Irrigation dynamics associated with positive pressure, apical negative pressure and passive ultrasonic irrigations: a computational fluid dynamics analysis.

Complexities in root canal anatomy and surface adherent biofilm structures remain as challenges in endodontic disinfection. The ability of an irrigant to penetrate into the apical region of a canal, along with its interaction with the root canal walls, will aid in endodontic disinfection. The aim of this study was to qualitatively examine the irrigation dynamics of syringe irrigation with different needle tip designs (open-ended and closed-ended), apical negative pressure irrigation with the EndoVac® system, and passive ultrasonic-assisted irrigation, using a computational fluid dynamics model. Syringe-based irrigation with a side-vented needle showed a higher wall shear stress than the open-ended but was localised to a small region of the canal wall. The apical negative pressure mode of irrigation generated the lowest wall shear stress, while the passive-ultrasonic irrigation group showed the highest wall shear stress along with the greatest magnitude of velocity.

Resolution of maxillary sinus mucositis after endodontic treatment of maxillary teeth with apical periodontitis: a cone-beam computed tomography pilot study.

INTRODUCTION: Apical periodontitis (AP) is an inflammatory response that can affect the maxillary sinus. This study characterized maxillary sinus mucositis adjacent to teeth with AP and assessed its resolution after endodontic treatment. METHODS: Thirty maxillary sinuses in subjects (n = 29) who had AP associated with maxillary posterior teeth were imaged with cone-beam computed tomography (CBCT). When mucositis was detected, its resolution was assessed with CBCT scanning 3 months after treatment, and periapical healing was assessed using the periapical index (PAI) after 6 months. RESULTS: Excluding 5 sinuses obscured by sinusitis, mucositis was detected in 14 of 25 sinuses (56%). Nonsignificant inverse association was observed between the mucosal lining thickness and the distance from the sinus to root apices with AP. Four noncompliant subjects were discontinued. Three months after treatment, mucositis was fully resolved in 3 of 10 subjects (30%), partially resolved in 3 of 10 subjects (30%), unchanged in 3 of 10 subjects (30%), and worsened in 1 subject (10%). Six months after treatment, 6 of 10 subjects (60%) had reduced PAI scores classified as healed or healing. The subject with expanded mucositis at 3 months was not healing at 6 months. CONCLUSIONS: Within the limited sample of this pilot study, CBCT imaging revealed a lower-than-expected prevalence of mucositis adjacent to teeth with AP. Fully resolved mucositis was not common 3 months after endodontic treatment, suggesting that in specific cases it might linger beyond 3 months after the elimination of the endodontic infection. Because of the low statistical power, the association between the resolution of mucositis and periapical healing could not be explored.