Ultrasonic versus sonic activation of the final irrigant in root canals instrumented with rotary/reciprocating files: An in-vitro scanning electron microscopy analysis

Effect of Different Irrigant Activation Techniques on the Penetration of Calcium Hydroxide, an Intracanal Medicament: An In Vitro Study

Background and objective The main goal of root canal treatment is to eliminate microorganisms from the canal and to prevent re-infection. To achieve these goals, instrumentation must be combined with adequate irrigation and the placement of intracanal medicament. This study aims to compare the effect of different irrigation activation techniques, i.e., passive ultrasonic irrigation (PUI), EndoActivator (EA), and conventional needle irrigation on the penetration of calcium hydroxide (CH), an intracanal medicament into dentinal tubules. Methodology A total of 60 single-rooted extracted human teeth were selected, which were de-coronated to standardize the root length of 12 mm. An access cavity was prepared, and biomechanical preparation was done. The samples were randomly assigned to three experimental groups: Group I received conventional needle irrigation, Group II underwent EA irrigation, and Group III was subjected to PUI. All the samples were filled with CH paste mixed with Rhodamine B dye, and the orifice openings were sealed with Cavit. The samples were stored in an incubator for 24 hours and were subsequently sectioned horizontally at the coronal, middle, and apical thirds using a hard tissue microtome. These were observed under a confocal laser scanning microscope to evaluate the depth of medicament penetration. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY). The Shapiro-Wilk test was employed to assess normality, while ANOVA and Tukey's post hoc analysis were utilized to determine significance. Results It was observed that the depth of penetration of CH into dentinal tubules was highest in Group III (PUI), followed by Group II (EA irrigation), with the least penetration observed in Group I (conventional needle irrigation). All the groups showed maximum penetration at the coronal third followed by the middle and apical third. Conclusions Passive ultrasonic irrigant activation resulted in more penetration of CH into the dentinal tubules followed by EA irrigant activation.

Comparison of ultrasonic versus side-vented needle irrigation for reductions in bacterial growth and postoperative pain: A randomized controlled trial

Background

Postoperative pain affects 16%-25% of root canal therapy patients. The irrigating system and irrigants used should reduce bacterial load without irrigant extrusion beyond the root canal apex, potentially reducing postoperative pain and discomfort.

Aim

This study aims to compare the effects of passive ultrasonic irrigation and side-vented needle irrigation on postoperative pain and bacterial load in single-rooted teeth with pulp necrosis.

Materials and Methods

Eighty patients with pulpal necrosis in single-rooted teeth were randomly categorized into two groups (n = 40 each): Group A (side-vented needle irrigation) and Group B (passive ultrasonic irrigation). Bacterial samples were collected using sterile paper points after initial access cavity preparation (S1) and standard endodontic instrumentation + irrigation (S2). Bacterial growth was assessed on MacConkey and blood agar. Pain was recorded 30 min preoperatively and 6, 12, 24, and 48 h postoperatively.

Statistical Analysis Used

Chi-square test, independent t-test and paired t-test.

Results

Irrigation with Irrisafe tips showed increased number of bacteria-free samples and a significant reduction in postoperative pain (at the 6 and 12 h time-points) when compared to side-vented needle.

Conclusions

Passive ultrasonic irrigation with Irrisafe tips may be more effective than side-vented needle irrigation in reducing postoperative pain and intracanal bacterial load in patients undergoing endodontic treatment.

Comparative evaluation of canal cleanliness at apical third using Self-Adjusting File and Wave One File with different irrigants: an in vitro scanning electron microscopic study

Aim

To evaluate the cleaning ability of two single-file rotary systems- Self-Adjusting File (SAF) and Wave one (WO) systems in removing the smear layer using sodium hypochlorite (NaOCl) + ethylene diamine tetraacetic acid (EDTA) and NaOCl + Qmix as irrigants at apical one-third of the root canal.

Methods

Forty extracted human mandibular premolars were selected and working length was determined. The canal was manually instrumented up to a number 25 size K-file. The roots were divided into the following groups with 10 samples each - Group 1 using SAF: Group 1a- 3% NaOCl + 17% EDTA, Group 1b- 3% NaOCl + Qmix. Group2 using WO: Group 2a- 3% NaOCl + 17% EDTA, Group 2b- 3% NaOCl + Qmix. In the SAF group, the irrigation was performed continuously using the special irrigation apparatus. In the WO group, syringe irrigation was done followed by final irrigant activation using passive ultrasonic irrigation (PUI). The roots were sectioned longitudinally and subjected to scanning electron microscopic (SEM) examination. The amount of smear layer was evaluated using a five score index at the apical third level. Statistical analysis was performed using the Chi-square test.

Results

Group 1 (SAF) showed better canal cleanliness at apical third compared to Group 2 (WO) with both irrigant combinations and the results were statistically significant (p<0.05). 3% NaOCl + Qmix was equally as effective as 3% NaOCl + 17% EDTA in removing the smear layer with no significant difference between them.

Conclusion

Within the limitation of this study, SAF in combination with 3% NaOCl + Qmix or 3% NaOCl + 17% EDTA should be used for removing smear layer in critical areas of the root canal.

The Effect of Passive Ultrasonic Irrigation and XP-Endo Finisher on Post-operative Pain after Endodontic Retreatment on Patients (Randomized Controlled Clinical Trial)

AIM: To evaluate the effect of passive ultrasonic irrigation or XP-Endo Finisher on postoperative pain in patients with underextended filling in previously endodontically treated mandibular first molar teeth requiring endodontic retreatment using visual analog scale (VAS) scale at 6, 12, 24, 48, 72 h, and 7 daytime intervals. METHODS: Seventy-eight patients with mandibular first molars which need endodontic retreatment were randomly allocated into one of three separate groups (n = 26); NaviTip group (control), XP-Endo Finisher group, or Ultra X group. Data were statistically analyzed with a significance level of p ≤ 0.05. RESULTS: XP-Endo Finisher agitation and ultrasonic agitation as a final irrigation protocol showed significantly lower pain values than the control group, but there was no significant difference in pain values between the experimental groups. CONCLUSION: Within the limitation of this study, it can be concluded that agitation techniques used during endodontic retreatment decreased the incidence and intensity of post-operative pain.

The Effect of Passive Ultrasonic Irrigation or XP-Endo Finisher on Post-Operative Pain in Patients with Necrotic Teeth with Apical Periodontitis (Randomized Controlled Clinical Trial)

Objective To evaluate the effect of passive ultrasonic irrigation or XP-Endo Finisher on post-operative pain in patients with necrotic teeth with apical periodontitis using (VAS) scale at 6, 12, 24, 48, 72 hours, and 7 day time intervals. Methods Seventy-eight patients diagnosed with necrotic mandibular first molar with symptomatic apical periodontitis were randomly allocated into 1 of 3 separate groups (n=26); Navitip group (control), XP-Endo Finisher group, or Ultra X group. After a single visit root canal treatment and a specific method of agitation, depending on each group, the patients were given a questionnaire on which the patient would mark the degree of pain in a scale from 0 to 10 at 6, 12, 24, 48, 72 hours and 7 days post-obturation. Data were statistically analyzed with a significance level of P ≤ 0.05. Results Ultrasonic agitation and XP-Endo Finisher agitation as a final irrigation protocol showed significantly lower pain values than the control group, but there was no significant difference in pain values between the experimental groups. Conclusion There was significantly less pain associated with ultrasonic and XP-Endo Finisher agitation compared to Navitip irrigation.

Efficacy of sonic and ultrasonic activation during endodontic treatment: a Meta-analysis of in vitro studies

OBJECTIVE

To ensure a successful endodontic treatment, it is important to have a proper disinfection of the root canal. The current study compares the root canal cleanliness and smear layer score between sonic and ultrasonic activation.

METHOD

Systematic literature review was implemented, using 12 databases. All in vitro studies comparing the efficacy of sonic and ultrasonic activation and reporting at least one outcome of interest were included.

RESULTS

At the apical level, pooling the data in the random-effects model (I²=64%, p = .1) revealed a statistically significant lower smear layer score within the sonic activation group (MD-0.48; 95% CI-0.92, -0.04; p = .03). Furthermore, there was a statistically significant lower push-out bond strength value among the sonic group, in contrast to the ultrasonic group at the middle (MD-0.69; 95% CI-1.13, -0.25; p = .002) and at the apical levels (MD-0.78; 95% CI-1.09, -0.46; p < .0001) of the root canal.

CONCLUSIONS

Sonic activation accomplished advancement relative to ultrasonic agitation in removing the smear layer, while ultrasonic activation resulted in significant cohesion between the sealers and the dentine tubules, decreasing the vulnerability of apical leakage and tooth fracture.

A Comparative Assessment of Three Different Irrigating Systems in Root Canal Treatment: An In vitro Study

Background:

Exact diagnosis, efficient cleaning, shaping as well as disinfection of the root canals lead to successful root canal treatment. The present study compared three different irrigating systems in root canal treatment.

Methodology:

Sixty recently extracted permanent mandibular molars were classified into four groups: Group I, II, III, and IV with 15 teeth each. Group I comprised Endo-Irrigator Plus system. Group II comprised EndoActivator, Group III utilized passive ultrasonic irrigation (PUI), and Group IV was control, in which no activation of the irrigant was done. Stereomicroscope (X20) magnification was used for checking isthmus cleanliness. The scoring criteria were divided into score 1–5 depending on the amount of debris in root canal walls.

Results:

The mean ± standard deviation debris removal score in Group I was 2.6 ± 0.80, in Group II was 3.8 ± 0.72, in Group III was 3.9 ± 1.06, and in Group IV was 4.2 ± 0.82. The difference was significant (P < 0.05).

Conclusion:

Authors found that Endo-Irrigator Plus exhibited better cleaning efficacy followed by EndoActivator and PUI.

Comparative Evaluation of Efficacy of Different Irrigating Needles and Devices in Removal of Debris from Apical Third of Root Canal: An In-vitro SEM Study

BACKGROUND

Irrigants were required to eliminate the microbes and debris from the intraradicular space and must have direct contact with the entire root canal wall. Therefore, different irrigation methods have been proposed to deliver the irrigant as close as possible to the remote areas of the root canal.

AIM

The aim of the present study is to evaluate the cleaning efficacy of single-beveled needle, side-vented needle, endovac, and endo-irrigator plus in the removal of debris from apical third of root canal by Scanning Electron Microscope.

MATERIALS AND METHODS

Forty single-rooted freshly extracted human permanent mandibular premolars were collected. Root canals were cleaned and instrumented till X2 (25/06) with rotary Protaper Next at working length 1 mm short of the apex. Teeth were randomly divided into four equal groups: Group 1 (n = 10): Endovac, Group 2 (n = 10): Endo irrigator plus, Group 3 (n = 10): Side-vented needle, and Group 4 (n = 10): Single-beveled needle. Irrigation was done with 5.25% NaOCl, followed by 17% ethylenediaminetetraacetic acid. Samples were sectioned and examined under SEM at apical levels.

STATISTICAL ANALYSIS

Analysis of variance followed by Tukey's post hoc test was performed.

RESULTS

The level of debris removal efficacy is as follows: Endovac > Endo-irrigator plus > Side-vented needle ~ Single-beveled needle.

CONCLUSION

Endovac showed the maximum number of debris removal and has better cleaning efficacy in the apical areas of the root canal, followed by Endo irrigator plus, Side-vented needle and Single-beveled needle.

Comparison of bacterial removal from dentinal tubules with different irrigant agitation techniques: An in vitro study

Aim

This investigation was conducted to assess the ability of various irrigant agitation devices to eradicate Enterococcus faecalis from the dentinal tubules of extracted teeth.

Methodology

Fifty roots of extracted human teeth were instrumented to size 30 k with a 0.04 taper. The roots were autoclaved and then injected with E. faecalis. The canals were assigned to one of four intervention groups and disinfected using (A) standard needle irrigation, (B) EndoUltra® Ultrasonic Activator, (C) the EndoActivator system, or (D) EDDY sonic activation and to two control groups that were (E) treated with saline and (F) not inoculated with any bacteria. The roots were split in half, dyed with a LIVE/DEAD Back Light Bacterial Viability Kit, and then scanned with a confocal laser scanning microscope (CLSM) to identify live/dead bacteria in the dentinal tubules.

Results

CLSM images revealed differences among the groups. Both the EndoUltra® Ultrasonic Activator group and the EDDY group had a combination of dead and live bacteria, while the EndoActivator group had mostly dead bacteria, in contrast to single needle irrigation which had mostly live bacteria. Activation of the irrigating solution resulted in more dead bacteria than standard needle irrigation at the coronal, middle, and apical parts of the roots. Overall, the EndoActivator system was superior to all other techniques in reducing live bacteria within the root canal.

Conclusion

Activation of sodium hypochlorite with sonic and ultrasonic systems dramatically reduced live bacteria contamination in the dentinal tubules of infected root canals.

The Effect of Final Rinse Agitation with Ultrasonic or 808 nm Diode Laser on Coronal Microleakage of Root-canal Treated Teeth

INTRODUCTION

This in vitro study aimed at comparing the effect of agitating the final irrigant solutions of root canal by ultrasonic or using 808 nm Diode laser on the apical seal of canal.

METHODS AND MATERIALS

A total of 90 extracted human maxillary central incisors were prepared up to size #45 and were randomly assigned to 4 experimental groups (n=20) and two control groups (n=5) respectively, as follows: I): 3 mL of 5.25% NaOCl was agitated as final irrigant solution with ultrasonic for 30 sec. The ultrasonic tip was 1 mm shorter than the working length, II): 3 mL of 5.25% NaOCl was agitated as final irrigant with 808 nm Diode laser for 30 sec. Fiber tip, placed in 1 mm shorter from working length was spirally moved coronally, III): 3 mL of 17% EDTA was agitated as final irrigant with 808 nm Diode laser for 30 sec and was applied similar to group II, IV): 3 mL of 17% EDTA was stimulated as final irrigant with ultrasonic for 30 sec and was applied similar to I. Apical seal was assessed by Dual Chamber technique using Bovine Serum Albumin protein. Kruskal-Wallis and Mann Whitney tests were used with significance level lower than 0.05% for statistical analysis.

RESULTS

The average leakage in the negative control, positive control, and groups I, II, III, IV were: 0.00, 13.5±5.1, 1.72±2.9, 5.12±5.6, 3.36±3.7, 2.4±4.2, respectively. Statistical analysis showed significant difference between groups (P<0.05). There was a significant difference between groups 1 and 2 in terms of protein leakage.

CONCLUSION

Agitating 5.25% sodium hypochlorite solution as the final irrigant with ultrasonic is more effective in apical leakage reduction compared to other groups.

Ex-vivo Smear Layer Removal Efficacy of Two Activated Irrigation Techniques After Reciprocating Instrumentation in Curved Canals

Introduction:

This study aimed to compare the effectiveness of two activated irrigation techniques in removing the smear layer after single-file reciprocating instrumentation in curved canals.

Materials and Methods:

Sixty distobuccal roots of maxillary molars were standardized to create a closed system, and then instrumented using WaveOne Primary (Dentsply Maillefer, Ballaigues, Switzerland) instruments. Fifty-four specimens were randomly distributed into 3 groups for final irrigation: Non-activated irrigation, passive ultrasonic irrigation (PUI), and EndoActivator (EA;Dentsply Maillefer, Tulsa, USA) irrigation. All specimens received 3 mL of 17% EDTA for 1 minute, followed by irrigation with 6 mL of 2.5% NaOCl. The apical, middle and cervical thirds of the specimens were analyzed using scanning electronic microscopy (SEM), and the amount of remaining smear layer on the canal walls was rated by three examiners using a five-category scoring system. Kendall’s concordance coefficient was used to assess inter-rater agreement. Kruskal-Wallis and Mann-Whitney (Bonferroni) tests were used to compare the scores.

Results:

Kendall’s concordance coefficient was ≥ 0.7, indicating an excellent level of agreement between the raters. No statistically significant difference in irrigation techniques efficacy for removal of the smear layer (p=0.061) was found for the apical third. The scores attributed to the specimens irrigated with the EA system were significantly lower than those of the other groups in the cervical and middle thirds (p< 0.05).

Conclusions:

The efficacy of the EA system in removing the smear layer in the cervical and middle thirds of root canals instrumented with reciprocating motion was significantly higher than that of either PUI or non-activated irrigation. Both EA and PUI performed similarly in apical third.