Ultrasonic Irrigation System Research Articles

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 < 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 efficacy of three passive ultrasonic irrigation systems on intracanal medicament removal in a novel standardised three-dimensionally printed model.

This study compared the efficacy of several passive ultrasonic irrigation (PUI) systems in removing intracanal medicament using 3-dimensionally printed root canal model assembled with dentin specimen. After the placement of the model in the agar container (37°C), the intracanal medicament was removed using three different PUI instruments including CK file, Irrisafe and Endosonic Blue. Then, the area coated by the medicament and the volumetric percentage of the remaining medicament was measured. Irrisafe and Endosonic Blue showed higher removal efficacy than CK and the control regarding both the coated area and remaining volume (p < 0.05). CK showed the lowest efficacy among the tested PUI systems (p > 0.05). Notably, Endosonic Blue group showed the smallest coated area among the tested groups (p < 0.05). Conclusively, PUI systems made of nickel-titanium alloy with small dimensions, such as Endosonic Blue, have advantages for the removal of intracanal medicaments from curved root canals.

Machine-Assisted Irrigation Systems for Smear Layer Removal in Root Canal Treatment

Objectives: The objective was to evaluate the efficacy of three machine-assisted irrigation systems in smear layer removal from apical one-third of the root canal system. Data Source: A comprehensive search of last 10 years was performed in the following systematic electronic database: PubMed/Medline and Scopus. Data Selection: We included in-vitro studies that compared Endoactivator, Endovac, and Passive ultrasonic irrigation system's clinical success of smear layer removal in apical one-third of the root canal systems. Data Synthesis: A total of 72 nonduplicated studies were retrieved in the systematic search. Seven studies included in the study assessed the success rate of smear layer removal in the apical third of the root canal system of three irrigation systems through scanning electron microscopic evaluation. These studies were classified as low risk of bias. The studies evaluating the scanning electronic microscopy of smear layer removal in the apical one-third of the root canal comparing the Endoactivator and Passive ultrasonic irrigation showed no statistical difference (P &lt; 0.05). The studies evaluating the scanning electronic microscopy of smear layer removal in the apical one-third of the root canal comparing the Endoactivator and Endovac showed statistical difference (P &gt; 0.05). Conclusion: Based on the findings, Endovac irrigation system was found to be effective in smear layer removal from apical one-third of the root canal system. Further in-vivo studies and clinical trials are required for more conclusive results.

COMPARISION OF THE INCIDENCE OF POSTOPERATIVE PAIN AFTER USING TWO CONTINUOUS ROTARY FILE SYSTEM WITH CONVENTIONAL NEEDLE AND ULTRASONIC IRRIGATION IN SINGLE VISIT ENDODONTICS: AN INVIVO STUDY

Aim: The aim of this study was to compare the incidence of postoperative pain after using protaper gold (Dentsply Maillefer) and Neoendo (Orikam) rotary file system with conventional needle and ultrasonic irrigation system in single visit endodontics.&#x0D; Materials and Methods: Sixty patients requiring endodontic therapy were included in this study and divided into four groups, each group consisting of 15 patients. Group I (n = 15), was instrumented using ProTaper Gold followed by needle (Neoendo side vent) irrigation using 2 ml 3% sodium hypochlorite. In Group II, teeth were instrumented using ProTaper Gold followed by 3% sodium hypochlorite irrigant and activated using Endoactivator (Orikam Ultra X) for 30 seconds. In Group III (n = 15), teeth were instrumented using Neoendo (Orikam) rotary file system followed by conventional needle irrigation using 3% sodium hypochlorite as mentioned in Group I. In Group IV (n = 15), teeth were instrumented using Neoendo rotary file system followed by 3% sodium hypochlorite irrigant which were activated using Endoactivator for 30 seconds as mentioned in Group II. Each root canal will be obturated using the single cone technique using Zinc oxide sealer. Postoperative pain response of patients was evaluated using the visual analogue scale (VAS) score. Results: For VAS pain scores, a statistically significant difference was found between the PTG and Neo Endo files (p= 0.000). Group II showed the least incidence of pain for a follow up period of one week followed by Group I and Group IV. Group III showed the highest incidence of pain among the four group. Conclusion: Within the limitations of this study, we may conclude that the PTG system along with the Passive Ultrasonic Irrigation System is a technique that is able to minimize the risk of postoperative pain after single visit root canal therapy compared to the other technique used in this study. However, all the techniques used in this study significantly reduced the post-operative pain within a time interval of one week.&#x0D; Key words: Protaper Gold, Neo Endo Files, Passive Ultrasonic Irrigation, Side Vent Needle, Controlled Memory Files

Irrigation effectiveness of continuous ultrasonic irrigation system: An ex vivo study.

This study evaluated the irrigation extrusion and smear layer (SL) removal of continuous ultrasonic irrigation (CUI). Forty root canals were shaped, embedded in warm sterile saline agar colored with 1% acid red, and distributed into four groups; three groups had the final irrigation sequence of sodium hypochlorite and EDTA solutions performed by using syringe irrigation (SI), EndoVac (EV), and CUI, respectively. Group 4 had the canals ultrasonically irrigated with saline (CUIS). Irrigant extrusion was verified by a color change of the agar. The SL was evaluated under scanning electron microscope. Irrigant extrusion was observed in two and four teeth in the CUI and SI, respectively, whilst none had irrigant extruded in the EV. In term of SL, the CUI was comparable to EV at 1 and 3 mm but different to SI at 1 mm. Although CUI might clean the root canal system effectively, it was unable to avoid irrigant extrusion.

Cleaning Efficiency of XP-endo Finisher File in Comparison with Sonic and Ultrasonic Irrigation Systems (An In Vitro Study)

Cleaning Efficiency of XP-endo Finisher File in Comparison with Sonic and Ultrasonic Irrigation Systems (An In Vitro Study)

Comparison of different agitation methods for the removal of calcium hydroxide from the root canal: Scanning electron microscopy study.

Aim:This ex vivo study compared the efficiency of different irrigations systems to remove calcium hydroxide from root canal walls, especially from the apical third by using scanning electron microscopy (SEM).Materials and Methods:Eighty-four single-rooted teeth were divided into 4 groups of 20 teeth each, according to different irrigation protocols using a 30-gauge slot-tipped needle, ultrasonic irrigation system, erbium-doped yttrium aluminum garnet laser (Er: YAG) laser, and EndoVac system. The rest 4 teeth were used as control groups (2 positive and 2 negative control groups). After coronal access, all teeth were instrumented by Protaper Next rotary files (Dentsply-Maillefer, Ballaigues, Switzerland) up to size X3, followed an irrigation protocol and filled with pure calcium hydroxide powder mixed with saline. Teeth were stored in an incubator for 7 days, and then, calcium hydroxide was removed using 3 techniques: Manually (Group 1), by ultrasonic irrigation (Group 2), by laser Er: YAG and x-pulse tip (Group 3), and by EndoVac system (Group 4). The teeth of control groups were instrumented as the experimental groups; no removal technique was applied in positive group, whereas in negative one, the root canals were left empty. Teeth were sectioned longitudinally and observed under SEM Results were statistically analyzed with the Kruskal–Wallis Test and Mann–Whitney Test.Results:The results showed a significant difference between laser and the other three groups in coronal and middle root third, but no statistic difference in apical third.Conclusion:Laser improved the removal of calcium hydroxide in comparison with conventional techniques.

Bactericidal effect of hydroxyl radicals generated by the sonolysis and photolysis of hydrogen peroxide for endodontic applications.

The aim of endodontic root canal treatment is the elimination of bacteria and their products from an infected tooth root canal. To effectively disinfect a root canal, an ultrasonic irrigation system, in which hydroxyl radicals (HO·) generated artificially by sonolysis of H2O2, was developed previously for endodontic applications and was demonstrated to have bactericidal efficacy against Enterococcus faecalis. To improve this system, we examined the invitro bactericidal effects of HO· generated from H2O2, activated by simultaneous irradiation with ultrasound for sonolysis and dental LED light for photolysis with a peak wavelength of 405nm. Regarding the LED irradiation, two methods were used: (i) 'ideal' experimental conditions (irradiation close to the glass tube), and (ii) simulated endodontic conditions (more distant irradiation of a masked glass tube). In these conditions, HO· generation from H2O2 was detected by electron spin resonance (ESR) spectroscopy, and bactericidal efficacy against E.faecalis was assessed by measuring the colony forming units (CFU)/mL. The results indicated that HO· generation by ESR measurements and the bactericidal effect on E.faecalis by viable count using CFU/mL were enhanced significantly in a time-dependent manner in both conditions. In a comparison of these conditions, bactericidal activity under 'ideal' experimental conditions was similar to that under simulated endodontic conditions. Moreover, the irradiation time for effective killing of E.faecalis through the sonolysis and photolysis of H2O2 under simulated endodontic conditions was shorter than that with sonolysis alone. These results demonstrate that H2O2 activated by ultrasound and LED light may be a safe and effective disinfection technique for endodontic root canal treatment.

Comparative Antibacterial Efficacies of Hydrodynamic and Ultrasonic Irrigation Systems In Vitro

IntroductionTo ensure root canal treatment success, endodontic microbiota should be efficiently reduced. The in vitro bactericidal effects of a hydrodynamic system and a passive ultrasonic irrigation system were compared. MethodsSingle-rooted extracted teeth (n = 250) were contaminated with suspensions of Enterococcus faecalis ATCC 29212, mixed aerobic cultures, or mixed anaerobic cultures. First, the antibacterial effects of the hydrodynamic system (RinsEndo), a passive ultrasonic irrigation system (Piezo smart), and manual rinsing with 0.9% NaCl (the control) were compared. Colony-forming units were counted. Second, the 2 systems were used with 1.5% sodium hypochlorite (NaOCl) alone or NaOCl + 0.2% chlorhexidine (CHX). The colony-forming units in the treated and untreated roots were determined during a period of 5 days. ResultsBoth irrigation systems reduced bacterial numbers more effectively than manual rinsing (P < .001). With NaCl, ultrasonic activated irrigation reduced bacterial counts significantly better than hydrodynamic irrigation (P = .042). The NaOCl + CHX combination was more effective than NaOCl alone for both systems (P < .001), but hydrodynamic irrigation was more effective with NaOCl + CHX than the passive ultrasonic irrigation system. ConclusionsBoth irrigation systems, when combined with NaOCl + CHX, removed bacteria from root canals.

Comparison of irrigant penetration up to working length and into simulated lateral canals using various irrigating techniques

To evaluate the effect of an apical negative pressure system, a passive ultrasonic irrigation system and a combination of both apical negative pressure and passive ultrasonic irrigation on the penetration of the irrigating contrast solution (ICS) up to working length and into simulated lateral canals. The root canals of 64 single-rooted teeth were instrumented using the ProTaper rotary system. In each sample, three simulated lateral canals were created at 2, 4 and 6mm levels from the root apex using a 06-size C+ file (Dentsply Maillefer, Ballaigues, Switzerland). Samples were randomly assigned into 4 experimental groups (n=16): group I - conventional needle irrigation, group II - passive ultrasonic irrigation, group III - apical negative irrigation system and group IV - combination of passive ultrasonic irrigation and apical negative pressure irrigation system. To examine irrigating solution penetration, Indian ink was mixed with 5.25% NaOCl and delivered into the root canals. Samples were then assessed by direct observation of the images taken using Canon EOS rebel T3. The depth of penetration of ICS up to the working length and into the simulated lateral canals was analysed using chi-squared tests. The combination (ANP and PUI) and ANP group had significantly deeper ICS penetration up to the working length (P<0.001). The combination (ANP and PUI) and the PUI group exhibited significantly greater ICS penetration into lateral canals at the 6mm level (P<0.001). At the 4 and 2mm levels, the combination of ANP and PUI had significantly greater ICS penetration into the lateral canals than the other groups (P<0.001). The combination of ANP and PUI was the only group able to achieve irrigating contrast solution penetration both up to the working length and into lateral canals.

Comparison of final irrigation techniques in removal of calcium hydroxide

The aim of this study was to compare new irrigation systems with a conventional irrigation technique for the removal of inter-appointment calcium hydroxide [Ca(OH)2 ]. Forty-seven extracted human single-rooted teeth were instrumented, and Ca(OH)2 paste was placed into root canals by using a lentulo spiral at the apical third. Teeth were randomly divided into three groups according to different irrigation protocols using a 30-gauge slot-tipped needle, EndoVac system and ProUltra® PiezoFlow™ ultrasonic irrigation system. Scanning electron microscopic images of the selected root canal surfaces (cervical, middle and apical third) were evaluated using a 5-grade scale. The influence of the irrigation system was evaluated using a two-way analysis of variance test and Tukey's test. The EndoVac and PiezoFlow groups demonstrated the lowest scale values (cleanest canals); however, there was no statistical difference between these two groups. The conventional irrigation group exhibited significantly higher scores (P < 0.05). The conventional needle irrigation was not sufficient to remove Ca(OH)2 from the root canal system. Irrigation with EndoVac and PiezoFlow™ ultrasonic irrigation systems improved the removal of the intracanal medicament resulting in cleaner root canal walls.