Ex-vivo evaluation of four irrigation protocols for the removal of hard-tissue debris from flattened root canals and isthmus in mandibular incisors / Avaliação ex-vivo de quatro protocolos de irrigação para a remoção de resíduos de tecido duro de canais radiculares achatados e istmo em incisivos inferiores
Keywords:irrigation, debris, ultrasonic activation
Introduction This study aimed to compare the effect of ultrasonic activation in comparison to conventional irrigation in the removal of dentin debris from the root canals walls. Methods Sixty single-rooted mandibular incisors with one only straight flattened root canal were selected and allocated across groups (n=15), according to the irrigation protocol: G1: conventional irrigation with 2.5% sodium hypochlorite; G2: conventional irrigation with 2% chlorhexidine gel and saline solution; G3: G1 + ultrasonic activation; G4: G2 + ultrasonic activation. Cross-sectional images were obtained and evaluated before and after root canal cleaning and shaping. Two-way (ANOVA) and t-test (P < 0.05) statistical tests were performed. Results G3 irrigation protocol removed significantly more dentin debris (p=0.0065), followed by the G1 protocol (p=0.0165) and by the G2 and G4 techniques, which were comparable (p=0.763). Conclusions Irrigation with sodium hypochlorite followed by ultrasonic activation promoted a significant reduction in dentin debris within the root canal system.
Zhender M. Root canal irrigants. J Endod. 2006;32:389-98.
van der Sluis LWM, Versluis M, Wu MK, Wesselink PR. Passive ultrasonic irrigation of the root canal: a review of the literature. Int Endod J. 2007;40:415-26.
Peters OA, Schonenberger K, Laib A. Effects of four Ni-Ti preparation techniques on root canal geometry assessed by micro computed tomography. Int Endod J. 2001;34:221-30.
Peters OA. Current challenges and concepts in the preparation of root canal systems. A review. J Endod. 2004;30:559-606.
Ricucci D, Siqueira Jr JF. Biofilms and Apical Periodontitis: Study of Prevalence and Association with Clinical and Histopathologic Findings. J Endod. 2010;36:1277-88.
Leoni GB, Versiani MA, Silva-Sousa YT, et al. Ex vivo evaluation of four final irrigation protocols on the removal of hard-tissue debris from the mesial root canal system of mandibular first molars. Int Endod J. 2017;50:398-406.
Martins Justo A, Abreu da Rosa R, Santini MF, et al. Effectiveness of final irrigant protocols for debris removal from simulated canal irregularities. J Endod. 2014;40:2009-14.
Mendonça DH, Colucci V, Rached-Junior FJ, et al. Effects of various irrigation/aspiration protocols on cleaning of flattened root canals. Braz Oral Res. 2015;29:1-9.
Nusstein JM. Sonic and ultrasonic irrigation. In: Bettina B, ed. Endodontic irrigation: chemical disinfection of the root canal system. Switzerland: Springer; 2015:173–98.
Neelakantan P, Devaraj S, Jagannathan N. Histologic assessment of debridement of the root canal isthmus of mandibular molars by irrigant activation techniques ex vivo. J Endod. 2016;42:1268-72.
Dutner J, Mines P, Anderson A. Irrigation trends among American Association of Endodontists members: a web-based survey. J Endod. 2012;38:37-40.
Perez R, Neves AA, Belladonna FG, et al. Impact of the needle insertion depth on the removal of hard-tissue debris. Int Endod J. 2016 Apr 9. doi: 10.1111/iej.12648.
Boutsioukis C, Lambrianidis T, Verhaagen B, et al. The effect of needle-insertion depth on the irrigant flow in the root canal: evaluation using an unsteady computational fluid dynamics model. J Endod. 2010;36:1664-8.
Adcock JM, Sidow SJ, Looney SW, et al. Histologic evaluation of canal and isthmus debridement efficacies of two different irrigant delivery techniques in a closed system. J Endod. 2011; 37: 544-8.
Siqueira Jr JF. Aetiology of root canal treatment failure: why well-treated teeth can fail. Int Endod J. 2001;34:1-10.
Arnold M, Ricucci D, Siqueira JR JF. Infection in a complex network of apical ramifications as the cause of persistent apical periodontitis: a case report. J Endod. 2013;39:1179-84.
Sarno MU, Sidow SJ, Looney SW, et al. Canal and isthmus debridement efficacy of the VPro EndoSafe negative-pressure irrigation technique. J Endod. 2012;38:1631-4.
Endal U, Endal U, Shen Y, et al. High-resolution computed tomographic study of changes in root canal isthmus area by instrumentation and root filling. J Endod. 2011;37:223-7.
Basrani B Haapasalo M. Update on endodontic irrigating solutions. Endodontic Topics. 2012;27:74-102.
Moorer WR, Wesselink PR. Factors promoting the tissue dissolving capability of sodium hypochlorite. Int Endod J. 1982;15:187-96.
Zandi H, Rodrigues RC, Kristoffersen AK, et al. Antibacterial effectiveness of 2 root canal irrigants in root-filled teeth with infection: a randomized clinical trial. J Endod. 2016;42:1307-13.
Ferraz CC, Gomes BP, Zaia AA, et al. In vitro assessment of the antimicrobial action and the mechanical ability of chlorhexidine gel as an endodontic irrigant. J Endod. 2001;27:452-5.
Weller RN, Brady JM, Bernier WE. Efficacy of ultrasonic cleaning. J Endod. 1980;6:740-3.
Haapasalo M, Shen Y, Wang Z, Gao Y. Irrigation in endodontics. Brit Dent J. 2014;216:299–303.
Conde AJ, Estevez R, Loroño G, et al. Effect of sonic and ultrasonic activation on organic tissue dissolution from simulated grooves in root canals using sodium hypochlorite and EDTA. Int Endod J. 2016 Nov 3. doi: 10.1111/iej.12717.
Bramante CM, Berbert A, Borges RP. A methodology for evaluation of root canal instrumentation. J Endod. 1987;13:243-245.
Carvalho-Sousa B, Costa-Filho JR, Almeida-Gomes F, et al. Evaluation of the dentin remaining after flaring using Gates Glidden drills and Protaper rotary files. RSBO. 2011;8:194-9.
Estrela C, Rabelo LE, de Souza JB, et al. Frequency of root canal isthmi in human permanent teeth determined by cone-beam computed tomography. J Endod. 2015;41:1535-9.
Liu CX, Li W, Zheng QH, et al. Anatomic study of canal isthmuses of mandibular permanent incisors by micro-CT. Hua Xi Kou Qiang Yi Xue Za Zhi. 2010;28:177-80.
Siqueira JF Jr, Rôças IN, Ricucci D, Hulsmann M. Causes and management of post-treatment apical periodontitis. Br Dent J. 2014;216:305–12.
Paqué F, Al-Jadaa A, Kfir A. Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars. Int Endod J. 2012;45:413–8.
Freire LG, Iglecias EF, Cunha RS, et al. Micro-computed tomographic evaluation of hard tissue debris removal after different irrigation methods and its influence on the filling of curved canals. J Endod. 2015;41:1660-6.
Walters MJ, Baumgartner JC, Marshall JG. Efficacy of irrigation with rotary instrumentation. J Endod. 2002;28:837-9.
Robinson JP, Lumley PJ, Cooper PR, et al. Reciprocating root canal technique induces greater debris accumulation than a continuous rotary technique as assessed by 3-dimensional micro-computed tomography. J Endod. 2013;39:1067–70.
De-Deus G, Marins J, Silva EJ, et al. Accumulated hard-tissue debris produced during reciprocating and rotary nickel-titanium canal preparation. J Endod. 2015;41:676–81.
Paqué F , Laib A, Gautschi H, Zehnder M. Hard-tissue debris accumulation analysis by high-resolution computed tomography scans. J Endod. 2009;35:1044–7.
Kuruvilla A, Jaganath BM, Krishnegowda SC, et al. A comparative evaluation of smear layer removal by using edta, etidronic acid, and maleic acid as root canal irrigants: An in vitro scanning electron microscopic study. J Conserv Dent. 2015;18:247-51.
Paqué F, Musch U, Hülsmann M. Comparison of root canal preparation using RaCe and ProTaper rotary Ni-Ti instruments. Int Endod J. 2005;38:8-16.
Boutsioukis C, Psimma Z, van der Sluis LW. Factors affecting irrigant extrusion during root canal irrigation: a systematic review. Int Endod J. 2013;46:599-618.
Zhu WC, Gyamfi J, Niu LN, et al. Anatomy of sodium hypochlorite accidents involving facial ecchymosis - a review. J Dent. 2013;41:935-48.
Versiani MA, Alves FR, Andrade-Junior CV, et al. Micro-CT evaluation of the efficacy of hard-tissue removal from the root canal and isthmus area by positive and negative pressure irrigation systems. Int Endod J. 2016;49:1079-87.
Gregorio C, Arias A, Navarrete N, et al. Effect of apical size and taper on volume of irrigant delivered at working length with apicalnegative pressure at different root curvatures. J Endod. 2013;39:119-24.
Versiani MA, Pecora JD, Sousa-Neto MD. Microcomputed tomography analysis of the root canal morphology of single-rooted mandibular canines. Int Endod J. 2013;46:800-7.
Nazari Moghaddam K, Mehran M, Farajian Zadeh H. Root canal cleaning efficacy of rotary and hand files instrumentation in primary molars. Iran Endod J. 2009;4:53-7.
Kato AS, Cunha RS, da Silveira Bueno CE, et al. Investigation of the efficacy of passive ultrasonic irrigation versus irrigation with reciprocating activation: an environmental scanning electron microscopic study. J Endod. 2016;42:659-63.