Efficacy of sonic and ultrasonic irrigation devices in the removal of debris from canal irregularities in artificial root canals

Abstract Objective To evaluate the efficacy of different sonic and ultrasonic devices in the elimination of debris from canal irregularities in artificial root canals. Materials and Methods A resin model of a transparent radicular canal filled with dentin debris was used. Five groups were tested, namely: Group 1 - ultrasonic insert 15.02; Group 2 - ultrasonic insert 25/25 IRRI K; Group 3 - ultrasonic insert 25/25 IRRI S; Group 4 - sonic insert 20/28 Eddy on a vibrating sonic air-scaler handpiece; Group 5 - 20.02 K-file inserted on a Safety M4 handpiece. Two different irrigants (5% sodium hypochlorite and 17% EDTA) and 3 different times of activation (20, 40, and 60 seconds) were tested. Means and standard deviations were calculated and statistically analyzed with the Kruskal-Wallis and Wilcoxon tests (p<0.05). Results No statistically significant differences were found between the two irrigants used. Group 4 removed more debris than the other groups (p<0.05). Groups 1, 2, and 3 removed more debris than group 5 (p<0.05). A statistically significant difference (p<0.05) was found for the time of activation in all groups and at all canal levels, except between 40 and 60 seconds in group 4 at coronal and middle third level (p>0.05). Conclusions No significant differences were found between 5% sodium hypochlorite and 17% EDTA. When the time of activation rises, the dentin debris removal increases in all groups. Both sonic and ultrasonic activation demonstrate high capacity for dentin debris removal.

New Technologies to Improve Root Canal Disinfection

Abstract Effective irrigant delivery and agitation are prerequisites to promote root canal disinfection and debris removal and improve successful endodontic treatment. This paper presents an overview of the currently available technologies to improve the cleaning of the endodontic space and their debridement efficacy. A PubMed electronic search was conducted with appropriate key words to identify the relevant literature on this topic. After retrieving the full-text articles, all the articles were reviewed and the most appropriate were included in this review. Several different systems of mechanical activation of irrigants to improve endodontic disinfection were analysed: manual agitation with gutta-percha cones, endodontic instruments or special brushes, vibrating systems activated by low-speed hand-pieces or by sonic or subsonic energy, use of ultrasonic or laser energy to mechanically activate the irrigants and apical negative pressure irrigation systems. Furthermore, this review aims to describe systems designed to improve the intracanal bacterial decontamination by a specific chemical action, such as ozone, direct laser action or light-activated disinfection. The ultrasonic activation of root canal irrigants and of sodium hypochlorite in particular still remains the gold standard to which all other systems of mechanical agitation analyzed in this article were compared. From this overview, it is evident that the use of different irrigation systems can provide several advantages in the clinical endodontic outcome and that integration of new technologies, coupled with enhanced techniques and materials, may help everyday clinical practice.

Resumo A irrigação do canal radicular é coadjuvante na desinfecção e remoção de debris, contribuindo para o sucesso do tratamento endodôntico. Este artigo apresenta uma visão geral das tecnologias atuais indicadas para melhorar a limpeza e desbridamento do canal radicular. Foi realizado um levantamento bibliográfico eletrônico no site Pubmed utilizando palavras-chave específicas ao tema a fim de abordar literatura relevante. Após busca eletrônica, artigos completos foram revisados e os mais apropriados ao tema foram incluídos nesta revisão. Diferentes sistemas de ativação mecânica foram considerados: agitação manual com cone de guta-percha, instrumentos e escovas endodônticas, sistemas de vibração ativados por peças manuais em baixa rotação ou por energia sônica e subsônica, ultrassom, laser, assim como sistemas de irrigação que utilizam pressão apical negativa. Além disso, esta revisão descreve outros meios indicados para ampliar a descontaminação endodôntica por meio de agentes químicos como ozônio e desinfeção por meio de luz. A ativação ultrassônica do hipoclorito de sódio ainda permanece o padrão ouro e nos estudos é usada como controle na comparação aos demais sistemas que empregam agitação mecânica. A presente revisão mostra vantagens de diversos sistema de irrigação e associações entre eles, podendo aumentar a efetividade da irrigação endodôntica.