Ex vivo assessment of irrigant penetration and renewal during the cleaning and shaping of root canals: a digital subtraction radiographic study.

AIM: To assess radiographically irrigant penetration in the root canal system of curved roots during root canal shaping procedures ex vivo. METHODOLOGY: Thirty extracted mandibular molar teeth with moderate to severe curvature were used. A special aiming device was used to guarantee that each successive radiograph was taken with the same positioning. The mesiolingual canal of each tooth was instrumented using the ProTaper system. For each step of the shaping procedure, two irrigation modalities were repeated in the same order. Active irrigation consisted of a 0.5-mL flush of sodium diatrizoate solution (Hypaque 50%) immediately followed by agitation with a size 08 K-file. Passive irrigation consisted of a 0.5-mL flush of sodium hypochlorite solution delivered with a syringe through a 27-gauge notched tip needle. A digital radiograph was taken after each modality and stored on computer for subsequent digital subtraction and measures of the depths of irrigant penetration. Comparisons were performed within an analysis-of-variance framework in a repeated-measures approach. RESULTS: The penetration of irrigants was significantly greater for each successive step of the shaping procedure when the two modalities were analysed separately (P < 0.001). The difference between the two modalities was statistically significant for each step of the shaping procedure (P < 0.0001). CONCLUSIONS: Shaping root canals improved both penetration and exchange of irrigant inside the root canal system. Complete renewal of the solution was impossible to achieve with a conventional syringe delivery system and a limited volume of solution. Recapitulation with a K-file after flushing improved irrigant penetration.

Ex vivo assessment of irrigant penetration and renewal during the final irrigation regimen.

AIM: To assess irrigant penetration in curved canals after shaping procedures ex vivo. METHODOLOGY: Thirty extracted mandibular molars with moderate to severe root canal curvature were included. A special aiming device was used to guarantee that each successive radiograph was taken with the same positioning. The mesiolingual canal of each tooth was instrumented with ProTaper rotary files. Apical third preparation was completed with an F1 instrument before additional step-back enlargement using F2 then F3 instruments. For each apical taper, the teeth were submitted successively to active irrigation (AI) then to passive irrigation (PI). AI consisted of a 0.5 mL flush of sodium diatrizoate (Hypaque 50%) immediately followed by manual mechanical activation with a gutta-percha point. PI consisted in flushing the canals with sodium hypochlorite passively delivered with a syringe. A digital radiograph was taken after each modality. The influence of needle tip design, needle tip insertion level, irrigant volume, root canal taper and solution activation was assessed by using digital subtraction radiography and measures of the depths of irrigant penetration. Comparisons were performed within an analysis of variance framework in a repeated-measures approach. RESULTS: For PI, all the four explanatory variables 'apical taper', 'volume of irrigant used', 'corono-apical level of needle tip placement', 'needle tip design' had a significant (P < 0.005) influence on outcome of irrigation penetration. CONCLUSIONS: Only active irrigation allowed complete penetration and exchange of irrigating solution. For syringe irrigation alone, the level of needle tip placement in the canal was the most dominating factor.