Debridement Efficiency Of Different Irrigating Protocols In Truss Cavity Access Preparation

Abstract

Minimal invasive dentistry is our goal to preserve the tooth structure. In this era the revolution in technological advances used in endodontic treatment such as digital radiographic imaging, operating microscopes, newly-designed endodontic access burs, heat treated rotary nickel-titanium root canal instruments, ultrasonic irrigation, negative pressure irrigation could enable the application of conservative endodontic access (CEC) cavity preparations. This is done to conserve tooth structure, especially chamber roof and peri-cervical dentine, challenges to clinicians of working effectively in confined spaces, and avoiding procedural complications, while lacking a convenient form, also biological (debridement) aspects have not been investigated. This study compared and evaluated the cleanliness efficiency of different irrigating systems in CEC. Methods: Eighty sound upper first premolars extracted due to orthodontic treatment were used in this study after taking pre-instrumentation digital x-ray using RVG to confirm the number of root canals and exclude any tooth with anatomical abnormality. The teeth were randomly divided into 4 groups (n = 20) in each according to the irrigation protocol (G1: Conventional method with Irriflex irrigating needle); (G2: ENDOVAC negative pressure irrigation system); (G3: PUI with ED62 irrigation ultrasonic tip); (G4: Er,Cr:YSGG Laser SWEEPS Mode). Conservative access preparation was done under high magnification. After instrumentation with M3 Pro Gold rotary file to a size 35/0.04 taper and irrigated, specimens were examined under SEM, and cleanliness of pulp chamber and root canal walls at coronal, middle, apical thirds was measured. Data were measured, tabulated and statistically analyzed by ANOVA and t-student test (P < 0 .05). Results: Group1 showed the highest smear layer scores at both apical and pulp chamber areas with no significant differences between all areas of the root canal and the pulp chamber. At the apical third of the root canal and the pulp chamber area, there was no significant difference between G2 (EndoVac) and G1 (IrriFlex) in smear layer elimination from root canal dentin wall. However, the least amount of smear layer and maximum number of open dentinal tubules was in G4 at all levels of the root canals and pulp chamber with no significant differences between G4 (Er,Cr:YSGG Laser) and G3 (PUI) showing the maximum cleanliness among all irrigation protocols compared to G1 and G2. There were no significant differences between all areas of the root canal and the pulp chamber in G3 and G4. Conclusions: debridement of the pulp chamber and root canals were significantly possible in CEC using new irrigation methods as Er,Cr:YSGG laser and PUI.