Skip to main content
Top
Published in: BMC Oral Health 1/2014

Open Access 01-12-2014 | Research article

A comparative study of the debridement efficacy and apical extrusion of dynamic and passive root canal irrigation systems

Authors: Ahmed Alkahtani, Tala D Al Khudhairi, Sukumaran Anil

Published in: BMC Oral Health | Issue 1/2014

Login to get access

Abstract

Background

Root canal irrigation carries a risk of extrusion of irrigant into the periapical tissues which can be associated with pain, swelling, and tissue damage. Studies have shown less extrusion with sonic or apical negative pressure devices compared with syringe and side-port needle or passive ultrasonic irrigation with continuous irrigant flow. This study aimed to evaluate the effectiveness of the EndoVac irrigation system, regarding 1) debris removal and 2) the control of apically extruded irrigating solution.

Methods

Fifty extracted human single-rooted teeth were used in this study. The teeth were then randomly divided into three experimental groups according to the type of irrigation used and one control group. In group 1, irrigation was performed using the EndoVac irrigation system. In group 2, irrigation was performed using a 30-gauge, tip-vented irrigation needle. In group 3, irrigation was performed using a 30-gauge, side-vented irrigation needle. The control group received instrumentation with no irrigation to serve as a control for cleaning efficiency. Root canal instrumentation was performed using the Profile NiTi rotary system with a crown-down technique. All of the experimental teeth were irrigated with the same amount of 5.25% sodium hypochlorite. The amount of extruded irrigating solution was then measured by subtracting the post-instrumentation weight from the pre-instrumentation weight using an electronic balance. The cleanliness of debris removal was evaluated using scanning electron microscopy.

Results

EndoVac irrigation had the least amount of extrusion followed by the side-vented and tip-vented method. The difference between the groups was statistically significant (P <0.01). As for the cleaning results, the debris collection in the EndoVac and tip-vented groups was the least in the apical third. In the control and the side-vented groups, the debris was the greatest in the apical third, but this difference was not significant among the three experimental groups.

Conclusions

The EndoVac irrigation system extruded significantly less irrigant solution than either needle irrigation system. Debris collection was the least in the apical third for the EndoVac irrigation system. No significant difference was found in the cleaning efficiency among the three irrigation systems.
Appendix
Available only for authorised users
Literature
1.
go back to reference Shin SJ, Kim HK, Jung IY, Lee CY, Lee SJ, Kim E: Comparison of the cleaning efficacy of a new apical negative pressure irrigating system with conventional irrigation needles in the root canals. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010, 109 (3): 479-484. 10.1016/j.tripleo.2009.10.050.CrossRefPubMed Shin SJ, Kim HK, Jung IY, Lee CY, Lee SJ, Kim E: Comparison of the cleaning efficacy of a new apical negative pressure irrigating system with conventional irrigation needles in the root canals. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010, 109 (3): 479-484. 10.1016/j.tripleo.2009.10.050.CrossRefPubMed
2.
go back to reference Ribeiro EM, Silva-Sousa YT, Souza-Gabriel AE, Sousa-Neto MD, Lorencetti KT, Silva SR: Debris and smear removal in flattened root canals after use of different irrigant agitation protocols. Microsc Res Tech. 2012, 75 (6): 781-790. 10.1002/jemt.21125.CrossRefPubMed Ribeiro EM, Silva-Sousa YT, Souza-Gabriel AE, Sousa-Neto MD, Lorencetti KT, Silva SR: Debris and smear removal in flattened root canals after use of different irrigant agitation protocols. Microsc Res Tech. 2012, 75 (6): 781-790. 10.1002/jemt.21125.CrossRefPubMed
3.
go back to reference Desai P, Himel V: Comparative safety of various intracanal irrigation systems. J Endod. 2009, 35 (4): 545-549. 10.1016/j.joen.2009.01.011.CrossRefPubMed Desai P, Himel V: Comparative safety of various intracanal irrigation systems. J Endod. 2009, 35 (4): 545-549. 10.1016/j.joen.2009.01.011.CrossRefPubMed
4.
go back to reference Haapasalo M, Endal U, Zandi H, Coil JM: Eradication of endodontic infection by instrumentation and irrigation solutions. Endod Top. 2005, 10 (1): 77-102. 10.1111/j.1601-1546.2005.00135.x.CrossRef Haapasalo M, Endal U, Zandi H, Coil JM: Eradication of endodontic infection by instrumentation and irrigation solutions. Endod Top. 2005, 10 (1): 77-102. 10.1111/j.1601-1546.2005.00135.x.CrossRef
5.
go back to reference Townsend C, Maki J: An in vitro comparison of new irrigation and agitation techniques to ultrasonic agitation in removing bacteria from a simulated root canal. J Endod. 2009, 35 (7): 1040-1043. 10.1016/j.joen.2009.04.007.CrossRefPubMed Townsend C, Maki J: An in vitro comparison of new irrigation and agitation techniques to ultrasonic agitation in removing bacteria from a simulated root canal. J Endod. 2009, 35 (7): 1040-1043. 10.1016/j.joen.2009.04.007.CrossRefPubMed
6.
go back to reference Brito PR, Souza LC, de Oliveira JCM, Alves FR, De-Deus G, Lopes HP, Siqueira JF: Comparison of the effectiveness of three irrigation techniques in reducing intracanal Enterococcus faecalis populations: an in vitro study. J Endod. 2009, 35 (10): 1422-1427. 10.1016/j.joen.2009.07.001.CrossRefPubMed Brito PR, Souza LC, de Oliveira JCM, Alves FR, De-Deus G, Lopes HP, Siqueira JF: Comparison of the effectiveness of three irrigation techniques in reducing intracanal Enterococcus faecalis populations: an in vitro study. J Endod. 2009, 35 (10): 1422-1427. 10.1016/j.joen.2009.07.001.CrossRefPubMed
7.
go back to reference Howard RK, Kirkpatrick TC, Rutledge RE, Yaccino JM: Comparison of debris removal with three different irrigation techniques. J Endod. 2011, 37 (9): 1301-1305. 10.1016/j.joen.2011.05.008.CrossRefPubMed Howard RK, Kirkpatrick TC, Rutledge RE, Yaccino JM: Comparison of debris removal with three different irrigation techniques. J Endod. 2011, 37 (9): 1301-1305. 10.1016/j.joen.2011.05.008.CrossRefPubMed
8.
go back to reference Sedgley CM, Nagel AC, 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 (2): 97-104. 10.1111/j.1365-2591.2004.00906.x.CrossRefPubMed Sedgley CM, Nagel AC, 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 (2): 97-104. 10.1111/j.1365-2591.2004.00906.x.CrossRefPubMed
9.
go back to reference Huang TY, Gulabivala K, Ng YL: A bio-molecular film ex-vivo model to evaluate the influence of canal dimensions and irrigation variables on the efficacy of irrigation. Int Endod J. 2008, 41 (1): 60-71.PubMed Huang TY, Gulabivala K, Ng YL: A bio-molecular film ex-vivo model to evaluate the influence of canal dimensions and irrigation variables on the efficacy of irrigation. Int Endod J. 2008, 41 (1): 60-71.PubMed
10.
go back to reference Boutsioukis C, Gogos C, Verhaagen B, Versluis M, Kastrinakis E, Van der Sluis LW: 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 (10): 874-881. 10.1111/j.1365-2591.2010.01761.x.CrossRefPubMed Boutsioukis C, Gogos C, Verhaagen B, Versluis M, Kastrinakis E, Van der Sluis LW: 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 (10): 874-881. 10.1111/j.1365-2591.2010.01761.x.CrossRefPubMed
11.
go back to reference Schneider SW: A comparison of canal preparations in straight and curved root canals. Oral Surg Oral Med Oral Pathol. 1971, 32 (2): 271-275. 10.1016/0030-4220(71)90230-1.CrossRefPubMed Schneider SW: A comparison of canal preparations in straight and curved root canals. Oral Surg Oral Med Oral Pathol. 1971, 32 (2): 271-275. 10.1016/0030-4220(71)90230-1.CrossRefPubMed
12.
go back to reference Abarajithan M, Dham S, Velmurugan N, Valerian-Albuquerque D, Ballal S, Senthilkumar H: 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 (3): 407-411. 10.1016/j.tripleo.2011.02.024.CrossRefPubMed Abarajithan M, Dham S, Velmurugan N, Valerian-Albuquerque D, Ballal S, Senthilkumar H: 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 (3): 407-411. 10.1016/j.tripleo.2011.02.024.CrossRefPubMed
13.
go back to reference Siu C, Baumgartner JC: Comparison of the debridement efficacy of the EndoVac irrigation system and conventional needle root canal irrigation in vivo. J Endod. 2010, 36 (11): 1782-1785. 10.1016/j.joen.2010.08.023.CrossRefPubMed Siu C, Baumgartner JC: Comparison of the debridement efficacy of the EndoVac irrigation system and conventional needle root canal irrigation in vivo. J Endod. 2010, 36 (11): 1782-1785. 10.1016/j.joen.2010.08.023.CrossRefPubMed
14.
go back to reference Nielsen BA, Craig Baumgartner J: Comparison of the EndoVac system to needle irrigation of root canals. J Endod. 2007, 33 (5): 611-615. 10.1016/j.joen.2007.01.020.CrossRefPubMed Nielsen BA, Craig Baumgartner J: Comparison of the EndoVac system to needle irrigation of root canals. J Endod. 2007, 33 (5): 611-615. 10.1016/j.joen.2007.01.020.CrossRefPubMed
15.
go back to reference Gernhardt CR, Eppendorf K, Kozlowski A, Brandt M: Toxicity of concentrated sodium hypochlorite used as an endodontic irrigant. Int Endod J. 2004, 37 (4): 272-280. 10.1111/j.0143-2885.2004.00804.x.CrossRefPubMed Gernhardt CR, Eppendorf K, Kozlowski A, Brandt M: Toxicity of concentrated sodium hypochlorite used as an endodontic irrigant. Int Endod J. 2004, 37 (4): 272-280. 10.1111/j.0143-2885.2004.00804.x.CrossRefPubMed
16.
go back to reference Pashley EL, Birdsong NL, Bowman K, Pashley DH: Cytotoxic effects of NaOCl on vital tissue. J Endod. 1985, 11 (12): 525-528. 10.1016/S0099-2399(85)80197-7.CrossRefPubMed Pashley EL, Birdsong NL, Bowman K, Pashley DH: Cytotoxic effects of NaOCl on vital tissue. J Endod. 1985, 11 (12): 525-528. 10.1016/S0099-2399(85)80197-7.CrossRefPubMed
17.
go back to reference Mitchell RP, Yang SE, Baumgartner JC: Comparison of apical extrusion of NaOCl using the EndoVac or needle irrigation of root canals. J Endod. 2010, 36 (2): 338-341. 10.1016/j.joen.2009.10.003.CrossRefPubMed Mitchell RP, Yang SE, Baumgartner JC: Comparison of apical extrusion of NaOCl using the EndoVac or needle irrigation of root canals. J Endod. 2010, 36 (2): 338-341. 10.1016/j.joen.2009.10.003.CrossRefPubMed
18.
go back to reference Al-Hadlaq SM, Al-Turaiki SA, Al-Sulami U, Saad AY: Efficacy of a new brush-covered irrigation needle in removing root canal debris: a scanning electron microscopic study. J Endod. 2006, 32 (12): 1181-1184. 10.1016/j.joen.2006.07.019.CrossRefPubMed Al-Hadlaq SM, Al-Turaiki SA, Al-Sulami U, Saad AY: Efficacy of a new brush-covered irrigation needle in removing root canal debris: a scanning electron microscopic study. J Endod. 2006, 32 (12): 1181-1184. 10.1016/j.joen.2006.07.019.CrossRefPubMed
19.
go back to reference Fukumoto Y, Kikuchi I, Yoshioka T, Kobayashi C, Suda H: An ex vivo evaluation of a new root canal irrigation technique with intracanal aspiration. Int Endod J. 2006, 39 (2): 93-99. 10.1111/j.1365-2591.2006.01050.x.CrossRefPubMed Fukumoto Y, Kikuchi I, Yoshioka T, Kobayashi C, Suda H: An ex vivo evaluation of a new root canal irrigation technique with intracanal aspiration. Int Endod J. 2006, 39 (2): 93-99. 10.1111/j.1365-2591.2006.01050.x.CrossRefPubMed
20.
go back to reference Brunson M, Heilborn C, Johnson DJ, Cohenca N: Effect of apical preparation size and preparation taper on irrigant volume delivered by using negative pressure irrigation system. J Endod. 2010, 36 (4): 721-724. 10.1016/j.joen.2009.11.028.CrossRefPubMed Brunson M, Heilborn C, Johnson DJ, Cohenca N: Effect of apical preparation size and preparation taper on irrigant volume delivered by using negative pressure irrigation system. J Endod. 2010, 36 (4): 721-724. 10.1016/j.joen.2009.11.028.CrossRefPubMed
21.
go back to reference Schoeffel GJ: The EndoVac method of endodontic irrigation: safety first. Dent Today. 2007, 26 (10): 92-94. 96PubMed Schoeffel GJ: The EndoVac method of endodontic irrigation: safety first. Dent Today. 2007, 26 (10): 92-94. 96PubMed
22.
go back to reference Schoeffel GJ: The EndoVac method of endodontic irrigation, part 2--efficacy. Dent Today. 2008, 27 (1): 86-87. 82, 84 Schoeffel GJ: The EndoVac method of endodontic irrigation, part 2--efficacy. Dent Today. 2008, 27 (1): 86-87. 82, 84
23.
go back to reference Parente JM, Loushine RJ, Susin L, Gu L, Looney SW, Weller RN, Pashley DH, Tay FR: 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 (11): 1001-1012. 10.1111/j.1365-2591.2010.01755.x.CrossRefPubMed Parente JM, Loushine RJ, Susin L, Gu L, Looney SW, Weller RN, Pashley DH, Tay FR: 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 (11): 1001-1012. 10.1111/j.1365-2591.2010.01755.x.CrossRefPubMed
24.
go back to reference Malentacca A, Uccioli U, Zangari D, Lajolo C, Fabiani C: Efficacy and safety of various active irrigation devices when used with either positive or negative pressure: an in vitro study. J Endod. 2012, 38 (12): 1622-1626. 10.1016/j.joen.2012.09.009.CrossRefPubMed Malentacca A, Uccioli U, Zangari D, Lajolo C, Fabiani C: Efficacy and safety of various active irrigation devices when used with either positive or negative pressure: an in vitro study. J Endod. 2012, 38 (12): 1622-1626. 10.1016/j.joen.2012.09.009.CrossRefPubMed
25.
go back to reference Trepagnier CM, Madden RM, Lazzari EP: Quantitative study of sodium hypochlorite as an in vitro endodontic irrigant. J Endod. 1977, 3 (5): 194-196. 10.1016/S0099-2399(77)80096-4.CrossRefPubMed Trepagnier CM, Madden RM, Lazzari EP: Quantitative study of sodium hypochlorite as an in vitro endodontic irrigant. J Endod. 1977, 3 (5): 194-196. 10.1016/S0099-2399(77)80096-4.CrossRefPubMed
26.
go back to reference Chow TW: Mechanical effectiveness of root canal irrigation. J Endod. 1983, 9 (11): 475-479. 10.1016/S0099-2399(83)80162-9.CrossRefPubMed Chow TW: Mechanical effectiveness of root canal irrigation. J Endod. 1983, 9 (11): 475-479. 10.1016/S0099-2399(83)80162-9.CrossRefPubMed
27.
go back to reference Abou-Rass M, Piccinino MV: The effectiveness of four clinical irrigation methods on the removal of root canal debris. Oral Surg Oral Med Oral Pathol. 1982, 54 (3): 323-328. 10.1016/0030-4220(82)90103-7.CrossRefPubMed Abou-Rass M, Piccinino MV: The effectiveness of four clinical irrigation methods on the removal of root canal debris. Oral Surg Oral Med Oral Pathol. 1982, 54 (3): 323-328. 10.1016/0030-4220(82)90103-7.CrossRefPubMed
28.
go back to reference Abramoff MD, Viergever MA: Computation and visualization of three-dimensional soft tissue motion in the orbit. IEEE Trans Med Imaging. 2002, 21 (4): 296-304. 10.1109/TMI.2002.1000254.CrossRefPubMed Abramoff MD, Viergever MA: Computation and visualization of three-dimensional soft tissue motion in the orbit. IEEE Trans Med Imaging. 2002, 21 (4): 296-304. 10.1109/TMI.2002.1000254.CrossRefPubMed
29.
go back to reference Mitchell RP, Baumgartner JC, Sedgley CM: Apical extrusion of sodium hypochlorite using different root canal irrigation systems. J Endod. 2011, 37 (12): 1677-1681. 10.1016/j.joen.2011.09.004.CrossRefPubMed Mitchell RP, Baumgartner JC, Sedgley CM: Apical extrusion of sodium hypochlorite using different root canal irrigation systems. J Endod. 2011, 37 (12): 1677-1681. 10.1016/j.joen.2011.09.004.CrossRefPubMed
30.
go back to reference Heilborn C, Reynolds K, Johnson JD, Cohenca N: Cleaning efficacy of an apical negative-pressure irrigation system at different exposure times. Quintessence Int. 2010, 41 (9): 759-767.PubMed Heilborn C, Reynolds K, Johnson JD, Cohenca N: Cleaning efficacy of an apical negative-pressure irrigation system at different exposure times. Quintessence Int. 2010, 41 (9): 759-767.PubMed
31.
go back to reference Drobotij E, Grower MF, Peters DD, Lorton L, Bernier WE: Comparison of the flushing effectiveness of four different types of needles after root canal preparation. J Endod. 1980, 6 (12): 870-875. 10.1016/S0099-2399(80)80049-5.CrossRef Drobotij E, Grower MF, Peters DD, Lorton L, Bernier WE: Comparison of the flushing effectiveness of four different types of needles after root canal preparation. J Endod. 1980, 6 (12): 870-875. 10.1016/S0099-2399(80)80049-5.CrossRef
32.
go back to reference Goldman M, Goldman LB, Cavaleri R, Bogis J, Lin PS: The efficacy of several endodontic irrigating solutions: a scanning electron microscopic study: Part 2. J Endod. 1982, 8 (11): 487-492. 10.1016/S0099-2399(82)80073-3.CrossRefPubMed Goldman M, Goldman LB, Cavaleri R, Bogis J, Lin PS: The efficacy of several endodontic irrigating solutions: a scanning electron microscopic study: Part 2. J Endod. 1982, 8 (11): 487-492. 10.1016/S0099-2399(82)80073-3.CrossRefPubMed
33.
go back to reference Goldman LB, Goldman M, Kronman JH, Lin PS: Scanning electron microscope study of a new irrigation method in endodontic treatment. Oral Surg Oral Med Oral Pathol. 1979, 48 (1): 79-83. 10.1016/0030-4220(79)90241-X.CrossRefPubMed Goldman LB, Goldman M, Kronman JH, Lin PS: Scanning electron microscope study of a new irrigation method in endodontic treatment. Oral Surg Oral Med Oral Pathol. 1979, 48 (1): 79-83. 10.1016/0030-4220(79)90241-X.CrossRefPubMed
34.
go back to reference Goldman M, Kronman JH, Goldman LB, Clausen H, Grady J: New method of irrigation during endodontic treatment. J Endod. 1976, 2 (9): 257-260. 10.1016/S0099-2399(76)80085-4.CrossRefPubMed Goldman M, Kronman JH, Goldman LB, Clausen H, Grady J: New method of irrigation during endodontic treatment. J Endod. 1976, 2 (9): 257-260. 10.1016/S0099-2399(76)80085-4.CrossRefPubMed
35.
go back to reference Susin L, Liu Y, Yoon JC, Parente JM, Loushine RJ, Ricucci D, Bryan T, Weller RN, Pashley DH, Tay FR: Canal and isthmus debridement efficacies of two irrigant agitation techniques in a closed system. Int Endod J. 2010, 43 (12): 1077-1090. 10.1111/j.1365-2591.2010.01778.x.CrossRefPubMedPubMedCentral Susin L, Liu Y, Yoon JC, Parente JM, Loushine RJ, Ricucci D, Bryan T, Weller RN, Pashley DH, Tay FR: Canal and isthmus debridement efficacies of two irrigant agitation techniques in a closed system. Int Endod J. 2010, 43 (12): 1077-1090. 10.1111/j.1365-2591.2010.01778.x.CrossRefPubMedPubMedCentral
36.
go back to reference Salzgeber RM, Brilliant JD: An in vivo evaluation of the penetration of an irrigating solution in root canals. J Endod. 1977, 3 (10): 394-398. 10.1016/S0099-2399(77)80172-6.CrossRefPubMed Salzgeber RM, Brilliant JD: An in vivo evaluation of the penetration of an irrigating solution in root canals. J Endod. 1977, 3 (10): 394-398. 10.1016/S0099-2399(77)80172-6.CrossRefPubMed
Metadata
Title
A comparative study of the debridement efficacy and apical extrusion of dynamic and passive root canal irrigation systems
Authors
Ahmed Alkahtani
Tala D Al Khudhairi
Sukumaran Anil
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2014
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/1472-6831-14-12

Other articles of this Issue 1/2014

BMC Oral Health 1/2014 Go to the issue