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Comparison of sodium hypochlorite extrusion by five irrigation systems using an artificial root socket model and a quantitative chemical method

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Abstract

Objectives

This is to compare the volumes of irrigant apically extruded by five irrigation systems in an artificial socket model simulating clinical conditions.

Materials and methods

Twenty extracted human single-rooted teeth were enlarged to size 40/04 and then embedded in silicone impression material. The root canal space was irrigated with nominal 3% sodium hypochlorite (NaOCl) using standard needle irrigation (SNI) with a 30-gauge notched needle, EndoActivator (EA), XP Endo Finisher (XP Endo), EndoVac (EV), and photon-induced photoacoustic streaming (PIPS). Extruded NaOCl was collected, reacted with taurine to form taurine-monochloramine, and absorbance of taurine-monochloramine was measured at 252 nm using a spectrophotometer. The five irrigation systems were compared with repeated measures ANOVA and pairwise comparisons.

Results

The EV group had very low extrusion (mean ± SD = 0.12 ± 0.2 μL) and differed significantly from the other four groups (P ≤ 0.001). Larger volumes of irrigant were extruded in the other irrigation groups. There were no significant differences in the extruded volumes among the SNI (7.4 ± 3.4 μL), EA (7.0 ± 6.1 μL), and XP Endo (7.8 ± 4.1 μL) groups (P = 1). The PIPS group had the highest mean extruded volume (12.9 ± 6.8 μL) and differed significantly from SNI (P = 0.030), EV (P < 0.0005), and EA (P = 0.02), but not XP Endo (P = 0.154).

Conclusion

Under the in vitro conditions of this study, irrigant extrusion appears unavoidable unless negative pressure irrigation such as EV is used. PIPS extrudes more irrigant than other systems, while SNI, EA, and XP Endo extrude similar volumes of irrigant.

Clinical relevance

The findings help clinicians select the optimal irrigation system to avoid irrigant extrusion.

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References

  1. Shuping GB, Orstavik D, Sigurdsson A et al (2000) Reduction of intracanal bacteria using nickel-titanium rotary instrumentation and various medications. J Endod 26:751–755

    Article  PubMed  Google Scholar 

  2. Ng YL, Mann V, Gulabivala K (2011) A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health. Int Endod J 44:583–609

    Article  PubMed  Google Scholar 

  3. Dutner J, Mines P, Anderson A (2012) Irrigation trends among American Association of Endodontists members: a web-based survey. J Endod 38:37–40

    Article  PubMed  Google Scholar 

  4. Psimma Z, Boutsioukis C, Kastrinakis E et al (2013) Effect of needle insertion depth and root canal curvature on irrigant extrusion ex vivo. J Endod 39:521–524

    Article  PubMed  Google Scholar 

  5. Sedgley CM, Nagel AC, Hall D et al (2005) Influence of irrigant needle depth in removing bioluminescent bacteria inoculated into instrumented root canals using real-time imaging in vitro. Int Endod J 38:97–104

    Article  PubMed  Google Scholar 

  6. Hulsmann M, Hahn W (2000) Complications during root canal irrigation—literature review and case reports. Int Endod J 33:186–193

    Article  PubMed  Google Scholar 

  7. Gernhardt CR, Eppendorf K, Kozlowski A et al (2004) Toxicity of concentrated sodium hypochlorite used as an endodontic irrigant. Int Endod J 37:272–280

    Article  PubMed  Google Scholar 

  8. Pashley EL, Birdsong NL, Bowman K et al (1985) Cytotoxic effects of NaOCl on vital tissue. J Endod 11:525–528

    Article  PubMed  Google Scholar 

  9. Ehrich DG, Brian JD, Walker WA (1993) Sodium hypochlorite accident: inadvertent injection into the maxillary sinus. J Endod 19:180–182

    Article  PubMed  Google Scholar 

  10. Koch JD, Jaramillo DE, DiVito E et al (2016) Irrigant flow during photon-induced photoacoustic streaming (PIPS) using particle image Velocimetry (PIV). Clin Oral Investig 20:381–386

  11. Mathew J, Emil J, Paulaian B et al (2014) Viability and antibacterial efficacy of four root canal disinfection techniques evaluated using confocal laser scanning microscopy. J Conserv Dent 17:444–448

    Article  PubMed  PubMed Central  Google Scholar 

  12. Al Shahrani M, DiVito E, Hughes CV et al (2014) Enhanced removal of enterococcus faecalis biofilms in the root canal using sodium hypochlorite plus photon-induced photoacoustic streaming: an in vitro study. Photomed Laser Surg 32:260–266

    Article  PubMed  PubMed Central  Google Scholar 

  13. Azim AA, Aksel H, Zhuang T et al (2016) Efficacy of 4 irrigation protocols in killing bacteria colonized in dentinal tubules examined by a novel confocal laser scanning microscope analysis. J Endod 42:928–934

  14. Mitchell RP, Baumgartner JC, Sedgley CM (2011) Apical extrusion of sodium hypochlorite using different root canal irrigation systems. J Endod 37:1677–1681

    Article  PubMed  Google Scholar 

  15. Mitchell RP, Yang SE, Baumgartner JC (2010) Comparison of apical extrusion of NaOCl using the EndoVac or needle irrigation of root canals. J Endod 36:338–341

    Article  PubMed  Google Scholar 

  16. George R, Walsh LJ (2008) Apical extrusion of root canal irrigants when using Er:YAG and Er,Cr:YSGG lasers with optical fibers: an in vitro dye study. J Endod 34:706–708

    Article  PubMed  Google Scholar 

  17. Yost RA, Bergeron BE, Kirkpatrick TC et al (2015) Evaluation of 4 different irrigating systems for apical extrusion of sodium hypochlorite. J Endod 41:1530–1534

    Article  PubMed  Google Scholar 

  18. Desai P, Himel V (2009) Comparative safety of various intracanal irrigation systems. J Endod 35:545–549

    Article  PubMed  Google Scholar 

  19. Beeson TJ, Hartwell GR, Thornton JD et al (1998) Comparison of debris extruded apically in straight canals: conventional filing versus profile .04 Taper series 29. J Endod 24:18–22

    Article  PubMed  Google Scholar 

  20. Ghivari SB, Kubasad GC, Chandak MG et al (2011) Apical extrusion of debris and irrigant using hand and rotary systems: a comparative study. J Conserv Dent 14:187–190

    Article  PubMed  PubMed Central  Google Scholar 

  21. Rodriguez-Figueroa C, McClanahan SB, Bowles WR (2014) Spectrophotometric determination of irrigant extrusion using passive ultrasonic irrigation, EndoActivator, or syringe irrigation. J Endod 40:1622–1626

    Article  PubMed  Google Scholar 

  22. Thomas EL, Grisham MB, Jefferson MM (1986) Preparation and characterization of chloramines. Methods Enzymol 132:569–585

    Article  PubMed  Google Scholar 

  23. King CC, Jefferson MM, Thomas EL (1997) Secretion and inactivation of myeloperoxidase by isolated neutrophils. J Leukoc Biol 61:293–302

    Article  PubMed  Google Scholar 

  24. Jamani K, Harrington E, Wilson H (1989) Rigidity of elastomeric impression materials. J Oral Rehabil 16:241–248

    Article  PubMed  Google Scholar 

  25. Yoshida N, Koga Y, Peng C-L et al (2001) In vivo measurement of the elastic modulus of the human periodontal ligament. Med Eng Phys 23:567–572

    Article  PubMed  Google Scholar 

  26. Tasdemir T, Er K, Celik D et al (2008) Effect of passive ultrasonic irrigation on apical extrusion of irrigating solution. Eur J Dent 2:198–203

    PubMed  PubMed Central  Google Scholar 

  27. İriboz E, Bayraktar K, Türkaydın D et al (2015) Comparison of apical extrusion of sodium hypochlorite using 4 different root canal irrigation techniques. J Endod 41:380–384

    Article  PubMed  Google Scholar 

  28. Charara K, Friedman S, Sherman A et al (2016) Assessment of apical extrusion during root canal irrigation with the novel GentleWave system in a simulated apical environment. J Endod 42:135–139

    Article  PubMed  Google Scholar 

  29. Ferraz CC, Gomes NV, Gomes BP et al (2001) Apical extrusion of debris and irrigants using two hand and three engine-driven instrumentation techniques. Int Endod J 34:354–358

    Article  PubMed  Google Scholar 

  30. Flanders DH (2002) Endodontic patency. How to get it. How to keep it. Why it is so important. N Y State Dent J 68:30–32

    PubMed  Google Scholar 

  31. Vera J, Hernandez EM, Romero M et al (2012) Effect of maintaining apical patency on irrigant penetration into the apical two millimeters of large root canals: an in vivo study. J Endod 38:1340–1343

    Article  PubMed  Google Scholar 

  32. Tinaz AC, Alacam T, Uzun O et al (2005) The effect of disruption of apical constriction on periapical extrusion. J Endod 31:533–535

    Article  PubMed  Google Scholar 

  33. Kustarci A, Akdemir N, Siso SH et al (2008) Apical extrusion of intracanal debris using two engine driven and step-back instrumentation techniques: an in-vitro study. Eur J Dent 2:233–239

    PubMed  PubMed Central  Google Scholar 

  34. Thomas EL, Grisham MB, Jefferson MM (1983) Myeloperoxidase-dependent effect of amines on functions of isolated neutrophils. J Clin Invest 72:441–454

    Article  PubMed  PubMed Central  Google Scholar 

  35. Weiss SJ, Klein R, Slivka A et al (1982) Chlorination of taurine by human neutrophils. Evidence for hypochlorous acid generation. J Clin Invest 70:598–607

    Article  PubMed  PubMed Central  Google Scholar 

  36. Lampert MB, Weiss SJ (1983) The chlorinating potential of the human monocyte. Blood 62:645–651

    PubMed  Google Scholar 

  37. Grisham MB, Jefferson MM, Melton DF et al (1984) Chlorination of endogenous amines by isolated neutrophils. Ammonia-dependent bactericidal, cytotoxic, and cytolytic activities of the chloramines. J Biol Chem 259:10404–10413

    PubMed  Google Scholar 

  38. Boutsioukis C, Psimma Z, Kastrinakis E (2014) The effect of flow rate and agitation technique on irrigant extrusion ex vivo. Int Endod J 47:487–496

    Article  PubMed  Google Scholar 

  39. Boutsioukis C, Lambrianidis T, Kastrinakis E (2009) Irrigant flow within a prepared root canal using various flow rates: a computational fluid dynamics study. Int Endod J 42:144–155

    Article  PubMed  Google Scholar 

  40. Shen Y, Gao Y, Qian W et al (2010) Three-dimensional numeric simulation of root canal irrigant flow with different irrigation needles. J Endod 36:884–889

    Article  PubMed  Google Scholar 

  41. Fukumoto Y, Kikuchi I, Yoshioka T et al (2006) An ex vivo evaluation of a new root canal irrigation technique with intracanal aspiration. Int Endod J 39:93–99

    Article  PubMed  Google Scholar 

  42. Arslan H, Akcay M, Ertas H et al (2015) Effect of PIPS technique at different power settings on irrigating solution extrusion. Lasers Med Sci 30:1641–1645

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors wish to thank Dr. Chad O. Edwards (Franklin, TN) for the PIPS operation and the UTHSC Biostatistic BERD Consulting Program for statistical support.

Author information

Author notes

  1. Adham A. Azim

    Present address: Department of Periodontics & Endodontics, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA

  2. Hacer Aksel

    Present address: Department of Endodontics, School of Dentistry, Hacettepe University, Ankara, Turkey

Authors and Affiliations

  1. Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, 875 Union Avenue, Laboratory, Cancer Research Building, 19 S. Manassas St. Lab Rm 255, office 256, Memphis, TN, 38163, USA

    Adham A. Azim, Hacer Aksel, M. Margaret Jefferson & George T.-J. Huang

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  1. Adham A. Azim
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  2. Hacer Aksel
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  3. M. Margaret Jefferson
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  4. George T.-J. Huang
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Corresponding author

Correspondence to George T.-J. Huang.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

This work was supported in part by a grant from the National Institutes of Health R01 DE019156 (G.T.-J.H.) and a Research Fund from the University of Tennessee Health Science Center (G.T.-J.H.).

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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For this type of study, formal consent is not required.

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Azim, A.A., Aksel, H., Margaret Jefferson, M. et al. Comparison of sodium hypochlorite extrusion by five irrigation systems using an artificial root socket model and a quantitative chemical method. Clin Oral Invest 22, 1055–1061 (2018). https://doi.org/10.1007/s00784-017-2187-y

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  • DOI: https://doi.org/10.1007/s00784-017-2187-y

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