Apical Extrusion of Sodium Hypochlorite Using Different Root Canal Irrigation Systems

doi:10.1016/j.joen.2011.09.004

Journal of Endodontics

Volume 37, Issue 12, December 2011, Pages 1677-1681

https://doi.org/10.1016/j.joen.2011.09.004 Get rights and content

Abstract

Introduction

Root canal irrigation carries a risk of extrusion of irrigant into the periapical tissues. The objective of this study was to compare different irrigation systems in matched pairs of teeth prepared to an apical size of 35.06 and 50.06 by measuring the frequency and extent of apical extrusion of sodium hypochlorite (NaOCl) into a simulated periapical environment. The null hypothesis was tested that there is no difference between systems.

Methods

Bilaterally matched pairs (n = 10) of single-canal extracted human anterior teeth were instrumented to an apical size of either 35.06 or 50.06. Teeth were embedded in a gel containing the pH-sensitive dye M-cresol purple that changes from yellow at pH 7.4 to purple at pH 9. Root canals were irrigated with 6% NaOCl (pH 11) by using EndoActivator (EA), EndoVac (EV), Rispi-Sonic/MicroMega 1500 (MM), passive ultrasonic irrigation (PUI), and syringe irrigation with a slot-tipped needle (SN), so that each tooth underwent all irrigation procedures in a randomized crossover design. Apical extrusion was evaluated by image analyses.

Results

The frequency of extrusion was less in teeth with apical preparation size 35.06 (36%) compared with 50.06 (60%) (P = .014) and was dependent on the irrigation system in 35.06 (P = .039) but not 50.06 groups. In the 35.06 group the frequency of extrusion was less for EV than for MM and SN (both P = .029). The extent of extrusion was less for MM compared with PUI (P = .024) and SN (P = .046) in the 35.06 group and greater for SN compared with all other systems in the 50.06 group (P < .05). The null hypothesis was rejected.

Conclusions

The frequency of apical extrusion of NaOCl was dependent on the type of root canal irrigation system and apical preparation size. The extent of extrusion depended on the irrigation system, with syringe and slotted-needle irrigation resulting in the greatest extent of extrusion.

Section snippets

Tooth Selection and Preparation

Ten pairs of single-canal bilaterally matched extracted human anterior teeth were used. Details on selection criteria and working length (WL) have been previously described (7). One tooth from each pair was instrumented to an apical size of ISO 35.06 and the other to 50.06 by using a crown-down technique and rotary files (Vortex; Dentsply Tulsa Dental, Johnson City, TN). Apical patency was maintained by passing a #15 file to WL after each rotary instrument. All teeth were irrigated with 1 mL 6%

Results

All positive and negative controls performed as expected.

Discussion

The results of this in vitro study demonstrate that both apical preparation size and the method of activation and delivery of NaOCl into the apical one-third play a role in the amount of extrusion into the apical tissues. The null hypothesis was rejected. The lowest frequency of extrusion occurred with the EV system at an apical preparation size of 35.06. Although an advantage of needle irrigation is that it provides easy control of needle depth in the canal as well as the volume of irrigant

Acknowledgments

The authors deny any conflicts of interest related to this study.

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Assessment of Irrigant Agitation Devices in Simulated Closed and Open Root Canal Systems
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The in vitro efficacy of irrigant activation devices has not been contrasted to their safety. This was attempted in this study using apically closed versus patent simulated root canal systems in epoxy resin models, with the latter featuring a simulated periapical lesion.
All 72 models had 2 joining canals connected by an isthmus, which was filled with dentin debris. The simulated periapical lesion was filled with colored gelatin in the 36 respective models. Canals were irrigated with 1.3% sodium hypochlorite. Samples were divided into 4 subgroups per system (n = 9): conventional irrigation, sonic low (EndoActivator; Dentsply Sirona, Charlotte, NC) and high frequency (EDDY; VDW, Munich, Germany), and ultrasonic agitation of the irrigant (always applying 3 cycles of 20 seconds). The total cleared surface areas (mm²) in the simulated isthmus and periapical lesion were compared between systems and devices using parametric tests (P < .05).
The cleaning of the isthmus was more effective in the apically open compared with the closed systems and was also significantly influenced by the agitation method (P < .001). In the closed systems, EDDY and ultrasonic agitation achieved the significantly (P < .05) best cleaning of the isthmus. In the open systems, ultrasonic agitation showed the single best result (P < .05). EDDY caused by far the highest and ultrasonic agitation the lowest dissolution of the gelatin in the simulated periapical lesion.
Under the conditions of this study, ultrasonic agitation of a previously administered sodium hypochlorite irrigant was more laterally targeted and thus safer and more effective than sonic agitation methods.
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Root canal treatment is performed to remove the bacteria proliferating in the root canals of a tooth. Many conventional root canal irrigation methods use an instrument inserted into the root canals. However, bacteria removal is often incomplete in the apical region of the root canal, and the treatment carries clinical risks, such as instrument fracture and extrusion of irrigation liquid through the canal apex. We here suggest a novel, remotely generated high-intensity ultrasound irrigation system that exhibits better irrigation performance and a reduced clinical risk. Our device employs powerful ultrasonic waves generated by a transducer placed outside a target tooth. The generated ultrasonic waves are guided to travel into the root canals. In the root canals of the target tooth, acoustic cavitation occurs, and vapor bubbles are created. The dynamic motions of vapor bubbles create remarkable cleaning effects. Using root canal models, we tested the cleaning performance of the proposed system and compared it with other conventional irrigation methods. The results revealed that biofilm in the apical region of the root canal models can be removed exclusively using the proposed system, thus demonstrating an improvement in cleaning performance. We also measured pressure at the apex of the root canals of an extracted tooth while operating the proposed system. Our system exhibited a smaller pressure compared to the syringe irrigation method, thus suggesting a reduced risk of apical extrusion of the irrigation liquid. Since the proposed system operates without inserting instruments into the root canal, it can clean multiple root canals in a tooth simultaneously with a single treatment. The proposed device would be a breakthrough in root canal treatment in terms of irrigation performance, clinical safety, and ease of treatment.
Comparative effects of erbium-doped yttrium aluminum garnet laser, the shock wave-enhanced emission photoacoustic streaming, and the conventional needle irrigation on apical extrusion of irrigants
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Citation Excerpt :
A #10 file was used to ensure root canal patency [4]. The teeth were mounted in acrylic resin blocks, and plastic capillary tubes (Pluss, Italy) were used to apply water pressure equal to periodontal pressure (7.99 cmH2O) to the apex [3,6] (Fig. 1). A total of 4 mL of irrigant was used in each group.
This study compared the effects of erbium-doped yttrium aluminum garnet (Er:YAG) laser with the shockwave-enhanced emission photoacoustic streaming (SWEEPS) protocol and the conventional needle irrigation (CNI) on extrusion of irrigants through the root apex of molar teeth with different apical diameters.
In this ex vivo experimental study, access cavities were prepared in 120 extracted maxillary and mandibular molars in 12 groups of conventional needle irrigation (CNI), auto-SWEEPS, ultra-short pulse (USP), and super-short pulse (SSP), each with 0.25, 0.4 and 0.8 mm apical diameters (n = 10). The root canals were prepared and mounted in resin blocks. Periodontal pressure was simulated by a capillary tube of water in the apex. The volume of extruded irrigant was quantified spectrophotometrically, and analyzed by the Kruskal-Wallis test.
Apical extrusion in CNI was the same in the three apical diameters, and was maximum compared with others groups. The amount of extruded irrigant through the apex was different among the three apical diameters in auto-SWEEPS (P = 0.002) and USP (P = 0.001) modes. The SSP mode caused maximum extrusion of irrigant with no significant difference among different apical diameters (P = 0.681) followed by auto-SWEEPS. The USP mode caused the lowest extrusion in 0.25 mm diameter (P = 0.006). In auto-SWEEPS, 0.25 mm diameter had a significant difference with 0.8 mm. In USP, 0.25 mm had a significant difference with 0.4 and 0.8 mm diameters. In 0.25 mm, USP and SSP (P < 0.05), and USP and auto-SWEEPS (P < 0.05) had significant differences. In 0.4 mm, only SSP and USP had a significant difference (P < 0.05).
. CNI with a 27-gage needle caused greater irrigant extrusion than the SWEEPS modes. The USP mode caused minimum extrusion of irrigant.
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The purpose of this study was to evaluate the impact of different sodium hypochlorite (NaOCl) irrigation protocols on organic tissue dissolution in the periapical region of simulated immature permanent teeth.
Eight single-rooted premolars and 48 samples of porcine palatal mucosa were used. Acrylic resin prototypes were constructed, placing the tissue in close contact with the dental apices. Specimens were then divided into 6 groups (n = 8): 2 control groups of normal saline irrigation with (NS/WA) or without (NS/NA) ultrasonic activation and 4 experimental groups of 1.5% and 2.5% NaOCl irrigation with (NaOCl 1.5%/WA and NaOCl 2.5%/WA) or without (NaOCl 1.5%/NA and NaOCl 2.5%/NA) activation. Root canals were irrigated with 20 mL of the solution for 5 minutes distributed over 4 irrigation cycles. In each cycle, after irrigation, the solution was either kept stagnant or activated for 30 seconds and then replaced. Specimens were weighed on a precision balance before and after the irrigation protocols. Tissue dissolution was measured by the difference between the initial and final weights. One-way analysis of variance was applied followed by the Tukey honestly significant difference test (α = 0.05).
The NS/NA and NS/WA groups had mean weight reductions similar to the 1.5% NaOCl/NA group (P > .05) and lower than the others (P < .05). The 2.5% NaOCl/NA and 2.5% NaOCl/WA groups had the highest mean weight loss (P < .05), whereas the 1.5% NaOCl/WA group had intermediate values (P < .05).
Periapical tissue dissolution occurred in all groups, with a greater impact observed with 2.5% NaOCl with or without ultrasonic activation.
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The aim of this study was to evaluate the volume of irrigant extrusion by different final agitation techniques in experimental models of immature teeth.
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: Supported by OHSU Graduate Endodontic Research Funds and a Resident Research grant from the American Association of Endodontists Foundation.

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Basic ResearchApical Extrusion of Sodium Hypochlorite Using Different Root Canal Irrigation Systems

Abstract

Introduction

Methods

Results

Conclusions

Section snippets

Tooth Selection and Preparation

Results

Discussion

Acknowledgments

J Endod

J Endod

J Endod

J Endod

J Endod

J Endod

J Endod

J Endod

J Endod

J Endod

J Endod

J Endod

J Endod

J Endod

J Endod

Basic Research
Apical Extrusion of Sodium Hypochlorite Using Different Root Canal Irrigation Systems