Influence of needle design and irrigation depth in the presence of vapor lock: A computational fluid dynamics analysis in human oval roots with apical ramification.

This paper aims to study the removal of a vapor lock located in the apical ramification of an oval distal root of a human mandibular molar, simulating different needles and irrigation depths with computational fluid dynamic. A geometric reconstruction of the micro-CT of the molar shaped up to a WaveOne Gold Medium instrument was used. A vapor lock located in the apical 2 mm was incorporated. Geometries with positive pressure needles (side-vented [SV], flat or front-vented [FV] and notched [N]) and the EndoVac microcannula (MiC) were created to run the simulations. Irrigation key parameters (flow pattern, irrigant velocity, apical pressure, wall shear stress) and vapor lock removal were compared among the different simulations. Each needle behaved differently that is, FV removed the vapor lock from one ramification and had the highest apical pressure and shear stress values; SV removed the vapor lock in the main root canal but not in the ramification and reached the lowest apical pressure from the positive pressure needles; N was not able to completely remove the vapor lock and showed low apical pressure and shear stress; MiC removed the vapor lock from one ramification, had negative apical pressure and the lowest maximum shear stress. The main conclusion is that none of the needles showed complete removal of vapor lock. MiC, N, and FV were able to partially remove the vapor lock from one out of the three ramifications. However, SV needle was the only simulation that showed high shear stress with low apical pressure.

Effects of continuous chelation on the instrumentation of curved canals with a martensitic NiTi file system: an ex vivo micro-CT evaluation.

This study aimed to evaluate the influence of continuous chelation on apical transportation and centrality in shaped curved canals prepared with a martensitic file system and evaluated by micro-CT. Twenty-four lower molar canals with a curvature of 25º-40º were scanned pre-operatively with micro-CT and divided into 2 groups according to two different irrigation regimens (n = 12). Group 1 was irrigated with NaOCl, group 2 with Dual Rinse. All canals were prepared with VDW.ROTATE system. The samples were scanned post-operatively and evaluated at 1, 3 and 5 mm from the apex to determine apical transportation and canal centrality using VG Studio software. Statistical analysis was performed with SPSS software using the non-parametric Mann-Whitney test. No statistically significant differences were found between the two groups for both apical transportation and canal centrality at any of the levels studied (p < 05). The use of continuous chelation during the instrumentation of the canals with martensitic alloy files does not produce greater transportation and does not generate changes in centralization compared to NaOCl-only irrigation. Combined chelation and disinfection while shaping with martensitic NiTi can simplify the irrigation regimen without inducing iatrogenic aberrations.

Positive and negative pressure irrigation in oval root canals with apical ramifications: a computational fluid dynamics evaluation in micro-CT scanned real teeth.

AIM: To compare using computational fluid dynamics (CFD) the flow pattern, irrigant velocity, apical pressure and shear stress produced by negative (MiC) and positive pressure with different types of needles (side-vented (SV), front-vented (FV) and notched (N)) at two insertion depths in the apical ramification of oval root canals. METHODOLOGY: The micro-CT of a mandibular molar with an oval root canal with an apical ramification was used for computational analysis after preparation and geometric reconstruction. Geometries with the needles in two positions (1 and 3 mm from WL) were created to run the simulations. Key parameters of irrigation were displayed with CFD and compared. RESULTS: The penetration depth of the needle in the root canal strongly influenced shear stress and apical pressure. The three needles revealed that the highest shear stress, velocity and apical pressure were 1 mm from the WL and generated medium velocities. In N simulations, the fluid flow did not reach the apical ramification and the lowest shear stress values for positive pressure needles were found. The predominant axial component for FV revealed a different pattern of irrigation with high shear stress values and higher apical pressures than those exerted by other needles. SV simulations had generalized fluid flow in most of the main canal, the highest shear stress values and lower apical pressure than the threshold determined for risk of extrusion. MiC was associated with low velocity, shear stress and apical pressure. CONCLUSION: The SV needle demonstrated a combination of low positive pressure and high shear stress; while N had the lowest shear stress and FV the highest apical pressure. MiC generated fluid flow in part of the apical ramification with negative apical pressure values but low shear stress and velocity.

Effect of sonic and ultrasonic activation on organic tissue dissolution from simulated grooves in root canals using sodium hypochlorite and EDTA.

AIM: To compare soft-tissue dissolution by sodium hypochlorite, with an EDTA intermediate rinse, with or without activation with passive ultrasonic activation (PUI) or sonic activation using the Endoactivator (EA) or Eddy tips (ED). METHODOLOGY: The root canals of eighty-three human maxillary central incisors were chemo-mechanically prepared and the teeth split. A standardized longitudinal intracanal groove was created in one of the root halves. Eighty-three porcine palatal mucosa samples were collected, adapted to fit into the grooves and weighed. The re-assembled specimens were randomly divided into four experimental groups (n = 20), based on the final rinse: no activation; EA; PUI; ED, using 2.5% sodium hypochlorite, with an EDTA intermediate rinse. A control group (n = 3) was irrigated with distilled water without activation. The solutions were delivered using a syringe and needle 2 mm from working length. Total irrigation time was 150 s, including 60 s of activation in the specific groups. The study was carried out at 36 ± 2 °C. The porcine palatal mucosa samples were weighed after completion of the assays. Student paired t-test and anova were used to assess the intra- and intergroup weight changes. The multiple comparisons were evaluated using Bonferroni correction (α = 0.05). RESULTS: Weight loss occurred in all experimental groups. Irrigant activation resulted in greater weight loss when compared to the nonactivated group [vs. EA (P = 0.001); vs. PUI (P < 0.001); vs. ED (P < 0.001)]. No significant differences were found amongst the different activation systems. CONCLUSIONS: Activation increased the tissue-dissolving activity of irrigants from artificial grooves in root canals of maxillary central incisors.