• Restorative Dentistry and Endodontics
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• v.38 no.3
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• pp.154-159
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• 2013

Objectives: The aim of this study was to compare the cleaning efficacy of different final irrigation regimens in canal and isthmus of mandibular molars, and to evaluate the influence of related variables on cleaning efficacy of the irrigation systems. Materials and Methods: Mesial root canals from 60 mandibular molars were prepared and divided into 4 experimental groups according to the final irrigation technique: Group C, syringe irrigation; Group U, ultrasonics activation; Group SC, VPro StreamClean irrigation; Group EV, EndoVac irrigation. Cross-sections at 1, 3 and 5 mm levels from the apex were examined to calculate remaining debris area in the canal and isthmus spaces. Statistical analysis was completed by using Kruskal-Wallis test and Mann-Whitney U test for comparison among groups, and multivariate linear analysis to identify the significant variables (regular replenishment of irrigant, vapor lock management, and ultrasonic activation of irrigant) affecting the cleaning efficacy of the experimental groups. Results: Group SC and EV showed significantly higher canal cleanliness values than group C and U at 1 mm level (p < 0.05), and higher isthmus cleanliness values than group U at 3 mm and all levels of group C (p < 0.05). Multivariate linear regression analysis demonstrated that all variables had independent positive correlation at 1 mm level of canal and at all levels of isthmus with statistical significances. Conclusions: Both VPro StreamClean and EndoVac system showed favorable result as final irrigation regimens for cleaning debris in the complicated root canal system having curved canal and/or isthmus. The debridement of the isthmi significantly depends on the variables rather than the canals.

• Proceedings of the KACD Conference
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• 2003.11a
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• pp.608-608
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• 2003

The main objectives of root canal therapy are cleaning and shaping and then obturating the root canal system in 3 dimensions to prevent reinfection. Many instrumentation techniques and devices, supported by an irrigation system capable of removing pulp tissue remnants and dentin debris, have been proposed to shape root canals. But current regimens in chemomechanical debridement using instrumentation and irrigation with NaOCl are not predictably effective in root canal disinfection. These findings are not surprising because the root canal system is complex and contains numerous ramifications and anatomical irregularities. The microorganisms in root canals not only invade the anatomic irregularities of the root canal system but also are present in the dentinal tubules. Therefore further disinfection with an effective antimicrobial agent may be necessary and it well1mown that use of intracanal medication will lower bacterial count in infected root canals. Calcium hydroxide has a long history of use in endodontics, and more attention has been given to the use of calcium hydroxide as intracanal dressing for the treatment of infected pulp. However, when treatment is completed in one visit, no intracanal medications other than intracanal irrigants are used. Recently, a mixture of a tetracycline isomer, an acid, and a detergent(MTAD), has been introduced as a final rinse for disinfuction of the root canal system. It has been shown that MTAD is able to remove the smear layer with minimal erosive changes on the surface of dentin, and is effective against Enterococcus faecalis, a microorganism resistant to the action of other antimicrobial medications. In another study, the ability of MTAD was investigated to disinfect contaminated root canals with whole saliva and compared its efficacy to that of NaOCl Based on the results, it seems that MTAD is significantly more effective than 5.25% NaOCl in eradicating bacteria from infected root canals. In the cytotoxicity evaluation, MTAD is less cytotoxic than engenol, 3% $H20_2,\;Ca(OH)_2$ paste, 5.25% NaGCl, Peridex, and EDTA and more cytotoxic than 2.63%,1.31% and 0.66% NaOCl. Is it promising or transient?

• The Journal of the Korean dental association
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• v.56 no.10
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• pp.556-566
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• 2018

Whether you use a hand file or an engine-driven file, you cannot remove bacteria completely from the root canal by mechanical work alone. If the root canal is well cleaned, endodontic irrigants will well penetrate into these areas that will not be mechanically accessible. It will decompose and remove the biofilm and also remove the smear layer to reach the dentinal tubule. Clinicians who are not yet using NaOCl as their primary irrigant, should be aware that there are no other irrigants that offer all the benefits of NaOCl and are inexpensive. Clinicians may be reluctant to use it because of concern about NaOCl accident, but this possibility is extremely low if used with caution.

• Restorative Dentistry and Endodontics
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• v.21 no.1
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• pp.267-279
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• 1996

Microorganisms are implicated the endodontic treatment failures. Persistent endodontic infection may be the result of retention of microorganisms in the dentin of the root canal walls. Dentinal tubules of the root canal walls have been shown to harbor microorganisms. The purpose of this study was to investigate the invasion of microorganism into the root dentin and dentinal tubules. The effects of irrigation solutions and smear layer on bacterial colonization of root canal were evaluated using a scanning electron microscopy. Canals of extracted human teeth with single and straight canals were stepback prepared using normal saline. Tooth samples were divided into four groups according to the irrigation solutions -5 % sodium hypochlorite and normal saline-and smear layer treatment. The smear layer was removed by 5% NaOCl and 20% EDTA for 10 min respectively. After sterilization, they were incubated with each strains of Streptococcus sanguis, Enterococcus faecalis, Staphylococcus aureus and Escherichia coli. Sodium hypochlorite solution reduced the adhesion of microorganisms effectively compared to normal saline. The smear layer inhibited colonization of E. faecalis, S. aureus and E. coli in the root canals due to their blocking of dentianl tubules. But S. sanguis invaded dentinal tubules in the root canals without smear layer. It was suggested that bacterial attachment might be different according to the strains. Sodium hypochlorite inhibited bacterial attachment in the dentinal tubules dramatically. The absence or presence of smear layer affected bacterial invasion of the dentinal tubules.

• Restorative Dentistry and Endodontics
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• v.34 no.6
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• pp.508-514
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• 2009

The purposes of this study were to compare the efficacy of irrigation systems by removing a calcium hydroxide $(Ca(OH)_2)$ paste from the apical third of the root canal and the effect of the patency file. Sixty single rooted human teeth were used in this study. The canals were instrumented by a crown-down manner with .04 taper ProFile to ISO #35. $Ca(OH)_2$ and distilled water were mixed and placed inside the root canals. The teeth were divided into 6 groups according to the root canal irrigation system and the use of patency file as follows: group 1 - conventional method: group 2 - $EndoActivator^{(R)}$: group 3 - $EndoVac^{(R)}$; group 4 - conventional method, patency: group 4 - $EndoActivator^{(R)}$, patency; group 6 - $EndoVac^{(R)}$, patency. All teeth were irrigated with sodium hypochlorite. After the root canal irrigation, the teeth were split in bucco-lingual aspect. Percentage of the root canal surface coverage with residual $Ca(OH)_2$ until 3 mm from working length was analyzed using Image Pro Plus ver. 4.0. Statistical analysis was performed using the One-way ANOVA, t-test and Scheffe's post-hoc test. Conventional groups had significantly more $Ca(OH)_2$ debris than $EndoActivator^{(R)}$, $EndoVac^{(R)}$ groups. There was no significant difference between $EndoActivator^{(R)}$ and $EndoVac^{(R)}$ groups. Groups with patency file showed more effective in removing $Ca(OH)_2$ paste than no patency groups. but. it was no significant difference. This study showed that $EndoActivator^{(R)}$ and $EndoVac^{(R)}$ systems were more effective in removing $Ca(OH)_2$ paste from the apical third of the root canal than conventional method.

• Restorative Dentistry and Endodontics
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• v.43 no.1
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• pp.1.1-1.8
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• 2018

Objectives: To determine the effect of root canal irrigants on the hydrophobicity and adherence of Staphylococcus epidermidis (S. epidermidis) to root canal dentin in vitro. Materials and Methods: Root dentin blocks (n = 60) were randomly divided into 4 groups based on the irrigation regimen: group 1, saline; group 2, 5.25% sodium hypochlorite (NaOCl); group 3, 5.25% NaOCl followed by 17% ethylenediaminetetraacetic acid (EDTA); group 4, same as group 3 followed by 2% chlorhexidine (CHX). The hydrophobicity of S. epidermidis to root dentin was calculated by cell surface hydrophobicity while the adherence was observed by fluorescence microscopy, and bacteria were quantified using ImageJ software (National Institutes of Health). Statistical analysis of the data was done using Kruskal-Wallis test and Mann-Whitney U test (p = 0.05). Results: The hydrophobicity and adherence of S. epidermidis to dentin were significantly increased after irrigating with group 3 (NaOCl-EDTA) (p < 0.05), whereas in group 4 (NaOCl-EDTA-CHX) both hydrophobicity and adherence were significantly reduced (p < 0.05). Conclusions: The adherence of S. epidermidis to dentin was influenced differently by root canal irrigants. Final irrigation with CHX reduces the bacterial adherence and may impact biofilm formation.

• Restorative Dentistry and Endodontics
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• v.25 no.1
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• pp.116-122
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• 2000

On the instrumented root canal wall, amorphous, irregular smear layer can be observed with Scanning Electron Microscope(SEM). The purpose of this study was to evaluate the effect of the presence or absence of smear layer on the adhesion of Staphylococcus aureus to the dentin of the root canal. Human incisors, extracted within 7 days, with no caries, no fracture, no calcification of canal, were selected. After cutting crown portion at cemento-enamel junction, root canal preparation was done by modified crown-down technique using Profile and Gates - Glidden Drill. During canal preparation, 10ml physiologic saline solution(group1&3) or 10ml 3.5% NaOCl(group2&4) was used as irrigation solution. And 10ml physiologic saline solution(group1&3) or 10ml 0.5M EDTA(group2&4) was applicated for final flush. After vertical sectioning and ethylene oxide gas sterilization, samples(group1&2) were immersed into BHIYHM broth inoculated with Staphylococcus aureus (ATCC 31153) and incubated for 3hrs at $37^{\circ}C$. All samples were prepared for and observed with SEM(JEOL JSM840S). The data were analyzed by Mann-Whitney rank sum test. The conclusions are as follows ; 1. Smear layer covers entire root canal surface after root canal preparation. 2. Smear layer has been removed away and the entrances of dentinal tubules have opened widely, when applying 0.5M EDTA and 3.5% NaOCl. 3. A significantly higher number of bacteria were adhered to the root canal dentin without smear layer(p<0.0001). 4. Smear layer produced during root canal preparation impedes bacterial adhesion and colonization to dentin matrix, therefore inhibits canal reinfection.

• Restorative Dentistry and Endodontics
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• v.18 no.2
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• pp.377-386
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• 1993

The purpose of this study was to evaluate the disinfection efficacy of root canal irrigation method and irrigation solution in infected root canals. Access cavity were prepared in single-rooted extracted human teeth and each canals were prepared with step-back method and sterilized with ethylene oxide gas. Prepared teeth were experimentally inoculated in the canals for 30 minutes with four aerobes(Streptococcus mutans, Stapylococcus aures, Streptococcus sanguis, and E. coli) and two anaerobes(Streptoccus intermedius, and Clostrium perfringens). Normal saline, 3% $H_2O_2$, and 3% NaOCl were used as irrgation solutions. And root canals were irrigated with each irrigation solutions manually with disposible syringe or ultrasonic instument. (Apoza Uitrasonc, Taiwan). The irrigation effect on the eradication of S. aures and S. intermedius with normal saline was not similar between manual method and ultrasonic method. No significant differences were observed in the eradication of E. coli and C. perfringens among the irrigation solution and irrespective of the irrigation methods. In S. aurues and S. mutans, there was somewhat different eradication effect according to irrigation solutions, but there was no significant difference between manual method and ultrasonic methods. These results suggest that ultrasonic irrigation method with saline is more effective in some strains than manual irrigation.

• Restorative Dentistry and Endodontics
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• v.48 no.1
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• pp.1.1-1.11
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• 2023

Objectives: This study evaluated the dentinal penetration depth of 2.5% sodium hypochlorite (NaOCl) in root canals with and without preparation and different irrigant activation protocols. Materials and Methods: Sixty-three bovine mandibular incisors were randomly allocated to 6 groups (n = 10): G1, preparation + conventional needle irrigation (CNI); G2, preparation + passive ultrasonic irrigation (PUI); G3, preparation + Odous Clean (OC); G4, no preparation + CNI; G5, no preparation + PUI; G6, no preparation + OC; and CG (negative control; n = 3). Samples were filled with crystal violet for 72 hours. Irrigant activation was performed. Samples were sectioned perpendicularly along the long axis, 3 mm and 7 mm from the apex. Images of the root thirds of each block were captured with a stereomicroscope and analyzed with an image analysis software. One-way analysis of variance, followed by the Tukey post hoc test, and the Student's t-test were used for data analysis, with a significance level of 5%. Results: The NaOCl penetration depth was similar when preparation was performed, regardless of the method of irrigation activation (p > 0.05). In the groups without preparation, G6 showed greater NaOCl penetration depth (p < 0.05). The groups without preparation had a greater NaOCl penetration depth than those with preparation (p = 0.0019). Conclusions: The NaOCl penetration depth was similar in groups with root canal preparation. Without root canal preparation, OC allowed deeper NaOCl penetration. The groups without preparation had greater NaOCl penetration than those undergoing root canal preparation.

• Restorative Dentistry and Endodontics
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• v.42 no.2
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• pp.105-110
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• 2017

Objectives: This study investigated the cleaning ability of ultrasonically activated irrigation (UAI) and a novel activation system with reciprocating motion (EC, EasyClean, Easy Equipamentos $Odontol\acute{o}gicos$) when used with a relatively new chelating agent (QMix, Dentsply). In addition, the effect of QMix solution when used for a shorter (1 minute) and a longer application time (3 minutes) was investigated. Materials and Methods: Fifty permanent human teeth were prepared with K3 rotary system and 6% sodium hypochlorite. Samples were randomly assigned to five groups (n = 10) according to the final irrigation protocol: G1, negative control (distilled water); G2, positive control (QMix 1 minute); G3, QMix 1 minute/UAI; G4, QMix 1 minute/EC; G5, QMix 3 minutes. Subsequently the teeth were prepared and three photomicrographs were obtained in each root third of root walls, by scanning electron microscopy. Two blinded and pre-calibrated examiners evaluated the images using a four-category scoring system. Data were statistically analyzed using Kruskal-Wallis and Dunn tests (p < 0.05). Results: There were differences among groups (p < 0.05). UAI showed better cleaning ability than EC (p < 0.05). There were improvements when QMix was used with auxiliary devices in comparison with conventional irrigation (p < 0.05). Conventional irrigation for 3 minutes presented significantly better results than its use for 1 minute (p < 0.05). Conclusions: QMix should be used for 1 minute when it is used with UAI, since this final irrigation protocol showed the best performance and also allowed clinical optimization of this procedure.