Passive Ultrasonic Irrigation Technique Research Articles

Evaluation of different irrigation activation techniques for the removal of various medicaments from a simulated internal resorption cavity: an in vitro study.

This study aimed to assess the efficacy of different activation techniques in removing calcium hydroxide (Ultracal XS), Ledermix, and Bio-C Temp from simulated internal root resorption (IRR) cavities. 108 single-rooted maxillary incisors were prepared using Reciproc R50 files. Simulated IRR cavities, 2mm in diameter and located 8mm from the apex, were created. Ultracal XS, Ledermix, and Bio-C Temp were applied to the samples, grouped by irrigation activation techniques: Standard Needle Irrigation (SNI), EDDY, Passive Ultrasonic Irrigation (PUI), and XP-endo Finisher (XPF). Medicament removal efficacy was evaluated using a standardized scoring system. Statistical analysis was performed using the Kruskal-Wallis test. XPF and PUI were more effective than SNI in medicament removal across the groups, with no significant difference. EDDY showed no significant difference than other groups. Ledermix was more effectively removed in all activation groups compared to Bio-C Temp. The XPF was superior in removing Ultracal XS compared to Bio-C Temp. However, none of the groups achieved complete medicament removal. XPF and PUI techniques enhance medicament removal efficacy. Bio-C Temp was more difficult to remove from the IRR cavities than other medicaments. Bio-C Temp could be removed from the canals less effectively compared to calcium hydroxide and Ledermix. Among the tested irrigation activation methods, XPF and PUI were found to be more effective at removing the tested medicaments.

Efficacy of laser-activated irrigation with the SWEEPS modality in removing calcium hydroxide from simulated internal resorption cavities

Aim: To compare the efficacy of shockwave-enhanced emission photoacoustic streaming (SWEEPS), sonic activation with EDDY, and passive ultrasonic irrigation (PUI) in the removal of calcium hydroxide medicaments from artificial internal resorption cavities. Methodology: Ninety mandibular premolars with single oval canals were prepared to size 50/0.04 and split longitudinally. Standardized cavities were prepared in the apical third of the root canal and filled with calcium hydroxide. The root halves were reassembled and divided into three groups (n = 30) according to the removal methods used. The amount of residual calcium hydroxide was evaluated using a four-grade scoring system. The differences between the groups were analyzed using the Kruskal–Wallis H test (p < 0.05). Results: SWEEPS removed significantly more calcium hydroxide than PUI (p < 0.003) and EDDY (p < 0.035). There was no significant difference between the EDDY and PUI groups (p = 1.000). Conclusion: None of the systems tested were able to completely remove the calcium hydroxide paste from the simulated internal resorption cavities; however, SWEEPS removed more calcium hydroxide than the EDDY and PUI techniques. How to cite this article: Erkan E, Aydın RN, Falakaloğlu S, Yeniçeri Özata M, Gündoğar M. Efficacy of laser-activated irrigation with the SWEEPS modality in removing calcium hydroxide from simulated internal resorption cavities. Int Dent Res 2023;13(2):48-53. https://doi.org/10.5577/idr.2023.vol13.no2.1 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Assessment of Dentinal Tubules Penetration by Hyben X Delivered into the Root Canal System as an Irrigant; An in Vitro Study.

Disinfection of the root canal system is crucial for a successful endodontic treatment. Several factors influence the performance of effective irrigation. Diverse irrigating substances have been used but none has proved to completely penetrate the root canal system. HybenX dries biofilm due to its hygroscopic properties; therefore, it is effective in the treatment of biofilm-related diseases. This investigation aimed to estimate HybenX's degree of penetration into the dentinal tubules of upper first premolars. Experimental in vitro intervention where 30 extracted maxillary premolars were evaluated to determine HybenX's degree of penetration and 5% sodium hypochlorite in the dentinal tubules using three different irrigation techniques (passive ultrasonic irrigation, dynamic manual irrigation and conventional single jet irrigation technique). After preparation, the root canals were irrigated with fluorescent rhodamine 6G; then 500-micrometer sections were made to be analyzed under a fluorescence microscope. Measurements were made in micrometer in ZEN software to determine the penetration degree of each substance in the different root thirds. In the apical third, significant differences between the 3 irrigation techniques were found (P<0.05), similarly, for the middle and cervical thirds. Significant statistical differences between the HybenX and sodium hypochlorite were found at the cervical and middle levels when using the conventional Monoject irrigation and passive ultrasonic irrigation techniques. As for the apical level, differences were found between the passive ultrasonic irrigation techniques and the dynamic manual irrigation technique. Based on this in vitro study, HybenX proved to highly penetrate into the dentinal tubules, especially when using the passive ultrasonic irrigation technique. HybenX may be a useful option for root canal irrigation in endodontics.

Effectiveness of XP-Endo Finisher and passive ultrasonic irrigation on intracanal medicament removal from root canals: a systematic review and meta-analysis

BackgroundXP-Endo Finisher (XPF) and passive ultrasonic irrigation (PUI) are commonly used in intracanal medicament removal. The effectiveness of these two techniques needs to be compared, and evidence-based research should be conducted.MethodsA comprehensive literature search was conducted in PubMed, Web of Science, Embase, Cochrane Library, and Google Scholar up to December 20th, 2020. The outcomes of the included trials were pooled into the Cochrane Collaboration’s Review Manager 5.3 software. Cochrane’s risk-of-bias tool 2.0 was applied to assess the risk of bias.ResultsNine articles were included in this systematic review and processed for data extraction, and eight studies were identified for meta-analysis. In general, the use of PUI showed better medicament removal effectiveness than XPF (odds ratio [OR]: 3.09; 95% confidence interval [CI], 1.96–4.86; P < 0.001). PUI was also significantly more efficient than XPF in the apical third (OR: 3.42; 95% CI, 1.32–8.84; P = 0.01). For trials using sodium hypochlorite (NaOCl) alone, PUI was also significantly more effective than XPF on intracanal medicaments removal (OR: 5.23; 95% CI, 2.79–9.82; P < 0.001). However, there was no significant difference between PUI and XPF when NaOCl and ethylenediaminetetraacetic acid (EDTA) were used in combination (OR: 1.51; 95% CI, 0.74–3.09; P = 0.26). In addition, for studies whose intracanal medicament periods were two weeks, the effectiveness of PUI was statistically better than the XPF (OR: 7.73; 95% CI, 3.71–16.07; P < 0.001). Nevertheless, for trials whose intracanal medicament time was one week or over two weeks, no differences between the XPF and PUI were found (OR: 1.54; 95% CI, 0.74–3.22; P = 0.25) (OR: 1.42; 95% CI, 0.44–4.61; P = 0.56).ConclusionsThe meta-analysis is the first study to quantitatively compare the effectiveness of XPF and PUI techniques on intracanal medicaments removal. With rigorous eligibility criteria, the study only included high-quality randomised controlled trials. The study indicated that PUI might be superior over XPF techniques for removing intracanal medicaments from artificial standardized grooves and cavities in the root canal system. The anatomical areas, irrigation protocol, and intracanal medicaments time may influence the cleaning efficacy.

Effect of Various Irrigating Devices on the Removal of Two Different Forms of Calcium Hydroxide from Internal Resorption Cavities.

The present study aimed to investigate the efficiency of passive ultrasonic irrigation (PUI), EndoActivator (EA), standard needle irrigation (SNI), and XP-endo Finisher files in removing pure calcium hydroxide (pCH) and injectable CH from in vitro root resorption cavities. Using a rotary system, the root canals of 116 extracted single rooted teeth were prepared. Imitated internal resorption cavities were then created in root halves. The specimens were divided into two groups according to the form of CH (n = 58): (I) pCH; (II) injectable CH. The teeth of each group were randomly divided into six subgroups: negative control (n = 5), positive control (n = 5), PUI (n = 12), XP-endo Finisher (n = 12), EA (n = 12), and SNI (n = 12). The root canals were irrigated using NaOCl and EDTA and split longitudinally, and both halves were evaluated with a stereomicroscope. Kruskal–Wallis and Mann–Whitney U tests were used to analyze data. The present results revealed that PUI completely removed pCH in 79% and injectable CH in 70.8% of the internal resorption cavities which was significantly higher than other methods (p < 0.05). There was no statically significant difference between different forms of CH in terms of CH removal (p=0.918). The PUI technique was observed as the most efficient method of P-CH and injectable CH removal from a replicated internal resorption cavity. Finally, according to the findings, different forms of CH were comparable in terms of CH removal.

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.

Cleaning Efficacy of the XP-Endo® Finisher Instrument Compared to Other Irrigation Activation Procedures: A Systematic Review

Background. One of the most important aims of an endodontic treatment is to obtain the complete removal or reduction of root canal remaining filling material: Smear layer, bacteria, intra-canal medicaments. To meet this requirement, several irrigation activation techniques have been proposed. Our systematic review examined studies which analyzed the XP-endo Finisher (XPF) instrument efficacy in removing root canal debris during initial endodontic treatment or retreatment, comparing it with the efficacy of other irrigation activation protocols, such as passive ultrasonic irrigation (PUI), laser activation procedure (Er:YAG), and Self-Adjusting File system (SAF). Methods. A systematic review was conducted using PubMed, Chocrane Library, and Scopus databases, identifying 51 items. Thirty-four articles were excluded based on title, abstract, full text, and language. Seventeen randomized controlled trials were selected and consequently submitted to quality assessment and data collection. Results. Conventional needle irrigation (CNI) is the less effective irrigation technique, but it is still unclear whether XPF is able to guarantee greater debris removal than the PUI technique. Er:YAG laser has been proven to be more effective in apical third than XPF instrument. Conclusions. Further investigations are needed in order to establish which final irrigation activation procedure could reach the maximum root canal debris reduction.

Efficacy of Different Irrigation Systems Used to Remove Calcium Hydroxide from the Root Canal

Introduction: The present study aimed to compare the cleaning efficacy of passive ultrasonic irrigation (PUI), self-adjusting file (SAF), EndoVac, and conventional syringe irrigation (CSI) techniques on Ca(OH)2 removal from the root canal. Methods: This study was conducted on the mesial roots of 36 human mandibular molar teeth. After 1 month, the Ca(OH)2 was removed from the experimental groups using four different irrigation techniques (SAF, PUI, EndoVac, and CSI). The inner surfaces of the canals were examined using a stereomicroscope at 30x magnification. The assessment of remaining Ca(OH)2 medicament in the grooves was performed by three calibrated dentists using a scoring system ranged 0-3. Results: None of the groups showed complete Ca(OH)2 removal from the root canals. The PUI technique removed significantly more Ca(OH)2 from all root canals, compared to EndoVac and CSI techniques (P<0.05). In the apical third, SAF group results were significantly better than the CSI group results (P<0.05). In the middle third, the SAF technique led to significantly better results in the removal of Ca(OH)2, compared to the techniques used in other groups (P<0.05).Conclusion: Currently, there is no irrigation system that can completely remove Ca(OH)2 from the root canal in endodontics. Regarding the removal of Ca(OH)2 from root canals, the PUI technique was significantly better than EndoVac and CSI techniques. In addition, the SAF technique showed significant efficacy in the middle third of the root canals.

Análise da remoção do hidróxido de cálcio de canais radiculares bovinos com diferentes técnicas através da microscopia eletrônica de varredura

Objetivo: Avaliar a eficácia da remoção de Ca (OH)2 do canal radicular, comparando o uso de limas manuais, Easy Clean e irrigação ultrassônica passiva (IUP). Método: Trinta dentes incisivos bovinos foram utilizados neste estudo. Os canais radiculares foram preparados e as amostras foram divididas aleatoriamente em 3 grupos de acordo com a técnica utilizada para a remoção do Ca(OH)2 (n = 10): G1: limas manuais; G2: lima Easy Clean; G3: IUP. Após quinze dias, os espécimes foram seccionados e processados para observação dos terços médio e apical utilizando microscopia eletrônica de varredura (MEV). Um avaliador cego e calibrado atribuiu escores a cada espécime. Os dados obtidos foram submetidos ao teste de Kruskal-Wallys, seguido do teste de Dunn. Resultados: Não houve diferença significativa na remoção do Ca(OH)2 entre a lima manual e a Easy Clean e entre Easy Clean e IUP. A técnica de IUP removeu significativamente mais Ca(OH)2 quando comparado com o grupo lima manual. Nenhuma das técnicas testadas removeu completamente o Ca(OH)2 das paredes do canal radicular. Conclusão: Independentemente da técnica utilizada, nenhum dos protocolos testados removeu completamente o Ca(OH)2 do canal radicular. Entretanto, a irrigação ultrassônica passiva foi mais eficaz do que o grupo das limas manuais.

The Effects of Different Agitation Techniques of Canal Irrigant on Tubular Penetration of a Bioceramic Sealer.

This study aimed to compare the effects of different agitation techniques of sodium hypochlorite (NaOCL) as the final irrigation with XP-Finisher file, passive ultrasonic irrigation (PUI), Er:YAG laser and irrigation with conventional syringes, on penetration of Sure Seal Root bioceramic sealer into dentinal tubules. Forty freshly extracted single-rooted human teeth were included in the present in vitro study. All the teeth were prepared up to #40 (4%) with Bio Race rotary file system, using crown-down technique. After chemomechanical preparation, the teeth were randomly assigned to 4 groups based on the agitation protocol: conventional needle irrigation (CNI) with a 30-G needle in a syringe, PUI, Er:YAG laser and XP-Finisher file, Subsequent to the agitation procedure, the root canals were obturated with tapered bioceramic-covered gutta-percha point and, bioceramic sealer, using the single-cone technique. The maximum penetration of the sealer into the dentinal tubules was determined in the coronal, middle and apical thirds using the scanning electron microscope (SEM) technique. After confirmation of the normal distribution of data with Shapiro-Wilk test, Data were analyzed using the one-way ANOVA and Tukey tests. The mean penetration depth of the bioceramic sealer into the dentinal tubules in the PUI group was greater than that of other groups; however, the difference between the two PUI and Er:YAG laser groups in the apical third was not significant (P=0.078). Er:YAG laser, PUI and XP-Finisher file agitation techniques resulted in significantly greater penetration of the bioceramic sealer into the dentinal tubules compared to the CNI (P<0.001). The XP-Finisher file technique in the apical (P=0.752) and middle thirds (P=0.339) and the Er:YAG laser technique in the apical thirds (P=0.086) were not significantly different from the conventional irrigation technique. The PUI technique resulted in significantly deeper penetration of the Bioceramic sealer into the dentinal tubules compared to the three other techniques.

In vitro Assessment of Calcium Hydroxide Removal from Endo Blocks by Simple Irrigation with NaOCl and the Passive Ultrasonic Irrigation Technique

Because endodontic pathology is caused due to bacterial contamination of the root canal system, endodontic treatment should focus on eliminating microorganisms in root canals. For more than 70 years Calcium Hydroxide has an important role in antimicrobial endodontic therapy. The use of calcium hydroxide is limited by the incomplete removal thereof, a residue covering 20% to 45% of the ductal wall, even after irrigation with NaOCl or EDTA. This study aims to evaluate the removal of calcium hydroxide in root canals using two different techniques.

Ex vivo evaluation of four final irrigation protocols on the removal of hard-tissue debris from the mesial root canal system of mandibular first molars.

To evaluate the efficacy of four final irrigation protocols on the reduction of hard-tissue debris accumulated within the mesial root canal system of mandibular first molars using micro-CT analysis. Forty mesial roots of mandibular molars with a single and continuous isthmus connecting the mesiobuccal and mesiolingual canals (Vertucci's Type I configuration) were selected and scanned at a resolution of 8.6μm. Canals were enlarged sequentially using WaveOne Small and Primary instruments activated in reciprocating motion without intracanal irrigation to allow debris to accumulate within the mesial root canal system. Then, specimens were anatomically matched and distributed into four groups (n=10), according to the final irrigation protocol: apical positive pressure (APP), passive ultrasonic irrigation (PUI), Self-adjusting File (SAF) and XP-endo Finisher (XPF). The final irrigation procedures were performed over 2min using a total of 5.5mL of 2.5% NaOCl per canal. Reconstructed data sets were coregistered, and the mean percentage reduction of accumulated hard-tissue debris after the final irrigation procedures was compared statistically between groups using the anovapost hoc Tukey test with a significance level set at 5%. Reduction of accumulated hard-tissue debris was observed in all groups after the final irrigation protocol. Overall, PUI and XPF groups had higher mean percentage reductions of accumulated hard-tissue debris (94.1% and 89.7%, respectively) than APP and SAF groups (45.7% and 41.3%, respectively) (P<0.05). No significant differences were found when comparing the results of PUI and XPF groups (P>0.05) or APP and SAF groups (P>0.05). The PUI technique and XP-endo Finisher instrument were associated with significantly lower levels of AHTD compared with conventional irrigation and the modified SAF system protocol in mesial root canals of mandibular molars.

Efficacy of passive ultrasonic irrigation in removing root filling material during endodontic retreatment

Abstract Introduction The aim of endodontic retreatment is to remove the previous root filling materials completely to allow for the subsequent steps of cleaning, canal shaping and filling replacement. Objective To evaluate the efficacy of passive ultrasonic irrigation (PUI) in the removal of residual root filling material after removing the bulk of the root filling with nickel-titanium rotary instruments. Material and method Eighteen mesial isthmus-containing roots of human mandibular molars were prepared and filled. The root canal filling was removed with the ProTaper Retreatment system and K-files. The specimens were randomized into 2 groups (n = 9), both irrigated with 2.5% NaOCl and 17% EDTA. In the conventional group, an irrigation syringe was used. In the PUI group, the PUI technique was used. The roots were sectioned longitudinally and evaluated under stereomicroscopy. Student’s t test was used to compare groups and the general linear model was used to compare the apical, cervical, and middle root thirds within each group, in regard to the percentages of remaining residual filling material. Result There was no statistically significant intergroup difference, irrespective of which root third was evaluated (P &gt; 0.05). In the PUI group, the apical third showed a significantly higher percentage of residual filling material, in comparison with the cervical (P = 0.038) and middle (P = 0.029) thirds. Conclusion The PUI technique was not more effective than the conventional irrigation technique in removing residual root filling material during endodontic retreatment in root canals with a complex anatomy.

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.

Efficacy of xylene and passive ultrasonic irrigation on remaining root filling material during retreatment of anatomically complex teeth

To evaluate the volume of remaining filling material in the mesial root canals of mandibular molars after root canal retreatment with different procedures performed sequentially. The mesial root canals of 12 human first mandibular molars were instrumented using the BioRace system until a size 25, .06 taper instrument. The mesial roots were filled with gutta-percha and AH-Plus using a vertical compaction technique. The specimens were scanned using microcomputed tomography with a voxel size of 16.8μm before and after the retreatment procedures. To remove the filling material, the root canals were enlarged until the size 40, .04 taper instrument. The second step was to irrigate the root canals with xylene in the attempt to clean the root canals with paper points. In the third step, the passive ultrasonic irrigation technique (PUI) was performed using 2.5% sodium hypochlorite. The initial and residual filling material volume (mm(3) ) after each step was evaluated from the 0.5 to 6.5mm level. The obtained data were expressed in terms of percentage of residual filling material. Statistical analysis was performed using the Friedman test (P<0.05). All specimens had residual filling materials after all retreatment procedures. Passive ultrasonic irrigation enhanced the elimination of residual filling material in comparison with the mechanical stage at the 0.5-2.5mm and 4.5-6.5mm levels (P<0.05). No significant difference was found between xylene and PUI methods. Filling materials were not completely removed by any of the retreatment procedures. The use of xylene and PUI after mechanical instrumentation enhanced removal of materials during endodontic retreatment of anatomically complex teeth.

Efficacy of self-adjusting file and passive ultrasonic irrigation on removing calcium hydroxide from root canals

The aim of this study was to evaluate the efficiencies of the self-adjusting file (SAF) system, passive ultrasonic irrigation (PUI), and conventional irrigation (CI) in removing calcium hydroxide (CH) from root canals. Fifty-one mandibular premolars were used. After root canals were instrumented and filled with a CH paste, 45 teeth were randomly assigned to three experimental groups according to CH removal technique: SAF system, PUI, or CI. The remaining 6 teeth served as positive and negative controls. All samples were evaluated by scanning electron microscopy (SEM) and scored. None of the techniques removed CH completely. However, results at coronal, middle and apical thirds showed that PUI technique was significantly more effective than SAF and CI in removing CH dressing residues from root canal walls.