Irrigation Activation Techniques Research Articles

Evaluation of canal patency and cleanliness following retreatment of bioceramic sealer-obturated root canals using three different irrigant activation protocols.

This study evaluated the effectiveness of three different irrigant activation techniques in cleaning and establishing patency during retreatment of root canals obturated with gutta-percha and bioceramic sealer. 60 extracted premolars with oval-shaped canals were instrumented and obturated with gutta-percha and EndosequenceBC sealer using the 'warm hydraulic condensation' technique. The teeth were retreated using Protaper Universal Retreatment and XP-Endo Shaper system and divided into four groups according to the irrigant activation protocol used: control, passive ultrasonic irrigation (PUI), Endovac irrigation (EVI) and XP-Endo Finisher R (XPFR). Apical patency was achieved in all the samples of the XPFR group (100%), which showed a significantly higher success rate compared with the control (73.3%) and EVI groups (73.3%) (p < 0.05). The scanning electron microscopic evaluation revealed significantly cleaner middle and apical third root canals in the PUI and XPFR groups compared with the control group (p < 0.05). These findings suggest that XPFR effectively cleans and establishes patency in root canals filled with bioceramic sealers.

Effects of different irrigation activation methods on root canal treatment of primary teeth.

There is currently a lack of research on the application of newly developed irrigation techniques in root canal treatment of primary teeth. This study aimed to evaluate the effects of various irrigation activation techniques on two key parameters: apical debris extrusion (ADE) and dentinal tubule penetration depth (DTPD) of the root canal filling material. A total of 96 primary mandibular second molars were randomly divided into 4 groups: Group 1-Conventional Needle Irrigation (CNI), Group 2-XP-Endo Finisher (XPF), Group 3-EndoActivator (EA), and Group 4-Passive Ultrasonic Irrigation (PUI). In all groups, the One Reci single-file system was used for root canal preparation. For ADE measurement, each group was rinsed with distilled water. For DTPD assessment, sodium hypochlorite (NaOCl) was applied. ADE quantification was performed by collecting debris in pre-weighed Eppendorf tubes. A combination of fluorescent dye and root canal filling material (DiaPex Plus) was used for root canal filling. In order to examine DTPD, horizontal cross-sections of the coronal and apical regions of the teeth were taken with a thickness of 1 mm. The maximum and mean DTPD was examined by confocal laser scanning microscopy. Data were analyzed using the Kruskal-Wallis, One-way ANOVA, and Mann-Whitney U tests (p = 0.05). As a result, PUI had the highest mean ADE and CNI had the lowest mean ADE, while CNI had the highest mean DTPD in both the coronal and apical regions, whereas PUI had the lowest mean DTPD in the coronal region, and EA had the lowest mean DTPD in the apical region. There were no statistically significant differences in DTPD and ADE among the four groups. Comparing intragroup maximum DTPD across all groups, it was significantly higher in the coronal region than in the apical region (p < 0.05). ADE and DTPD of root canal filling materials in primary teeth did not differ significantly among CNI, XPF, EA and PUI irrigation activation techniques.

Comparative evaluation of smear layer removal by using different irrigant activation techniques: An in vitro scanning electron microscopic study.

This in vitro study aims to assess and compare the effectiveness of different irrigation activation techniques in removing the smear layer from the root canal dentin using Scanning electron microscope (SEM) analysis. A total of 60 extracted single-rooted premolar with straight canal and mature apex were used for this study. After the selection of teeth, all the samples were decoronated followed by biomechanical preparation. The sample after preparation was irrigated with sodium hypochlorite and randomly divided into three groups with 20 sample in each group (n = 20), (Group 1) control, (Group 2) ultrasonic, and (Group 3) laser. The irrigant activation was done in all the groups and then sample was prepared for the scanning electron microscope analysis. The statistical analysis was performed using the Mann-Whitney-U-test. The findings suggested that the diode laser irrigant activation technique was superior to the ultrasonic and conventional techniques to eradicate smear layers. With the limitation of this study, diode laser activation showed better cleaning of root dentinal walls compared to ultrasonic activator and traditional method.

Debris and Smear Layer Removal in Curved Root Canals: A Comparative Study of Ultrasonic and Sonic Irrigant Activation Techniques.

The aim of this study was to compare the cleaning efficacy of three irrigant activation devices with a control of non-activated syringe and needle irrigation in curved root canals. Sixty human curved roots were endodontically prepared and divided into four groups (n = 15) with similar root curvature distributions. Final irrigation using 4% NaOCl was performed with a syringe and needle (30-G) alone, or with Eddy sonic powered irrigation system (polymeric tip #0.25/0.06), Endosonic ultrasonic activation (polymeric tip #0.25/0.03), or Irrisafe ultrasonic activation (stainless-steel tip, #0.25/0.00). SEM was used to evaluate cleaning efficacy, employing five-score systems for debris and smear layer. While no significant difference in debris removal was observed between Endosonic or Irrisafe activation and non-activated irrigation, Eddy sonic powered irrigation system significantly improved debris removal in the apical third of curved root canals. Smear layer removal was effective in coronal and mid-root sections for all groups but less so in the apical third. Thus, Eddy sonic powered irrigation system demonstrated higher efficacy in removing debris from the apical third of curved root canals compared with non-activated syringe and needle irrigation. However, all three irrigant activation systems exhibited no difference from the non-activated control in smear layer removal.

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 &lt; 0.05), while it was insignificant for the AHP sealer (p &gt; 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.

Analysis of the depth of penetration of an epoxy resin-based sealer following a final rinse of irrigants and use of activation systems: An in vitro study.

The objective of the study was to compare and evaluate the depth of penetration of an epoxy resin-based sealer following a final rinse of 17% ethylenediaminetetraacetic acid (EDTA) and 18% 1-hydroxyethylidene 1, 1-diphosphonate (HEDP), with diode laser and passive ultrasonic activation (PUI): an in vitro confocal laser scanning microscopy study. Fifty-two extracted human mandibular premolar teeth with single root and single canal were selected. They were disinfected in 0.1% thymol solution, cleaned of calculus and soft tissues, and stored in 0.1% thymol solution till use. All teeth were radiographed and selected as per the inclusion and exclusion criteria. The teeth were decoronated using a diamond disk under copious water spray to acquire a standardized root length of 14 mm. Working length was established by inserting a size 10-K file into each root canal until it is visible at the apical foramen and by subtracting 1 mm from the recorded length. Instrumentation of the root canal was done till master apical file size of F3 using ProTaper universal, rotary instruments. The canals were irrigated with 2 mL of 3% sodium hypochlorite between successive files. Teeth were randomly divided into four subgroups n = 12 according to the intervention. Passive ultrasonic irrigation and diode laser were used to activate the irrigants. Final irrigation was performed with distilled water. These specimens were examined using confocal laser scanning microscope (OLYMPUS FLUOVIEW FV 3000) for dentinal tubule penetration of the sealer. Two-way ANOVA test and Tukey's multiple post hoc test were used for statistical analysis. Highly significant difference was seen between the groups with EDTA and HEDP, with HEDP demonstrating the highest penetration. Among the activation techniques used in this study, PUI showed the highest penetration of the sealer. The least penetration was seen with diode laser activation and EDTA. The irrigation activation techniques significantly influence the penetration of sealer into root dentinal tubules. When penetration of sealer with different irrigation techniques and irrigants was evaluated, significant greater level of sealer penetration was attained with PUI activation of HEDP.

Antibacterial effectiveness of different final irrigation activation techniques.

Background and objective: To evaluate and compare the antibacterial effectiveness of ultrasonic, diode laser, XP endo finisher and finisher gentle file brush against Enterococcus faecalis in root canal dentin. Methods: Fifty-five single-rooted extracted mandibular premolars were decoronated to have a length of 12 mm, instrumented biomechanically with protaper Next up to size X3. After sterilization, five roots were selected as negative controls and the remaining teeth were inoculated with E. faecalis and incubated for 48 hr and at 37 ºC. The roots were then randomly divided into five groups (n=10), GI: Control group, GII: 5.25% NaOCl irrigation was activated by the ultrasonic system , GIII: By 980-nm diode laser , GIV: By Xp-endo finisher and GV : Activated by Finisher gentle file-brush. The antimicrobial efficacy was tested by collecting transfer fluid saline from the canals and counting the colony forming units (CFUs) of viable E. faecalis on agar plates. The statistical calculations were performed in JMP pro 14.3.0. using Analysis of Variance (ANOVA) followed by a Tukey test to define the differences between the tested groups. Result: The mean bacterial CFU were 10.6 X 10^7 for Finisher gentle file brush, 35.6×10^7 for Diode laser, 39.6×10^7 for ultrasonic and 42.3×10^7 for XP Endo Finisher. Finisher gentle file brush showed a significant reduction in the colony count compared to the other groups. Conclusion: None of the irrigation activation techniques removed the bacteria completely from the canal. The four tested irrigation activation techniques were shown to be effective in the disinfection of the E. faecalis-contaminated root canals. Finisher gentle file brush was the most effective against E. faecalis, while XP endo finisher was the least effective against E. faecalis. treatment against E. faecalis in the root canal. Keywords: Utrasonic, Diode laser, XP endo finisher, irrigation activation techniques

Evaluation of efficacy of photodynamic disinfection against enterococcus faecalis and compare it with the effect of different endodontic irrigant activation techniques.

Background and objective: The aim of this in vitro study was to assess the efficacy of photodynamic disinfection against Enterococcus faecalis, and compare it with the effect of different endodontic irrigant activation techniques. Methods: Fifty single-rooted premolars with single canals were chosen for the study. Five teeth were chosen to serve as the negative control group. The remaining samples were infected with normal Enterococcus faecalis strains. They were then randomly separated into five groups, with nine teeth serving as a positive control group (E. Cont.). Each group consisted of 9 samples based on the kind of irrigant activation: E.A (Diode laser), E.B (Ultrasonic), E.C (conventional), and E.D (FotoSan). The ProTaper NEXT rotary system up to model X3 was used to prepare all samples. For each group, 5.25% NaOCl was injected as an initial irrigant with a 30G double-side vented syringe needle, followed by 17% EDTA, then activated with NaOCl as a final irrigant. CFU of each sample was counted before and after irrigation regime, and they were compared to the control group. The efficiency of the disinfection techniques was determined using scanning electron microscopes (SEM). Result: The quantity of bacterial colony counting revealed that the control group had the largest mean of a bacterial colony (135.56±50.58); while the FotoSan group had the lowest colony mean number (23.11±9.82). SEM results indicated that the FotoSan group (5.56±3.16) and Diode laser (5.56±3.57) had the lowest surviving colony mean number. Conclusion: As an additional method, photodynamic therapy may increase the disinfection capacity of traditional endodontic treatment against E. faecalis in the root canal. Keywords:photodynamic disinfection, enterococcus faecalis, endodontic irrigant activation

Effect of Different Irrigant Activation Techniques on the Penetration of Calcium Hydroxide, an Intracanal Medicament: An In Vitro Study

Effect of Different Irrigant Activation Techniques on the Penetration of Calcium Hydroxide, an Intracanal Medicament: An In Vitro Study

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.

Histological evaluation of the debris removal efficiency of activation of sodium hypochlorite solution at different concentrations

BackgroundThis study aims to histologically evaluate the efficiency of debris removal through activation of 2.5% and 5.25% NaOCI using laser, ultrasonic, and intracanal heating methods.MethodsSixty-four maxillary central incisor teeth were randomly divided into two groups according to the irrigation solution (n = 32); 2.5% NaOCI and 5.25% NaOCI. Subsequently, the samples were further divided into four subgroups according to the final irrigation activation technique (n = 8); SubgroupA: Er,Cs:YSGG laser, SubgroupB: Ultrasonic, Subgroup C: Intracanal heating, Subgroup D: no activation. Generalized Linear Models and Bonferroni tests were used for statistical analysis (p < 0.05).ResultsThe effect of NaOCI concentration was statistically significant (p < 0.001). Furthermore, the activation of NaOCI by laser exhibited a statistically significant difference compared to the ultrasonic and intracanal heating methods (p < 0.001).ConclusionThe efficiency of root canal cleaning increases with higher NaOCI concentration. Activation of NaOCI also significantly enhances its effectiveness.

Assessment of Penetrability for Different Endodontic Irrigation Activating Techniques Using Cone-Beam Computed Tomography and Periapical Digital Radiography—An In Vitro Study

The elimination of necrotic and inflamed pulp tissue, dentin debris, and microorganisms is essential for the success of endodontic treatment. However, the root canal’s complexity has led to incomplete cleaning and disinfection. This study aims to compare the efficacy of the penetrability of three different irrigation activating techniques to the apical third of the root canal. Sixty sound single-rooted human mandibular premolars are prepared with rotary instrumentation under continuous sodium hypochlorite irrigation. Three irrigation activation techniques are utilized: group 1 (n = 20), conventional needle irrigation (CN); group 2 (n = 20), side-vented endodontic needle irrigation (EN); and group 3 (n = 20), manual activation irrigation with gutta-percha cone (MA). The penetrability is assessed with the aid of a radiopaque irrigation solution using digital radiography in conjunction with cone-beam computed tomographic (CBCT) measurements. Data are analyzed using a statistical package for social sciences (SPSS), using multiple comparisons to compare the baseline and test values. One-way analysis of variance with post hoc analysis (Tukey honestly significant difference) is performed to detect the statistically significant differences between groups. Manual activation (MA) shows effective delivery of the irrigant into full WL, followed by endodontic needle (EN) and conventional (CN) methods of activation (p &lt; 0.001). The results of the present study show that maximum penetrability of the irrigant is observed with manual activation (MA) using a gutta cone in comparison with the conventional needle (CN).

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.&#x0D; 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.&#x0D; Results: In all sections, the EDDY group had a lower penetration area of residual sealer than the CNI group (P&lt; .05). In comparison to the coronal section, the penetration percentage of the CNI and EA groups was lower in the apical section (P&lt; .05). In the CNI group, the penetration depth was higher at the coronal section than at the apical and middle sections (P&lt; .05), and it was higher at the coronal section than at the apical section.&#x0D; 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 &lt; 0.05. In addition, statistically significant (p &lt; 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.