Comparison of a Continuous Ultrasonic Irrigation Device and Conventional Needle Irrigation in the Removal of Root Canal Debris



      The purpose of this in vitro study was to compare a continuous ultrasonic irrigation device (VPro StreamClean System [VSS], Vista Dental Products, Racine, WI) with conventional needle irrigation when used as a final irrigation procedure to debride the apical region of the root canal. The null hypothesis that there is no difference was tested.


      Root canals of matched pairs (N = 20) of extracted human teeth were prepared to an apical size of 36/.04 using Profile series 29/.04 rotary files (Dentsply Tulsa Dental, Tulsa, OK) with 6% sodium hypochlorite (NaOCl) irrigation. One tooth of each pair was randomly assigned to receive final irrigation with either VSS or conventional needle irrigation. The gauge of the needle (#30), the irrigation cycles (ie, 5 mL NaOCl, 5 mL 15% EDTA, and 5 mL NaOCl), the irrigant flow rate (5 mL/min), and needle depth placement (1 mm from the working length [WL]) were experimental constants. Serial sections were obtained at 1 and 3 mm from the WL, stained with hematoxylin-eosin, and viewed at 100× magnification for the presence of debris. The percentage of debris in the canal lumen after VSS or conventional needle irrigation was compared by using the Wilcoxon matched pairs test.


      There was significantly less debris in the VSS group compared with the conventional needle irrigation group at the 1-mm level (1.50% [VSS] vs 9.90% [conventional needle irrigation], P = .0001) and the 3-mm level (0.45% [VSS] vs 5.16% [conventional needle irrigation], P = .0014). The null hypothesis was rejected.


      Final irrigation with the VSS compared with conventional needle irrigation delivery resulted in significantly less debris present in root canals at 1 and 3 mm from the WL.

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


        • 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
        • Paragliola R.
        • Franco V.
        • Fabiani C.
        • et al.
        Final rinse optimization: influence of different agitation protocols.
        J Endod. 2010; 36: 282-285
        • 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
        • Weller R.N.
        • Brady J.M.
        • Bernier W.E.
        Efficacy of ultrasonic cleaning.
        J Endod. 1980; 6: 740-743
        • Jensen S.A.
        • Walker T.L.
        • Hutter J.W.
        • Nicoll B.K.
        Comparison of the cleaning efficacy of passive sonic activation and passive ultrasonic activation after hand instrumentation in molar root canals.
        J Endod. 1999; 25: 735-738
        • Jiang L.M.
        • Verhaagen B.
        • Versluis M.
        • Langedijk J.
        • Wesselink P.
        • van der Sluis L.W.
        The influence of the ultrasonic intensity on the cleaning efficacy of passive ultrasonic irrigation.
        J Endod. 2011; 37: 688-692
        • Gu L.S.
        • Kim J.R.
        • Ling J.
        • Choi K.K.
        • Pashley D.H.
        • Tay F.R.
        Review of contemporary irrigant agitation techniques and devices.
        J Endod. 2009; 35: 791-804
        • 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
        • Lee S.J.
        • Wu M.K.
        • Wesselink P.R.
        The effectiveness of syringe irrigation and ultrasonics to remove debris from simulated irregularities within prepared root canal walls.
        Int Endod J. 2004; 37: 672-678
        • Al-Jadaa A.
        • Paque F.
        • Attin T.
        • Zehnder M.
        Acoustic hypochlorite activation in simulated curved canals.
        J Endod. 2009; 35: 1408-1411
        • 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
        • 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
        • Barney J.
        An In Vitro Study Evaluating the Efficacy of the Ultrasonic Bypass SystemTM, Using Different Intracanal Irrigating Solutions.
        ([master's thesis]) Indiana University, Indianapolis, IN2010
        • Binkley S.
        An In Vitro SEM Study Comparing the Debridement Efficacy of the EndoactivatorTM system versus the Ultrasonic BypassTM System Following Hand-Rotary Intrumentation.
        ([master's thesis]) Indiana University, Indianapolis, IN2010
        • Sedgley C.M.
        • Nagel A.C.
        • Hall D.
        • Applegate B.
        Influence of irrigant needle depth in removing bioluminescent bacteria inoculated into instrumented root canals using real-time imaging in vitro.
        Int Endod J. 2005; 38: 97-104
        • 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
        • Nielsen B.A.
        • Craig Baumgartner J.
        Comparison of the EndoVac system to needle irrigation of root canals.
        J Endod. 2007; 33: 611-615
        • Bystrom A.
        • Sundqvist G.
        The antibacterial action of sodium hypochlorite and EDTA in 60 cases of endodontic therapy.
        Int Endod J. 1985; 18: 35-40
        • McGurkin-Smith R.
        • Trope M.
        • Caplan D.
        • Sigurdsson A.
        Reduction of intracanal bacteria using GT rotary instrumentation, 5.25% NaOCl, EDTA, and Ca(OH)2.
        J Endod. 2005; 31: 359-363
        • Rocas I.N.
        • Siqueira Jr., J.F.
        Comparison of the in vivo antimicrobial effectiveness of sodium hypochlorite and chlorhexidine used as root canal irrigants: a molecular microbiology study.
        J Endod. 2011; 37: 143-150
        • Nair P.N.
        • Henry S.
        • Cano V.
        • Vera J.
        Microbial status of apical root canal system of human mandibular first molars with primary apical periodontitis after “one-visit” endodontic treatment.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 99: 231-252
        • Boutsioukis C.
        • Gogos C.
        • Verhaagen B.
        • Versluis M.
        • Kastrinakis E.
        • Van der Sluis L.W.
        The effect of apical preparation size on irrigant flow in root canals evaluated using an unsteady Computational Fluid Dynamics model.
        Int Endod J. 2010; 43: 874-881
        • Chow T.W.
        Mechanical effectiveness of root canal irrigation.
        J Endod. 1983; 9: 475-479
        • Boutsioukis C.
        • Verhaagen B.
        • Versluis M.
        • Kastrinakis E.
        • Wesselink P.R.
        • van der Sluis L.W.
        Evaluation of irrigant flow in the root canal using different needle types by an unsteady computational fluid dynamics model.
        J Endod. 2010; 36: 875-879
        • 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
        • 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
        • 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.
        Ultrasonic debridement of root canals: an insight into the mechanisms involved.
        J Endod. 1987; 13: 93-101