Apical Negative Pressure: Safety, Efficacy and Efficiency

Abstract

The objective of dentistry is to prevent oral disease and retain the natural dentition, hopefully for the lifetime of the patient. The objective of endodontic treatment is to prevent and/or treat apical periodontitis. In order for an endodontic irrigant delivery system to be mechanically effective and satisfy the objective of endodontics, it must reach the apical terminus, create a current along the root canal wall and have the ability to remove debris, tissue and bacterial contaminants. Currently, the irrigant of choice to achieve this objective is full-strength sodium hypochlorite (NaOCl).During endodontic irrigation, the organic component of pulpal tissue consumes NaOCl rapidly as the reaction of hydrolysis occurs forming water and releasing ammonia and carbon dioxide as the by-products. In very short order, a column of gas develops at the apical one third of the root canal (apical vapour lock). The conundrum that the clinician faces is to safely and effectively deliver the irrigants to the apical terminus, break the apical vapour lock and allow constant exchange of irrigant and thereby continual hydrolysis of pulpal tissue by the NaOCl, without the risk of apical extrusion. This chapter will outline the scientifi c evidence surrounding apical negative pressure as a safe and reliable method to deliver irrigants to the apical terminus, thereby satisfying the objectives of endodontic treatment.G. Glassman , DDS, FRCD(C) (*) Associate in Dentistry, Graduate,

Apical negative pressure irrigation versus syringe irrigation: a systematic review of cleaning and disinfection of the root canal system

“…Potentially useful references from the relevant chapters of the following six endodontic textbooks were also included: ‘Disinfection of root canal systems: the treatment of apical periodontitis’ (Cohenca et al . ), ‘ Endodontic irrigation: chemical disinfection of the root canal system ’ (Glassman & Charara ), ‘ Endodontics ’ (Peters & Koka ), ‘ Pathways of the pulp ’ (Metzger et al . , Peters & Peters ), ‘ Problems in endodontics: etiology, diagnosis, and treatment ’ (Hülsmann & Rodig ) and ‘ Problem solving in endodontics ’ (Gutmann & Lovdahl ).…”

Effect of Chemical Debridement and Irrigant Activation on Endodontic Treatment Outcomes: An Updated Overview

“…A study concluded that within the same time frame, the irrigation volume used with the EndoVac system is much higher than the irrigation volume delivered with syringe irrigation [24]. There are claims that apical negative pressure irrigation had a better cleaning effect than conventional syringe irrigation [24,28] but not enough evidence to support it [29]. In a recent systematic review, apical negative pressure showed a superior effect to conventional syringe irrigation in reducing bacteria, inflammatory infiltrate, and improving periapical healing, but heterogenicity seen in the articles suggests that these results and superiority of a particular irrigation technique are inconclusive [30].…”