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Assessment of Apical Extrusion during Root Canal Irrigation with the Novel GentleWave System in a Simulated Apical Environment

Published:November 04, 2015DOI:https://doi.org/10.1016/j.joen.2015.04.009

      Highlights

      • The apical extrusion of GentleWave, a conventional open-ended 30-G needle, or Endovac was studied with an apparatus with an apical pressure threshold of 5.88 ± 0.15 mm Hg.
      • GentleWave and Endovac did not cause treatment fluid apical extrusion.
      • Occasional apical extrusion with a 30-G conventional open-ended needle was noted and associated with the canal size.

      Abstract

      Introduction

      This study assessed apical extrusion during treatment with GentleWave (GW; Sonendo Inc, Laguna Hills, CA), a conventional open-ended 30-G needle (CN), or Endovac (EV; SybronEndo, Orange, CA) in root canals enlarged to different dimensions with and without apical constriction.

      Methods

      Sixteen mandibular molars were mounted in an in vitro apparatus. Roots were immersed in a pressure-regulated chamber containing distilled water with pressure kept at 5.88 ± 0.15 mm Hg to simulate periapical back pressure. Mesiobuccal (curved ≤30°) and distal (straight) canals were instrumented to the working length (WL) as follows: minimal instrumentation (MI, #15/.04), traditional instrumentation (#35/.06), or overinstrumentation (OI, #35/.06, to the WL + 1 mm). Canals were tested 5 times each with distilled water using GW, CN (at WL-3 mm), or EV and the mass (g) of extruded water recorded. Extrusion frequency and mean extruded mass were compared for each canal, irrigation group, and canal instrumentation mode (Wilcoxon t test, P < .05).

      Results

      No extrusion occurred with GW and EV, whereas the frequency of extrusion with CN was 33%. Mean extruded water mass using CN ranged in mesial canals from 0.000 ± 0.000 g (OI) to 0.047 ± 0.098 g (MI) and in distal canals from 0.123 ± 0.191 g (MI) to 0.505 ± 0.490 g (OI). With traditional instrumentation and OI instrumentation, extruded mass in distal canals was significantly higher than in mesial canals (P < .002) and distal canals with MI (P < .020).

      Conclusions

      Within this study's limitations, root canal treatment with GW and irrigation with EV was not associated with extrusion. Extruded irrigation mass using the open-ended 30-G needle depended on the canal type and enlargement. These results have to be interpreted with caution, and further investigations are warranted to evaluate the possibility of extrusion using GW in different tooth types and clinical situations.

      Key Words

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      References

        • Cano V.
        • Nair P.N.
        • Henry S.
        • 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
        • Basrani B.
        • Haapasalo M.
        Update on endodontic irrigating solutions.
        Endod Topics. 2012; 27: 74-102
        • Haapasalo M.
        • Shen Y.
        • Qian W.
        • Gao Y.
        Irrigation in endodontics.
        Dent Clin North Am. 2010; 54: 291-312
        • Pashley E.L.
        • Birdsong N.L.
        • Bowman K.
        • Pashley D.H.
        Cytotoxic effects of NaOCl on vital tissue.
        J Endod. 1985; 11: 30-33
        • Malentacca A.
        • Uccioli U.
        • Zangari D.
        • et al.
        Efficacy and safety of various active irrigation devices when used with either positive or negative pressure: an in vitro study.
        J Endod. 2012; 38: 1622-1626
        • Boutsioukis C.
        • Lambrianidis T.
        • Kastrinakis E.
        • Bekiaroglou P.
        Measurement of pressure and flow rates during irrigation of a root canal ex vivo with three endodontic needles.
        Int Endod J. 2007; 40: 504-513
        • Boutsioukis C.
        • Gogos C.
        • Verhaagen B.
        • et al.
        The effect of root canal taper on the irrigant flow: evaluation using an unsteady Computational Fluid Dynamics model.
        Int Endod J. 2010; 43: 909-916
        • Nielsen B.A.
        • Craig Baumgartner J.
        Comparison of the EndoVac system to needle irrigation of root canals.
        J Endod. 2007; 33: 611-615
        • Desai P.
        • Himel V.
        Comparative safety of various intracanal irrigation systems.
        J Endod. 2009; 35: 545-549
        • Psimma Z.
        • Boutsioukis C.
        • Kastrinakis E.
        • Vasiliadis L.
        Effect of needle insertion depth and root canal curvature on irrigant extrusion ex vivo.
        J Endod. 2013; 39: 521-524
        • Motta M.V.
        • Chaves-Mendonca M.A.
        • Stirton C.G.
        • Cardozo H.F.
        Accidental injection with sodium hypochlorite: report of a case.
        Int Endod J. 2009; 42: 175-182
        • Zhu W.
        • Gyamfi J.
        • Niu L.
        • et al.
        Anatomy of sodium hypochlorite accidents involving facial ecchymosis—a review.
        J Dent. 2013; 41: 935-948
        • Pashley E.L.
        • Birdsong N.L.
        • Bowman K.
        • Pashley D.H.
        Cytotoxic effects of NaOCl on vital tissue.
        J Endod. 1985; 11: 525-528
        • Ehrich D.G.
        • Brian J.D.
        • Walker W.A.
        Case report sodium hypochlorite accident: inadvertent injection into the maxillary sinus.
        J Endod. 1993; 19: 180-182
        • Markose G.
        • Cotter C.J.
        • Hislop W.S.
        Facial atrophy following accidental subcutaneous extrusion of sodium hypochlorite.
        Br Dent J. 2009; 206: 263-264
        • Kleier D.J.
        • Averbach R.E.
        • Mehdipour O.
        The sodium hypochlorite accident: experience of diplomates of the American Board of Endodontics.
        J Endod. 2008; 34: 1346-1350
        • Dutner J.
        • Mines P.
        • Anderson A.
        Irrigation trends among American Association of Endodontists members: a web-based survey.
        J Endod. 2012; 38: 37-40
        • De Gregorio C.
        • Paranjpe A.
        • Garcia A.
        • et al.
        Efficacy of irrigation systems on penetration of sodium hypochlorite to working length and to simulated uninstrumented areas in oval shaped root canals.
        Int Endod J. 2012; 45: 475-481
        • Haapasalo M.
        • Wang Z.
        • Shen Y.
        • et al.
        Tissue dissolution by a novel multisonic ultracleaning system and sodium hypochlorite.
        J Endod. 2014; 40: 1178-1181
        • Ma J.
        • Shen Y.
        • Yang Y.
        • et al.
        In vitro study of calcium hydroxide removal from mandibular molar root canals.
        J Endod. 2015; 41: 553-558
        • Mitchell R.P.
        • Baumgartner J.C.
        • Sedgley C.M.
        Apical extrusion of sodium hypochlorite using different root canal irrigation systems.
        J Endod. 2011; 37: 1677-1681
        • Psimma Z.
        • Boutsioukis C.
        • Vasiliadis L.
        • Kastrinakis E.
        A new method for real-time quantification of irrigant extrusion during root canal irrigation ex vivo.
        Int Endod J. 2013; 46: 619-631
        • Mitchell R.P.
        • Yang S.E.
        • Baumgartner J.C.
        Comparison of apical extrusion of NaOCl using the EndoVac or needle irrigation of root canals.
        J Endod. 2010; 36: 338-341
        • Schneider S.W.
        A comparison of canal preparations in straight and curved root canals.
        Oral Surg Oral Med Oral Pathol. 1971; 32: 271-275
        • Goode N.
        • Khan S.
        • Eid A.A.
        • et al.
        Wall shear stress effects of different endodontic irrigation techniques and systems.
        J Dent. 2013; 41: 636-641
        • Lyons R.H.
        • Kennedy J.A.
        • Burwell C.S.
        The measurement of venous pressure by the direct method.
        Am Heart J. 1938; 16: 675-693
        • Baumann U.A.
        • Marquis C.
        • Stoupis C.
        • et al.
        Estimation of central venous pressure by ultrasound.
        Resuscitation. 2005; 64: 193-199
        • Mehdipour O.
        • Kleier D.J.
        • Averbach R.E.
        Anatomy of sodium hypochlorite accidents.
        Compend Contin Educ Dent. 2007; 28 (548, 550): 544-546
        • Spoorthy E.
        • Velmurugan N.
        • Ballal S.
        • Nandini S.
        Comparison of irrigant penetration up to working length and into simulated lateral canals using various irrigating techniques.
        Int Endod J. 2013; 46: 815-822
        • Brown D.C.
        • Moore B.K.
        • Brown C.E.
        • Newton C.W.
        An in vitro study of apical extrusion of sodium hypochiorite during endodontic canal preparation.
        J Endod. 1995; 21: 587-591
        • Park E.
        • Shen Y.
        • Khakpour M.
        • Haapasalo M.
        Apical pressure and extent of irrigant flow beyond the needle tip during positive-pressure irrigation in an in vitro root canal model.
        J Endod. 2013; 39: 511-515
        • Hauman C.H.
        • Chandler N.P.
        • Tong D.C.
        Endodontic implications of the maxillary sinus: a review.
        Int Endod J. 2002; 35: 127-141
        • Khan S.
        • Niu L.
        • Eid A.
        • et al.
        Periapical pressures developed by nonbinding irrigation needles at various irrigation delivery rates.
        J Endod. 2013; 39: 529-533