Efficiency of Different Endodontic Irrigation and Activation Systems, Self-Adjusting File Instrumentation/Irrigation System, and XP-Endo Finisher in Removal of the Intracanal Smear Layer: An Ex vivo Scanning Electron Microscope Study

Abstract

Aim: This ex vivo study was designed to evaluate and compare different endodontic irrigation and activation systems, the self-adjusting file (SAF) instrumentation/irrigation system, and XP-endo finisher for removal of intracanal smear layer. Materials and Methods: Fifty recently extracted, noncarious human intact single-rooted premolars were selected and divided into five groups ( n = 10) according to the root canal irrigation systems; syringe and needle irrigation, passive ultrasonic irrigation (PUI), EndoVac irrigation system, SAF system, and XP-endo finisher. All groups were prepared to apical size F4 file except for the SAF group which was prepared to apical size 20 K-file and then instrumented with the SAF file. Each sample was subjected to final irrigation using different irrigation/activation systems. After splitting the samples, one half of each root was selected for examination under scanning electron microscope. The irrigation systems were compared using the Fisher's exact test with significance set at P < 0.05. Results: In the coronal part, there was no difference among the groups. In the mid-root section, the results of the PUI, EndoVac, SAF, and XP-endo finisher groups tended to be better than syringe and needle irrigation, but the difference was not significant. The apical part of the canal, the SAF system, and XP-endo finisher group seemed to be cleaner than those of the EndoVac group, but this difference was not significant. Conclusions: Within the limitations of the present study, SAF system and XP-endo finisher group cleaned the apical part of the canal more efficiently than EndoVac, PUI, and syringe and needle irrigation.

Comparative evaluation of machine assisted irrigation activation technique and conventional syringe irrigation on postoperative pain in patients undergoing endodontic treatment: A Systematic review and meta-analysis

“…Out of the nine randomized clinical trials (10,11,12,13,14,15,16,17,18) reviewed for this systematic review, five studies (10,11,13,14,17) included asymptomatic teeth and another four studies (12,15,16,18) included symptomatic teeth. In the five studies (10,11,13,14,17) that assessed asymptomatic teeth, greater reduction of post operative pain was observed, thus presence of preoperative symptoms is considered an important confounding factor among the studies.…”

“…(25) Thus, only patients without a contributing medical history who did not take analgesic medication recently were included in three studies. Three out of nine studies (10,11,12,13,14,15,16,17,18) only have included patients without a non-contributing history who did not take analgesic medication recently. The rest of the studies did not include this as the criteria and hence would contribute to reporting bias.…”

“…All the nine studies included in this systematic review had at least one machine assisted activation device like ultrasonic, sonic devices or negative apical pressure device. Three studies (10,15,16) included the use of negative apical pressure devices like EndoVac; four studies (11,12,17,18) employed sonic activated devices like Endoactivator and two studies (13,14) used ultrasonic device for irrigation activation. All the studies found that post operative pain is lesser than the conventional manual irrigation.…”

“…Machine-assisted activation devices like ultrasonic, sonic devices, and negative apical pressure devices were used as an intervention group in all the nine studies included in this systematic review. Three studies (10,15,16) included the use of negative apical pressure devices like EndoVac, sonic activated devices like Endoactivator were used in four studies (11,12,17,18) and ultrasonic irrigation technique was used in two studies. These methods of machine-assisted irrigation techniques were assessed against conventional needle syringe irrigation techniques in assessing postoperative endodontic pain Follow-up of postoperative pain ranged from 8hrs to 72 hours and was recorded using a visual analog scale (VAS).…”

“…The meta-analysis was performed on 6 studies( (12,14,15,16,17,18) that have qualified with the required data outcome that could be analysed quantitatively. The results of the overall comparison have been depicted as a forest plot.…”