Advertisement

Comparative Evaluation of Canal Isthmus Debridement Efficacy of Modified EndoVac Technique with Different Irrigation Systems

  • Anchu Rachel Thomas
    Correspondence
    Address requests for reprints to Dr Anchu Rachel Thomas, Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research, Alapakkam Main Road, Maduravoyal, Chennai–600 095, Tamil Nadu, India.
    Affiliations
    Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research, Chennai, India
    Search for articles by this author
  • Natanasabapathy Velmurugan
    Affiliations
    Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research, Chennai, India
    Search for articles by this author
  • Surendran Smita
    Affiliations
    Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research, Chennai, India
    Search for articles by this author
  • Sundaramurthy Jothilatha
    Affiliations
    Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research, Chennai, India
    Search for articles by this author

      Abstract

      Introduction

      The purpose of this study was to evaluate the canal isthmus debridement efficacy of a new modified EndoVac (Discus Dental, Culver City, CA) irrigation protocol in comparison with EndoVac, passive ultrasonic irrigation (PUI), and conventional needle irrigation in mesial roots of mandibular molars.

      Methods

      The mesial roots of 64 extracted mandibular molars mounted in resin using Kuttler's endodontic cube, sectioned at 2 and 4 mm from the working length, were randomly divided into 4 groups (n = 16): group 1: Max-I-Probe (Dentsply Tulsa Dental, York, PA), group 2: EndoVac (EVI), group 3: modified EndoVac, and group 4: PUI. The specimens were reassembled and instrumented. A standard irrigation protocol was used during cleaning and shaping and final irrigation with the 4 irrigation/agitation techniques. Images of the isthmus region were taken before and after cleaning and shaping and after final irrigation. The percentage reduction of debris in the isthmus region was calculated by using the software program Image J (v1.43; National Institutes of Health, Bethesda, MD). Intergroup analysis was performed using the Kruskal Wallis and Mann-Whitney U tests. Intragroup analysis was performed using Friedman and Wilcoxon signed rank tests. The level of significance was set at P < .05.

      Results

      Intragroup analysis revealed a statistically significant difference in the percentage reduction of debris after cleaning and shaping and after final irrigation protocol in all the groups (P < .001). The final irrigation protocol produced significantly cleaner canal isthmuses in all the groups (P < .001). On intergroup analysis, the modified EVI group performed significantly better than the other groups. The EVI and PUI groups performed better than the Max-I-Probe group. There was no statistical significance between the EVI and PUI groups.

      Conclusions

      Canal isthmuses were significantly cleaner with the modified EndoVac irrigation technique when compared with the cleanliness seen with the other irrigation systems.

      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

        • Peters O.A.
        • 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: 221-230
        • Peters O.A.
        Current challenges and concepts in the preparation of root canal systems. A review.
        J Endod. 2004; 30: 559-606
        • Walton R.E.
        Histological evaluation of different methods of enlarging the pulp canal space.
        J Endod. 1976; 2: 304-311
        • 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: 1664-1668
        • 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
        • Hsu Y.
        • Kim S.
        The resected root surface: the issue of canal isthmuses.
        Dent Clin North Am. 1997; 41: 529-540
        • Tam A.
        • Yu D.C.
        Location of canal isthmus and accessory canals in the mesiobuccal root of maxillary first permanent molars.
        J Can Dent Assoc. 2002; 68: 28-33
        • Endal U.
        • Shen Y.
        • Knut A.
        • et al.
        High-resolution computed tomographic study of changes in root canal isthmus area by instrumentation and root filling.
        J Endod. 2011; 37: 223-227
        • Howard R.K.
        • Kirkpatrick T.C.
        • Rutledge R.E.
        • Yaccino J.M.
        Comparison of debris removal with three different irrigation techniques.
        J Endod. 2011; 37: 1301-1305
        • Johnson M.
        • Sidow S.J.
        • Looney S.W.
        • et al.
        Canal and isthmus debridement efficacy using a sonic irrigation technique in a closed-canal system.
        J Endod. 2012; 38: 1265-1268
        • 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
        • Nielson B.A.
        • Baumgartner J.C.
        Comparison of the EndoVac system to needle irrigation of root canals.
        J Endod. 2007; 33: 611-615
        • Weller R.N.
        • Niemczyk S.P.
        • Kim S.
        Incidence and position of the canal isthmus. Part 1. Mesiobuccal root of the maxillary first molar.
        J Endod. 1995; 21: 380-383
        • Teixeira F.B.
        • Sano C.L.
        • Gomes B.P.
        • et al.
        A preliminary in vitro study of the incidence and position of the root canal isthmus in maxillary and mandibular first molars.
        Int Endod J. 2003; 36: 276-280
        • Von Arx T.
        Frequency and type of canal isthmuses in first molars detected by endoscopic inspection during peri-radicular surgery.
        Int Endod J. 2005; 38: 160-168
        • de Pablo O.V.
        • Estevez R.
        • Peix Sanchez M.
        • et al.
        Root anatomy and canal configuration of the permanent mandibular first molar: a systematic review.
        J Endod. 2010; 36: 1919-1931
        • Mannocci F.
        • Peru M.
        • Sherriff M.
        • et al.
        The isthmuses of the mesial root of mandibular molars: a microcomputed tomographic study.
        Int Endod J. 2005; 38: 558-563
        • Klyn S.L.
        • Kirkpatrick T.C.
        • Rutledge R.E.
        In vitro comparisons of debris removal of the EndoActivator system, the F file, ultrasonic irrigation, and NaOCl irrigation alone after hand-rotary instrumentation in human mandibular molars.
        J Endod. 2010; 36: 1367-1371
        • Brunson M.
        • Heilborn C.
        • Johnson J.
        • Cohenca N.
        Effect of apical preparation size and preparation taper on irrigant volume delivered by using negative pressure irrigation system.
        J Endod. 2010; 36: 721-724
        • Ahmad M.
        • Pitt Ford T.R.
        • Crum L.A.
        • et al.
        Ultrasonic debridement of root canals: acoustic cavitation and its relevance.
        J Endod. 1988; 14: 486-493
        • Brito P.R.
        • Souza L.C.
        • Machado de Oliveira J.C.
        • et al.
        Comparison of the effectiveness of three irrigation techniques in reducing intracanal Enterococcus faecalis populations: an in vitro study.
        J Endod. 2009; 35: 1422-1427
        • Heilborn C.
        • Reynolds K.
        • Johnson J.D.
        • Cohenca N.
        Cleaning efficacy of an apical negative-pressure irrigation system at different exposure times.
        Quintessence Int. 2010; 41: 759-767
        • Parente J.M.
        • Loushine R.J.
        • Susin L.
        • et al.
        Root canal debridement using manual dynamic agitation or the EndoVac for final irrigation in a closed system and an open system.
        Int Endod J. 2010; 43: 1001-1012
        • Abarajithan M.
        • Dham S.
        • Velmurugan N.
        • et al.
        Comparison of Endovac irrigation system with conventional irrigation for removal of intracanal smear layer: an in vitro study.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; 112: 407-411
        • Mancini M.
        • Cerroni L.
        • Iorio L.
        • et al.
        Smear layer removal and canal cleanliness using different irrigation systems (EndoActivator, EndoVac, and passive ultrasonic irrigation): field emission scanning electron microscopic evaluation in an in vitro study.
        J Endod. 2013; 39: 1456-1460
        • Munoz H.R.
        • Camacho-Cuadra K.
        In vivo efficacy of three different endodontic irrigation systems for irrigant delivery to working length of mesial canals of mandibular molars.
        J Endod. 2012; 38: 445-448
        • Schoeffel G.J.
        The EndoVac method of endodontic irrigation and activation systems on the penetration of sodium hypohlorite into simulated lateral canals and upto working length.An invitro study.
        J Endod. 2010; 36: 1216-1221
        • Gade V.J.
        • Sedani S.K.
        • Lokade J.S.
        • et al.
        Comparative evaluation of debris removal from root canal wall by using EndoVac and conventional needle irrigation: an in vitro study.
        Contemp Clin Dent. 2013; 4: 432-436
        • De Gregorio C.
        • Estevez R.
        • Cisneros R.
        • et al.
        Effect of EDTA, sonic, and ultrasonic activation on the penetration of sodium hypochlorite into simulated lateral canals: an in vitro study.
        J Endod. 2009; 35: 891-895
        • Gu L.S.
        • Kim J.R.
        • Ling J.
        • et al.
        Review of contemporary irrigant agitation techniques and devices.
        J Endod. 2009; 35: 791-804
        • de Gregorio C.
        • Paranjpe A.
        • Garcia A.
        • et al.
        Efficacy of irrigation systems on penetration of sodium hypochlorite to working length and to simulated un instrumented areas in oval shaped root canals.
        Int Endod J. 2012; 45: 475-481
        • de Gregorio C.
        • Estevez R.
        Efficacy of different irrigation and activation systems on the penetration of sodium hypochlorite into simulated lateral canals and up to working length: an in vitro study.
        J Endod. 2010; 36: 1216-1221
        • Jiang L.M.
        • Lak B.
        • Eijsvogels L.M.
        • et al.
        Comparison of the cleaning efficacy of different final irrigation techniques.
        J Endod. 2012; 38: 838-841
        • 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
        • Adcock J.M.
        • Sidow S.J.
        • Looney S.W.
        • et al.
        Histologic evaluation of canal and isthmus debridement efficacies of two different irrigant delivery techniques in a closed system.
        J Endod. 2011; 37: 544-548
        • Baker N.A.
        • Eleazer P.D.
        • Averbach R.E.
        • Seltzer S.
        Scanning electron microscopic study of the efficacy of various irrigating solutions.
        J Endod. 1975; 1: 127-135