Sodium hypochlorite penetration into dentinal tubules after manual dynamic agitation and ultrasonic activation: a histochemical evaluation.

The aim of this study was to compare the effects of Manual Dynamic Agitation and Passive Ultrasonic Irrigation on sodium hypochlorite (NaOCl) penetration into dentinal tubules using its bleaching ability. Thirty-four single-rooted teeth with round-shaped root canals were distributed in two homogeneous groups and one control group, characterized by different NaOCl activation systems: Manual Dynamic Agitation and Passive Ultrasonic Irrigation. After instrumentation, all root canals were stained with 10% copper sulphate solution followed by 1% rubeanic acid alcohol solution under vacuum. Final irrigation was performed with 5 mL of 5.25% NaOCl solution for 1 min and activated with Manual Dynamic Agitation or Passive Ultrasonic Irrigation for another 1 min depending on the treatment group. The teeth were transversely sectioned at the middle portion of the apical, middle, and coronal thirds and observed under light microscope. NaOCl solution penetration was evaluated by measuring the percentage of bleached circumference of the root canal relative to the stained circumference, bleached areas, mean, and maximum penetration depth. No differences in the evaluated parameters were observed between groups (p > 0.05). Within groups, an increase of values was recorded from apical to coronal direction as for percentage of staining, percentage of bleaching and bleached area. NaOCl penetration into dentinal tubules did not significantly vary among the three levels. No significant differences in penetration of sodium hypochlorite into dentinal tubules when activated by means of Manual Dynamic Agitation or Passive Ultrasonic Irrigation were observed in the apical, middle, and coronal thirds of teeth with single straight round root canals.

Evaluation of Apical Vapor Lock Formation and comparative Evaluation of its Elimination using Three different Techniques: An in vitro Study.

AIM: The aim of this study was (i) to evaluate the formation of air bubbles in the apical region of root canal (apical vapor lock) during syringe irrigation, using cone beam computed tomography (CBCT) and (ii) comparative evaluation of the elimination of an established vapor lock by EndoActivator, ultrasonics, and manual dynamic agitation (MDA), using CBCT. MATERIALS AND METHODS: A total of 60 extracted human single-rooted teeth were equally divided into three groups of 20 teeth each. The samples were decoronated 17 mm from the apex, cleaned, and shaped to size F4 Protaper using 3% sodium hypochlorite. Samples were irrigated with 3% sodium hypochlorite + cesium chloride radiopaque dye, and preoperative CBCT images were obtained. After formation of apical vapor lock in the scanned teeth, EndoActivator (group I), passive ultrasonic irrigation (group II), and MDA with K-file (group III) were performed and the teeth were again placed in CBCT scanner and results analyzed using the chi-square test. RESULTS: The apical vapor lock was formed in all the samples. Out of the 20 teeth in each group, the apical vapor lock was eliminated in 18 samples of EndoActivator group (90%), 16 samples of ultrasonic group (80%), while it was eliminated in 10 samples by MDA (50%). CONCLUSION: It is concluded that (1) apical vapor lock is consistently formed during endodontic irrigation in closed canal systems and (2) sonic activation performs better than the ultrasonics and MDA in eliminating the apical vapor lock, with statistically significant difference between all the three groups (p < 0.05). CLINICAL SIGNIFICANCE: The results suggest that the apical vapor lock (dead water zone) is consistently formed during routine endodontic irrigation which impedes irrigant penetration till the working length, thereby leading to inefficient debridement. Hence, to eliminate this vapor lock, techniques, such as sonics or ultrasonics should be used along with the irrigant after shaping and cleaning of the root canal.

Antibiofilm activity of sodium hypochlorite against enterococcus faecalis using four irrigant activation protocols.

Aims: The aim of the study was to compare the activity of sodium hypochlorite (NaOCl) against Enterococcus faecalis when used with four different irrigation protocols. Methodology: Sixty-five single-rooted mandibular premolars with closed apex were prepared till size 35/0.04. The specimens were sterilized and infected with E. faecalis colonies that were cultured separately. The canals were randomly divided into four experimental groups based on irrigation activation protocol, with each group having 15 specimens each - Group 1: control, Group 2: manual dynamic agitation (MDA), Group 3: passive ultrasonic irrigation (PUI), Group 4: intracanal heating (ICH), and Group 5: passive ultrasonic irrigation followed by ICH (PUI ICH). The dentinal shavings were collected and sampled before (S1) and after (S2) the different irrigation techniques were performed. The colony-forming units were counted, and the bacterial reduction was calculated for each group. Results: A significant reduction in the number of E. faecalis colonies was observed for all the experimental groups (P < 0.001). The groups with ICH of NaOCl showed a considerable reduction in bacterial colonies than other groups (P < 0.001), with Group 5 that combined ultrasonics with ICH showed the highest reduction. Conclusion: ICH of NaOCl may be used as an adjunct to root canal irrigation to reduce the bacterial concentration from root canal spaces.

Effect of the Irrigation Agitation Technique on Postoperative Pain in Teeth With Symptomatic Irreversible Pulpitis.

Introduction Irrigation of the root canal system is a vital step in endodontic treatment aimed at disinfecting the canal. The efficacy of irrigation can be improved by various irrigation agitation methods. One such novel method of interest is the manual dynamic agitation (MDA) technique. However, the effect of MDA on postoperative pain as compared to needle irrigation (NI) with sodium hypochlorite has been scarcely explored. This study aimed to compare the effects of NI and MDA techniques on postoperative pain in teeth with symptomatic irreversible pulpitis. Materials and methods This quasi-experimental study was conducted at the Department of Operative and Paediatric Dentistry, Fauji Foundation Dental Hospital, over four months after gaining ethical approval. One hundred and sixty-eight participants diagnosed with symptomatic irreversible pulpitis were enrolled in the study through the purposive sampling technique. The participants were divided into two groups based on the irrigation technique used: Group A (NI) and Group B (MDA). Postoperative pain was recorded after six hours, 24 hours, 48 hours, and seven days using the 0-100mm visual analog scale (VAS). The VAS scores were compared using an independent sample t-test. Results Out of 168 participants, 48.2% were in Group A and 51.2% in Group B. The study found that VAS pain scores for Group B (MDA) were significantly lower at six hours, 24 hours, 48 hours, and seven days as compared to Group A (NI), with a p-value less than 0.001. Conclusion This study shows that the MDA technique leads to decreased postoperative pain both immediately after endodontic treatment and a week later as compared to the NI technique. Hence, the use of MDA can aid in controlling postendodontic pain and, therefore, ensure smoother recovery and increased patient satisfaction.

Influence of different irrigant activation methods on apical debris extrusion and bacterial elimination from infected root canals.

Introduction: The study aimed to determine the apical debris extrusion and microbial elimination from infected root canals after using different irrigant activation methods. Materials and Methods: Forty freshly extracted human mandibular premolars were selected and randomly assigned to four groups (n = 10). The teeth were mechanically prepared, sterilized, and inoculated with Enterococcus faecalis for 1 week. Irrigation was done with 3% sodium hypochlorite following conventional syringe irrigation-Group 1, manual dynamic agitation (MDA)-Group 2, passive ultrasonic irrigation (PUI)-UltraX -Group 3, and sonic irrigation (SI)-EndoActivator -Group 4, and the extruded debris were collected using Myers and Montgomery model. The microbial samples were taken from the canals using sterile paper points, cultured and recorded as colonies. The amount of extruded debris was measured by subtracting the final weight of the Eppendorf tube with debris from the initial weight of the tube. Results: I. Group 3 showed the least apical debris extrusion (P < 0.05), followed by Groups 2 and 1 and the highest with Group 4. II. Group 3 showed the least colony-forming units (CFUs)/ml, followed by Group 4, and finally, Group 2 showed lesser mean CFUs/ml compared to Group 1 (P < 0.05). Conclusion: All the irrigation activation methods were associated with apical debris extrusion, with the PUI system extruding the least amount of debris compared to the other groups. Irrigation activation techniques were beneficial in reducing the microbial load from the infected canals with the PUI system showing a complete elimination of the microbes, followed by SI and MDA.

The Sealer Penetration into the Dentinal Tubules: An Appraisal of Different Irrigation Systems: Original Research.

INTRODUCTION: A good endodontic sealer aids in a successful root canal treatment. Sealer in turn depends on the thorough irrigation technique and debris removal. Hence, in the present study, we intend to compare the sealer's dispersion into dentinal tubules of the different irrigation systems by confocal laser scanning microscopy (CLSM). METHODOLOGY: Seventy-six single-rooted, freshly removed human mandibular premolars were taken. They were separated into equal groups as conventional endodontic needle irrigation system, Endovacirrigation, Endoactivator irrigation, and manual dynamic agitation groups. Protaper rotary system was used and obturation was done with gutta-percha. The sealer used was AH Plus labeled with fluorescent dye (0.1% Rhodamine B isothcyanate). Transverse sections from the root apex at the levels of 1 mm, 3 mm, and 5 mm were scanned using CLSM. The sealer's penetration for the depth and the percentage were measured. RESULTS: We observed that endovac irrigation system showed maximum percentage and depth of sealer's penetration compared to endoactivator, manual dynamic agitation, and conventional methods at 1, 3, and 5 mm levels from the apex. CONCLUSION: The irrigation systems significantly influence the penetration of the Sealer into root dentinal tubules. When penetration of sealer at different levels, compared to endoactivator, manual dynamic agitation, and conventional method, significant greater levels were attained with the EndoVac system.

A Comparative Evaluation of Smear Layer Removal Using Erbium:YAG Laser-Activated Irrigation, Sonic Irrigation, and Manual Dynamic Irrigation: A Scanning Electron Microscope Study.

Introduction: The conventional chemomechanical procedures are ineffective in complete disinfection of the pulp space due to the complexities of the root canal architecture. The present study aims to compare the efficacy of erbium: YAG laser-activated irrigation, sonic irrigation, and manual dynamic irrigation in the removal of the smear layer through a scanning electron microscope study. Methods: Fifty extracted single rooted mandibular premolars with single canal were used and instrumented until F3 ProTaper rotary file reached the working length. Upon the completion of the canal preparation, each specimen was irrigated with 3 mL of 4% NaOCl for 3 minutes, 3 mL saline for 1 minute and 3 mL of 17% EDTA for 3 minutes. The teeth were assigned to three experimental groups (n=15 each): manual dynamic irrigation, sonic irrigation (EndoActivator), and Er:YAG laser using an X pulse tip. Root canals were sectioned longitudinally and the smear layer at the apical, middle and coronal third was examined under a scanning electron microscope. Smear layer scores were analyzed by Kruskal-Wallis and Mann-Whitney U tests at P = 0.05. Results: The Er:YAG laser group showed significantly lower smear layer scores in the apical third as compared to all other groups. EndoActivator resulted in better cleaning efficacy at the apical area compared to manual dynamic agitation. Conclusion: This study showed results in favor of Er:YAG with an X-pulse tip followed by EndoActivator activation.

Evaluation and comparison on the wettability of three root canal sealers after three different irrigant activation techniques: An in vitro study.

BACKGROUND: Wettability of root canal sealers to the root canal wall plays a significant role in the attainment of a fluid-tight seal. AIMS: This study aimed to evaluate and compare the wettability of three different root canal sealers on the root canal walls after three different irrigant activation techniques using the contact angle meter. SUBJECTS AND METHODS: Thirty-six single-rooted mandibular premolars after decoronation and cleaning and shaping up to size #35 were randomly divided into three groups with 12 samples in each group (n = 12) based on the different activation techniques: Group I (passive irrigation with side-vented needle), Group II (manual dynamic agitation), and Group III (passive ultrasonic irrigation). Root segments were split longitudinally and were subdivided into three subgroups based on the root canal sealers tested with four samples in each subgroup (n = 4): Subgroup A (Tubliseal EWT), Subgroup B (AH Plus), and Subgroup C (Endosequence BC sealer). A controlled volume droplet of sealer was placed on each specimen and was subjected to the contact angle meter. STATISTICAL ANALYSIS: Data were statistically analyzed using the one-way ANOVA and Tukey's post hoc test at a significance level of 0.05 (P < 0.05). RESULTS: A statistically significant difference was seen among all the groups and subgroups with the highest contact angle value for Group III and Subgroup C and the least value for Group I and Subgroup A. CONCLUSIONS: Passive irrigation with side-vented needle and Tubli-Seal EWT showed better wettability on dentin.

Activated Irrigation vs. Conventional non-activated Irrigation in Endodontics - A Systematic Review.

OBJECTIVE: Irrigant activation has been claimed to be beneficial in in vitro and clinical studies. This systematic review aims to investigate the clinical efficiency of mechanically activated irrigants and conventional irrigation. METHODS: A literature search (PROSPERO registration number: CRD42018112595) was undertaken in PubMed, Cochrane and hand search. The inclusion criteria were clinical trials, in vivo/ex vivo on adult permanent teeth involving an active irrigation device and a control group of conventional irrigation. The exclusion criteria were studies done in vitro, animals and foreign language. Adult patients requiring endodontic treatment of permanent dentition and irrigant activation during the treatment were chosen as the participants and intervention respectively. RESULTS: After removal of duplicates, 89 articles were obtained, and 72 were excluded as they did not meet the selection criteria. 6 devices (EndoVac, EndoActivator, Ultrasonic, MDA (manual dynamic agitation), CUI (Continuous Ultrasonic Irrigation) and PUI (Passive Ultrasonic Irrigation)) and 6 variables of interest (Post-operative pain, periapical healing, antibacterial efficacy, canal and/or isthmus cleanliness, debridement efficacy and delivery up to working length) were evaluated in the 17 included articles. The risk of bias and quality of the selected articles were moderate. Results showed that mechanical active irrigation reduces post-operative pain. It improved debridement, canal/isthmus cleanliness. It also improved delivery of irrigant up to working length. Bacterial count was more with active irrigation, though not significant. There is no effect on long-term periapical healing. CONCLUSION: It may be concluded that mechanical active irrigation devices are beneficial in reducing post-operative pain and improving canal and isthmus cleanliness during Endodontics.

Histologic Assessment of Debridement of the Root Canal Isthmus of Mandibular Molars by Irrigant Activation Techniques Ex Vivo.

INTRODUCTION: This study aimed to evaluate the efficacy of a new irrigation system (EndoIrrigator Plus; Innovations Endo, Nasik, India) using a histologic method ex vivo. METHODS: Mandibular molars with a normal pulp extracted for periodontal reasons (N = 68) were assessed for the presence of an isthmus using cone-beam computed tomographic imaging. Root canals of the included molars (n = 40) were instrumented up to a ProTaper F2 instrument (Dentsply Maillefer, Baillagues, Switzerland) using 3% sodium hypochlorite as irrigant in a closed apical design. Final irrigation delivery/activation was performed as follows (n = 10): group 1, syringe irrigation; group 2, apical negative pressure delivery with continuous warm activated irrigation and evacuation system (CWAIS); group 3, manual dynamic agitation (MDA); and group 4, passive ultrasonic irrigation (PUI). Untreated teeth (n = 5) served as histologic controls. The isthmus regions (1, 3, and 5 mm from the apex) were analyzed by hematoxylin-eosin stain to calculate the percentage of remaining pulp tissue (RPT) relative to the area of the isthmus. Results were analyzed using the Mann-Whitney U test (P = .05). RESULTS: CWAIS showed significantly less RPT than the other groups at all 3 root levels (P < .05). MDA showed significantly less RPT at 1 and 3 mm from the apex compared with PUI and syringe irrigation (P < .05). There was no significant difference between PUI and MDA at the 5-mm level (P > .05). CONCLUSIONS: None of the methods could completely clean the isthmus. CWAIS left behind the least amount of RPT.

Effectiveness of different irrigation techniques on smear layer removal in apical thirds of mesial root canals of permanent mandibular first molar: A scanning electron microscopic study.

AIM: The aim of this study was to compare smear layer removal after final irrigant activation with sonic irrigation (SI), manual dynamic agitation (MDA), passive ultrasonic irrigation (PUI), and conventional syringe irrigation (CI). MATERIALS AND METHODS: Forty mesial canals of mandibular first molars (mesial roots) were cleaned and shaped by using ProTaper system to size F1 and sodium hypochlorite 3% and 17% ethylenediaminetetraacetic acid. The specimens were divided into 4 equal groups (n = 10) according to the final irrigation activation technique: Group 1, PUI; group 2, manual dynamic activation (MDA); group 3, SI; and group 4, control group (simple irrigation). Samples were split longitudinally and examined under scanning electron microscope for smear layer presence. RESULTS: Control groups had the highest smear scores, which showed the statistically significant highest mean score at P < 0.05. This was followed by ultrasonic, MDA, and finally sonic, with no significant differences between them. CONCLUSIONS: Final irrigant activation with sonic and MDA resulted in the better removal of the smear layer than with CI.