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

Efficacy of Laser Activated versus Sonic Activated Irrigation for Debris Removal in Conservatively Instrumented Root Canals

INTRODUCTION

To compare the efficacy of laser activated and sonic activated irrigation on the removal of debris in mesial root canal systems of mandibular molars using micro-computed tomographic analysis.

METHODS

Forty-eight mesial roots of extracted mandibular molars with isthmus were selected and randomly allocated into 2 groups: Sonic Group and Laser Group. The root canals were minimally instrumented to a maximum apical file size of 20/06v (DCTaper, SSWhite, NJ). The Sonic Group received irrigant activation using the SmartLite Pro EndoActivator (Dentsply Tulsa, OK) with a 15/02 tip. The Laser Group received irrigant activation using the WaterLase iPlus (Biolase, CA) with a RFT2 tip. The teeth were activated for the same time with the same volume of irrigants. Micro-computed tomographic scans were obtained preinstrumentation, preirrigation, and postirrigation. To quantify debris removal, the air-filled volume was measured preirrigation and postirrigation, and the percentage increase in air-filled volume was calculated. Data were analyzed statistically (independent samples t-test, significance set at 5%).

RESULTS

The Laser Group demonstrated a significantly higher mean percentage increase in air-filled volume (37.4%) compared to the Sonic Group (20.2%). This difference was statistically significant (P < .05).

CONCLUSIONS

The Laser Group was significantly more effective in removing debris compared to the Sonic Group in minimally instrumented root canal systems. However, due to the limitations of this study, further research is needed to assess the impact of laser activated irrigation on clinical outcomes.

Efficacy of different Er:YAG laser-activated photoacoustic streaming modes compared to passive ultrasonic irrigation in the retreatment of curved root canals

OBJECTIVES

To evaluate the efficacy of passive ultrasonic irrigation (PUI) and super short pulse (SSP) and shock wave-enhanced emission photoacoustic streaming (SWEEPS) modes of Er:YAG laser-activated irrigation (LAI) with two different laser tips, in removing filling remnants after conventional retreatment in severely curved root canals.

MATERIALS AND METHODS

The study sample consisted of 40 extracted molars with curved mesiobuccal root canals. The canals were instrumented with ProTaper Next and filled with an epoxy resin-based sealer and gutta-percha using continuous wave vertical compaction and warm injection back-filling. After retreatment with ProTaper Universal Retreatment system and sodium hypochlorite (NaOCl), all samples were randomly divided into four groups (n = 10) according to the final irrigation technique: PUI, LAI/SSP, SWEEPS/flat-tip, and SWEEPS/radial-tip, using 6 mL of 3% NaOCl for an activation time of 3 × 30 s. The samples were subjected to micro-CT scans after root canal filling, retreatment, and final irrigation. The filling material volume and percentage reduction were calculated.

RESULTS

All tested irrigation techniques were successful in the elimination of the filling remnants after the retreatment (p < 0.001). The LAI/SSP group showed a higher reduction rate than the SWEEPS/flat-tip group (p = 0.032). No significant differences were found between the other groups (p > 0.05).

CONCLUSION

All tested techniques improved the removal of filling material during retreatment in curved canals. LAI/SSP showed slightly better results than other techniques.

CLINICAL RELEVANCE

The study highlights the need for additional activated irrigation after the retreatment of curved root canals. The choice between PUI and LAI is not decisive for success.

Effect of activated chlorhexidine and irritrol with photon-induced-photoacoustic-streaming and EDDY® on the dislocation resistance of biodentine

Background

Irrigant activation techniques, which are more effective in anatomically complex areas, can be used to maximize irrigant efficacy.

Aim

This in vitro study aimed to evaluate the efficacy of different agitation techniques on the dislocation resistance of Biodentine to the root canal dentin.

Materials and Methods

Seventy single-rooted teeth divided into seven experimental groups (n = 10); Group I-Irritrol/Photon-induced-photoacoustic-streaming (PIPS), Group II-Irritrol/EDDY^®, Group III- Irritrol/Syringe-needle-irrigation (SNI), Group IV-Chlorhexidine-gluconate (CHX)/PIPS, Group V-CHX/EDDY^®, Group VI-CHX/SNI, Group VII-Saline. The midroot dentin slice was obtained from each tooth, and Biodentine was condensed with hand pluggers into the root canal lumen. The push-out bond strength values were measured using a universal testing machine. Each sample was categorized into one of the three failure modes: adhesive/cohesive/mixed. Scanning-Electron-Microscopy (SEM) was used to conduct the analyses, and the composition of Biodentine was analyzed using Energy-Dispersive Spectroscopy. The One-way ANOVA, post-hoc Tukey's test, and the Chi-square test were used for statistical analysis.

Results

The push-out bond strength values of Biodentine showed that Group VII-Saline had a statistically significant difference (P = 0.002), however, the differences between the other groups were not statistically significant (P = 0.922). The percentages of the failure modes of the samples showed that there was a higher rate of mixed failure except for Group VII-Saline. SEM examination showed that Group VII-Saline had no open dentinal tubules, whereas the other groups, particularly the Irritrol groups, had open dentinal tubule areas.

Conclusions

Within the scope of the study, using Irritrol or CHX as the final irrigation in the root canal treatment did not result in differences in the dislocation resistance of Biodentine to root canal dentin when PIPS and EDDY^® were used.