were prepared with an ultrasonic tip at one-half of each root canal. The grooves were covered with EndoSeal MTA and re-attached roots were investigated based on the activation techniques applied. The results showed that significantly more material (p < 0.05) was removed in the EDDY group compared to the NI, PUI and XPF groups in the apical region. In the coronal region, no significant difference was observed between EDDY, XPF and PUI (p > 0.05), whereas all the latter were significantly more effective than NI (p < 0.05). These findings show that the removal of EndoSeal MTA can be more effective with EDDY compared to XPF, PUI and NI in the apical region.