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A comparison between two negative pressure irrigation techniques in simulated immature tooth: an ex vivo study

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Abstract

Objectives

This ex vivo study evaluated the irrigation efficacy of a new apical negative pressure system (ANP) in canals with simulated immature teeth, by comparing it to EndoVac (EV) system in terms of smear layer (SL) removal and irrigation extrusion.

Materials and methods

Three millimetres of the root end of 40 single canalled lower incisors were resected and decoronated to standardize root canal length. After instrumentation, the specimens were embedded in warm normal saline agar coloured with 1 % acid red and randomly divided into four groups; one control group and three experimental groups. Except in the control group where distilled water was used as irrigant using positive pressure irrigation needle, the canals were irrigated with 6 % NaOCl and 17 % EDTA using the intracanal negative pressure needle (iNP) system, the EV system or 27G open-ended needle under positive pressure (PP). NaOCl extrusion was determined by observing a discolouration of the agar surrounding the root. The SL was evaluated by observing scanning electron microscope images based on a four-level scoring system.

Results

Two specimens with irrigant extrusion were observed in the iNP group, which was significantly different (logistic regression, p < 0.05) to EV and PP. There were no significant differences (Kruskall-Wallis test, p > 0.05) among the experimental groups in terms of SL removal, but all were significantly different to the control group.

Conclusions

Irrigation with the iNP could be a viable alternative to EV as an apical negative pressure irrigation technique especially while treating immature teeth.

Clinical relevance

ANP in canal cleanliness is recommended to be utilized in treating immature teeth where periapical tissues should be saved and stimulated. The iNP system might have the potential to avoid irrigant extrusion while cleaning the canal till the apical end.

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References

  1. Peters OA, Schönenberger K, Laib A (2001) Effects of four Ni-Ti preparation techniques on root canal geometry assessed by micro computed tomography. Int Endod J 34:221–230

    Article  PubMed  Google Scholar 

  2. Byström A, Sundqvist G (1981) Bacteriologic evaluation of the efficacy of mechanical root canal instrumentation in endodontic therapy. Scand J Dent Res 89:321–328

    PubMed  Google Scholar 

  3. Miller TA, Baumgartner JC (2010) Comparison of the antimicrobial efficacy of irrigation using the EndoVac to endodontic needle delivery. J Endod 36:509–511

    Article  PubMed  Google Scholar 

  4. Ciucchi B, Khettabi M, Holz J (1989) The effectiveness of different endodontic irrigation procedures on the removal of the smear layer: a scanning electron microscopic study. Int Endod J 22:21–28

    Article  PubMed  Google Scholar 

  5. Moorer WR, Wesselink PR (1982) Factors promoting the tissue dissolving capability of sodium hypochlorite. Int Endod J 15:187–196

    Article  PubMed  Google Scholar 

  6. Mader CL, Baumgartner JC, Peters DD (1984) Scanning electron microscopic investigation of the smeared layer on root canal walls. J Endod 10:477–483

    Article  PubMed  Google Scholar 

  7. Trope M (2010) Treatment of the immature non-vital tooth with apical periodontitis. Dent Clin N Am 54:313–324

    Article  PubMed  Google Scholar 

  8. Sonoyama W, Liu Y, Yamaza T et al (2008) Characterization of the apical papilla and its residing stem cells from human immature permanent teeth: a pilot study. J Endod 34:166–171

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lovelace T, Henry M, Hargreaves K, Diogenes A (2011) Evaluation of the delivery of mesenchymal stem cells into the root canal space of necrotic immature teeth after clinical regenerative endodontic procedure. J Endod 37:133–138

    Article  PubMed  Google Scholar 

  10. Andreasen JO, Bakland L (2012) Pulp regeneration after non-infected and infected necrosis, what type of tissue do we want? A review. Dent Traumatol 28:13–18

    Article  PubMed  Google Scholar 

  11. Huang GT, Gronthos S, Shi S (2009) Mesenchymal stem cells derived from dental tissues vs those from other sources: their biology and role in regenerative medicine. J Dent Res 88:792–806

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bryce G, O’Donnell D, Ready D, Ng YL, Pratten J, Gulabivala K (2009) Contemporary root canal irrigants are able to disrupt and eradicate single- and dual-species biofilms. J Endod 35:1243–1248

    Article  PubMed  Google Scholar 

  13. Trevino E, Patwardhan A, Henry M, Perry G, Dybdal-Hargreaves N, Hargreaves K, Diogenes A (2011) Effect of irrigants on the survival of human stem cells of the apical papilla in a platelet-rich plasma scaffold in human root tips. J Endod 37:1109–1115

    Article  PubMed  Google Scholar 

  14. Hülsmann M, Hahn W (2000) Complications during root canal irrigation—literature review and case reports. Int Endod J 33:186–193

    Article  PubMed  Google Scholar 

  15. Shin S-J, Kim H-K, Jung I-Y, Lee C-Y, Lee S-J, Kim E (2010) Comparison of the cleaning efficacy of a new apical negative pressure irrigating system with conventional irrigation needles in the root canals. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:479–484

    Article  PubMed  Google Scholar 

  16. Hockett JL, Dommisch JK, Johnson JD, Cohenca N (2008) Antimicrobial efficacy of two irrigation techniques in tapered and nontapered canal preparations: an in vitro study. J Endod 34:1374–1377

    Article  PubMed  Google Scholar 

  17. Fukumoto Y, Kikuchi I, Yoshioka T, Kobayashi C, Suda H (2006) An ex vivo evaluation of a new root canal irrigation technique with intracanal aspiration. Int Endod J 39:93–99

    Article  PubMed  Google Scholar 

  18. Mitchell RP, Yang S-E, Baumgartner JC (2010) Comparison of apical extrusion of NaOCl using the EndoVac or needle irrigation of root canals. J Endod 36:338–341

    Article  PubMed  Google Scholar 

  19. Cohenca N, Heilborn C, Johnson J, Flores D, Ito I, da Silva L (2010) Apical negative pressure irrigation versus conventional irrigation plus triantibiotic intracanal dressing on root canal disinfection in dog teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:e42–e46

    Article  PubMed  Google Scholar 

  20. Tay FR, Gu L-S, Schoeffel GJ et al (2010) Effect of vapor lock on root canal debridement by using a side-vented needle for positive-pressure irrigant delivery. J Endod 36:745–750

    Article  PubMed  PubMed Central  Google Scholar 

  21. Brunson M, Heilborn C, Johnson DJ (2010) Cohenca N (2010) Effect of apical preparation size and preparation taper on irrigant volume delivered by using negative pressure irrigation system. J Endod 36:721–724

    Article  PubMed  Google Scholar 

  22. Gorman MC, Steiman HR, Gartner AH (1995) Scanning electron microscopic evaluation of root-end preparations. J Endod 21:113–117

    Article  PubMed  Google Scholar 

  23. Tawfik H, AbuSeida A, Hashem A, Nagy M (2013) Regenerative potential following revascularization of immature permanent teeth with necrotic pulps. Int Endod J 46:910–922

    Article  PubMed  Google Scholar 

  24. Windley W, Teixeira F, Levin L, Sigurdsson A, Trope M (2005) Disinfection of immature teeth with a triple antibiotic paste. J Endod 31:439–443

    Article  PubMed  Google Scholar 

  25. Desai P, Himel V (2009) Comparative safety of various intracanal irrigation systems. J Endod 35:545–549

    Article  PubMed  Google Scholar 

  26. Tinaz AC, Alacam T, Uzun O, Maden M, Kayaoglu G (2005) The effect of disruption of apical constriction on periapical extrusion. J Endod 31:533–535

    Article  PubMed  Google Scholar 

  27. McCabe P (2015) Revascularization of an immature tooth with apical periodontitis using a single visit protocol: a case report. Int Endod J 48:484–497

    Article  PubMed  Google Scholar 

  28. Boutsioukis C, Psimma Z, van der Sluis LWM (2013) Factors affecting irrigant extrusion during root canal irrigation: a systematic review. Int Endod J 46:599–618

    Article  PubMed  Google Scholar 

  29. Boutsioukis C, Psimma Z, Kastrinakis E (2014) The effect of flow rate and agitation technique on irrigant extrusion ex vivo. Int Endod J 47:487–496

    Article  PubMed  Google Scholar 

  30. Myers GL, Montgomery S (1991) Comparison of weights of debris extruded apically by conventional filing and canal master techniques. J Endod 17:275–277

    Article  PubMed  Google Scholar 

  31. Susin L, Liu Y, Yoon JC et al (2010) Canal and isthmus debridement efficacies of two irrigant agitation techniques in a closed system. Int Endod J 43:1077–1090

    Article  PubMed  PubMed Central  Google Scholar 

  32. Chow TW (1983) Mechanical effectiveness of root canal irrigation. J Endod 9:475–479

    Article  PubMed  Google Scholar 

  33. Boutsioukis C, Lambrianidis T, Kastrinakis E (2009) Irrigant flow within a prepared root canal using various flow rates: a Computational Fluid Dynamics study. Int Endod J 42:144–155

    Article  PubMed  Google Scholar 

  34. Gao Y, Haapasalo M, Shen Y et al (2009) Development and validation of a three-dimensional computational fluid dynamics model of root canal irrigation. J Endod 35:1282–1287

    Article  PubMed  Google Scholar 

  35. Parente JM, Loushine RJ, Susin L et al (2010) Root canal debridement using manual dynamic agitation or the EndoVac for final irrigation in a closed system and an open system. Int Endod J 43:1001–1012

    Article  PubMed  Google Scholar 

  36. da Silva LAB, Nelson-Filho P, da Silva RAB et al (2010) Revascularization and periapical repair after endodontic treatment using apical negative pressure irrigation versus conventional irrigation plus triantibiotic intracanal dressing in dogs’ teeth with apical periodontitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:779–787

    Article  PubMed  Google Scholar 

  37. Cohenca N, Romualdo P, da Silva L, da Silva R, de Queiroz A, De Rossi A, Nelson-Filho P (2014) Tissue response to root canal irrigation systems in dogs’ teeth with apical periodontitis. Clin Oral Invest. 1–10

  38. Lottanti S, Gautschi H, Sener B, Zehnder M (2009) Effects of ethylenediaminetetraacetic, etidronic and peracetic acid irrigation on human root dentine and the smear layer. Int Endod J 42:335–343

    Article  PubMed  Google Scholar 

  39. Abarajithan M, Dham S, Velmurugan N, Valerian-Albuquerque D, Ballal S, Senthilkumar H (2011) Comparison of Endovac irrigation system with conventional irrigation for removal of intracanal smear layer: an in vitro study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 112:407–411

    Article  PubMed  Google Scholar 

  40. Çapar İ, Ari Aydinbelge H (2014) Effectiveness of various irrigation activation protocols and the self adjusting file system on smear layer and debris removal. Scanning 36:640–647

    Article  PubMed  Google Scholar 

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Conflict of interest

The iNP needle is currently patent pending in Japan and USA. Drs. Yoshioka and Fukumoto are the inventors of the iNP needle and have potential financial interest.

Compliance with ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.

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Correspondence to Carlos G. Adorno.

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Jamleh, A., Fukumoto, Y., Takatomo, Y. et al. A comparison between two negative pressure irrigation techniques in simulated immature tooth: an ex vivo study. Clin Oral Invest 20, 125–131 (2016). https://doi.org/10.1007/s00784-015-1489-1

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  • DOI: https://doi.org/10.1007/s00784-015-1489-1

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