Apical Negative Pressure Research Articles

In Vitro Efficacy of Apical Negative Pressure Irrigation in Primary Teeth: A Smear Layer Analysis.

This study aimed to assess the efficacy of root canal debris removal in primary teeth through irrigation using the Endo-Irrigator Plus (CWAIS). A total of 25 primary mandibular first molars were divided into five groups, with five teeth in each group. After determining the working length and performing biomechanical preparation, groups I and II were subjected to hand and rotary instrumentation (ProTaper, Dentsply, United States of America) with conventional syringe irrigation with positive pressure, while groups III and IV were instrumented using hand and rotary instrumentation with positive and negative pressure irrigation employing the Endo-Irrigator Plus (CWAIS) system. Sodium hypochlorite (5.25%) and ethylenediaminetetraacetic acid (EDTA) (17%) were used as irrigants. Group V served as the control group, undergoing only root canal access opening. The removal of the smear layer was analyzed at the cervical, middle, and apical thirds of the canal using environmental scanning electron microscopy (SEM). Statistical significance was set at p < 0.05. Statistically significant differences were observed among all groups at the cervical, middle, and apical levels (p < 0.05). Groups III and IV exhibited significantly lower smear scores at all levels, particularly in the apical third, as observed through SEM examination. The use of the Endo-Irrigator Plus (CWAIS) system demonstrated superior debridement of intracanal debris in primary teeth compared to the positive pressure irrigation method. Badnaware SD, Kakade A, Takate V, et al. In Vitro Efficacy of Apical Negative Pressure Irrigation in Primary Teeth: A Smear Layer Analysis. Int J Clin Pediatr Dent 2024;17(6):653-657.

Outcome of nonsurgical management of large cyst-like periapical lesions using a modified apical negative pressure irrigation system: a case series study

ObjectiveTo assess the effectiveness of a self-constructed modified apical negative pressure irrigation (ANPI) system employing commonly used clinical instruments in nonsurgical root canal therapy (NSRCT) for large cyst-like periapical lesions (LCPLs).MethodsFrom 2017 to 2022, 35 patients diagnosed with LCPLs (5-15 mm) via preoperative clinical and radiographic evaluations of endodontic origin underwent NSRCT combined with ANPI. These patients were subjected to postoperative clinical and radiographic follow-up at 3 months, 6 months, 1 year, 2 years, 3 years, and 4 years, with a CBCT scan specifically conducted at 6-month follow-up. Through the reconstruction of three-dimensional cone beam computed tomography (CBCT) data, an early prognosis was facilitated by monitoring changes in lesion volume. Various treatment predictors—including sex, type of treatment, lesion size, preoperative pain, jaw, type of teeth involved, sealer extrusion, and the number of root canals—were meticulously analyzed. The evaluation of post-treatment outcomes leveraged both clinical observations and radiographic data collected during the follow-up periods. The Kruskal‒Wallis test and one-way ANOVA were also conducted to determine the independent factors influencing treatment outcomes. A significance level of 5% was established.ResultsThirty-five teeth from 35 patients with a median age of 28 years (range 24–34) were treated; the median follow-up duration was 19 months (range 12–26). The overall success rate was 91.4%, with a median lesion reduction of 77.0% (range 54.2–96.4%) at 6 months. Patients under 30 years of age exhibited a significantly greater success rate than older patients did (100.0% vs. 80.0%, p = 0.037). Other factors, such as sex, jaw, treatment type, preoperative pain, cyst size, tooth location, sealer extrusion, and the number of roots, did not significantly impact treatment outcomes.ConclusionsDespite limitations related to the observational case-series study design and relatively small sample size, our findings suggest that utilizing the ANPI in the NSRCT for LCPLs may hold promise. The notably higher success rate in patients younger than 30 years is worth noting.

An Ex-vivo Comparative Study to Evaluate the Efficacy of Three Root Canal Irrigation Systems in Reduction of Enterococcus Faecalis.

The purpose of this ex-vivo study is to evaluate the efficacy of three irrigation techniques in the reduction of E. faecalis in root canal. Eighty healthy maxillary anteriors were employed in this investigation. The bacteria E. faecalis was left on teeth for 7 days while they were kept. Once teeth were contaminated, they were randomly divided into three groups of 20 for experimentation and a control group of 20 for comparison. NaviTip FX was used to irrigate Group I, the Max-I-probe was used to water Group II, and the Endovac system was used to water Group III. The number of colony forming units (CFUs) was determined by growing bacteria from root canal samples for 2 days in Brain heart infusion agar after chemo-mechanical operations. There was a substantial decrease in bacterial numbers across all experimental groups compared to group IV (control). Group III (Endovac) had the fewest bacterial colonies among the test groups. There were no discernible changes between Group I (the Navitip FX) and Group II (the Max I probe). Endovac was the most effective of the three irrigation methods for reducing CFUs. This study's findings lend credence to the idea that the apical negative pressure approach has more potential than the conventional irrigation delivery system for achieving an enhanced antibacterial impact.

Management of symptomatic irreversible pulpitis using irrigation agitation techniques in anterior teeth.

Endodontic pain, a common complication after root canal treatment, affects 2.5% to 60% of patients. Therefore, it is of interest to compare apical negative pressure irrigation (EndoVac) with conventional needle irrigation to assess their impact on postoperative pain in permanent anterior teeth with symptomatic irreversible pulpitis. Fifty patients were randomly assigned to either the EndoVac or needle irrigation group. Pre and post-operative pain levels were assessed using a Visual Analog Scale and the amount of Ibuprofen taken was recorded. At 12-, 24-, and 48-hour intervals, the EndoVac group reported significantly less pain than the needle irrigation group. The needle irrigation group also required more Ibuprofen. The apical negative pressure irrigation system (EndoVac) resulted in significantly less postoperative pain and reduced the need for analgesic medication than the conventional needle irrigation protocol.

Positive Pressure and Negative Pressure Irrigation Dynamics with Different Needle Designs Using Computational Fluid Dynamics

This study aimed to investigate the irrigation dynamics of the positive pressure side-vented (SV) needle, EndoVac (micropores) needle and modified apical negative pressure (mANP) open-ended needle using computational fluid dynamics (CFD). A simulation of a prepared root canal (conical frustum) of 15 mm length with an apical diameter of 0.40 mm following Protaper F4 apical preparation was created using three-dimensional (3D) CAD software. The 3D simulated needle of SV 30G needle, EndoVac with micropores needle and mANP, 30G flat open-ended needle were also created. The irrigation dynamics were evaluated through transient CFD simulations. In addition, the irrigation dynamics of mANP at 0.2 mm, 0.5 mm, and 1.0 mm short from the working length were also assessed. The EndoVac and mANP showed negative apical static pressure and streamline patterns able to reach the apical region, thus indicating negligible extrusion. Meanwhile, SV showed positive apical static pressure and almost nonexistent streamlines beyond the needle tip. The SV showed the highest wall shear stress (WSS) magnitude of 1030Pa whereas Endovac (161 Pa) and mANP1 (258 Pa). However, SV revealed lower average WSS (10 Pa) compared to mANP1 (13 Pa) and mANP2 (11 Pa). This is due to SV developed a localised maximum WSS opposite the open vent area only therefore, uneven distribution of WSS. The EndoVac system developed a localised maximum WSS in the pair of micropores furthest away from the apical. CFD analysis of the EndoVac, mANP and SV showed different technique approach, needle design and needle depths insertion affect the irrigation dynamics pattern and magnitude.

Influence of needle design and irrigation depth in the presence of vapor lock: A computational fluid dynamics analysis in human oval roots with apical ramification.

This paper aims to study the removal of a vapor lock located in the apical ramification of an oval distal root of a human mandibular molar, simulating different needles and irrigation depths with computational fluid dynamic. A geometric reconstruction of the micro-CT of the molar shaped up to a WaveOne Gold Medium instrument was used. A vapor lock located in the apical 2 mm was incorporated. Geometries with positive pressure needles (side-vented [SV], flat or front-vented [FV] and notched [N]) and the EndoVac microcannula (MiC) were created to run the simulations. Irrigation key parameters (flow pattern, irrigant velocity, apical pressure, wall shear stress) and vapor lock removal were compared among the different simulations. Each needle behaved differently that is, FV removed the vapor lock from one ramification and had the highest apical pressure and shear stress values; SV removed the vapor lock in the main root canal but not in the ramification and reached the lowest apical pressure from the positive pressure needles; N was not able to completely remove the vapor lock and showed low apical pressure and shear stress; MiC removed the vapor lock from one ramification, had negative apical pressure and the lowest maximum shear stress. The main conclusion is that none of the needles showed complete removal of vapor lock. MiC, N, and FV were able to partially remove the vapor lock from one out of the three ramifications. However, SV needle was the only simulation that showed high shear stress with low apical pressure.

Negative Pressure Irrigation Dynamics between Two Needle Designs using Computational Fluid Dynamics

Objective: This study aimed to investigate the irrigation dynamics of the EndoVac and modified apical negative pressure (mANP) using Computational Fluid Dynamics (CFD) for application in endodontic irrigation. Methodology: A simulation of a prepared root canal (conical frustum) of 12 mm length with an apical diameter of 0.40 mm following Protaper F4 apical preparation was created using three-dimensional (3D) CAD software. 3D simulated aspiration needles (EndoVac, micropores needle) and (mANP, 30G flat open-ended needle) were also created. The irrigation dynamics were evaluated through transient CFD simulations. In addition, the irrigation dynamics of mANP were also assessed at three different needle depths of insertion. Results: The EndoVac and mANP streamlines pattern showed irrigants able to reach the apical end. Both needle designs demonstrated negative static apical pressure. The mANP using an open-ended needle design revealed a higher average WSS magnitude in all three different needle depths of insertion compared to the EndoVac. Conclusion: CFD analysis of the EndoVac and mANP revealed that different needle designs and needle depth insertion affect the irrigation dynamics pattern and magnitude in a simulated root canal. The open-ended needle design of mANP1 contributed to the higher WSS magnitude, discharge coefficient, and apical static pressure compared to the EndoVac.

Application of apical negative pressure irrigation in the nonsurgical treatment of radicular cysts: A case report

Application of apical negative pressure irrigation in the nonsurgical treatment of radicular cysts: A case report

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.

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).

Evaluation of the Efficacy of Different Irrigation Systems on the Removal of Root Canal Smear Layer: A Scanning Electron Microscopic Study

Irrigation represents a crucial step in endodontics for bacteria disinfection and smear layer removal. Several irrigation strategies have been proposed, although their effects are controversial. This study aims to assess the comparison of four different irrigation systems on the smear layer removal utilizing scanning electron microscopy (SEM). Forty sound monoradicular teeth were collected and casually allocated into four groups (n = 10): Group A, conventional irrigation; Group B, IrriFlex irrigation; Group C, ultrasonic irrigation system; Group D, apical negative pressure irrigation. After chemo-mechanical preparation and longitudinal root separation, the three root thirds were analyzed by SEM. Micrographs were carried out at ×2000 to analyze the smear layer residual in each third of the root canal. Statistically significant differences were found between Group A and Group D (p &lt; 0.05). Groups B and C showed satisfactory results in the coronal and middle thirds, while Group D was the only system that achieved satisfactory results in the apical third. However, the complete smear layer removal in the root canal was never achieved with any of the four systems tested. In conclusion, among the four tested irrigation systems, the greatest efficacy on smear layer removal was reached by Group D.

The Bond Strength of Root Canal Filling after Calcium Hydroxide Removal with a Simple Apical Negative Pressure Kit in Oval-Shaped Root Canal.

The aim of this study was to evaluate the effect of a simple irrigating device, which produced from the apical negative pressure concept, as a final irrigating method after calcium hydroxide (CH) medication on the bond strength of epoxy resin-based sealer in the oval-shaped root canal. Forty-eight single-rooted premolars with oval-shaped canals were included in the study. The crown was decoronized and canal instrumented with Mtwo (VDW GmbH, Munich, Germany) up to size 40/04. The specimens were assigned to four groups according to the irrigation protocol after 1 week of CH medication: control group (no medication) and three experimental groups conventional needle irrigation (CNI), passive ultrasonic irrigation (PUI), and simple apical negative pressure kit (sANP). The teeth were obturated with a warm vertical technique using epoxy resin-based sealers. After 1 week, the roots were transversally sectioned at coronal, middle, and apical thirds. A push-out test was performed by a universal testing machine, and statistical analysis was performed using One-Way ANOVA with Duncan's post hoc test. The bond strength in the control group was significantly higher than the CNI group in all root canal thirds (P < 0.05). At coronal third, sANP showed lower bond strength than PUI group (P < 0.05). However, the bond strength of sANP group was comparable to the control group (P > 0.05) which was significantly higher than the PUI group at apical third (P < 0.05). A sANP enhanced the bond strength of epoxy resin-based sealer in the apical third of CH-medicated root canal in the oval-shaped canal.

Efficacy of Different Endodontic Irrigant Activation Systems on Smear Layer Removal and Canal Cleanliness: Comparative Scanning Electron Microscopic Study

AIM: This study assessed the effectiveness of 5 different irrigant activation systems on canal cleanliness and removal of smear layer from root canals. METHODS: A total of 110 mandibular premolars with straight root canal were assigned to five groups (n = 20): conventional needle irrigation, passive ultrasonic activation, sonic activation with EndoActivator, negative apical pressure EndoVac (EV), or EDDY system, besides a control group (n = 10). All teeth were prepared to size 40, and irrigated with NaOCl (5.25%) according to the respective technique. Roots were split longitudinally and subjected to scanning electron microscopic analysis. The presence of smear layer and debris was evaluated using 5-grade scoring systems with ×1000 and ×400 magnification, respectively. Data were analyzed at 5%. RESULTS: Regarding the smear layer, activation with EV and ED was significantly more effective than other activation groups (p &lt; 0.05). Activation of the irrigant significantly improved removal of debris (p &lt; 0.05). CONCLUSION: No activation technique was able to eliminate smear layer and debris completely from root canals, nevertheless, EDDY is significantly better in removing debris and smear layer from the apical third of the canal.

Effectiveness of Different Irrigant Activation Systems on Smear Layer Removal: A Scanning Electron Microscopic Study.

The aim of this study was to evaluate the effectiveness of smear layer removal after the use of different irrigation methods (passive ultrasonic irrigation (PUI), continuous ultrasonic irrigation (CUI), apical negative pressure irrigation and conventional irrigation) using scanning electron microscopy (SEM) as an analytical tool. A total of 100 single-canal teeth were decoronated and randomly divided into five groups (n = 20) according to the irrigation method used: conventional irrigation with front outlet syringe, conventional irrigation with lateral outlet syringe, apical negative pressure irrigation (EndoVac), PUI with Irrisafe and CUI with ProUltra PiezoFlow ultrasonic irrigation needle. Root canal preparation was performed with the ProTaper Gold system up to the F4 instrument, and 5.25% NaOCl was used as an irrigant. After chemical-mechanical preparation, the roots were split longitudinally, and the coronal, middle and apical thirds were examined. SEM digital photomicrographs were taken at ×1000 magnification to evaluate the amount of smear layer in each root canal third; CUI significantly removed more smear layer than any other irrigant activation protocol (p < 0.05); CUI was more effective in removing the smear layer than the other irrigation protocols. However, none of the irrigation protocols were able to produce root canals completely free from smear layer.

Calcium Hydroxide Removal Using Four Different Irrigation Systems: A Quantitative Evaluation by Scanning Electron Microscopy

This study compares conventional endodontic needle irrigation, passive ultrasonic irrigation, apical negative pressure irrigation, and mechanical activation to remove calcium hydroxide from single straight root canals. Eighty-four mandibular premolars were prepared in a crown-down manner up to size #40. Two teeth represented a negative control, and another two served as a positive control. Calcium hydroxide paste was placed inside root canals. The remaining eighty samples were analyzed based on the activation techniques, and the cleanliness of the canals was quantified using Fiji’s software on 500× magnified SEM backscattered electron micrographs. Considering the whole canal, all instruments showed better performance than conventional endodontic needle irrigation in removing calcium hydroxide (p &lt; 0.05). Irrisafe and XP-endo Finisher could remove a significantly higher amount of calcium hydroxide than Endovac (p &lt; 0.05). Irrisafe and XP-endo Finisher have been able to remove more calcium hydroxide than EndoVac.

Removal of accumulated hard tissue debris from mesial root of mandibular molars evaluated using micro-CT - a systematic review and network meta-analysis.

Aim The aim of this systematic review and network meta-analysis was to identify the best irrigant activation technique (IAT) for the removal of accumulated hard tissue debris (AHTD) from the mesial root of mandibular molars evaluated using micro-CT studies.Methods The research question was based on the PICO format. Four electronic databases - PubMed, Scopus, Embase and Web of Science - were searched for articles up to June 2020. Selected articles were assessed for bias using the Joanna Briggs Institute Critical appraisal tool. The network meta-analysis using a fixed-effects model and SUCRA ranking were performed. The quality of the evidence was assessed using the CINeMA framework.Results Eleven studies were included for qualitative synthesis while seven were included for quantitative synthesis. The risk of bias of all included articles was low. The results based on SUCRA values revealed the IAT shock wave-enhanced emission photoacoustic streaming (100%) resulted in the greatest reduction of the volume of AHTD from mesial roots of mandibular molars. Ranking of the other IATs was as follows: photon-induced photoacoustic streaming (87%), laser-activated irrigation (79.3%), XP EndoFinisher (71.2%), ultrasonically activated irrigation (59.6%), apical negative pressure (42.3%), EasyClean (37.4%), EDDY (26.2%), EndoActivator (24.2%), self-adjusting file (11.6%) and needle irrigation (11.3%).Conclusion None of the IATs rendered the root canals completely free of AHTD. The laser-activated irrigation groups fared better than all other interventions in reducing AHTD from the mesial roots of mandibular molars. The confidence rating ranged from low to high for indirect evidence and moderate to high for mixed evidence. Results must be interpreted with caution due to the laboratory nature of the included studies.

Use of Negative Apical Pressure Technique for Removal of Apically Extruded Gutta-percha Fragment

The aim of this case report was to present using negative apical pressure technique for removal of apically extruded gutta-percha during retreatment procedures. A 22 year-old female patient was referred to the clinic with severe pain, swelling, and tenderness to percussion and palpation in the tooth of #26. Periapical radiograph showed previous root canal treatment of tooth #26 with incomplete root canal fillings. During retreatment procedures gutta-percha apically extruded from mesial root canal. The patient was recalled after one day. At the second session, it was observed that the swelling was increased. One of the tips for calcium hydroxide paste application was adjusted to suction of dental unit. Tip was placed into the canal as deep as possible. After a few attempts, apically extruded gutta-percha was removed and the patient was recalled after one day. At one day from the fragment removal, the swelling was decreased. Calcium hydroxide paste was placed into the canals for one week. At the fourth session, the patient was asymptomatic and the treatment was completed at this session. Keywords: gutta-percha, negative apical pressure, retreatment

Comparison of various irrigation activation procedures after post space preparation on push-out bond strength of fiber posts: an in vitro study

Aim: This study aimed to compare the effectiveness of various irrigation activation methods applied after post space preparation on the push-out bond strengths of fiber posts to root canal dentin. Materials and methods: Twenty maxillary central incisor teeth were prepared and root-filled. Following the preparation of the post spaces, the teeth were randomly allocated to 5 groups (n=4) based on the irrigation activation method. Post spaces were irrigated with 2.5% NaOCl and 17% EDTA and various irrigation activation techniques were applied in each group as follow. Group 1: conventional syringe irrigation (CSI); Group 2: manual-dynamic activation (MDA); Group 3: negative apical pressure (EndoVac); Group 4: passive ultrasonic irrigation (PUI) and Group 5: Er,Cr:YSGG laser. Subsequent to fiber post placement, the samples were transversally sectioned and push-out tests were applied for measurement of the bond strength of fiber posts. Results: Irrigation activation with Er,Cr:YSGG laser, EndoVac and PUI resulted higher push-out bond strength in comparison to MDA and CSI (P<.05). Conclusions: Irrigation activation with EndoVac, PUI and Er,Cr:YSGG laser provides superior bonding strength for fiber posts. gth for fiber posts.

In Vitro Assessment of Intracanal Calcium Hydroxide Removal Using Various Irrigation Systems: An SEM Study

The aim of this research was to assess the effectiveness of three different irrigation systems in elimination of calcium hydroxide [Ca(OH)2]from root canals. This in vitro research included ninety recently extracted mandibular premolar teeth with a solitary root. The sample teeth were subjected to disinfection employing sodium hypochlorite at 5.25%. The root canal preparation was performed followed by placement of premixed Ca(OH)2 within every canal. The sample teeth were then randomly allocated into one of the three experimental groups (each comprising 30 samples) as follows: Group 1, NaviTip FX irrigation system; group 2, Vibringe sonic irrigation system; and group 3, EndoVac apical negative pressure irrigation system. Following the preparation, each of the sample teeth was examined beneath a scanning electron microscope (SEM) at a magnification of 1000×. An intragroup comparative analysis revealed that the highest Ca(OH)2 elimination was seen at middle third (0.82 ± 0.09, 0.30 ± 0.11) in NaviTip FX irrigation system and Vibringe sonic irrigation system, respectively. Higher Ca(OH)2 was eliminated at the apical third (0.26 ± 0.02) by the EndoVac irrigation system. At coronal third, maximum Ca(OH)2 removal was seen in EndoVac irrigation system (0.49 ± 0.03). A statistically significant difference was noted amid Vibringe sonic irrigation and EndoVac irrigation systems. The intergroup evaluation of Ca(OH)2 elimination at coronal, middle, and apical third showed a statistically significant difference between NaviTip FX irrigation and Vibringe sonic irrigation as well as between NaviTip FX irrigation and EndoVac irrigation at a p value of 0.001. The difference between EndoVac irrigation and Vibringe sonic irrigation was not statistically significant. Amid the limitations of this research, this research concludes that none among the irrigation methods employed could totally eliminate the Ca(OH)2 off the root canals. Nevertheless, EndoVac apical negative pressure irrigation has slightly superior potential in eliminating Ca(OH)2 from the root canals in comparison with Vibringe sonic irrigation as well as the NaviTip FX irrigation system. Even though the Ca(OH)2 is largely suggested as medicament, its elimination at the point of canal obturation is likewise significant and complex as any remaining portion may avoid sealer diffusion inside the dentinal tubules, consequently substantially escalating the apical leakage of endodontically treated teeth.

In vitro apical pressure created by 2 irrigation needles and a multisonic system in mandibular molars.

ObjectivesThe aim of this study was to evaluate the apical pressure generated by 2 endodontic irrigation needles and the GentleWave system in mandibular molars.Materials and MethodsThe mesial and distal root canals of 12 mandibular molars were irrigated with a 30-gauge close-end needle or with a 30-gauge open-end needle. Procedures were performed in the mesial and distal canals. The GentleWave procedure and irrigation at 1 mm from the apex in the distal roots using an open-end needle were used, respectively, as negative and positive controls. The apical pressure was measured using a data acquisition pressure setup. Apical pressure exerted by the different needles in the 2 different canal types was statistically compared using 2-way analysis of variance.ResultsSignificant differences were found in the apical pressure for both needles and the canal type. The lowest values were obtained with close-end needles and in mesial canals. Negative apical pressure values were obtained using GentleWave.ConclusionsThe needle and the canal type influenced the apical pressure. The GentleWave procedure produced negative apical pressure.