Effectiveness of laser-assisted irrigation and passive ultrasonic irrigation techniques on smear layer removal in middle and apical thirds.

The purpose of this study was to investigate the evaluation of laser-assisted irrigation (LAI) on the removal of the smear layer as compared to passive ultrasonic irrigation (PUI). Forty-eight single-rooted, upper-central incisor teeth were selected and prepared with ProTaper rotary instruments up to size #40 (F4) at the working lengths. Specimens were divided into four groups, as follows: (a) PUI with 5 mL of 2.5% NaOCl for 60 s; (b) PUI with 2.5 mL of 17% EDTA and 2.5 mL of 2.5% NaOCl each for 30 s; (c) LAI with 5 mL of 2.5% NaOCl for 60 s; and (d) LAI with 2.5 mL of 17% EDTA and 2.5 mL of 2.5% NaOCl each for 30 s. In the PUI groups, the ultrasonically activated file was inserted 1 mm short of the working length, but in the LAI groups, the fiber tip was applied into the pulp chamber. LAI in the pulp chamber with the combination of 17% EDTA and 2.5% NaOCl removed more of the smear layer than the other groups (p < 0.018). LAI in the pulp chamber with the combination of 2.5% NaOCl and 17% EDTA better removed the smear layer than LAI applied similarly but without EDTA or PUI with the same NaOCl and EDTA combinations using an ultrasonically activated file inserted 1 mm short of the working length.

Effectiveness of ProTaper Universal retreatment instruments used with rotary or reciprocating adaptive motion in the removal of root canal filling material.

AIM: To compare the effectiveness of ProTaper Universal retreatment instruments with continuous rotation and adaptive motion (AM; a modified reciprocating motion that combines rotational and reciprocating motion) in the removal of filling material. METHODOLOGY: Mesiobuccal root canals in 36 mandibular first molars were instrumented up to size F2 with the ProTaper Universal instrument (Dentsply Maillefer, Ballaigues, Switzerland) and filled using sealer and ProTaper Universal F2 gutta-percha cones. Gutta-percha was then down-packed and the root canal backfilled using the extruder hand-piece of the Elements Obturation System (SybronEndo, Orange, CA, USA). The teeth were assigned to two groups (n = 18), and removal of the root fillings was performed using one of the following techniques: group 1) ProTaper Universal retreatment files used with rotational motion (RM) and group 2) ProTaper Universal retreatment files used with adaptive motion (AM) (600° clockwise/0° counter-clockwise to 370° clockwise/50° counter-clockwise). The teeth were sectioned, and both halves were analysed at 8 × magnification. The percentage of remaining filling material was recorded. The data were analysed statistically using the Student's t-test at a 95% confidence level (P < 0.05). RESULTS: There was no significant difference between the groups with respect to the total time required for retreatment (P = 0.481). The AM technique left significantly less filling material than the RM method (P = 0.013). CONCLUSION: The use of ProTaper Universal retreatment files with adaptive motion removed more filling materials from root canals than the rotational movement.

An in vitro comparison of irrigation using photon-initiated photoacoustic streaming, ultrasonic, sonic and needle techniques in removing calcium hydroxide.

AIM: To evaluate the effect of various techniques including photon-initiated photoacoustic streaming (PIPS), ultrasonic, sonic and needle irrigation on the removal of calcium hydroxide [Ca(OH)2 ] from artificial grooves created in root canals. METHODS: The root canals of 48 extracted single-rooted teeth with straight canals were prepared using ProTaper rotary instruments up to size 40. After the specimens had been split longitudinally, a standardized groove was prepared in the apical part of one segment that was filled with Ca(OH)2 powder mixed with distilled water. Each tooth was reassembled and the apices closed with wax. The specimens were irrigated for 60 s with one of the following techniques: needle irrigation using 17% EDTA, PIPS with 17% EDTA, ultrasonic irrigation using 17% EDTA and sonic irrigation (EndoActivator) using 17% EDTA. The root segments were then disassembled, and the amount of remaining Ca(OH)2 evaluated under a stereomicroscope at 25× magnification. A pixel count of Ca(OH)2 remaining on the artificially created grooves was recorded as a percentage of the overall groove surface. The data were evaluated statistically using one-way analysis of variance and the least significant difference post hoc tests at 95% confidence level (P = 0.05). RESULTS: Photon-initiated photoacoustic streaming was superior in removing Ca(OH)2 as compared to needle irrigation (P < 0.001), sonic irrigation (P < 0.001) and ultrasonic irrigation (P = 0.046). CONCLUSION: Photon-initiated photoacoustic streaming provided complete removal of Ca(OH)2 from artificial grooves in straight root canals. Ultrasonic irrigation enhanced the Ca(OH)2 removal capacity of irrigating solution but did not provide complete removal from artificial grooves.

Effect of photon-initiated photoacoustic streaming on removal of apically placed dentinal debris.

AIM: To compare the efficacy of photon-induced photoacoustic streaming (PIPS) technique with conventional, sonic and ultrasonic irrigation on the removal of apically placed dentinal debris from an artificial groove created in a root canal. METHODOLOGY: Root canal preparation was performed up to size 40 on 48 extracted single-rooted teeth using ProTaper rotary instruments. The specimens were then split longitudinally, and a standardized groove was prepared in the apical part of each segment. Each groove was filled with dentinal debris mixed with 5% NaOCl. Each tooth was reassembled and irrigated as follows: (i) conventional irrigation with 1% NaOCl, (ii) sonic, (iii) ultrasonic irrigation, and (iv) PIPS. The root segments were disassembled, and the amount of remaining dentinal debris was evaluated under a stereomicroscope at 20× magnification, using a four-grade scoring system. The data were evaluated statistically using Kruskal-Wallis and Mann-Whitney U-tests with a 95% confidence level (P = 0.05). RESULTS: Photon-induced photoacoustic streaming removed significantly more dentinal debris than conventional irrigation (P < 0.001), sonic irrigation (P < 0.001) or ultrasonic irrigation (P = 0.005). There was no significant difference between sonic and ultrasonic irrigation (P = 0.377). CONCLUSIONS: Photon-induced photoacoustic streaming was more effective than conventional, sonic and ultrasonic irrigation in the removal of apically placed dentinal debris.

Efficacy of various irrigation protocols on the removal of triple antibiotic paste.

AIM: To compare the efficacy of irrigation protocols on the removal of triple antibiotic paste (metronidazole, ciprofloxacin and minocycline) (TAP) from artificial grooves in root canals. METHODOLOGY: Root canals in 72 extracted single-rooted teeth were prepared using ProTaper rotary instruments up to size F5. The roots were split longitudinally and a standardized groove was prepared in the apical part of one segment. TAP was placed in the grooves, and the root halves were reassembled. The roots were randomly divided into six experimental groups according to the irrigation protocol used: distilled water, 1% NaOCl, 2.5% NaOCl, 100% ethanol, 17% EDTA and passive ultrasonic irrigation (PUI) with 1% NaOCl. The root segments were disassembled, and the amount of TAP remaining was evaluated under a stereomicroscope at 20× magnification using a four-grade scoring system. The data were evaluated statistically using Kruskal-Wallis and Mann-Whitney U-tests with a 95% confidence level (P = 0.05). RESULTS: There were significant differences amongst the groups (P < 0.001). Passive ultrasonic irrigation (PUI) with 1% NaOCl removed significantly more TAP than the other irrigating solutions (P < 0.05). Distilled water, 1% NaOCl, ethanol and EDTA were associated with significantly more remaining TAP. CONCLUSIONS: PUI with 1% NaOCl was more effective in removing TAP from artificial grooves in root canals than other irrigating solutions without ultrasonic agitation. It was not possible completely to remove TAP from root canals.