Advertisement

Efficacy and Safety of Various Active Irrigation Devices When Used with Either Positive or Negative Pressure: An In Vitro Study

Published:October 19, 2012DOI:https://doi.org/10.1016/j.joen.2012.09.009

      Abstract

      Introduction

      The purpose of this in vitro study was to evaluate and compare the efficacy and safety of different devices available for canal cleansing.

      Methods

      The following systems were tested: passive ultrasonic irrigation, EndoVac (Discus Dental, Culver City, CA), and the irrigation ultrasonic needle (ProUltra PiezoFlow Irrigation Ultrasonic Needle; Dentsply Tulsa Dental Specialties, Tulsa, OK) used in both the injection mode (IUNI) and the aspiration mode (IUNA). In the control group, traditional irrigation with a syringe and side-vented needle was used. A resin model was used with 4 lateral canals (respectively at 2, 5, 8, and 11 mm from the apical foramen) filled with bovine pulp stained with fuchsin. The model also included a 2-mm chamber in communication with the apex, again filled with bovine pulp, which enabled the measurement of the extrusion of NaOCl beyond the apex.

      Results

      With regard to efficacy, the most effective systems were found to be those using the ultrasonic needle, either in aspiration or injection modes; EndoVac was the least effective. Conversely, IUNI was found to bring the highest risk with regard to the extrusion of sodium hypochlorite beyond the apex. EndoVac was the safest but only by a slight margin compared with IUNA and passive ultrasonic irrigation.

      Conclusions

      Based on this study, the system that best reconciles efficacy and safety appears to be IUNA.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Endodontics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Haapasalo M.
        • Endal U.
        • Zandi H.
        • Coil J.M.
        Eradication of endodontic infection by instrumentation and irrigation solutions.
        Endod Topics. 2005; 10: 77-102
        • Gu L.S.
        • Kim J.R.
        • Ling J.
        • et al.
        Review of contemporary irrigant agitation techniques and devices.
        J Endod. 2009; 35: 791-804
        • Haapasalo M.
        • Shen Y.
        • Qian W.
        • Gao Y.
        Irrigation in endodontics.
        Dent Clin North Am. 2010; 54: 291-312
        • Schafer E.
        • Zapke K.
        A comparative scanning electron microscopic investigation of the efficacy of manual and automated instrumentation of root canals.
        J Endod. 2000; 26: 660-664
        • Weller R.N.
        • Brady J.M.
        • Bernier W.E.
        Efficacy of ultrasonic cleaning.
        J Endod. 1980; 6: 740-743
        • Gutarts R.
        • Nusstein J.
        • Reader A.
        • Beck M.
        In vivo debridement efficacy of ultrasonic irrigation following hand-rotary instrumentation in human mandibular molars.
        J Endod. 2005; 31: 166-170
        • DeNunzio M.S.
        • Hicks M.L.
        • Pelleu Jr., G.B.
        • et al.
        Bacteriological comparison of ultrasonic and hand instrumentation of root canals in dogs.
        J Endod. 1989; 15: 290-293
        • Spoleti P.
        • Siragusa M.
        • Spoleti M.J.
        Bacteriological evaluation of passive ultrasonic activation.
        J Endod. 2003; 29: 12-14
        • van der Sluis L.W.
        • Versluis M.
        • Wu M.K.
        • Wesselink P.R.
        Passive ultrasonic irrigation of the root canal: a review of the literature.
        Int Endod J. 2007; 40: 415-426
        • Ahmad M.
        • Pitt Ford T.J.
        • Crum L.A.
        Ultrasonic debridement of root canals: acoustic streaming and its possible role.
        J Endod. 1987; 13: 490-499
        • Ahmad M.
        • Pitt Ford T.R.
        • Crum L.A.
        • Walton A.J.
        Ultrasonic debridement of root canals: acoustic cavitation and its relevance.
        J Endod. 1988; 14: 486-493
        • Haidet J.
        • Reader A.
        • Beck M.
        • Meyers W.
        An in vivo comparison of the step-back technique versus a step-back/ultrasonic technique in human mandibular molars.
        J Endod. 1989; 15: 195-199
        • Archer R.
        • Reader A.
        • Nist R.
        • et al.
        An in vivo evaluation of the efficacy of ultrasound after step-back preparation in mandibular molars.
        J Endod. 1992; 18: 549-552
        • van der Sluis L.W.
        • Wu M.K.
        • Wesselink P.R.
        The efficacy of ultrasonic irrigation to remove artificially placed dentine debris from human root canals prepared using instruments of varying taper.
        Int Endod J. 2005; 38: 764-768
        • Al-Jadaa A.
        • Paque F.
        • Attin T.
        • Zehnder M.
        Necrotic pulp tissue dissolution by passive ultrasonic irrigation in simulated accessory canals: impact of canal location and angulation.
        Int Endod J. 2009; 42: 59-65
        • Castelo-Baz P.
        • Martin-Biedma B.
        • Cantatore G.
        • et al.
        In vitro comparison of passive and continuous ultrasonic irrigation in simulated lateral canals of extracted teeth.
        J Endod. 2012; 38: 688-691
        • Al-Jadaa A.
        • Paque F.
        • Attin T.
        • Zehnder M.
        Acoustic hypochlorite activation in simulated curved canals.
        J Endod. 2009; 35: 1408-1411
        • Malki M.
        • Verhaagen B.
        • Jiang L.M.
        • et al.
        Irrigant flow beyond the insertion depth of an ultrasonically oscillating file in straight and curved root canals: visualization and cleaning efficacy.
        J Endod. 2012; 38: 657-661
        • Vera J.
        • Arias A.
        • Romero M.
        Effect of maintaining apical patency on irrigant penetration into the apical third of root canals when using passive ultrasonic irrigation: an in vivo study.
        J Endod. 2011; 37: 1276-1278
        • Carver K.
        • Nusstein J.
        • Reader A.
        • Beck M.
        In vivo antibacterial efficacy of ultrasound after hand and rotary instrumentation in human mandibular molars.
        J Endod. 2007; 33: 1038-1043
        • Burleson A.
        • Nusstein J.
        • Reader A.
        • Beck M.
        The in vivo evaluation of hand/rotary/ultrasound instrumentation in necrotic, human mandibular molars.
        J Endod. 2007; 33: 782-787
        • Desai P.
        • Himel V.
        Comparative safety of various intracanal irrigation systems.
        J Endod. 2009; 35: 545-549
        • Hulsmann M.
        • Rodig T.
        • Nordmeyer S.
        Complications during root canal irrigation.
        Endod Topics. 2009; 16: 27-63
        • Fukumoto Y.
        • Kikuchi I.
        • Yoshioka T.
        • et al.
        An ex vivo evaluation of a new root canal irrigation technique with intracanal aspiration.
        Int Endod J. 2006; 39: 93-99
        • Jiang L.M.
        • Verhaagen B.
        • Versluis M.
        • et al.
        The influence of the ultrasonic intensity on the cleaning efficacy of passive ultrasonic irrigation.
        J Endod. 2011; 37: 688-692
        • Susin L.
        • Liu Y.
        • Yoon J.C.
        • et al.
        Canal and isthmus debridement efficacies of two irrigant agitation techniques in a closed system.
        Int Endod J. 2010; 43: 1077-1090