Efficacy of Handpiece Mounted Continuous Irrigation System for the Removal of Residual Pulpal Debris During Root Canal Preparation

Abstract

Objective The removal of residual pulpal debris (RPD) from the root canal walls, especially in necrotic teeth is important for successful endodontic outcome. The aim of this study was to evaluate the RPD removal efficacy of handpiece mounted continuous irrigation with simultaneous root canal preparation from the apical third of root canals as compared to conventional syringe irrigation (SI).

Materials and Methods Ninety extracted teeth were randomly divided into three groups: SI; handpiece mounted continuous irrigation (CI); and both syringe and continuous irrigation (CI+SI). After root canal preparation, roots were sectioned at 1 (a), 3 (b) and 5 (c) mm from apex and prepared for Hematoxylin-Eosin staining. Sections were microscopically examined for presence of RPD.

Statistical Analysis Intergroup difference in average percentage of RPD at different root levels was calculated by using analysis of variance test (ANOVA). Tuckey test was used for pairwise comparison.

Results ANOVA showed significant difference between all three groups (p < 0.05). SI group showed a significantly higher percentage of RPD as compared with CI and CI+ SI groups at all root levels (p < 0.01). At root level a, CI showed a significantly higher percentage of RPD as compared with CI+SI (p < 0.01).

Conclusion Handpiece mounted CI during rotary instrumentation showed a significant reduction in RPD as compared with conventional syringe irrigation. This technique was found to be an effective method for an enhanced root canal debridement.

Keywords

continuous irrigation - debridement - dentin debris - root canal - sodium hypochlorite - syringe irrigation

Publikationsverlauf

Artikel online veröffentlicht:
11. Mai 2021

• References

• 1 Villalta-Briones N, Baca P, Bravo M. et al. A laboratory study of root canal and isthmus disinfection in extracted teeth using various activation methods with a mixture of sodium hypochlorite and etidronic acid. Int Endod J 2021; 54 (02) 268-278
• 2 Shabbir J, Qazi F, Farooqui W, Ahmed S, Zehra T, Khurshid Z. Effect of Chinese propolis as an intracanal medicament on post-operative endodontic pain: a double-blind randomized controlled trial. Int J Environ Res Public Health 2020; 17 (02) E445
• 3 Reem M, Dalia F. Apical debris extrusion and root canal cleanliness using several rotary nickel titanium files with different kinematics in round and oval canals. Dent Sci Updat 2020; 1 (01) 39-49
• 4 Walters MJ, Baumgartner JC, Marshall JG. Efficacy of irrigation with rotary instrumentation. J Endod 2002; 28 (12) 837-839
• 5 Yang Q, Liu MW, Zhu LX, Peng B. Micro-CT study on the removal of accumulated hard-tissue debris from the root canal system of mandibular molars when using a novel laser-activated irrigation approach. Int Endod J 2020; 53 (04) 529-538
• 6 Virdee SS, Seymour DW, Farnell D, Bhamra G, Bhakta S. Efficacy of irrigant activation techniques in removing intracanal smear layer and debris from mature permanent teeth: a systematic review and meta-analysis. Int Endod J 2018; 51 (06) 605-621
• 7 Hussein Hussein A, Hameed Mohammed R. A study to compare the cleaning efficiency of different irrigation systems for macro debris removal in instrumented canals (An in vitro study).. J Baghdad Coll Dent 2015; 27 (02) 11-16
• 8 Molina B, Glickman G, Vandrangi P, Khakpour M. Evaluation of root canal debridement of human molars using the GentleWave system. J Endod 2015; 41 (10) 1701-1705
• 9 Boutsioukis C, Verhaagen B, Versluis M. Kastrinakis E, Wesselink PR, van der Sluis LW. Evaluation of irrigant flow in the root canal using different needle types by an unsteady computational fluid dynamics model. J Endod 2010; 36 (05) 875-879
• 10 Gu LS, Kim JR, Ling J, Choi KK, Pashley DH, Tay FR. Review of contemporary irrigant agitation techniques and devices. J Endod 2009; 35 (06) 791-804
• 11 Stojicic S, Zivkovic S, Qian W, Zhang H, Haapasalo M. Tissue dissolution by sodium hypochlorite: effect of concentration, temperature, agitation, and surfactant. J Endod 2010; 36 (09) 1558-1562
• 12 del Carpio-Perochena A, Bramante CM, de Andrade FB. et al. Antibacterial and dissolution ability of sodium hypochlorite in different pHs on multi-species biofilms. Clin Oral Investig 2015; 19 (08) 2067-2073
• 13 Tay FR, Gu L-S, Schoeffel GJ. et al. Effect of vapor lock on root canal debridement by using a side-vented needle for positive-pressure irrigant delivery. J Endod 2010; 36 (04) 745-750
• 14 Pasricha SK, Makkar S, Gupta P. Pressure alteration techniques in endodontics- a review of literature. J Clin Diagn Res 2015; 9 (03) ZE01-ZE06
• 15 de Gregorio C, Estevez R, Cisneros R, Paranjpe A, Cohenca N. Efficacy of different irrigation and activation systems on the penetration of sodium hypochlorite into simulated lateral canals and up to working length: an in vitro study. J Endod 2010; 36 (07) 1216-1221
• 16 Shen Y, Zhou HM, Zheng YF, Peng B, Haapasalo M. Current challenges and concepts of the thermomechanical treatment of nickel-titanium instruments. J Endod 2013; 39 (02) 163-172
• 17 Dutner J, Mines P, Anderson A. Irrigation trends among American Association of Endodontists members: a web-based survey. J Endod 2012; 38 (01) 37-40
• 18 Perez R, Neves AA, Belladonna FG. et al. Impact of needle insertion depth on the removal of hard-tissue debris. Int Endod J 2017; 50 (06) 560-568
• 19 Metzger Z. The self-adjusting file (SAF) system: an evidence-based update. J Conserv Dent 2014; 17 (05) 401-419
• 20 Konstantinidi E, Psimma Z, Chávez de Paz LE, Boutsioukis C. Apical negative pressure irrigation versus syringe irrigation: a systematic review of cleaning and disinfection of the root canal system. Int Endod J 2017; 50 (11) 1034-1054
• 21 Neelakantan P, Khan K, Li KY, Shetty H, Xi W. Effectiveness of supplementary irrigant agitation with the Finisher GF brush on the debridement of oval root canals instrumented with the Gentlefile or nickel titanium rotary instruments. Int Endod J 2018; 51 (07) 800-807
• 22 Haapasalo M, Shen Y, Wang Z. et al. Apical pressure created during irrigation with the GentleWave™ system compared to conventional syringe irrigation. Clin Oral Investig 2016; 20 (07) 1525-1534
• 23 Hu S, Duan L, Wan Q, Wang J. Evaluation of needle movement effect on root canal irrigation using a computational fluid dynamics model. Biomed Eng Online 2019; 18 (01) 52
• 24 Petridis X, Busanello FH, So MVR, Dijkstra RJB, Sharma PK, van der Sluis LWM. Factors affecting the chemical efficacy of 2% sodium hypochlorite against oral steady-state dual-species biofilms: exposure time and volume application. Int Endod J 2019; 52 (08) 1182-1195
• 25 Agarwal A, Deore RB, Rudagi K, Nanda Z, Baig MO, Fareez MA. Evaluation of apical vapor lock formation and comparative evaluation of its elimination using three different techniques: an in vitro study. J Contemp Dent Pract 2017; 18 (09) 790-794
• 26 Keleş A, Alçin H, Sousa-Neto MD, Versiani MA. Supplementary steps for removing hard tissue debris from isthmus-containing canal systems. J Endod 2016; 42 (11) 1677-1682
• 27 Yaylali IE, Kececi AD, Ureyen Kaya B. Ultrasonically activated irrigation to remove calcium hydroxide from apical third of human root canal system: a systematic review of in vitro studies. J Endod 2015; 41 (10) 1589-1599
• 28 Bao P, Shen Y, Lin J, Haapasalo M. Lin James, Haapasalo Markus. In vitro efficacy of XP-endo finisher with 2 different protocols on biofilm removal from apical root canals. J Endod 2017; 43 (02) 321-325
• 29 de Hemptinne F, Slaus G, Vandendael M, Jacquet W, De Moor RJ, Bottenberg P. In vivo intracanal temperature evolution during endodontic treatment after the injection of room temperature or preheated sodium hypochlorite. J Endod 2015; 41 (07) 1112-1115
• 30 Chandler N, Chellappa D. Lubrication during root canal treatment. Aust Endod J 2019; 45 (01) 106-110
• 31 Bıçakcı H, Çapar İD, Genç S, İhtiyar A, Sütçü R. Influence of rotary instrumentation with continuous irrigation on pain and neuropeptide release levels: a randomized clinical trial. J Endod 2016; 42 (11) 1613-1619
• 32 Haapasalo M, Shen Y, Wang Z, Gao Y. Irrigation in endodontics. Br Dent J 2014; 216 (06) 299-303
• 33 Klyn SL, Kirkpatrick TC, Rutledge RE. In vitro comparisons of debris removal of the EndoActivator system, the F file, ultrasonic irrigation, and NaOCl irrigation alone after hand-rotary instrumentation in human mandibular molars. J Endod 2010; 36 (08) 1367-1371