New Technologies to Improve Root Canal Disinfection

Abstract

Effective irrigant delivery and agitation are prerequisites to promote root canal disinfection and debris removal and improve successful endodontic treatment. This paper presents an overview of the currently available technologies to improve the cleaning of the endodontic space and their debridement efficacy. A PubMed electronic search was conducted with appropriate key words to identify the relevant literature on this topic. After retrieving the full-text articles, all the articles were reviewed and the most appropriate were included in this review. Several different systems of mechanical activation of irrigants to improve endodontic disinfection were analysed: manual agitation with gutta-percha cones, endodontic instruments or special brushes, vibrating systems activated by low-speed hand-pieces or by sonic or subsonic energy, use of ultrasonic or laser energy to mechanically activate the irrigants and apical negative pressure irrigation systems. Furthermore, this review aims to describe systems designed to improve the intracanal bacterial decontamination by a specific chemical action, such as ozone, direct laser action or light-activated disinfection. The ultrasonic activation of root canal irrigants and of sodium hypochlorite in particular still remains the gold standard to which all other systems of mechanical agitation analyzed in this article were compared. From this overview, it is evident that the use of different irrigation systems can provide several advantages in the clinical endodontic outcome and that integration of new technologies, coupled with enhanced techniques and materials, may help everyday clinical practice.

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

“…To counteract this disadvantage, irrigant agitation strategies have been suggested (Plotino et al . ). The Gentlefile system also offers a brush (Finisher GF Brush) which consists of six strands of SS that open outwards automatically when operated in a handpiece at 6500 rpm (http://www.gentlefile.com/wp-content/uploads/2016/07/the-finisher-GF-brush-kit-6.7.pdf).…”

“…Irrigation of the root canal system using a needle and syringe does not generate sufficient hydrodynamic shear stresses to dislodge the biofilms or tissue that adhere to the root canal walls (Goode et al 2013, Chen et al 2014, Neelakantan et al 2016a. To counteract this disadvantage, irrigant agitation strategies have been suggested (Plotino et al 2016). The Gentlefile system also offers a brush (Finisher GF Brush) which consists of six strands of SS that open outwards automatically when operated in a handpiece at 6500 rpm (http://www.gentlefile.com/wpcontent/uploads/2016/07/the-finisher-GF-brush-kit-6.…”

The influence of the final irrigation protocol on the efficiency of root canal cleaning

“…The smear layer prevents adequate adherence of a sealer to the walls of the root canal and can be a potential area for the growth of numerous bacteria, but also prevent antibacterial agents from reaching the residual bacteria in the dentinal tubules [4,5]. Mechanical instrumentation eliminates the largest number of bacteria, but maximum reduction of the number of microorganisms organized into biofilms demands an irrigant with good antibacterial effect and adequate irrigation techniques [6,7,8].…”

COMPARATIVE EVALUATION OF SMEAR LAYER REMOVAL USING EDTA, PASSIVE ULTRASONIC IRRIGATION & DIODE LASER: A SCANNING ELECTRON MICROSCOPIC STUDY.

“…The ultrasonic irrigating system works on the principle of sonic activation of files to produce hydrodynamic intracanal fluid agitation. [6] Lasers have also been used to remove the smear layer such as argon laser, neodymium-doped yttrium aluminum garnet, CO2 laser, erbium-doped yttrium aluminum garnet and diode. Currently, a final irrigation sequence with a chelating agent EDTA and NaOCl is being used to remove the inorganic and organic components of the smear layer.…”