Manual Dynamic Irrigation Research Articles

Comparative evaluation of the efficacy of various irrigating techniques by checking the depth of penetration of the sealer- An in-vitro study

Sonic irrigant activation has gained widespread popularity among general dentists and endodontists currently. It is usually seen that sonic powered flosser which we have used in our study is in use in many dental colleges by post graduate students as it is construed to be the cheaper version of Endoactivator.To investigate the efficacy of sonic powered flosser with various irrigating techniques by checking the depth of sealer penetration. Forty five single-rooted teeth were instrumented and divided into 3 groups of 15 teeth each, as Group 1: endoactivator; Group 2: powered sonic flosser; Group 3: manual dynamic irrigation. The samples were obturated with AH Plus sealer labelled with Rhodamine B dye. The teeth were sectioned and viewed under confocal microscope to determine the depth of sealer penetration.Statistical analysis used: One way Anova F test was used for overall comparison among three groups and Tukey's post hoc test were used to evaluate the efficiency levels between groups. P value less than 0.05 was considered significant for all statistical test. The results showed that the maximum penetration was exhibited by endoactivator followed by manual dynamic irrigation and least by powered sonic flosser. The middle third showed the maximum penetration, followed by apical third in all the groups. Sonic powered flosser and manual agitation weren’t found to be as effective as Endoactivator, so in the absence of Endoactivator, sonic and manual agitation can’t be relied upon for desired results. The agitation of the irrigants is found to be most effective with endoactivator in order to achieve appreciable sealer penetration.So using sonic powered flosser will not be able to render the results as good as endoactivator.

Farklı irrigasyon aktivasyon yöntemlerinin rezin siman kullanılarak yapıştırılan fiber postların bağlanma dayanımına etkileri

Amaç: Endodontik tedavili ve koronal harabiyeti fazla olan dişlerin restorasyonunda sıklıkla kullanılan fiber postların uzun dönem başarısında, postun dentine etkin bir şekilde bağlanması kritik önem taşır. Bu çalışmanın amacı, çeşitli irrigasyon aktivasyon yöntemlerinin post boşluğunun farklı bölgelerinde fiber postların bağlanma dayanımına etkisini araştırmaktır. Gereç ve yöntemler: Endodontik tedavileri yapılan 48 adet alt 1. premolar diş, post boşluğuna uygulanacak olan irrigasyon yöntemine göre 4 gruba ayrıldı (n=12): pasif irrigasyon (Pİ); manuel-dinamik irrigasyon (MDİ); sonik irrigasyon (Sİ), ultrasonik irrigasyon (Uİ). Fiber postlar, post boşluğuna kendinden adeziv rezin siman ile yapıştırıldı. Kökler, her biri 2 mm olacak şekilde koronal, orta ve apikal olmak üzere 3 enine kesite ayrıldı. Push-out bağlanma dayanımları universal test cihazı kullanılarak MPa cinsinden hesaplandı. Başarısızlık tipleri her bir örneğin stereomikroskop altında incelenmesi ile şu şekilde gruplandı: siman-dentin arası adeziv başarısızlık-Adeziv(S/D); siman-fiber post arası adeziv başarısızlık-Adeziv(S/F); ilk 2 başarısızlık tipinin beraber görüldüğü başarısızlık-karma. Bulgular: En düşük ortalama bağlanma dayanımı Pİ için elde edildi (p<0.05). Diğer gruplar arasında istatistiksel açıdan farklılık bulunmadı (p>0.05). Köklerden elde edilen kesitlerden koronal bölge, apikal bölgeden istatistiksel olarak anlamlı düzeyde yüksek bağlantı değeri gösterdi (p<0.05). MDİ,Sİ ve Uİ gruplarında karma hata dominant olarak gözlenirken adeziv (S/D) hatayı en fazla gösteren grup Pİ oldu. Sonuç: Post boşluğu hazırlandıktan sonra manuel-dinamik, sonik ve ultrasonik irrigasyon aktivasyon yöntemlerinden birinin kullanılması, fiber postların kök kanal dentinine olan bağlanma dayanımını arttırmaktadır. Uygulanan irrigasyon yönteminden bağımsız olarak fiber postun bağlanma dayanımı, koronal bölgede apikal bölgeden daha yüksektir.

Rotasyon ve resiprokasyon hareketi ile çalışan farklı eğe sisteminin apikal transportasyon ve kanal düzleşmesine etkisinin karşılaştırılması

Background: The effective bonding of fiber posts which are recommended in the restoration of endodontically treated teeth with excessive coronal damage is of critical importance for the long-term success. The aim of this study was to investigate the effect of various irrigation activation protocols on the push-out bond strength of fiber posts in different parts of the post space.Methods: Forty-eight endodontically treated mandibular first premolar teeth were divided into 4 groups according to irrigation protocol (n=12): passive irrigation(PI); manual-dynamic irrigation(MDI); sonic irrigation(SI), ultrasonic irrigation(UI). Fiber posts were bonded with a self-adhesive resin cement. Three transvers sections, were obtained from the coronal, middle, and apical regions of the root, in 2 mm thich each. Push-out bond strength in each section was calculated in MPa using a universal-testing machine. Each sample was examined under a stereomicroscope and failure types were classified as follows: adhesive failure between cement and dentin-Adhesive(C/D); adhesive failure between cement and fiber post-Adhesive(C/F); the combination of both adhesive failure types-mix.Results: The lowest bond strength was obtained for PI group (p<0.05). There was no statistically significant difference between the other groups (p>0.05). Coronal region showed higher bond strength than the apical region regardless of test group (p<0.05). While mixed failure was observed dominantly in the MDI, SI and UI groups, PI was the group that showed the adhesive(C/D) failure type in most.Conclusion: After preparing the post space, the use of any of the manual-dynamic, sonic or ultrasonic irrigation activation methods increases the bond strength of fiber posts to root canal dentin compared to passive irrigation. Regardless of the irrigation method applied, the bond strength of the fiber post to the root canal was higher in the coronal region compared to the apical region.

An in vitro radiological evaluation of irrigant penetration in the root canals using three different irrigation systems: Waterpik WP-100 device, passive irrigation, and manual dynamic irrigation systems.

Background:Instrumentation and irrigation of the root canal facilitating effective debridement is considered the most important single factor in the prevention and treatment of endodontic diseases.Aim:The aim of the study was to evaluate the depth of penetration of the irrigant depending on the final activation using Waterpik device modified with NaviTip needle, passive irrigation, and manual dynamic activation using the radiopaque solution in conjunction with digital dental radiography.Materials and Methods:Ninety freshly extracted single-rooted mandibular premolars based on the inclusion and exclusion criteria were used for this study. Access cavity preparation was done for all the samples, and the working length of each sample was determined using a size 10-k file. The radiopaque solution (Urografin) was delivered into (Groups A, B, and C) prepared canal of samples at the rate of 1 ml in 30 s with up-and-down motion.Results:The test results showed that Waterpik WP-100 group showed significantly high infiltration index values as compared to passive irrigation and manual irrigation group at P < 0.002 and P = 0.007, respectively.Conclusion:Sonic irrigation using a Waterpik device modified with a NaviTip needle permits better infiltration of the irrigant.

In vitro evaluation of the efficacy of different protocols on calcium hydroxide dressing removal

Objective: To compare in vitro irrigation systems’ efficacy in removing calcium hydroxide paste (Ca(OH)2) in single-root teeth. Methods: Sixty permanent teeth were prepared using ProTaper® rotatory instruments, up to F3. Specimens were split longitudinally into two halves, and two grooves located in the apical and coronal zones were created. Ca(OH)2 application into the grooves was assessed by radiographic and photographic methods. After the halves were reassembled in a silicone mold, teeth were randomly divided into experimental groups (n=15), testing Ca(OH)2 removal: 1 – CanalBrush™; 2 – E1 – Irrisonic tip; 3 – manual dynamic irrigation (MDI); 4 – XP-endo Finisher® (XP). A total volume of 10 mL of 2.5% sodium hypochlorite was used in each tooth. Finally, all groups were scored regarding the Ca(OH)2 remnants using the same methods as before. Statistical analysis was conducted using the Kruskal-Wallis test followed by Mann-Whitney U tests (with Bonferroni correction). A value of p&lt;0.05 was considered statistically significant. Results: None of the techniques demonstrated 100% efficacy in both regions. CanalBrush™ was more effective in the apical region. Overall, E1 – Irrisonic tip and CanalBrush™ removed significantly more Ca(OH)2 than MDI and XP-endo Finisher® (p&lt;0.05). Conclusion: Globally, E1 – Irrisonic tip and CanalBrush™ were more effective, although without statistically significant differences between them.

A Comparative Evaluation of Smear Layer Removal Using Erbium:YAG Laser-Activated Irrigation, Sonic Irrigation, and Manual Dynamic Irrigation: A Scanning Electron Microscope Study.

Introduction: The conventional chemomechanical procedures are ineffective in complete disinfection of the pulp space due to the complexities of the root canal architecture. The present study aims to compare the efficacy of erbium: YAG laser-activated irrigation, sonic irrigation, and manual dynamic irrigation in the removal of the smear layer through a scanning electron microscope study. Methods: Fifty extracted single rooted mandibular premolars with single canal were used and instrumented until F3 ProTaper rotary file reached the working length. Upon the completion of the canal preparation, each specimen was irrigated with 3 mL of 4% NaOCl for 3 minutes, 3 mL saline for 1 minute and 3 mL of 17% EDTA for 3 minutes. The teeth were assigned to three experimental groups (n=15 each): manual dynamic irrigation, sonic irrigation (EndoActivator), and Er:YAG laser using an X pulse tip. Root canals were sectioned longitudinally and the smear layer at the apical, middle and coronal third was examined under a scanning electron microscope. Smear layer scores were analyzed by Kruskal-Wallis and Mann-Whitney U tests at P = 0.05. Results: The Er:YAG laser group showed significantly lower smear layer scores in the apical third as compared to all other groups. EndoActivator resulted in better cleaning efficacy at the apical area compared to manual dynamic agitation. Conclusion: This study showed results in favor of Er:YAG with an X-pulse tip followed by EndoActivator activation.

Debris Removal from the Mesial Root Canal System of Mandibular Molars with Laser-activated Irrigation

IntroductionThe purpose of this study was to compare in vitro the canal and isthmus debridement of manual-dynamic, passive ultrasonic, and laser-activated irrigation with an Er:YAG laser in mesial roots of human mandibular molars. MethodsFifty extracted mandibular molars with an isthmus were embedded in resin and sectioned axially 4 mm from the apex. The teeth were reassembled with guide pins and bolts, and the mesial canals were instrumented up to a ProTaper F2 rotary file (Dentsply Maillefer, Ballaigues, Switzerland). Teeth were randomly assigned to the following irrigant activation groups (n = 10): conventional needle irrigation (NI), manual-dynamic irrigation with a ProTaper F2 gutta-percha cone, ultrasonically activated irrigation using a size 20 Irrisafe (Satelec Acteon, Mérignac, France), and laser-activated irrigation (LAI) with an Er:YAG laser and a conical 400-μm fiber tip in the canal entrance or a 600-μm tip over the canal entrance. Root cross-sectional images were taken before and after final irrigation, and the area occupied by debris in the main canal and the isthmus was determined using image analysis software. Differences in debris before and after activation were statistically compared within and across groups. ResultsSignificant reductions in debris levels were observed in all groups, except for NI and manual-dynamic irrigation (canal only). None of the methods rendered the canal systems debris free. In the canal, LAI with an Er:YAG laser and a 600-μm tip over the canal entrance removed significantly more debris than NI. In the isthmus, LAI with an Er:YAG laser and a conical 400-μm fiber tip in the canal entrance removed significantly more debris than NI. ConclusionsWithin the limitations of this in vitro study, canal and isthmus cleanliness significantly improved after irrigant activation.

Effects of seven different irrigation techniques on debris and the smear layer: a scanning electron microscopy study.

Conventional manual irrigation with a syringe and needle remains widely accepted technique in the irrigation procedures. However, its flushing action has some limitations. Currently, several techniques and systems are available and reported to improve the insufficiency of syringe irrigation. The aim of this study was to evaluate the effectiveness of 7 different irrigation techniques compared to standard irrigation. Straight roots from 80 extracted human maxillary central incisors were collected, and root canals were instrumented with K-files up to apical size 50. The teeth were randomly divided into 8 groups (n = 10), and final irrigation procedures were performed with 17% ethylenediaminetetraacetic acid and 5.25% NaOCl solutions using following irrigation agitation techniques: RinsEndo, EndoVac, Canal CleanMax, sonic, Canal Brush, NaviTip FX, manual dynamic irrigation, and conventional irrigation. The presence of debris and smear layer (SL) at coronal, middle, and apical thirds was evaluated by using a 5-grade scoring system with ×200 and ×1000 magnification, respectively. Concerning debris removal, the MM 1500 sonic group reduced apical debris significantly better than the other groups tested (P < 0.05). There was no significant difference among the tested groups (P > 0.05) related SL removal in all levels. MM 1500 scored best with debris removal; however, there was no significant reduction in the SL in apical third with any of the methods tested.

Effect of manual dynamic activation with citric acid solutions in smear layer removal: A scanning electron microscopic evaluation

Background/purposeChelating agents have been used for the removal of the smear layer on teeth. However, due to inadequate volume and/or penetration of the solutions during irrigation, smear layer removal is less effective in the apical third. The purpose of this study was to compare the efficacy of three chelating solutions with and without manual dynamic irrigation in smear layer removal. Materials and methodsSixty-six single-root canal teeth were decoronated, instrumented, and divided into six experimental groups (n = 10) and two control groups (n = 3). The groups received a final rinse with 1 mL of 17% EDTA and 5% or 10% citric acid (CA) for 1 minute, with or without manual dynamic activation, followed by a final 3-mL rinse with 4.2% NaOCl (5 minutes). The teeth were then longitudinally split and prepared for environmental scanning electron microscopy analysis. Digital images (500×) were taken for smear layer removal evaluation at 2 mm, 6 mm, and 10 mm from the working length. ResultsThe most effective smear layer removal occurred with 5% and 10% CA combined with manual dynamic activation (Groups 7 and 8), where significant differences were observed when compared with the EDTA groups (Groups 2 and 6; P < 0.05). We found no significant differences between manual dynamic activation with 5% and 10% CA (Groups 7 and 8) in smear layer or debris removal (P > 0.05). ConclusionManual dynamic activation of CA improves smear layer removal, and a reduction in CA concentration to 5% does not compromise smear layer removal in comparison with higher concentrations.

Efficacy of laser-based irrigant activation methods in removing debris from simulated root canal irregularities

In root canal therapy, irrigating solutions are essential to assist in debridement and disinfection, but their spread and action is often restricted by canal anatomy. Hence, activation of irrigants is suggested to improve their distribution in the canal system, increasing irrigation effectiveness. Activation can be done with lasers, termed laser-activated irrigation (LAI). The purpose of this in vitro study was to compare the efficacy of different irrigant activation methods in removing debris from simulated root canal irregularities. Twenty-five straight human canine roots were embedded in resin, split, and their canals prepared to a standardized shape. A groove was cut in the wall of each canal and filled with dentin debris. Canals were filled with sodium hypochlorite and six irrigant activation procedures were tested: conventional needle irrigation (CI), manual-dynamic irrigation with a tapered gutta percha cone (manual-dynamic irrigation (MDI)), passive ultrasonic irrigation, LAI with 2,940-nm erbium-doped yttrium aluminum garnet (Er:YAG) laser with a plain fiber tip inside the canal (Er-flat), LAI with Er:YAG laser with a conical tip held at the canal entrance (Er-PIPS), and LAI with a 980-nm diode laser moving the fiber inside the canal (diode). The amount of remaining debris in the groove was scored and compared among the groups using non-parametric tests. Conventional irrigation removed significantly less debris than all other groups. The Er:YAG with plain fiber tip was more efficient than MDI, CI, diode, and Er:YAG laser with PIPS tip in removing debris from simulated root canal irregularities.

Effect of passive ultrasonic irrigation and manual dynamic irrigation on smear layer removal from root canals in a closed apex in vitro model

To compare the effect of passive ultrasonic irrigation with manual dynamic irrigation on smear layer removal from root canals using a closed apex in vitro model. The root canals of 45 freshly-extracted human single-rooted mandibular premolar teeth were prepared by the Pro-Taper rotary system to an apical preparation of F4 size. Prepared teeth were randomly divided into three groups; two experimental groups and one control group (n=15) on the basis of the type of activation of final irrigation as follows: (a) Group A, 3% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA), no activation received; (b) Group B, 3% NaOCl and 17% EDTA, ultrasonic activation with a small file; and (c) Group C, 3% NaOCl and 17% EDTA, manual activation with a master gutta-percha point. The prepared teeth were decoronated and split into two halves longitudinally, and observed under a scanning electron microscope to assess the removal of the smear layer. In the apical-third region, the mean smear scores for groups B and C were significantly less than those of Group A (control group) (P<0.05). Both activation techniques are important adjuncts in removing the smear layer, with manual dynamic activation being a simpler, safer, and more cost-effective technique.

Debris and smear removal in flattened root canals after use of different irrigant agitation protocols

Scanning electron microscopy (SEM) can be used to analyze the presence of debris and smear layer on the internal walls of root canal. This study evaluated the debris and smear removal in flattened root canals using SEM after use of different irrigant agitation protocols. Fifty mandibular incisors were distributed into five groups (n = 10) according to the irrigant agitation protocol used during chemomechanical preparation: conventional syringe irrigation with NaviTip needle (no activation), active scrubbing of irrigant with brush-covered NaviTip FX needle, manual dynamic irrigation, continuous passive ultrasonic irrigation, and apical negative pressure irrigation (EndoVac system). Canals were irrigated with 5 mL of 2.5% NaOCl at each change of instrument and received a final flush with 17% EDTA for 1 min. After instrumentation, the roots were split longitudinally and SEM micrographs at ×100 and ×1,000 were taken to evaluate the amount of debris and smear layer, respectively, in each third. Data were analyzed by Kruskal-Wallis and Dunn's post-hoc tests (α = 5%). Manual dynamic activation left significantly (p < 0.05) more debris inside the canals than the other protocols, while ultrasonic irrigation and EndoVac were the most effective (p < 0.05) for debris removal. Regarding the removal of smear layer, there was no statistically significant difference (p > 0.05) either among the irrigant agitation protocols or between the protocol-canal third interactions. Although none of the irrigant agitation protocols completely removed debris and smear layer from flattened root canals, the machine-assisted agitation systems (ultrasound and EndoVac) removed more debris than the manual techniques.

Review of root canal irrigant delivery techniques and devices

Introduction: Eliminating the residual debris and bacteria in the root canal system is one of the main purposes of the endodontic treatment. However, the complexity on the anatomy of the root canal system makes it difficult to eliminate the bacterial biofilm existing along the root canal surface and necrotic pulp tissue by mechanical instrumentation and chemical irrigation. Recently, more effective irrigant delivery systems for root canal irrigation have been developed. The purpose of this review was to present an overview of root canal irrigant delivery techniques and devices available in endodontics. Review: The contents of this paper include as follows; - syringe-needle irrigation, manual dynamic irrigation, brushes - sonic and ultrasonic irrigation, passive ultrasonic irrigation, rotary brush, RinsEndo, EndoVac, Laser Conclusion: Though technological advances during the last decade have brought to fruition new agitation devices that rely on various mechanisms, there are few evidence based study to correlate the clinical efficacy of these devices with improved outcomes except syringe irrigation with needle and ultrasonic irrigation. The clinicians should try their best efforts to deliver antimicrobial and tissue solvent solutions in predictable volumes safely to working length. [J Kor Acad Cons Dent 2011;36(3):180-187.]

Canal and isthmus debridement efficacies of two irrigant agitation techniques in a closed system

To compare canal and isthmus debris debridement efficacies of the manual dynamic irrigation (MDI) and apical negative pressure (ANP) techniques in the mesial root of mandibular first molars with narrow isthmi, using a closed canal design. Micro-computed tomography was employed to select 20 teeth, each containing a narrow isthmus. Each root was sealed at the apex with hot glue and embedded in polyvinylsiloxane to simulate a closed canal system. The teeth were submitted to a standardized instrumentation protocol. Final irrigation was performed with either the MDI or the ANP technique using the EndoVac system (N=10). Masson trichrome-stained sections were prepared from completely demineralized roots at 10 canal levels between 1 and 2.8mm of the anatomical apices. Areas occupied by canals and isthmus of each root and debris in the corresponding regions were digitized by the NIH Image J software and statistically analysed using two-way repeated measures anova. For the instrumented canals, there were no differences between the two groups (P=0.131) in the area occupied by debris at all canal levels (P=0.343). Conversely, for the isthmus, less debris was found in the ANP group (P<0.001) but no differences were seen in each group with respect to the 10 canal levels (P=0.352). Neither technique completely removed debris from the isthmus regions. However, the EndoVac system, which encompasses the ANP concept, removed considerably more debris from narrow isthmi in mandibular mesial roots.

The efficacy of dynamic irrigation using a commercially available system (RinsEndo®) determined by removal of a collagen ‘bio‐molecular film’ from an ex vivo model

To compare the efficacy of three irrigation protocols using an established ex vivo bio-molecular film model. Thirty human teeth with single straight canals were randomly allocated to three groups [static, manual-dynamic, automated-dynamic (RinsEndo]; each with a sub-group (n = 5) for needle position at 4 or 10 mm short of the working length (WL). The root canals were prepared to apical size 40, taper 0.08. The teeth were split longitudinally into two halves and a standard coat of stained-collagen was applied to the canal surfaces. The re-assembled teeth were irrigated using one of the protocols with the irrigation needle at one of two positions. Digital images of the canal surfaces, before and after irrigation with 18 mL of 2.5% NaOCl, were used to score surface coverage with stained-collagen using image-analyses (ipWin4). The data were analysed using linear regression models. The canal area covered with stained-collagen was significantly (P < 0.001) less after dynamic irrigation (manual/automated) compared with static irrigation; but automated-dynamic irrigation was significantly (P = 0.037) less effective than manual-dynamic irrigation. The 'orientation of needle port', 'corono-apical level of canal' and 'apical extent of needle placement' were significant (P < 0.001) factors influencing efficacy of irrigation. Residual collagen was most evident in the coronal third. Deeper penetration of the needle tip resulted in significantly (P < 0.001) more effective collagen removal. Automated-dynamic irrigation was significantly more effective (16%) than static irrigation but significantly less effective (5%) than manual-dynamic irrigation. Irrigation was more effective (7%) when the needle was placed closer to WL.

A collagen ‘bio‐molecular film’ex vivo model to evaluate the efficacy of dynamic irrigation using the RinsEndo® system

Aim To evaluate the efficacy of three irrigation protocols using a model consisting of a standard collagen film coating the root canal walls of extracted teeth.Methodology Thirty human teeth with single straight canals were randomly allocated to three groups for static (n = 10), manual dynamic (n = 20) or automated dynamic (n = 10) irrigation. The root canals were prepared to apical size 40 with a 0.08 taper. The teeth were split longitudinally to give two halves and stained collagen was applied to the canal surfaces in a standard manner. The re‐assembled teeth were irrigated using one of the protocols. Digital images were taken of the canal surfaces before and after irrigation with 18 mL of NaOCl. Static irrigation consisted of simple placement of an irrigation needle (gauge 30) in a fixed orientation 4 mm or 10 mm short of the working length. Manual dynamic irrigation consisted of push–pull agitation of the placed irrigant with a well‐fitting, tapered gutta‐percha point. Automated dynamic irrigation was carried out using the RinsEndo® system. The percentage canal surface coverage with stained collagen was calculated using a software package (ipWin4®). The data were analyzed using paired‐t tests and GEE linear regression models.Results The area of canal covered with stained collagen was significantly (P &lt; 0.001) less (21% or 16%, respectively) after manual or automated dynamic irrigation compared with static irrigation. However, the RinsEndo® system was significantly (P = 0.037) less effective (5%) than manual dynamic irrigation. The ‘corono‐apical level of canal’ and the ‘depth of needle tip penetration’ emerged as significant factors influencing outcome of irrigation. Residual collagen was least evident in the middle third, followed by apical and then coronal thirds. Deeper penetration of the needle tip resulted in 7.5% (P &lt; 0.001) more effective collagen removal. The orientation of the side‐port of the irrigation needle was not a significant factor (P = 0.051).Conclusions Automated dynamic irrigation using RinsEndo® system was significantly more effective (16%) in removing stained collagen from the root canal than static irrigation. However, it was significantly less effective (5%) than manual dynamic irrigation. Irrigation was more effective (7%) when the needle was placed closer to the apex.