Passive Ultrasonic Irrigation Group Research Articles

Influence of agitation methods of irrigants after methylene blue-mediated PDT on the bonding interface of a fiber post cementation system

BackgroundThis study evaluated the effects of final agitation methods of irrigants to remove methylene blue and sodium hypochlorite residues after PDT-assisted endodontic treatment on the bond strength of fiber posts cemented with etch-and-rinse adhesive and conventional resin cement. MethodsNinety bovine teeth were endodontically treated. In sequence, post space preparation followed by methylene blue-mediated PDT and sodium hypochlorite (NaOCl) irrigation were performed. Six final irrigations protocols for dye and NaOCl removal were performed prior to cementation with etch-and-rinse adhesive (Adper Scocthbond Multipurpose) and conventional dual resin cement (RelyX ARC): Conventional endodontic irrigation (CEI), passive ultrasonic irrigation (PUI), mechanical agitation with XP Endo Finisher (XPF), XP Clean (XPC) or Easy Clean (ECL) and distilled water (NCO - control). After fiber post cementation, push-out bond strength test was performed at different thirds of the post space. Failure mode was also analyzed. ANOVA and Tukey's post-hoc test was used for data analysis (α=5%). ResultsPUI, XPF e XPC protocols showed the highest bond strength values with no difference among them (p > 0.05), although they were similar to NCO, regardless of the post space third. CEI e ECL showed similar bond strength values, regardless of the third (p > 0.05). Adhesive failure was the most incident for CEI and ECL, while mixed and cohesive failures were predominant in PUI, XPF, XPC and NCO groups. ConclusionsMechanical agitation of distilled water with XPF, XPC and PUI after methylene blue-mediated PDT and irrigation with 2.5% sodium hypochlorite promoted bond strength of the resin cementation system in post space dentin comparable to control group.

Evaluation of Debris Removal Efficacy of Conventional Syringe, Irrisafe, XP-endo Finisher File, and Photon-Induced Photoacoustic-Streaming Methods in Teeth with Artificial Internal Resorption Using Two Different Methodologies.

Objective: This study sought to evaluate the effect of conventional syringe irrigation (CSI), irrigation with XP-endo Finisher file (XP-F), passive ultrasonic irrigation (PUI), and photon-induced photoacoustic-streaming (PIPS) methods on dentine debris removal from teeth with simulated internal root resorption (IRR) cavities by using scoring and image analyzing methods. Materials and methods: Chemomechanical preparation of 88 single-rooted sample teeth was completed, they were split longitudinally and IRR cavities were prepared. Simulated debris was placed into the cavities. Four teeth were separated to serve as the negative control group. According to the final irrigation technique, 4 experimental groups were created (n = 20): Group 1, CSI; Group 2, XP-F; Group 3, PUI; and Group 4, PIPS. The amount of remaining debris in the IRR cavities was examined under a stereomicroscope. Analysis was performed using two different methodologies: (1) scoring method and (2) image analyzing method. The data were statistically evaluated by one-way analysis of variance, Kruskal-Wallis, chi-square, and Dunn tests with a significance level set as 5%. Results: In both methodologies, PIPS was found to be significantly more effective than XP-F in terms of debris removal. There was no significant difference between XP-F and PUI (p > 0.05). According to the findings obtained from the image analyzing method, PIPS and PUI groups were not significantly different (p > 0.05). Conclusions: PIPS method can be selected as an irrigation activation methodology in teeth with IRR. Considering the similar results of both evaluation methods, image analyzing programs can be used as an alternative in studies on debris removal.

Post-Operative Pain after Single-Visit Endodontic Treatment Using Different Root Canal Irrigation Activating Techniques

Aim: To clinically evaluate the effect of different irrigation activation techniques (needle irrigation, passive ultrasonic irrigation (PUI) and EndoVac) on post-operative pain after single-visit endodontic treatment. Materials and methods: Thirty patients aged between 16 and 40 years requiring endodontic therapy of asymptomatic vital/non vital maxillary central or canine teeth were selected for this study. In all cases, root canal treatment was done is single-visit in which root canals were prepared using nickel-titanium ProTaper Universal rotary system in crown down manner up to master apical file size F4 or F5 according to the initial apical canal size. Irrigation was done using 2.5% NaOCl. Patients were randomly assigned into three groups according to the final irrigation activation method, group 1 (control group) needle irrigation, group 2 PUI and group 3 EndoVac system. Obturation was done using cold lateral compaction technique. Post-operative pain was assessed after 6, 12, 24, 48 hours, one week and two weeks respectively. Post-operative pain evaluation was done using Visual Analogue Scale (VAS). Results: EndoVac group showed the least post-operative pain values while needle irrigation group showed the highest values. This was statistically significant at 6 and 48 hours time intervals. PUI group showed lower pain values than needle group and this was significant at 48 hours time interval. In all groups the intensity of post-operative pain decreased over time. Conclusion: EndoVac system and PUI reduce post-operative pain after single-visit endodontic treatment than needle irrigation in the first 48 hours.

Influence of different calcium hydroxide removal protocols on the bond strength of epoxy resin-based sealer in long oval root canals.

This study evaluated the effect of different protocols for Ca(OH)2 removal on the bond strength (BS) of epoxy resin-based sealer in long oval root canals. Forty-eight mandibular incisors with long oval root canals were selected by CBCT. Biomechanical preparation was performed, the samples were filled with Ca(OH)2 paste and distributed in four groups (n= 12): G-without Ca(OH)2 paste (C); G2-syringe/needle (SN); G3-SN + XP-Endo® Finisher (XPF); G4-SN + passive ultrasonic irrigation (PUI). After 7 days, Ca(OH)2 was removed and teeth were filled using AHPlus and guttapercha. In four samples from each group, the sealer was manipulated with 0.1% rhodamine to assess sealer penetration by fluorescent laser confocal microscopy (FLCM). Samples were sectioned in slices for BS, scanning electron microscopy, and FLCM analysis. The BS data were analyzed by ANOVA and Tukey tests (α= 0.05). The lowest BS values were found for the SN group (12.89 ± 4.36) compared to C (35.55 ± 10.05), while PUI group presented intermediate values (28.57 ± 9.35) and the XPF group (31.34 ± 9.8) showed values that were sometimes similar to C group and sometimes similar to PUI group (p> .05). The analysis of the adhesive interface showed evident gaps, with the presence of residues between the dentin and the filling material for the SN group, and for C, XPF and PUI groups juxtaposed adhesive interface. FLCM images showed sealer penetration in the dentinal tubules along the entire perimeter for C, XPF, and PUI groups. Ca(OH)2 removal with XPF and PUI from long oval root canals resulted in higher bond strength values compared to SN, besides better sealer penetration on dentinal tubules and juxtaposed adhesive interface.

Effect of a novel laser-initiated photoacoustic activation of a solvent or sodium hypochlorite in the removal of filling remnants after retreatment of curved root canals

BackgroundThis study aimed to evaluate the effect of Er:YAG laser-initiated shockwave-enhanced emission of photoacoustic streaming (SWEEPS®) and passive ultrasonic irrigation (PUI) combining thymol-based solvent or sodium hypochlorite (NaOCl) in the removal of filling remnants from curved canals. MethodsForty-eight curved root canals were instrumented and filled with an epoxy-resin-based sealer and gutta-percha. The canals were retreated with a Wave One Gold primary file (tip size 25; variable taper) and sodium hypochlorite (NaOCl). After the retreatment, the samples were randomly divided into four groups according to the additional irrigation protocol: PUI/NaOCl, PUI/solvent, SWEEPS®/NaOCl or SWEEPS®/solvent. The volume of filling material in root canal was measured after root canal filling, after mechanical retreatment, after final irrigation protocol and after additional irrigation protocol, using micro-CT. The results were analyzed using Kruskal-Wallis test with the post-hoc Mann-Whitney U test and Wilcoxon test (α=0.05). ResultsIn the PUI group, irrigation with the solvent or NaOCl resulted in similar filling reduction (p = 0.224). In the SWEEPS® group, irrigation with NaOCl resulted in a significantly greater filling reduction compared to the solvent (p = 0.021). The SWEEPS®/NaOCl group was more effective than the PUI/NaOCl group (p = 0.008). No significant differences were found between PUI/solvent and SWEEPS® groups (p>0.05) and PUI/NaOCl and SWEEPS®/solvent group (p>0.05). ConclusionAlthough all tested protocols improved the removal of filling remnants from curved root canal, the SWEEPS® was more successful than PUI when NaOCl was used. Both tested techniques showed similar efficacy when in combination with the solvent.

Effect of Different Irrigation Activation Techniques on Sealer Penetration: A Confocal Laser Microscopy Study.

To compare the efficiency of a new sonic powered irrigation system named EDDY (VDW, Munich, Germany), passive ultrasonic irrigation (PUI) and conventional needle irrigation (CNI) in root canal sealer penetration. A total of 45 mandibular premolars were instrumented up to size 30, 0.9 taper and randomly divided into three groups (n = 15) depending on the final irrigation activation technique: EDDY, PUI or CNI. After the final irrigation procedures, the root canals were obturated with labelled sealer mixed with 0.1% rhodamine B. Transverse sections at 3, 5 and 7 mm from the root apex were examined using confocal laser scanning microscopy. The maximum depth and total area and percentage of sealer penetration were measured using ImageJ analysis software (National Institutes of Health, Bethesda, MD, USA). In the EDDY group, the penetration depth was higher compared to the CNI group in the apical and middle sections and compared to the PUI group in the apical section (P ˂ 0.05). The penetration area in the EDDY group was higher compared to the CNI group in all sections and compared to the PUI group in the coronal section (P ˂ 0.05). The percentage of penetration was higher in the EDDY group compared to the CNI group in all sections and compared to the PUI group in the coronal section (P ˂ 0.05). In the present study, sealer penetration was superior in the EDDY group than the CNI group in the apical section. In the middle and coronal sections, sealer penetration was similar for the EDDY and PUI groups.

The use of chelating agents with passive ultrasonic irrigation enhances root canal filling sealing ability

The aim of this study was to compare the influence of a final rinse with and without passive ultrasonic irrigation (PUI), using 17% ethylenediaminetetraacetic acid (EDTA) or 10% citric acid (CA), with 2.5% sodium hypochlorite (NaOCl) with PUI, on the sealing ability of root canal fillings. Root canal instrumentation was performed in single-rooted premolars using NaOCl as the irrigant. Subsequently, the roots were randomly allocated into four experimental groups (n=23): EDTA+PUI, EDTA, CA+PUI, CA and control group: NaOCl+PUI. The specimens were root-filled using gutta-percha with a resin-based sealer and inserted into a device to measure glucose leakage at 7 and 30 days. Kruskal-Wallis and Mann- Whitney tests were used to evaluate the differences between the solutions and with or without PUI. Friedman’s ANOVA was used to compare time points (P<0.05). PUI groups showed lower infiltration values (EDTA+PUI 0.74±0.77 and CA+PUI 5.32±1.45) when compared to the groups on which PUI was not performed (EDTA 7.20±2.18 and CA 20.73±4.70), this difference was significant for EDTA (P<0.01) and CA (P=0.000). Also, EDTA showed less glucose infiltration than CA, with or without PUI (P<0.005). NaOCl+PUI showed a higher cumulative glucose infiltration (22.92±9.71). A final rinse using EDTA or CA with PUI enhances the sealing of root canal fillings. EDTA showed less infiltration.

Efficiency of Different Endodontic Irrigation and Activation Systems, Self-Adjusting File Instrumentation/Irrigation System, and XP-Endo Finisher in Removal of the Intracanal Smear Layer: An Ex vivo Scanning Electron Microscope Study.

Aim:This ex vivo study was designed to evaluate and compare different endodontic irrigation and activation systems, the self-adjusting file (SAF) instrumentation/irrigation system, and XP-endo finisher for removal of intracanal smear layer.Materials and Methods:Fifty recently extracted, noncarious human intact single-rooted premolars were selected and divided into five groups (n = 10) according to the root canal irrigation systems; syringe and needle irrigation, passive ultrasonic irrigation (PUI), EndoVac irrigation system, SAF system, and XP-endo finisher. All groups were prepared to apical size F4 file except for the SAF group which was prepared to apical size 20 K-file and then instrumented with the SAF file. Each sample was subjected to final irrigation using different irrigation/activation systems. After splitting the samples, one half of each root was selected for examination under scanning electron microscope. The irrigation systems were compared using the Fisher's exact test with significance set at P < 0.05.Results:In the coronal part, there was no difference among the groups. In the mid-root section, the results of the PUI, EndoVac, SAF, and XP-endo finisher groups tended to be better than syringe and needle irrigation, but the difference was not significant. The apical part of the canal, the SAF system, and XP-endo finisher group seemed to be cleaner than those of the EndoVac group, but this difference was not significant.Conclusions:Within the limitations of the present study, SAF system and XP-endo finisher group cleaned the apical part of the canal more efficiently than EndoVac, PUI, and syringe and needle irrigation.

Evaluation of the Effectiveness of Erbium Lasers on Removing Calcium Hydroxide

Objective: The purpose of this study was to compare the efficacy of Erbium, chromium-doped yttrium, scandium, gallium and garnet (Er,Cr:YSGG), and Erbium-doped yttrium aluminum garnet laser (Er:YAG) lasers with passive ultrasonic irrigation (PUI) and conventional syringe irrigation (CSI) for the removal of calcium hydroxide [Ca(OH)2] paste from standardized canal irregularities. Methods: Forty single-rooted human teeth were split longitudinally, forming halves, and cut a standardized groove in canal walls. After filling each groove with Ca(OH)2 paste, the teeth were reassembled and stored for 1 week. Ca(OH)2 was removed with CSI by using 10 milliliters (mL) of 5% sodium hypochlorite (NaClO) and 10 mL of 17% ethylenediaminetetraacetic acid (EDTA), respectively. The teeth were randomly divided into four groups (n=10). CSI group was irrigated with10 mL of 5% NaClO, 10 mL of 17% EDTA, and 10 mL of distilled water with CSI (control group), respectively. In Er:YAG group, 5% NaClO was activated with Er:YAG laser, and in Er,Cr:YSGG group, Er,Cr:YSGG laser equipped with Radial Firing Tip 2 (RFT 2) was used. In the PUI group, PUI was used with 2.5% NaClO. All groups received irrigation with 10 mL of distilled water as final irrigation. The root halves were examined with a stereomicroscope using a 4-grade scoring system. Results: Residues of Ca(OH)2 in artificial grooves were observed in all groups. In Er,Cr:YSGG group, only three specimens got a score of 1 (less than half of the groove is filled). Er,Cr:YSGG group was found slightly higher yet the difference was found to be not significant with other groups. Conclusions: Although Er,Cr:YSGG laser equipped with RFT 2 tip seems to have a superior effect on removing Ca(OH)2 from the standardized canal irregularities, there was no statistically significant difference between the applications.

Evaluation of the penetration of CHX 2% on dentinal tubules using Conventional Irrigation, Sonic Irrigation (EDDY) and Passive Ultrasonic Irrigation (PUI) techniques: An in vitro study.

BackgroundVarious procedures and techniques have been developed to increase the effectiveness and penetration of irrigants into the dentinal tubules and anatomical anfractuosities. Objective: The purpose of this in vitro study was to compare the effect of different irrigation techniques such as conventional irrigation with a syringe, sonic activation irrigation with EDDY and Passive Ultrasonic Irrigation. All these on dentinal tubule penetration using Chlorhexidine. Material and Methods45 lower premolar teeth extracted for orthodontic reasons were used. These teeth were decoronated to a length of 18mm. This working length was achieved by inserting a size 15 K file into the root canal until it was observed in the ápex. Then the length was reduced to 1 mm. The instrumentation was performed with the Wave One Gold system up to a file # 45. Irrigated with 2mL of CHX between instruments. A final irrigation was performed using 5 mL of 17% EDTA with an E1 - Irrisonic insert for 30 seconds. Then, the root canal was irrigated with 5 mL of distilled water and dried with paper tips. The final irrigation of the 2% CHX with Rhodamine B was carried out with the different techniques of irrigation. Syringe irrigation with 5 mL, sonic irrigation and passive ultrasonic activation activated for 30 seconds in two stages. Axial cuts were made at 200 microns, the observation was done with stereomicroscope and image analysis in Image J software. ResultsStatistically significant differences were found only in the apical region, where the depth penetration in the PUI group was 76 µm, MI 48 µm and SI 41 µm, while in the penetration area, the PUI group was 99 µm2, MI 77 µm2 and finally SI 53 µm2. ConclusionsThe CHX was able to penetrate the dentinal tubules of three-thirds of the roots, for which the technique that showed the greatest penetration capacity was the ultrasonic activation. Key words:Clorhexidine. Dentinal tubule. Dentinal penetration. Passive ultrasonic irrigation. Eddy. Manual irrigation.

Efficacy of different methods of calcium hydroxide removal on bond strength of calcium silicate-based sealer

AimTo evaluate the efficacy of different methods of calcium hydroxide removal [XP-endo finisher (XP-F) file, passive ultrasonic irrigation (PUI) and NaviTip FX (NTFX) irrigating needle] on push-out bond strength of Endoseal MTA calcium silicate-based sealer.Materials and methodsForty extracted human premolars with nearly straight mature roots were used in this study. Teeth were decoronated to obtain a standardized root length of nearly 15 ± 1 mm. Root canals were prepared using ProTaper Universal rotary system up to F4 (40/0.06). Thirty samples were filled with calcium hydroxide paste then after 7 days, it was removed using different methods: G1: XP-F, G2: PUI, G3: NTFX. The remaining ten teeth with no prior medication were used as a control group (G4). All samples were obturated using gutta-percha/Endoseal MTA then transversally sectioned into coronal, middle, apical sections. The obtained sections were subjected to push-out bond strength test using a universal testing machine.ResultsThe highest mean push-out bond strength values were recorded for the control group followed by XP-F file and PUI while the lowest value for NTFX groups. The coronal section recorded the highest mean push-out bond strength value while the lowest value for the apical section with a significant difference in all groups.ConclusionPush-out bond strength values for XP-F and PUI groups were higher than NTFX group.

Irrigant Agitation Techniques versus Passive Ultrasonic Irrigation for Removing Debris from Curved Root Canals: An Environmental Scanning Electron Microscopic Study.

The aim of this study was to compare the efficacy of passive ultrasonic irrigation (PUI) versus mechanical agitation of the irrigant promoted by the EasyClean (EC) and XP-Endo Finisher (XP-F) systems in removing debris from root canal walls, using environmental scanning electron microscopy (ESEM). Twelve curved mesiobuccal canals of mandibular molars were prepared with the ProTaper Next system up to file X2 (25/0.06). The specimens were embedded in flasks containing silicone putty, sectioned lengthwise, and a 4-mm long groove was made on the canal wall of the buccal half of the specimen, extending from 2 mm up to 6 mm short of the apex. Five cross-sectional markings were made along this groove to establish standardized locations for imaging. The same specimens were used to prepare a negative control group (without debris), a positive control group (completely covered by debris), and 3 experimental groups according to the final irrigation protocol employed: PUI, EC or XP-F. ESEM images were obtained and evaluated by 3 examiners. The amount of debris observed on the images was classified according to a 4-category scoring system. The kappa test was used to assess inter-examiner agreement, and the Kruskal-Wallis and Dunn tests were used to compare the scores (P<0.05). The scores attributed to the PUI, EC, and XP-F groups were statistically similar to those attributed to the negative control group (P>0.05). Based on this in-vitro study, the mechanical agitation of the irrigant promoted by EC and XP-F was as effective as using PUI to remove debris from the root canal walls.

Evaluation of different irrigation solutions and activation methods on removing calcium hydroxide

Background/purposeDual Rinse HEDP is a soft chelator which can be used simultaneously with sodium hypochlorite (NaOCl). The aim of this study is to evaluate the efficacy of Dual Rinse HEDP with different irrigation systems on removing calcium hydroxide [Ca(OH)2]. Materials and methodsEighty maxillary central incisor teeth were shaped and a standard groove on the apical third of the root canal surface was prepared. The root canals were filled with Ca(OH)2. Samples were divided into two groups according to the solution and these two groups were divided into three subgroups based on the activation technique. In group 1 (n = 10) Ca(OH)2 was removed using conventional irrigation with NaOCl whereas in group 2 (n = 10) conventional irrigation with NaOCl – Dual Rinse HEDP mixture was used. Group 3 (n = 15) and group 4 (n = 15) received sonic activation with the same irrigants as groups 1 and 2 respectively. In group 5 (n = 15) passive ultrasonic irrigation (PUI) was used with NaOCl while in group 6 (n = 15) the irrigant was the mixture. The amount of remaining Ca(OH)2 in the artificial grooves were evaluated under a light microscope. ResultsNone of the procedures managed to completely remove the Ca(OH)2 from artificial grooves. There was no significant difference between the groups (p = 0.053). The scores were significantly lower in PUI group compared to the other techniques between NaOCl groups (p = 0.021). ConclusionDual Rinse HEDP does not make a difference on elimination of Ca(OH)2. PUI is more efficient than both methods when NaOCl solution is used.

The effect of a preparation containing glycocholic acid and/or agitation on the tissue dissolution ability of sodium hypochlorite.

This study assessed the porcine palatal mucosa dissolution, from artificial grooves, by a final rinse of sodium hypochlorite (NaOCl) solely or mixed with Keratobacter ((KB); or agitation) passive ultrasonic irrigation (PUI) or sonic activation (SA). Soft-tissue samples (n=123) were weighed and placed inside root canal grooves in central maxillary incisors. The specimens were randomly divided into six test groups (n=20): NaOCl 3% with or without KB and the irrigation dynamics: positive pressure (PP), SA or PUI. An EDTA intermediate rinse was included. Soft-tissue weights were measured subsequently. The NaOCl+KB_PUI group showed the highest mean weight reduction, whilst the NaOCl_PP group recorded the lowest. NaOCl+KB subgroups were associated with hastened reduction compared with NaOCl subgroups. NaOCl_PP presented with significantly lower weight reduction when compared with the remaining experimental groups. The addition of KB to NaOCl or its agitation enhances tissue dissolution ex vivo. The agitation of KB-containing mixtures offers no further benefits.

Microbial reduction after using different root canal irrigation–activation techniques

AimThe aim was to clinically evaluate the microbial reduction after using different irrigation–activation techniques including needle irrigation, passive ultrasonic irrigation (PUI) and EndoVac.Materials and MethodsTwenty-four patients with single rooted, single-canal teeth with primary endodontic infection were selected for this study then randomly assigned into three groups according to the final irrigation–activation method. Group 1 (control group) needle irrigation, group 2 (PUI irrigation) and group 3 (EndoVac irrigation). The first microbial sample (S1) was taken after access cavity preparation under complete aseptic condition then the second microbial sample (S2) after chemomechanical preparation using ProTaper Universal rotary system up to F3 or F4 or F5 according to canal size. Finally, the third microbial sample (S3) was taken after irrigation–activation, the three samples were cultured on blood agar aerobic and anaerobic, incubated for 24–48 h at 37°C, the growing colonies were counted and recorded as colony forming units.ResultsPUI group showed the highest microbial reduction, while the needle group showed the lowest microbial reduction with statistically significant difference with both PUI group and EndoVac group. While no statistically significant difference was recorded between PUI and EndoVac groups.ConclusionIrrigation–activation increases the efficacy of irrigation concerning the microbial reduction and PUI is the most recommended method of activation.

Comparison of the efficacy of CanalBrush, EndoActivator, and Passive Ultrasonic Irrigation on the removal of triple antibiotic paste from root canal walls: An in vitro study

ABSTRACTAim:The aim of this study was to compare the efficacy of CanalBrush (CB), EndoActivator (EA), and Passive Ultrasonic Irrigation (PUI) on the removal of triple antibiotic paste (TAP) from root canal walls.Materials and Methods:Thirty-six extracted human single-rooted teeth were prepared using ProTaper Universal rotary files (DentsplyMaillefer, Ballaigues, Switzerland) up to size F5. The root canals were filled with TAP, and after 21 days, roots were randomly assigned to three groups (n = 10) according to irrigation regimens used: CB, EA, and PUI. In three teeth, TAP was not removed (positive controls), and the other three teeth were not filled with TAP (negative controls). The roots were sectioned, and the amount of TAP remaining was evaluated at the mesial halves of each tooth at ×30 magnification under a stereomicroscope using a 4-grade scoring system. Data were evaluated using the Kruskal–Wallis and Mann–Whitney U tests.Results:There were significant differences among the experimental groups according to the different parts of the root canals (P < 0.05). At the apical and middle third, EA and PUI groups removed more TAP than CB group; however, there was a statistically significant difference only between CB and PUI groups (<0.01 at apical third and <0.05 at middle third). At the coronal third, there was no statistically significant difference between all the three groups (P > 0.05).Conclusion:PUI led to superior results compared to CB in the middle and apical thirds. There was no significant difference between EA and PUI techniques.

Effectiveness of Vapor Lock Effect Removal in Endo Training Blocks: Manual Dynamic Agitation versus Passive Ultrasonic Irrigation

Root canal cleaning plays an important role in endodontics. In most cases, root canal cleaning is performed using irrigants, such as sodium hypochlorite or EDTA (ethylenediaminetetraacetic acid). The efficacy of these irrigants may be compromised by different phenomena, such as vapor lock. Different methods can be used to overcome this problem; in this paper, we compare the efficacy of two such methods: manual dynamic agitation (MDA) and passive ultrasonic irrigation (PUI). We shaped 50 endo training blocks, which were divided into two groups of 25 samples each, into MDA or PUI groups. In both groups, the vapor lock was produced by delivering a watery solution using a disposable syringe with a tip-opened needle. Using the MDA technique, vapor lock was removed in 15/25 cases. The PUI technique produced the same results in 17/25 cases, where vapor lock was only reduced, not removed. The MDA method produced an average reduction in vapor lock of 80%, whereas the PUI method yielded a 55% reduction. The differences among groups were assessed through a Mann–Whitney U test, and the results had a p-value of 0.0013, which was considered to be statistically significant. The MDA method was able to effectively remove vapor lock. PUI, however, was only able to reduce but not remove vapor lock.

Antibiofilm Activity of Three Different Irrigation Techniques: An in Vitro Study.

The microbial infection of the endodontic space occurs in a necrotic tooth as a result of dental caries, trauma, periodontal disease, or previous root canal therapy. The disruption of the biofilms and the reduction of the bacterial load inside root canals are crucial for the success of root canal therapy. The aim of this study was to compare, in vitro, the antibiofilm efficacy of a novel passive sonic irrigation (PSI) device with passive ultrasonic irrigation (PUI) and conventional needle irrigation (CNI). Forty-four single-rooted human teeth were inoculated with a culture of E. faecalis for 28 days. The specimens were randomly divided into three groups: PUI, CNI, and PSI (n = 12). The activation protocols were performed using both 17% EDTA and 5.25% NaOCl. Residual bacterial biofilm was taken by means of a canal brush and colony-forming unit (CFU) were counted. The data were analyzed using one-way ANOVA and Games-Howell’s post hoc tests. A major reduction in CFU was observed in the PSI and PUI groups, in comparison with the CNI group. No difference was found (p > 0.05) in terms of CFU reduction between PSI and PUI. PSI could be as effective as PUI in the removal of bacterial biofilms from straight root canals.

Comparison of the Efficacy of Different Techniques for the Removal of Root Canal Filling Material in Artificial Teeth: A Micro-Computed Tomography Study.

This study aimed to assess the efficacy of canal filling material removal using three different techniques after filling with a Gutta–Percha (GP) cone and calcium silicate-based sealer, by measuring the percentage of volume debris of GP and sealer remaining intracanal with micro computed tomography (micro-CT). The filling material was removed from 30 plastic teeth by a nickel–titanium (Ni–Ti) rotary retreatment system. Final irrigation was performed with 2 mL of saline and 10 specimens were randomly allocated to a conventional group. In the passive ultrasonic irrigation (PUI) group, ultrasonic irrigation was added to the conventional group (n = 10). In the Gentlefile Brush (GF Brush) group, irrigation with GF Brush was added to the conventional group (n = 10). Remaining filling material was measured using micro-CT imaging analysis. The total mean volume of residual filling material after retreatment in the conventional group, PUI group and GF Brush group were 4.84896 mm3, 0.80702 mm3, and 0.05248 mm3, respectively. The percentage of filling material remaining intracanal was 6.76% in the conventional group, 1.12% in the PUI group and 0.07% in the GF Brush group. This study shows that the cleaning effect of the GF Brush system is superior to those of Ni–Ti retreatment files and the PUI system in the apical area.

Effect of EDTA and QMIX Ultrasonic Activation on the Reduction of Microorganisms and Endotoxins in Ex Vivo Human Root Canals.

The present study aimed to compare the effectiveness of QMiX and 17% EDTA associated to passive ultrasonic irrigation (PUI) or manual agitation (MA) on the reduction of E. faecalis, E. coli and LPS from root canals. Forty single rooted human teeth were randomly divided into four groups (n=10), according to the final irrigation protocol: EDTA+MA, QMiX+MA, EDTA+PUI, QMiX+PUI. Sample collections were obtained from the root canal content immediately before preparation (baseline-S1), after instrumentation (S2), after final irrigation protocol (S3) and 7 days after instrumentation and final irrigation (S4). The antimicrobial effectivity and on endotoxin content were analyzed by culture procedure (CFU/mL) and LAL assay (EU/mL), respectively. The results were statistically analyzed by Kruskal-Wallis and Friedman test (α=5%). QMiX+MA and QMiX+PUI reduced 100% of E. coli and E. faecalis bacteria and also prevented E. faecalisregrowth at S4. EDTA significantly reduced E. coli, but it was not effective in reducing E. faecalis. All protocols reduced EU/mL when compared to S1, however at S4 there was a significant reduction of EU/mL only in the QMiX+MA and QMiX+PUI groups in relation to S3 and S2, respectively. Final irrigation with QMiX associated with MA or PUI had superior antibacterial efficacy compared to EDTA, eliminating 100% of E. coli and E. faecalis strains. In addition, QMiX+PUI reduced 97.61% of the initial content of LPS.