Micro-CT evaluation of different final irrigation protocols on the removal of hard-tissue debris from isthmus-containing mesial root of mandibular molars

Silva, Emmanuel João Nogueira Leal; Carvalho, Carla Rodrigues; Belladonna, Felipe Gonçalves; Prado, Marina Carvalho; Lopes, Ricardo Tadeu; De‐Deus, Gustavo; Moreira, Edson Jorge Lima

doi:10.1007/s00784-018-2483-1

Cited by 55 publications

(68 citation statements)

References 37 publications

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“…, Silva et al . ), none of the tested irrigation protocols was able to render the isthmus of mesial root canal systems of mandibular molars completely free of debris. In the present study, no significant differences were observed between final irrigation protocols regarding the removal of AHTD.…”

Section: Discussionmentioning

confidence: 91%

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Micro‐CT evaluation of sonically and ultrasonically activated irrigation on the removal of hard‐tissue debris from isthmus‐containing mesial root canal systems of mandibular molars

et al. 2019

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Aim To evaluate the efficacy of sonically and ultrasonically activated irrigation on removal of accumulated hard‐tissue debris (AHTD) in mesial root canal systems of mandibular molars using micro‐computed tomographic (micro‐CT) analysis. Methodology Forty mesial roots of mandibular molars with two independent canals joined apically by an isthmus (Vertucci type II) were selected. The root canals were instrumented using Reciproc R25 instruments, and specimens were scanned at a resolution of 10.5 μm. Subsequently, n = 10 roots were assigned to each of the four final irrigation groups such that the group means and variances were almost identical: sonically activated irrigation with EndoActivator (EA) or EDDY (ED), ultrasonically activated irrigation (UAI) and manual irrigation without activation (MI). The final irrigation procedures were performed using a total of 5 mL 1% NaOCl and 5 mL 15% EDTA per canal over 5 min with activation time of 4 × 20 s. Reconstructed data sets were coregistered, and the mean percentage reduction of AHTD after final irrigation was compared statistically between groups using analysis of variance at a significance level set at 5%. Results A significant reduction of AHTD was achieved after final irrigation in all groups (P < 0.05), ranging from 44.1% to 66.8%. The vol% of debris after irrigation was 3.7 ± 1.9% for EA, 3.3 ± 2.3% for ED, 2.1 ± 1.6% for UAI and 4.4 ± 2.3% for MI, with no significant difference between groups (P > 0.05). Conclusions None of the final irrigation protocols completely removed AHTD from mesial root canal systems in extracted human mandibular molars. Sonically and ultrasonically activated irrigation performed no better compared to manual irrigation.

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Section: Discussionmentioning

confidence: 91%

“…, Silva et al . ) and has been proved to be a precise tool for quantitative and qualitative evaluation of hard‐tissue debris within the root canal system (Paqué et al . , De‐Deus et al .…”

Section: Discussionmentioning

confidence: 99%

Micro‐CT evaluation of sonically and ultrasonically activated irrigation on the removal of hard‐tissue debris from isthmus‐containing mesial root canal systems of mandibular molars

et al. 2019

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“…To overcome the limitations of conventional irrigation, several irrigation activation techniques such as sonic, ultrasonic devices, lasers and negative pressure irrigation system have been employed to improve the efficacy of cleaning and debriding solutions (Gu et al , Gutmann & Lovdahl ). Recent studies have investigated the efficacy of these techniques in removing AHTD from isthmus‐containing mesial root canals of mandibular molars (De‐Deus et al , Freire et al , Keleş et al , Versiani et al , Leoni et al , Verstraeten et al , Passalidou et al , Silva et al ). Ultrasonically activated irrigation (UAI) is apparently the predominant agitation technique in clinical application.…”

Section: Introductionmentioning

confidence: 99%

Micro‐CT study on the removal of accumulated hard‐tissue debris from the root canal system of mandibular molars when using a novel laser‐activated irrigation approach

et al. 2019

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Aim To compare the efficacy of ultrasonically activated irrigation (UAI), photon‐induced photoacoustic streaming (PIPS) and shock wave enhanced emission photoacoustic streaming (SWEEPS) activation for the removal of accumulated hard‐tissue debris (AHTD) from the root canal system of mandibular molars when assessed using microcomputed tomography (micro‐CT). Methodology A total of 30 mandibular first and second molars with joining mesial root canals containing an isthmus and a single distal canal were subjected to three micro‐CT scans (before and after canal instrumentation and after final irrigation) at a resolution of 15 μm. Mesial canals were prepared up to a ProTaper F3 rotary file, and distal canals were prepared up to a ProTaper F4 rotary file. Teeth were randomly assigned to three groups according to the irrigant activation method (n = 10): the UAI group, the PIPS group and the SWEEPS group. The final irrigation procedures were performed using a total of 15.5 mL of 1% NaOCl for each tooth with an activation time of 3 × 30 s. After three‐dimensional model reconstruction and volumetric measurement of root canals, the percentage reduction (%Rd) of AHTD was calculated. The %Rd of AHTD was analysed statistically using one‐way analysis of variance and nonparametric tests at a significance level of 5%. Results There were no significant differences between the three groups in terms of canal volume before or after instrumentation, or the volume of debris after canal preparation (P > 0.05). In the mesial canals, irrigation with SWEEPS reduced the overall debris by 84.31%, which was significantly more than the reduction associated with PIPS and UAI (58.79% and 50.27%, respectively). In the distal canals, the %Rd of AHTD was significantly different between PIPS and SWEEPS and between UAI and SWEEPS (P < 0.05), but was not significantly different between PIPS and UAI groups (P > 0.05). The SWEEPS was associated with a greater %Rd of AHTD than the PIPS and UAI groups. Conclusions SWEEPS was associated with significantly less debris compared than PIPS and UAI, especially in isthmus‐containing mesial roots. None of the activation techniques completely removed debris from root canal systems.

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“…Sodium hypochlorite (NaOCl) is the most commonly used root canal irrigant; it has an effective antimicrobial activity, a broad bacterial range, and creates a significant reduction in endotoxins levels (Zehnder , Fidalgo et al , Neelakantan et al ). However, several studies have demonstrated that complete bacterial elimination cannot be achieved consistently with any of the current disinfection protocols (Siqueira Jr et al , Silva et al ). Therefore, efforts have been made to develop novel techniques to provide additional disinfection for the root canal system, such as passive ultrasonic irrigation (PUI) (Dioguardi et al ), photodynamic therapy (PDT) (Eslami ), continuous irrigating techniques (Dioguardi et al , Silva et al ) and apical positive and negative pressure irrigation methods (Dioguardi et al , Eslami , Silva et al ).…”

Section: Introductionmentioning

confidence: 99%

“…However, several studies have demonstrated that complete bacterial elimination cannot be achieved consistently with any of the current disinfection protocols (Siqueira Jr et al , Silva et al ). Therefore, efforts have been made to develop novel techniques to provide additional disinfection for the root canal system, such as passive ultrasonic irrigation (PUI) (Dioguardi et al ), photodynamic therapy (PDT) (Eslami ), continuous irrigating techniques (Dioguardi et al , Silva et al ) and apical positive and negative pressure irrigation methods (Dioguardi et al , Eslami , Silva et al ). Amongst these protocols, ozone therapy has been investigated aiming to increase microbial load reduction within the canal system and thus improve endodontic outcomes.…”

Section: Introductionmentioning

confidence: 99%

The effect of ozone therapy in root canal disinfection: a systematic review

et al. 2019

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Aim To answer the following focused question: ‘As regards microorganism load reduction for patients undergoing root canal treatment, is the use of ozone therapy comparable to conventional chemomechanical techniques using sodium hypochlorite (NaOCl)?’ Data sources A systematic review was conducted using controlled vocabulary and free‐text key words in the following databases: PubMed, Science Direct, Scopus, Web of Science and Open Grey until 2 November 2018. Additional studies were sought through hand searching of endodontic journals. Study eligibility criteria, participants and interventions The inclusion criteria comprised studies that compared microbial reduction in root canals after treatments with ozone and NaOCl in extracted mature human teeth or randomized clinical trials. Study appraisal and synthesis methods The quality assessment of included laboratory studies was performed with the following parameters: (i) sample size calculation, (ii) samples with similar dimensions, (iii) control group, (iv) standardization of procedures, (v) statistical analysis and (vi) other risk of bias. For randomized clinical trials, the qualitative analysis of the studies was performed from the bias risk assessment using the tool ‘Bias Risk Assessment of Randomized Controlled Studies’ Cochrane Handbook 5.0.2. Results The search resulted in 180 published studies. After removal of duplicate studies and full‐text analysis, eight studies were selected and seven were considered low risk of bias (seven ex vivo studies and one random clinical trial). Overall, the results demonstrated that ozone therapy provides significantly less microbial load reduction than NaOCl. As an adjunct in chemomechanical preparation, ozone was ineffective in increasing the antimicrobial effect of NaOCl. Ozone performance was strongly associated with the application protocol used: it is dose, time and bacterial strain dependent, besides the correlation with the use of complementary disinfection sources. Limitations A restricted number of randomized clinical trial was found, and the difference amongst the methodology of the studies did not allow a meta‐analysis to be performed. Conclusions and implications of key findings Although the selected studies had limitations, this review reached a satisfactory methodological and moderate evidence quality contributing to important preliminary information regarding ozone therapy. As regards load reduction of microorganisms for patients undergoing root canal treatment, ozone is not indicated neither to replace nor to complement the antimicrobial action of NaOCl.

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Micro-CT evaluation of different final irrigation protocols on the removal of hard-tissue debris from isthmus-containing mesial root of mandibular molars

Abstract: This study highlighted that all final irrigation protocols (PUI, EndoVac, SAF, and EasyClean) promoted a similar removal of AHTD. However, none of the final irrigation protocols was able to render mesial canals of mandibular molars completely free from packed debris.

Cited by 55 publications

References 37 publications

Micro‐CT evaluation of sonically and ultrasonically activated irrigation on the removal of hard‐tissue debris from isthmus‐containing mesial root canal systems of mandibular molars

Micro‐CT evaluation of sonically and ultrasonically activated irrigation on the removal of hard‐tissue debris from isthmus‐containing mesial root canal systems of mandibular molars

Micro‐CT study on the removal of accumulated hard‐tissue debris from the root canal system of mandibular molars when using a novel laser‐activated irrigation approach

The effect of ozone therapy in root canal disinfection: a systematic review

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