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[The effect of root canal irrigation and variance of apical foramen pressure by use of casing aspiration needle system in vitro].

The authors introduced casing aspiration needle system (CANS) to irrigating root canal. The effect of root irrigation on removing canal debris and the variance of apical foramen pressure on extracted teeth were compared between the conventional irrigation and CANS irrigation. The results indicated that the effect of root canal irrigation by CANS was much better than the conventional method (P < 0.01). CANS irrigation didn't produce pressure to apical foramen during root canal irrigation. However, in the conventional method, with irrigation needle inserted deeper and deeper in root cancal the pressure of apical foramen gets higher and higher.

Humans↗

Effectiveness of root canal irrigation.

When root canals are being enlarged, repeated irrigation is mandatory. Under the conditions of this study, the most significant factor in obtaining maximum results in root canal irrigation is the diameter of the canals. The removal of debris seems to be a function of canal diameter rather than the type of solution used.

Contrast Media↗

Lactic acid root canal irrigation for dowel and core treatment: a pilot study.

STATEMENT OF PROBLEM: Various solutions used to irrigate root canals and remove the smear layer prior to obturation of a root canal affect surface topography and may influence the sealing ability of endodontic therapy, retention of endodontic dowels, and restoration survival. PURPOSE: This study microscopically evaluated the effects of varying dilutions of lactic acid on the removal of the smear layer created by hand instrumentation in the coronal, middle, and apical thirds of root canals. Lactic acid solution was compared with other solutions deemed to be suitable root canal irrigants. MATERIAL AND METHODS: Thirty-five extracted human single-rooted teeth were manually shaped with files (K-flex) using the step-back technique. ISO size 50 files were used as master apical files. The teeth were equally divided into 7 test groups according to the canal irrigant used. While the teeth were cleaned and shaped, the root canals were irrigated with 3 mL of 1 of the following irrigants between each file size and as a final flush: no irrigant (control), 5% hydrogen peroxide, 5% sodium hypochlorite, a combination of 5% hydrogen peroxide and 5% sodium hypochlorite, 15% ethylenediaminotetraacetic acid (EDTA), 10% lactic acid, or 20% lactic acid. Specimens were critical-point dried and freeze-fractured for scanning electron microscope analysis at 3 sites (cervical, middle, and apical). RESULTS: Scanning electron micrographs showed no differences between the cervical, middle, and apical levels of the specimens tested with any of the irrigants used. Also, no difference was found within individual groups. The surface of the control specimens had a smear layer that contained smear plug material. Hydrogen peroxide and sodium hypochlorite used separately and in combination consistently produced surfaces with a smear layer. Lactic acid solutions and EDTA, however, removed the dentinal smear layer but left remnants of smear plugs in the dentinal tubules. CONCLUSIONS: Within the limitations of this study, differences related to the type of irrigant used were found in the characteristics of the pulpal dentin surface. Although lactic acid effectively cleaned and smoothed the dentin walls of root canals of endodontically prepared teeth, further study is needed before this procedure can be recommended for routine clinical use.

Chelating Agents↗

Efficacy of different irrigation methods and concentrations of root canal irrigation solutions on bacteria in the root canal.

The effectiveness of two different root canal irrigating solutions, each in two different concentrations or formulations, with two different irrigation methods was compared in vitro by means of bacterial survival determinations. 75 human root canals were enlarged, sterilized and inoculated with a mixed culture of Escherichia coli and Streptococcus mutans. After inoculation, the root canals were irrigated either manually or with an ultrasonic device for equal times (20s) with the same amount (5 ml) of sodium hypochlorite (1% and 2%), Fokalhydran I and Fokalhydran II. Sodium hypochlorite (1% and 2%) was used in a 1:100 dilution. Fokalhydran I and II were used in a 1:10 dilution. In the sodium hypochlorite group, the 1% concentration applied with a syringe proved to be most effective against Escherichia coli and Streptococcus mutans. The least effective concentration and application method against both bacteria species was obtained with 2% NaOCL and ultrasonics. Against Escherichia coli and Streptococcus mutans, a significantly lower effectiveness was found with 2% NaOCL applied with ultrasonics with respect to the rest of the sodium hypochlorite group. Fokalhydran I was significantly better than Fokalhydran II against Escherichia coli. However, no significant differences could be seen against Streptococcus mutans within this group.

Analysis of Variance↗

Electronic determination of root canal length by newly developed measuring device. Influences of the diameter of apical foramen, the size of K-file and the root canal irrigants.

A new electronic root canal measuring device called "ENDEX" which is able to determine the root canal length under moistened conditions using a relative value of different alternative electric currents is discussed in this study. This study is designed to investigate the efficiencies of the new device, in vitro, with respect to change in the root canal environment; namely the influence of the size of K-file, the diameter of the apical foramen and the various root canal irrigants. According to the present study, it was confirmed that the location of the apical foramen was clearly detected under moistened root canal with saline solution using any size of K-file. The locations of the tip of K-files were 0.5 mm inside the apical foramen when the relative value displayed 0.3 Volt, so that the apical constriction could not disturb during root canal measurement. One of the big problem with prior electrical measurement devices was not being able to determine the canal length under moistened conditions. However with this improved device, intracanal irrigants, such as saline, 5% NaOC1, 14% EDTA and 3% H2O2 did not interfere in detecting apical foramen irregardless of the size of K-file and the size of the apical foramen.

Dental Pulp Cavity↗

[High volume vs. activated root canal irrigation].

Irrigation of the root canal is carried out to remove the smear layer and the overlying pulp tissue remnants and dentin chips left by preparation. Our results show that even high volume irrigation is less effective in the apical section than towards cervical. A positive effect of activated continuous irrigation was demonstrated above all in the apical third of the root canal. Almost complete removal of both the smear layer and the overlying debris was achieved. Since high volume, continuous activated irrigation is superior to any other form of irrigation, particularly in the apical section, the results of our studies suggest that further efforts to develop such a root canal irrigation system to the state in which it can be clinically used are necessary.

Dental Cavity Preparation↗

An ex vivo evaluation of a new root canal irrigation technique with intracanal aspiration.

AIM: To evaluate the effectiveness of a new root canal irrigation technique with intracanal aspiration in removing the smear layer and to assess irrigant extrusion ex vivo. METHODOLOGY: Thirty-five instrumented canals of extracted human canine teeth that had been resected apically by removing 3 mm of the root tip were divided into one control and four experimental groups of seven teeth each. The roots were fixed in a plastic case and surrounded with normal saline agar coloured with 1% acid red. No irrigation was performed in the control teeth. Each root canal in the experimental groups was irrigated with 9 mL of 14% ethylenediaminetetraacetic acid for 3 min, and then with 6 mL of 6% sodium hypochlorite (NaOCl) for 2 min. In the intracanal aspiration technique, the irrigant was delivered from the tip of an injection needle placed 12 mm from the apical root-end and an aspiration needle that was connected to a Root ZX apex locator placed 2 and 3 mm short of the apical root-end in groups 1 and 2, respectively. In the conventional method, the tip of an injection needle used for delivery of the irrigant and as an active electrode was placed 2 and 3 mm short of the apical root-end in groups 3 and 4, respectively, the tip of the aspiration needle was placed 12 mm from the apical root-end in these groups. The readings of the Root ZX during irrigation were recorded. The cleanliness of the canal was evaluated by scoring smear layer from scanning electron microscopy (SEM) images of the canal. Extrusion of NaOCl was detected by measuring the discoloured area of the agar around the apical root-end. The data obtained were statistically analysed by one-way anova, the Kruskal-Wallis test and Friedman's test. RESULTS: In the SEM study, the canals in groups 1-3 were significantly cleaner than those in the control and group 4 (P < 0.05). The mean Root ZX readings in groups 1-3 were approximately "0.5". The discoloured area in group 3 was significantly larger than the other groups (P < 0.05). CONCLUSIONS: Irrigation using the intracanal aspiration technique allowed more effective removal of the smear layer than that performed by the conventional method in an apically resected canine tooth. The intracanal aspiration technique produced limited extrusion of the irrigant beyond the apical foramen.

Apicoectomy↗

The influence of canal curvature on the mechanical efficacy of root canal irrigation in vitro using real-time imaging of bioluminescent bacteria.

There are no quantitative data on the mechanical efficacy of irrigation in the removal of bacteria from curved canals. This study quantitatively analyzed the effects of root canal curvature and preparation size on the mechanical efficacy of irrigation using 33 mandibular single-rooted bicuspids allocated to groups according to root canal curvatures, group 1 (straight) 4 to 8 degrees, group 2 (intermediate curvature) 15 to 19 degrees, and group 3 (greatest curvature) 24 to 28 degrees. Teeth were sequentially instrumented to sizes 27/.04, 36/.04, and 46/.04 using a crown-down technique. Suspensions of the bioluminescent reporter strain Pseudomonas fluorescens 5RL (1.5 x 10(6) cells) were inoculated into canals of sterilized teeth after each sequential instrumentation. Canals were irrigated with 6 ml of irrigant delivered 1 mm from working length using a 30-gauge needle. Remaining bacteria were quantified using real-time bioluminescent imaging. Irrigation was significantly less effective in 24 to 28 degrees curvature canals prepared to size 27/.04 compared to 46/.04 (p < 0.007, repeated-measures ANOVA).

Bicuspid↗

A scanning electron microscopic evaluation of different root canal irrigation regimens.

The purpose of this study was to assess the effectiveness of endodontic irrigants in removing the smear layer from instrumented root canal walls using Scanning Electron Microscopy (SEM). The endodontic irrigants used were: 1% sodium hypochlorite (NaOCl); 1% NaOCl mixed to 17% EDTAC; 2% chlorhexidine gel; and Ricinus communis gel. Photomicrographs of the middle and apical thirds were evaluated with the aid of the Fotoscore - v. 2.0 software. The results indicated that the mixture of sodium hypochlorite and EDTAC completely removed the smear layer from dentinal walls. The other endodontic irrigants were not as efficient in cleansing the root canals.

Chlorhexidine↗

[Intracanal aspiration technique for root canal irrigation: evaluation of smear layer removal].

A new irrigation technique (intracanal aspiration technique, IAT) was developed to minimize the extrusion of root canal irrigant. Fifteen instrumented canals of extracted canines were divided into one control and four experimental groups of 3 teeth each. Each root was fixed in a case and surrounded with colored saline agar to measure the meter value of the Root ZX and to evaluate the extrusion of the irrigant. In control teeth, no irrigation was performed. In Groups 1 and 2, the root canal was irrigated using IAT with an aspiration needle placed 2 or 3 mm short of the apex. In Groups 3 and 4, the root canal was irrigated in a conventional manner with a washing needle placed 2 or 3 mm short of the apex. The file folder of a Root ZX was attached to the aspiration needle in Groups 1 and 2, and to a washing needle in Groups 3 and 4. Each canal was irrigated with 9 ml of 14% EDTA solution and 6 ml of 6% NaClO in experimental groups, and the meter value of the Root ZX during irrigation was recorded. After the irrigation, cleanliness of the canal was evaluated using a SEM and extrusion of NaClO by discoloration of the agar. Irrigation using IAT was more effective for removing smear layer compared to the conventional method and extrusion of the irrigant was minimized. In addition, the Root ZX measurement during IAT could monitor the extent of the irrigant in the apical canal.

Dental Pulp Cavity↗

Efficacy of several concentrations of sodium hypochlorite for root canal irrigation.

Sodium hypochlorite (NaOCl) has been recommended for irrigation during root canal preparation. This investigation used scanning electron microscopy to examine instrumented and uninstrumented surfaces in the middle third of root canals following the use of several concentrations of NaOCl (5.25%, 2.5%, 1.0%, and 0.5%). NaOCl was delivered with either an endodontic irrigation needle or an ultrasonic device. All of the concentrations of NaOCl with either delivery system were very effective in flushing out loose debris from the root canals. A smear layer with some exposed dentinal tubules was seen on all instrumented surfaces regardless of concentration of NaOCl or irrigation device. NaOCl in concentrations of 5.25%, 2.5%, and 1% completely removed pulpal remnants and predentin from the uninstrumented surfaces. Although 0.5% NaOCl removed the majority of pulpal remnants and predentin from the uninstrumented surfaces, it left some fibrils on the surface.

Bicuspid↗

Effectiveness of oxidative potential water as a root canal irrigant.

AIM: The aim of this study was to evaluate the effectiveness of oxidative potential water (OPW) as an irrigant, based on its ability to remove the smear layer and/or debris from instrumented root canals. METHODOLOGY: One hundred and twenty root canals from extracted human maxillary incisors were instrumented using a conventional step-back technique with irrigation from sodium hypochlorite (NaOCl) or oxidative potential water (OPW). After instrumentation, the canals were irrigated by syringe or ultrasound using 15% EDTA or OPW as an irrigant. The volume of each irrigant used for syringe irrigation was 10, 20, and 30 mL, respectively, whilst the duration for ultrasonic irrigation was 1, 3, and 5 min, respectively. After irrigation, each root was split longitudinally in two with cutting pliers, and the specimens were prepared for SEM observation. The presence of debris and smear layer on each canal wall was assessed using a three-point scale for each parameter. RESULTS: Smear layer was effectively removed with EDTA both introduced via syringe and via ultrasonic irrigation. A similar effect was observed with OPW via syringe irrigation following instrumentation with 5% NaOCl. The canal walls in any of these cases showed open and patent dentinal tubules following smear layer removal. Some specimens irrigated with EDTA exhibited the effect of demineralization on the dentine resulting in funnelling of tubule orifices. Syringe irrigation was more effective in smear layer removal, except for ultrasonic irrigation with 15% EDTA, whilst ultrasonic irrigation was more effective in debris removal including the use of OPW as irrigant following instrumentation with 5% NaOCl. Neither syringe nor ultrasonic irrigation with OPW following instrumentation with OPW removed smear layer or debris effectively. CONCLUSIONS: The most effective irrigation technique for smear removal was 15% EDTA irrigation by means of syringe following instrumentation with 5% NaOCl solution. However, the most effective irrigation technique for debris removal was ultrasonic irrigation regardless of irrigant used. OPW irrigation by means of syringe following instrumentation with 5% NaOCl showed a similar effect to that of 15% EDTA irrigation for removal of smear layer and debris.

Anti-Infective Agents, Local↗

Comparison of antibacterial and toxic effects of various root canal irrigants.

AIM: To compare the antibacterial properties and toxicity of 5.25% sodium hypochlorite (NaOCl), 2% chlorhexidine gluconate and 0.2% chlorhexidine gluconate plus 0.2% cetrimide (Cetrexidin); Vebas, San Giuliano, Milan, Italy). METHODOLOGY: The antibacterial effects of the irrigants in vitro were examined after 5 min and 48 h in freshly extracted human teeth with single roots, whose canals were infected by Enterococcus faecalis ATCC 29212. In a separate in vivo study, bacterial culture samples were collected before treatment from the infected root canals of deciduous teeth containing necrotic pulp tissue. Irrigants were used to clean the canals which were then left empty for 48 h. Aerobic/facultative anaerobic and anaerobic bacterial growth were compared before and 48 h after irrigation. Finally, the toxic effects of the irrigants were assessed by injecting them into the subcutaneous tissues of rats. The inflammatory reactions that occurred 2 h, 48 h and 2 weeks after the injections were evaluated. RESULTS: In the laboratory study, the 2% chlorhexidine gluconate and Cetrexidin were significantly more effective on E. faecalis than the 5.25% NaOCl at 5 min (P < 0.05). Similarly, in the in vivo study, 2% chlorhexidine gluconate and Cetrexidin were significantly more effective on anaerobic bacteria than the 5.25% NaOCl at 48 h (P < 0.05). At the end of 2 weeks, the toxicity of the NaOCl solution was greater than that of the other irrigants (P < 0.05). CONCLUSIONS: Cetrexidin and 2% chlorhexidine gluconate were more effective, and had more residual antibacterial effects and lower toxicity than 5.25% NaOCl solution.

Animals↗

Scanning electron microscopic study of the cleaning ability of chlorhexidine as a root-canal irrigant.

AIM: To evaluate in vitro the cleaning of root-canal walls after irrigation with different irrigants. METHODOLOGY: A total of 36 recently extracted human teeth were divided into four experimental groups according to the irrigating solution used: saline; 2% chlorhexidine; 2.5% sodium hypochlorite; and 2.5% sodium hypochlorite + EDTA. The cleaning of the apical, middle and coronal thirds of the root canals was evaluated by scanning electron microscope examination using a 4-point scoring system. RESULTS: The best cleaning was obtained using 2.5% sodium hypochlorite and EDTA, followed by 2.5% sodium hypochlorite only (P < 0.05), whose cleaning was similar to chlorhexidine only in the cervical third. Cleaning by saline and 2% chlorhexidine was worse than the other two groups and was similar in all thirds. Better cleaning was found in the cervical and middle thirds for all groups with the worst results in the apical third. CONCLUSIONS: The apical third of the root canals was not cleaned as well as the middle and coronal thirds. Cleaning by chlorhexidine and saline was inferior compared to the cleaning by sodium hypochlorite with and without EDTA.

Analysis of Variance↗

Cleaning efficacy and dentin micro-hardness after root canal irrigation with a strong acid electrolytic water.

The purpose of this study was to evaluate the cleaning effect of root canal walls using strong acid electrolytic water (SAEW) as a root canal irrigant, and to investigate the influence of SAEW on the root canal dentin by micro-hardness test. Forty-three single-rooted, single-canaled teeth were instrumented using standard step-back technique with K-files. Irrigation was performed using distilled water, 5.25% NaOCl and 3% H(2)O(2), SAEW, or 15% EDTA solution in five groups. Samples were prepared to be examined under a scanning electron microscope (SEM) and micro Vickers hardness (H(V)) test machine. Our results showed that the root cleaning effects of the combined use of SAEW and NaOCl solution as root canal irrigants were equivalent to those in the group with NaOCl and 15% EDTA. When SAEW was used for 1 min under ultrasonic vibration, no decreases in the hardness of dentin inside the root canal were detected.

Acid Etching, Dental↗