Passive Ultrasonic Irrigation Group Research Articles

Effectiveness of laser-assisted irrigation and passive ultrasonic irrigation techniques on smear layer removal in middle and apical thirds.

The purpose of this study was to investigate the evaluation of laser-assisted irrigation (LAI) on the removal of the smear layer as compared to passive ultrasonic irrigation (PUI). Forty-eight single-rooted, upper-central incisor teeth were selected and prepared with ProTaper rotary instruments up to size #40 (F4) at the working lengths. Specimens were divided into four groups, as follows: (a) PUI with 5 mL of 2.5% NaOCl for 60 s; (b) PUI with 2.5 mL of 17% EDTA and 2.5 mL of 2.5% NaOCl each for 30 s; (c) LAI with 5 mL of 2.5% NaOCl for 60 s; and (d) LAI with 2.5 mL of 17% EDTA and 2.5 mL of 2.5% NaOCl each for 30 s. In the PUI groups, the ultrasonically activated file was inserted 1 mm short of the working length, but in the LAI groups, the fiber tip was applied into the pulp chamber. LAI in the pulp chamber with the combination of 17% EDTA and 2.5% NaOCl removed more of the smear layer than the other groups (p < 0.018). LAI in the pulp chamber with the combination of 2.5% NaOCl and 17% EDTA better removed the smear layer than LAI applied similarly but without EDTA or PUI with the same NaOCl and EDTA combinations using an ultrasonically activated file inserted 1 mm short of the working length.

Micro–Computed Tomographic Evaluation of Hard Tissue Debris Removal after Different Irrigation Methods and Its Influence on the Filling of Curved Canals

IntroductionThe aim of this study was to compare the efficacy of passive ultrasonic irrigation (PUI) and the EndoVac (EV) System (Discus Dental, Culver City, CA) in hard tissue debris removal and its influence on the quality of the root canal filling with the aid of micro–computed tomographic scanner. MethodsTwenty-four mandibular molars were subjected to 4 microtomographic scannings (ie, before and after instrumentation, after final irrigation, and after obturation) using the SkyScan 1176 X-ray microtomograph (Bruker microCT, Kontich, Belgium) at a resolution of 17.42 μm. Mesial canals were prepared using R25 Reciproc instruments (VDW GmbH, Munich, Germany) and divided into 2 groups according to the final irrigation method: the PUI group (n = 12) and the EV group (n = 12). All specimens were filled with the continuous wave of condensation technique. CTAn and CTvol software (Bruker microCT) were used for volumetric analysis and 3-dimensional model reconstruction of the root canals, hard tissue debris, and the filling material. Data were statistically analyzed using the Student t test. ResultsAnalysis of the micro–computed tomographic scans revealed debris accumulated inside the root canals, occupying an average of 3.4% of the canal's volume. Irrigation with PUI and the EV system reduced the volume of hard tissue debris in 55.55% and 53.65%, respectively, with no statistical difference between them (P > .05). Also, there was no difference among the groups with regard to the volume of filling material and voids (P > .05). ConclusionsPUI and the EV system were equally efficient in the removal of hard tissue debris and the quality of root canal filling was similar in both groups, with no influence from the irrigation method.

Comparison of Different Irrigation Activation Regimens and Conventional Irrigation Techniques for the Removal of Modified Triple Antibiotic Paste from Root Canals

IntroductionThe aim of this study was to compare the efficacy of irrigation activation regimens and conventional syringe irrigation technique in the removal of modified triple antibiotic paste (mTAP) from root canal walls. MethodsFifty-six extracted human mandibular premolars were prepared using ProTaper rotary files (Dentsply Maillefer, Ballaigues, Switzerland) up to size F4. The root canals were filled with mTAP medicament, and after 21 days, the roots were randomly assigned to 5 groups (n = 10) according to the irrigation regimens used: conventional syringe irrigation (CI), Self-Adjusting File (SAF; ReDent-Nova, Ra'anana, Israel), EndoVac (Discus Dental, Culver City, CA), EndoActivator (Dentsply, Tulsa, OK), and passive ultrasonic irrigation (PUI). In 3 teeth, mTAP was not removed (positive controls), and another 3 teeth were not filled with mTAP (negative controls). The roots were sectioned, and the amount of remaining medicament at each root half (n = 20) was evaluated at 30× magnification using a 4-grade scoring system. Data were evaluated using the Kruskal-Wallis and Mann-Whitney U tests. ResultsThere were statistically significant differences among all experimental groups; of which, the CI group was the significantly least efficient in removing mTAP from the root canal (P < .05). At the apical and middle third, the PUI, SAF, EndoVac, and EndoActivator groups removed significantly more mTAP medicament than the CI group (P < .05); however, there were no significant differences between these groups (P > .05). The SAF and PUI showed significantly better performances in removing mTAP from the coronal third (P < .05). ConclusionsThe use of irrigation activation regimens significantly improves the removal of mTAP from root canals when compared with CI.

Evaluation of penetration depth of 2% chlorhexidine digluconate into root dentinal tubules using confocal laser scanning microscope.

ObjectivesThis study evaluated the penetration depth of 2% chlorhexidine digluconate (CHX) into root dentinal tubules and the influence of passive ultrasonic irrigation (PUI) using a confocal laser scanning microscope (CLSM).Materials and MethodsTwenty freshly extracted anterior teeth were decoronated and instrumented using Mtwo rotary files up to size 40, 4% taper. The samples were randomly divided into two groups (n = 10), that is, conventional syringe irrigation (CSI) and PUI. CHX was mixed with Rhodamine B dye and was used as the final irrigant. The teeth were sectioned at coronal, middle and apical levels and viewed under CLSM to record the penetration depth of CHX. The data were statistically analyzed using Kruskal-Wallis and Mann-Whitney U tests.ResultsThe mean penetration depths of 2% CHX in coronal, middle and apical thirds were 138 µm, 80 µm and 44 µm in CSI group, respectively, whereas the mean penetration depths were 209 µm, 138 µm and 72 µm respectively in PUI group. Statistically significant difference was present between CSI group and PUI group at all three levels (p < 0.01 for coronal third and p < 0.001 for middle and apical thirds). On intragroup analysis, both groups showed statistically significant difference among three levels (p < 0.001).ConclusionsPenetration depth of 2% CHX into root dentinal tubules is deeper in coronal third when compared to middle and apical third. PUI aided in deeper penetration of 2% CHX into dentinal tubules when compared to conventional syringe irrigation at all three levels.

The effect of passive ultrasonic activation of 2% chlorhexidine or 3% sodium hypochlorite in canal wall cleaning.

Objectives: the purpose of this study was to compare debris removal and open tubules effectiveness of sodium hypochlorite (NaOCl) and chlorhexidine (CHX) applied as final irrigation in different protocols Study Design: sixty extracted premolars were divided into six groups according to the final irrigation technique: A and B 3 % NaOCl or 2 % CHX with the Miraject needle and no agitation; C and D, passive ultrasonic irrigation (PUI) with Irrisafe 20 tips and 3 % NaOCl or 2 % CHX; E and F, PUI with Irrisafe 25 tips and 3 % NaOCl or 2% CHX. The remaining dentine debris and opened tubules were evaluated by SEM at three root levels by two blinded investigators. The Kruskal Wallis and the Mann-Whitney U test was used to compare groups and levels, with a significance of p<0.05. Results: Debris elimination was significantly higher in PUI groups (p<0.05). PUI groups showed a higher capability to open tubules, compared to groups A and B. In the coronal third, groups D to F eliminated more debris and opened more tubules than conventional irrigation (p<0.05). In medium third, group E eliminated significantly more debris (1.60) than group A (2.60). No differences were obtained among groups in apical third. Both NaOCl and CHX applied with PUI showed no differences in debris elimination or opened tubules. Conclusions: Final PUI with Irrisafe tips was the most effective procedure for eliminating the debris and opening up dentinal tubules, independent of the irrigant solution or Irrisafe type size. Key words:Ultrasonic irrigation, PUI, sodium hypochlorite, chlorhexidine.

Comparative Evaluation of Canal Isthmus Debridement Efficacy of Modified EndoVac Technique with Different Irrigation Systems

IntroductionThe purpose of this study was to evaluate the canal isthmus debridement efficacy of a new modified EndoVac (Discus Dental, Culver City, CA) irrigation protocol in comparison with EndoVac, passive ultrasonic irrigation (PUI), and conventional needle irrigation in mesial roots of mandibular molars. MethodsThe mesial roots of 64 extracted mandibular molars mounted in resin using Kuttler's endodontic cube, sectioned at 2 and 4 mm from the working length, were randomly divided into 4 groups (n = 16): group 1: Max-I-Probe (Dentsply Tulsa Dental, York, PA), group 2: EndoVac (EVI), group 3: modified EndoVac, and group 4: PUI. The specimens were reassembled and instrumented. A standard irrigation protocol was used during cleaning and shaping and final irrigation with the 4 irrigation/agitation techniques. Images of the isthmus region were taken before and after cleaning and shaping and after final irrigation. The percentage reduction of debris in the isthmus region was calculated by using the software program Image J (v1.43; National Institutes of Health, Bethesda, MD). Intergroup analysis was performed using the Kruskal Wallis and Mann-Whitney U tests. Intragroup analysis was performed using Friedman and Wilcoxon signed rank tests. The level of significance was set at P < .05. ResultsIntragroup analysis revealed a statistically significant difference in the percentage reduction of debris after cleaning and shaping and after final irrigation protocol in all the groups (P < .001). The final irrigation protocol produced significantly cleaner canal isthmuses in all the groups (P < .001). On intergroup analysis, the modified EVI group performed significantly better than the other groups. The EVI and PUI groups performed better than the Max-I-Probe group. There was no statistical significance between the EVI and PUI groups. ConclusionsCanal isthmuses were significantly cleaner with the modified EndoVac irrigation technique when compared with the cleanliness seen with the other irrigation systems.

Comparison of the Efficacies of Debris Removal With Four Different Irrigation Techniques

Background: In this study, we compared the effectiveness of debris removal among the EndoVac (EV), passive ultrasonic irrigation (PUI), self-adjusting file (SAF) and needle irrigation (NI) techniques. Methods: Forty-two single-canal teeth were divided into four groups of 10 teeth each and two controls. The experimental groups were NI, SAF, PUI and EV. After irrigation protocols, the teeth were sectioned at 1 and 3 mm from the apex using a precision saw. The specimens were observed under stereomicroscope at × 128 magnification and digitally photographed. The amount of remaining debris was calculated as a percentage of the canal lumen area. Results: The amounts of debris remaining at 1 mm in NI, SAF, PUI and EV groups were 18.11%, 7.12%, 12.71% and 4.42%, respectively. The amounts of debris at 3 mm in NI, SAF, PUI and EV groups were 9.61%, 5.22%, 8.42% and 2.61% respectively. The amount of debris in the EV group was significantly lower than the other groups (P &lt; 0.01). The amount of debris at 3 mm was significantly lower than at 1 mm (P &lt; 0.01). Conclusion: EV irrigation resulted in significantly less debris at both 1 and 3 mm from the apex compared with the other irrigation techniques. J Curr Surg. 2014;4(3):70-75 doi: http://dx.doi.org/10.14740/jcs242e

Efficacy of laser‐driven irrigation versus ultrasonic in removing an airlock from the apical third of a narrow root canal

The purpose of the study was to test the hypothesis that air entrapment occurs in the apical third of a root canal during irrigation. A second objective was to test the null hypothesis that there is no difference between laser-driven irrigation (an erbium, chromium:yttrium-scandium-gallium-garnet laser) and passive ultrasonic irrigation in removing an airlock from the apical third. One hundred twenty extracted human teeth with single narrow root canals were randomised into two experimental groups (n = 40) and two control groups (n = 20). The specimens were shaped using hand instruments up to a size 30/0.02 file. The teeth were irrigated with a mixture of saline, radiopaque contrast and ink in solution. In the passive ultrasonic irrigation group, the irrigant was activated with an ultrasonic device for 60 s. In the laser group, the irrigant was activated with a laser for 60 s. It was concluded that if the insertion of irrigation needle is shorter than the working length, air entrapment may develop in the apical third, but the use of laser-driven irrigation is completely effective in removing it.

In Vitro Comparison of Passive and Continuous Ultrasonic Irrigation in Simulated Lateral Canals of Extracted Teeth

IntroductionComplete endodontic system disinfection requires the removal of vital and necrotic pulp tissue, microorganisms, and toxins. The purpose of this study was to compare the effects of 2 ultrasonic irrigation techniques on the penetration of sodium hypochlorite into the main canal and simulated lateral canals of extracted teeth. MethodsTwo simulated lateral canals each were created 2, 4, and 6 mm from the working length in 60 single-rooted teeth (6 canals/tooth, n = 360). To resemble the clinical situation, a closed system was created in each tooth. The teeth were randomly assigned to 3 experimental irrigation groups: group 1 (n = 20), positive pressure irrigation (PPI); group 2 (n = 20), passive ultrasonic irrigation (PUI); and group 3 (n = 20), continuous ultrasonic irrigation (CUI). Samples were evaluated by direct observation of still images recorded under a dental operating microscope. To examine irrigating solution penetration, 20% Chinese ink (Sanford Rotring GmbH, Hamburg, Germany) was added to a 5% sodium hypochlorite solution and delivered into the root canals. ResultsThe results showed a significantly higher (P < .05) penetration of irrigant into the lateral canals in the CUI group. PUI and CUI did not differ significantly in solution penetration into the apical thirds of the main canals. The PPI group showed a significantly lower penetration of sodium hypochlorite into the main and lateral canals compared with the CUI and PUI groups. ConclusionsCUI as a final rinse significantly increased the penetration of irrigating solution into simulated lateral canals.

In Vivo Efficacy of Three Different Endodontic Irrigation Systems for Irrigant Delivery to Working Length of Mesial Canals of Mandibular Molars

IntroductionMany in vitro studies have debated over the ability of different irrigant delivery and/or agitation systems to reach the apical third of curved root canals; however, little is known about irrigant penetration in vivo. Therefore, the purpose of this study was to compare the efficacy of the conventional endodontic irrigation needle, passive ultrasonic irrigation (PUI), and a negative pressure system for irrigant delivery to working length (WL) of mesial canals of mandibular molars. MethodsThirty mesial canals of 30 vital mandibular first or second molars were randomly assigned into 3 groups (n = 10): (1) Monoject syringe with 27-gauge needle; (2) PUI with IrriSafe tip; and (3) EndoVac system. All canals were treated following the same preparation protocol to size 35/0.04 by using 5.25% NaOCl as irrigant during preparation procedure. Before obturation, canals were irrigated with 1 mL of a radiopaque solution by using the assigned irrigation system, and a digital radiograph was taken by using a parallel technique. With the aid of image editing software the distance between WL and maximum irrigant penetration was measured. ResultsMean distances for Monoject, PUI, and EndoVac groups were 1.51 mm, 0.21 mm, and 0.42 mm, respectively. Analysis of variance test showed statistically significant differences between groups (P < .001). Tukey honestly significant difference test showed statistically significant differences between the Monoject group and the other 2 groups (P < .001) but no significant differences between PUI and EndoVac groups (P = .06). ConclusionsPUI and EndoVac are more effective than the conventional endodontic needle in delivering irrigant to WL of root canals.

Effect of Passive Ultrasonic Irrigation on Apical Extrusion of Irrigating Solution

To determine the influence of passive ultrasonic irrigation (PUI) on apical extrusion of irrigating solution. Twenty freshly extracted maxillary and mandibular incisors with single straight root canals were instrumented with ProTaper rotary files. During final irrigation, the root canals were filled with 2.5% sodium hypochlorite (NaOCl) solution and PUI was performed with a piezoelectronic unit. A stainless steel instrument (size 15) was inserted into the root canal and the irrigant was ultrasonically activated for one minute. This sequence was repeated three times, resulting in a total PUI time of three minutes. The volume of extruded irrigant was measured by Pipetman pipettes. The data were statistically analyzed with the Mann-Whitney U test. The mean volume of apical extruded irrigant was 2.15 muL for the PUI group and 14 muL for the control group. The experimental group extruded significantly smaller amounts of irrigant than the control group (P<.05). The PUI procedure as a final irrigation was associated with less apical extrusion of the irrigating solution.