Clinical efficacy of activated irrigation in endodontics: a focused review

Cheung, Amelia Wan Tin; Lee, Angeline Hui Cheng; Cheung, Gary Shun Pan

doi:10.5395/rde.2021.46.e10

Cited by 17 publications

(14 citation statements)

References 79 publications

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“…From the context of anatomical challenges, while instrumentation of the root canal with stainless steel or nickel titanium hand or engine-driven instruments may help in removing biofilms from root canal walls, much is required to eliminate biofilms and reduce microbial loads from the anatomical eccentricities [ 33 , 116 ]. The goal of activated irrigation is to mechanically flush the irrigating solutions such as sodium hypochlorite into such eccentricities in addition to chemically enhancing their ability to dissolve organic matter [ 117 , 118 ]. In this regard, there has been wide confusion over the use of agitation and activation strategies.…”

Section: Clinical Implications Of Root Canal Infectionsmentioning

confidence: 99%

Microbiological Aspects of Root Canal Infections and Disinfection Strategies: An Update Review on the Current Knowledge and Challenges

Wong

Manoil

Näsman

et al. 2021

Front. Oral. Health

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The oral cavity is the habitat of several hundreds of microbial taxa that have evolved to coexist in multispecies communities in this unique ecosystem. By contrast, the internal tissue of the tooth, i.e., the dental pulp, is a physiologically sterile connective tissue in which any microbial invasion is a pathological sign. It results in inflammation of the pulp tissue and eventually to pulp death and spread of inflammation/infection to the periradicular tissues. Over the past few decades, substantial emphasis has been placed on understanding the pathobiology of root canal infections, including the microbial composition, biofilm biology and host responses to infections. To develop clinically effective treatment regimens as well as preventive therapies, such extensive understanding is necessary. Rather surprisingly, despite the definitive realization that root canal infections are biofilm mediated, clinical strategies have been focused more on preparing canals to radiographically impeccable levels, while much is left desired on the debridement of these complex root canal systems. Hence, solely focusing on “canal shaping” largely misses the point of endodontic treatment as the current understanding of the microbial aetiopathogenesis of apical periodontitis calls for the emphasis to be placed on “canal cleaning” and chemo-mechanical disinfection. In this review, we dissect in great detail, the current knowledge on the root canal microbiome, both in terms of its composition and functional characteristics. We also describe the challenges in root canal disinfection and the novel strategies that attempt to address this challenge. Finally, we provide some critical pointers for areas of future research, which will serve as an important area for consideration in Frontiers in Oral Health.

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Section: Clinical Implications Of Root Canal Infectionsmentioning

confidence: 99%

Microbiological Aspects of Root Canal Infections and Disinfection Strategies: An Update Review on the Current Knowledge and Challenges

Wong

Manoil

Näsman

et al. 2021

Front. Oral. Health

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“…This phenomenon is called PIPS which can be considered as an extraordinary method for irrigant activation. [23][24][25][26][27][28][29][30][31][32] The aim of the present study was to assess the effect of PIPS and diode laser agitation on smear layer removal, sealer penetration and bond strength.…”

Section: Discussionmentioning

confidence: 99%

“…This vapour bubble will collapse after reaching its maximum volume. 2,[28][29][30][31][32] The characteristic of cavitation is the production of a cavity containing air bubbles in the liquid. This option allows the flushing fluid to enter the apical third of the canal more easily.…”

Section: Discussionmentioning

confidence: 99%

“…Apical sealing was highly improved on utilizing lasers for irrigant activation before obturation. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Further studies should be carried out to improve the effects of lasers and its combination with different irrigating solutions in eliminating the smear layer from the root canal walls. Further research on the diode laser for the practical use in endodontics is needed before it is clinically applied.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of Photoinduced Photoacoustic Streaming and Diode Laser Irrigation Techniques on Smear Layer Removal, Sealer Penetration and Push-out Bond Strength

et al. 2022

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Introduction: The present study aimed to test the efficiency of photoinduced photoacoustic streaming using 2940 nm Er: YAG laser and 980 nm diode laser agitation on smear layer removal, sealer penetration and push-out bond strength. Methods: Sixty single canaled human permanent teeth were collected for this study. Specimens were grouped into three experimental groups (20 teeth in each group), depending on the activation protocol used for final irrigation: Group I (needle agitation), group II (980nm diode laser agitation) and group III (photon induced photoacoustic streaming (PIPS) using 2940 nm Er: YAG laser. The quantity of irrigant was standardized in all groups to 4 ml. The irrigant was activated for 40 seconds in different groups under continuous flow. Two teeth from each group were used to check the smear layer removal, and then the remaining teeth in each group were randomly divided into three equal experimental subgroups according to methods of evaluation used: subgroup A: Sealing ability evaluated by dye penetration method; subgroup B: SEM for sealer penetration; and subgroup C: Push-out bond strength assessed by the universal test machine. Results: As regards smear layer removal, results showed that the PIPS group had opened dentinal tubules, followed by the diode laser group, while the least cleaning effect was found in the Side-vented needle group. As for Sealing ability and dye penetration, a statistically significant difference was found between all of the three groups, with the Er:YAG laser (PIPS) having the best sealing ability and sealer penetration. Push-out bond strength results showed no statistically significant difference between diode and Er:YAG groups, with a significant difference between each of them and the Side-vented needle group. Conclusion: Using the diode or Er:YAG laser (PIPS) for irrigant activation led to better irrigant penetration and smear layer removal which subsequently led to obvious sealer penetration, better sealing, and strength properties of endodontic treated teeth.

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“…Considerable efforts have been invested in achieving better and more predictable root canal disinfection protocols including manual agitation, sonic, ultrasonic and laser‐activated irrigation methods (Haapasalo et al, 2010; Swimberghe et al, 2019a). However, limited evidence is available regarding their effectiveness (Cheung et al, 2021). In part, this gap in knowledge can be attributed to the innumerable and non‐standardized models that have been used to study the effects of irrigation techniques.…”

Section: Introductionmentioning

confidence: 99%

A novel three‐dimensionally printed model to assess biofilm removal by ultrasonically activated irrigation

et al. 2021

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Aim To apply an innovative three‐dimensionally printed tooth model to investigate the efficacy of three ultrasonically activated irrigation (UAI) systems in removing multispecies biofilms from dentine samples. Methodology Three‐dimensionally printed teeth with a curved root canal were fabricated with a standardized slot in the apical third of the root to achieve precision fit of human root dentine specimens. Multispecies biofilms including Enterococcus faecalis, Streptococcus mitis and Campylobacter rectus were developed in the root canal for 21 days. The canals were allocated to be irrigated with 1% sodium hypochlorite (NaOCl) using a syringe and needle or ultrasonically activated NaOCl with a stainless‐steel file (Irrisafe), a conventional nickel‐titanium (Ni‐Ti) file (CK) or a blue heat‐treated Ni‐Ti file (Endosonic Blue). Infected root canals irrigated with distilled water served as controls. Bacterial reduction was determined by colony‐forming unit (CFU) counting (n = 20), whilst biofilms were analysed using confocal laser scanning microscopy (n = 7) and field emission scanning electron microscopy. For CFU counting, the independent two‐sample t‐test (Welch's t‐test) was examined to compare overall bacterial reduction amongst groups. For CLSM analysis, the data were analysed using one‐way analysis of variance (ANOVA), followed by the Scheffé post hoc test. The p‐values <.05 were considered to indicate statistical significance. Results All groups in which NaOCl was ultrasonically activated had significantly lower CFU values than the syringe‐and‐needle irrigation and control groups (p < .05). Ultrasonic activation with the stainless‐steel file and blue heat‐treated Ni‐Ti file significantly reduced the biofilm volume compared with other groups (p < .05). Overall, UAI with the blue heat‐treated file resulted in the highest antibacterial and biofilm removal efficacy. Conclusions UAI with different inserts had differential antibiofilm effects. The blue heat‐treated Ni‐Ti ultrasonic insert resulted in the greatest antibacterial and biofilm removal from dentine in this standardized root canal model.

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Clinical efficacy of activated irrigation in endodontics: a focused review

Cited by 17 publications

References 79 publications

Microbiological Aspects of Root Canal Infections and Disinfection Strategies: An Update Review on the Current Knowledge and Challenges

Microbiological Aspects of Root Canal Infections and Disinfection Strategies: An Update Review on the Current Knowledge and Challenges

Efficacy of Photoinduced Photoacoustic Streaming and Diode Laser Irrigation Techniques on Smear Layer Removal, Sealer Penetration and Push-out Bond Strength

A novel three‐dimensionally printed model to assess biofilm removal by ultrasonically activated irrigation

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