• The Journal of the Korean dental association
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• v.58 no.5
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• pp.276-283
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• 2020

Objectives: The aim of this study was to evaluate the efficacy of CK files as an ultrasonic instrument, and to determine most efficient file size for smear layer removal. Materials and Methods: Thirty-six extracted human mandibular premolars with single, straight root canals and mature apices were mechanically prepared and randomly divided into three groups. Group 1 (Control) underwent conventional needle irrigation, Group 2 (CKS) underwent passive ultrasonic irrigation with a #20 CK file, and Group 3 (CKL) underwent passive ultrasonic irrigation with a #30 CK file. After preparation and irrigation, all teeth were dried and split with a chisel to obtain the mesial and distal half of their roots. Each sample was evaluated using a scanning electron microscope, and data were analyzed using the Kruskal-Wallis and Mann-Whitney rank sum tests (p<0.05). Results: The CKS group showed less debris in the apical third than the other groups (p<0.05). In this section, no significant difference was observed among the other groups. And, there was no significant difference among any groups for the middle third section. Conclusion: This study showed that PUI with #20 CK file removed more smear layer compared to using #30 CK file at the apical third of the root canal.

• Restorative Dentistry and Endodontics
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• v.40 no.2
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• pp.143-148
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• 2015

Objectives: This study evaluated the maximum depth and percentage of irrigant penetration into dentinal tubules by passive ultrasonic irrigation (PUI). Materials and Methods: Thirty extracted human teeth were instrumented and divided into three groups. According to final irrigation regimen, 5.25% sodium hypochlorite (Group A, NaOCl), 2% chlorhexidine (Group B, CHX) and saline solution (Group C, control group) were applied with Irrisafe 20 tips (Acteon) and PUI. Irrigant was mixed with 0.1% rhodamine B. Sections at 2 mm, 5 mm, and 8 mm from the apex were examined with confocal laser scanning microscopy (CLSM). The percentage and maximum depth of irrigant penetration were measured. Kruskal-Wallis test and Mann-Whitney test were performed for overall comparison between groups at each level and for pairwise comparison, respectively. Within a group, Wilcoxon test was performed among different levels. p values less than 0.05 were considered significant. Results: In all groups, highest penetration depth and percentage of penetration were observed at the 8 mm level. At 2 mm level, Groups A and B had significantly greater depths and percentages in penetration than Group C (p < 0.05), but there were no significant differences between Groups A and B. At 5 mm level, penetration depths and percentage of penetration was not significantly different among the groups. Conclusions: NaOCl and CHX applied by PUI showed similar depth and percentage of penetration at all evaluated levels.

• Journal of Dental Rehabilitation and Applied Science
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• v.33 no.2
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• pp.97-105
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• 2017

Purpose: The purpose of this study was comparing the efficacy of passive irrigation (PI) and passive ultrasonic irrigation (PUI) for ability to remove debriment of canals. Materials and Methods: Mandibular premolars were decoronated and standardized to 16 mm length. After root canal enlargement and half separating longitudinally, standardized groove of 4 mm length, 0.2 mm width and 0.5 mm depth were formed on the dentin wall of one half. Three depressions in the canal wall of the opposite half, 0.3 mm in diameter and 0.5 mm in depth, were formed. After each groove and depression was filled with dentin debris, two sections of each half were reassembled using impression putty material. In group 1 the canals were irrigated with 2.5% NaOCl by PI. In group 2 the canals were irrigated with 2.5% NaOCl by PUI. Before and after root canal irrigation, the root canal wall of the section was taken with a microscope and a digital camera as images. The amount of dentin debris remaining in grooves and depressions was assessed using a scoring system. Results: There was no significant difference between PI and PUI except for the middle 1/3 of the root canal (P = 0.004). Conclusion: At the middle 1/3 of the root canal, PUI removed more dentine debris than PI. But the removal efficiency of dentin debris is not significantly different between the PUI and PI at the apical area of root canal in mandibular premolars.

• The Journal of the Korean dental association
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• v.53 no.10
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• pp.743-750
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• 2015

Objectives: This study compared the mechanical efficacy of sonic activated and passive ultrasonic irrigation for removing intracanal medicament from a simulated root canal under controlled conditions. Materials and Methods: Thirty simulated root canal in resin blocks were randomly divided into 3-groups. The canals were enlarged using ProTaper files and K3XF (#30/0.06). After cleaning and drying, canals were filled with Calcipex. Overfilled materials were wiped out and measured their weight to the unit of 1/10mg. After one week storage in 100% humidity $37^{\circ}C$ temperature, canals were irrigated using 20mL of saline with one of following methods according to the designated groups (n = 10). For group-NI, 30-gauge nickel-titanium irrigation needle was used. During irrigation with every 5mL, needle was moved in-and-out with 4-mm amplitudes. EndoActivator and ultrasonic tip were used for group-EA and group-UT respectively for 20 seconds after every 5mL irrigation using needle. Then the weight was measured again to calculate the weight of residual remnants. The data were analyzed by one-way ANOVA and Duncan's post-hoc test at a significance level of 95%. Results: The weight of the residual medicaments were $3.62{\pm}0.81mg$, $2.84{\pm}0.28mg$, and $2.73{\pm}0.90mg$ for group-NI, -EA, and -UT, respectively. Group-EA and group-UT had no significant differences to remove intracanal medicament and left significantly less amount of paste than group-NI (p < 0.05). Conclusions: Under the controlled conditions of this study, the sonic activation and PUI have similar mechanical efficacy for removing intracanal medicament.

• Restorative Dentistry and Endodontics
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• v.36 no.3
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• pp.180-187
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• 2011

Introduction: Eliminating the residual debris and bacteria in the root canal system is one of the main purposes of the endodontic treatment. However, the complexity on the anatomy of the root canal system makes it difficult to eliminate the bacterial biofilm existing along the root canal surface and necrotic pulp tissue by mechanical instrumentation and chemical irrigation. Recently, more effective irrigant delivery systems for root canal irrigation have been developed. The purpose of this review was to present an overview of root canal irrigant delivery techniques and devices available in endodontics. Review: The contents of this paper include as follows; - syringe-needle irrigation, manual dynamic irrigation, brushes - sonic and ultrasonic irrigation, passive ultrasonic irrigation, rotary brush, RinsEndo, EndoVac, Laser Conclusion: Though technological advances during the last decade have brought to fruition new agitation devices that rely on various mechanisms, there are few evidence based study to correlate the clinical efficacy of these devices with improved outcomes except syringe irrigation with needle and ultrasonic irrigation. The clinicians should try their best efforts to deliver antimicrobial and tissue solvent solutions in predictable volumes safely to working length.

• Restorative Dentistry and Endodontics
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• v.39 no.2
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• pp.104-108
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• 2014

Objectives: To evaluate the effect of passive ultrasonic agitation on the cleaning capacity of a hybrid instrumentation technique. Materials and Methods: Twenty mandibular incisors with mesiodistal-flattened root shape had their crowns sectioned at 1 mm from the cementoenamel junction. Instrumentation was initiated by catheterization with K-type files (Denstply Maillefer) #10, #15, and #20 at 3 mm from the working length. Cervical preparation was performed with Largo bur #1 (Dentsply Maillefer) followed by apical instrumentation with K-type files #15, #20 and #25, and finishing with ProTaper F2 file (Denstply Maillefer). All files were used up to the working length under irrigation with 1 mL of 2.5% sodium hypochlorite (Biodyn$\hat{a}$mica) at each instrument change. At the end of instrumentation, the roots were randomly separated into 2 groups (n = 10). All specimens received final irrigation with 1 mL of 2.5% sodium hypochlorite. The solution remained in the root canals in Group 1 for one minute; and ultrasonic agitation was performed in Group 2 for one minute using a straight tip inserted at 1 mm from working length. The specimens were processed histologically and the sections were analyzed under optic microscope (x64) to quantify debris present in the root canal. Results: The samples submitted to ultrasonic agitation (Group 2) presented significant decrease in the amount of debris in comparison with those of Group 1 (p < 0.05). Conclusions: The hybrid instrumentation technique associated with passive ultrasonic agitation promoted greater debris removal in the apical third of the root canals.

• Journal of Dental Rehabilitation and Applied Science
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• v.36 no.2
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• pp.104-111
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• 2020

Purpose: The purpose of this study is comparing the efficiency of debris removal of passive ultrasonic irrigation depend on different protocols. Materials and Methods: Forty-eight mandibular premolars were randomly divided into 2 groups depend on vibration power (Weak and Strong, n = 24). And then two groups were subdivided into 3 groups depend on the number of times that PUI used (1, 2 and 3, n = 8). After standardization, teeth were split into two halves. On the wall of one half of root canal, three depressions were cut at 1, 3 and 5 mm from the apex and in the same way two depressions were cut on the other half of root canal at 2, 4 mm from the apex. Each depression was filled with mixture of dentine and NaOCl. After irrigation, images of the root canal wall were taken, and then the amount of remaining dentine debris was evaluated. Results: There was no significant difference between weak and strong power of vibration groups. Weak vibration groups did not show significant difference depend on the different number of times PUI used. But in the strong vibration groups, twice and three times used groups show better removal efficiency. Conclusion: The removal efficiency of dentine debris is not significantly different depend on the power of vibration. And multiple use of PUI could have better irrigating effects at the apical third area in the strong vibration group.

• Restorative Dentistry and Endodontics
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• v.47 no.1
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• pp.11.1-11.11
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• 2022

This study aimed to describe the outcomes of the GentleWave system (GW) (Sonendo) on root canal treatment. Published articles were collected from scientific databases (MEDLINE/PubMed platform, Web of Science, Scopus, Science Direct and Embase). A total of 24 studies were collected from August/2014 to July/2021, 20 in vitro and 4 clinical. GW System was not associated with extrusion of the irrigant, promoted faster organic dissolution than conventional syringe irrigation (CSI), passive ultrasonic irrigation (PUI) continuous ultrasonic irrigation (CUI) and EndoVac, reduced more bacterial DNA and biofilm than PUI and CUI, promoted higher penetration of sodium hypochlorite into dentinal tubules than PUI and CUI in vitro, and removed more intracanal medication than CSI and PUI. GW was able to remove pulp tissue and calcifications. Moreover, its ability to remove hard-tissue debris and smear layer was better than that of CSI, and its ability to remove root canal obturation residues was lower or similar to that of PUI, and similar to that of CSI and EndoVac. Regarding root canal obturation of minimally instrumented molar canals, GW was associated with high-quality obturation. Clinically, the success rate of endodontic treatment using GW was 97.3%, and the short-term postoperative pain in the GW group was not different from CSI. Further research, mainly clinical, is needed to establish whether GW has any advantages over other available irrigation methods.

• Restorative Dentistry and Endodontics
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• v.40 no.2
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• pp.149-154
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• 2015

Objectives: This study evaluated the penetration depth of 2% chlorhexidine digluconate (CHX) into root dentinal tubules and the influence of passive ultrasonic irrigation (PUI) using a confocal laser scanning microscope (CLSM). Materials and Methods: Twenty freshly extracted anterior teeth were decoronated and instrumented using Mtwo rotary files up to size 40, 4% taper. The samples were randomly divided into two groups (n = 10), that is, conventional syringe irrigation (CSI) and PUI. CHX was mixed with Rhodamine B dye and was used as the final irrigant. The teeth were sectioned at coronal, middle and apical levels and viewed under CLSM to record the penetration depth of CHX. The data were statistically analyzed using Kruskal-Wallis and Mann-Whitney U tests. Results: The mean penetration depths of 2% CHX in coronal, middle and apical thirds were $138{\mu}m$, $80{\mu}m$ and $44{\mu}m$ in CSI group, respectively, whereas the mean penetration depths were $209{\mu}m$, $138{\mu}m$ and $72{\mu}m$ respectively in PUI group. Statistically significant difference was present between CSI group and PUI group at all three levels (p < 0.01 for coronal third and p < 0.001 for middle and apical thirds). On intragroup analysis, both groups showed statistically significant difference among three levels (p < 0.001). Conclusions: Penetration depth of 2% CHX into root dentinal tubules is deeper in coronal third when compared to middle and apical third. PUI aided in deeper penetration of 2% CHX into dentinal tubules when compared to conventional syringe irrigation at all three levels.

• Restorative Dentistry and Endodontics
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• v.46 no.1
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• pp.11.1-11.11
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• 2021

Objectives: The aim of this study was to compare smear layer removal by conventional application (CA), passive ultrasonic irrigation (PUI), EasyClean (EC), and XP-Endo Finisher (XPF), using 17% ethylenediaminetetraacetic acid (EDTA) after chemomechanical preparation, as evaluated with scanning electron microscopy (SEM). Materials and Methods: Forty-five single-rooted human mandibular premolars were selected for this study. After chemomechanical preparation, the teeth were randomly divided into 5 groups according to the protocol for smear layer removal, as follows: G1 (control): CA of distilled water; G2 (CA): CA of 17% EDTA; G3 (PUI): 17% EDTA activated by PUI; G4 (EC): 17% EDTA activated by EC; and G5 (XPF): 17% EDTA activated by XPF. SEM images (×1,000) were obtained from each root third and scored by 3 examiners. Data were evaluated using the Kruskal-Wallis and Dunn tests (p < 0.05). Results: In the apical third, there were no statistically significant differences among the groups (p > 0.05). In the cervical and middle thirds, the experimental groups performed better than the control group (p < 0.05); however, G2 presented better results than G3, G4, and G5 (p < 0.05), which showed no differences among one another (p > 0.05). Conclusions: No irrigation method was able to completely remove the smear layer, especially in the apical third. Using CA for the chelating solution performed better than any form of activation.