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Abstract
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.
References
1. Weller RN, Brady JM, Bernier WE. Efficacy of ultrasonic cleaning. J Endod. 1980. 6:740–743.
2. Schäfer E, Zapke K. A comparative scanning electron microscopic investigation of the efficacy of manual and automated instrumentation of root canals. J Endod. 2000. 26:660–664.
3. Gutarts R, Nusstein J, Reader A, Beck M. In vivo debridement efficacy of ultrasonic irrigation following hand-rotary instrumentation in human mandibular molars. J Endod. 2005. 31:166–170.
4. Ciucchi B, Khettabi M, Holz J. The effectiveness of different endodontic irrigation procedures on the removal of the smear layer: a scanning electron microscopic study. Int Endod J. 1989. 22:21–28.
5. Zehnder M. Root canal irrigants. J Endod. 2006. 32:389–398.
6. Naenni N, Thoma K, Zehnder M. Soft tissue dissolution capacity of currently used and potential endodontic irrigants. J Endod. 2004. 30:785–787.
7. Zamany A, Safavi K, Spångberg LS. The effect of chlorhexidine as an endodontic disinfectant. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003. 96:578–581.
8. Ram Z. Effectiveness of root canal irrigation. Oral Surg Oral Med Oral Pathol. 1977. 44:306–312.
9. Chow TW. Mechanical effectiveness of root canal irrigation. J Endod. 1983. 9:475–479.
10. Sedgley CM, Nagel AC, Hall D, Applegate B. Influence of irrigant needle depth in removing bioluminescent bacteria inoculated into instrumented root canals using real-time imaging in vitro. Int Endod J. 2005. 38:97–104.
11. van der Sluis LW, Gambarini G, Wu MK, Wesselink PR. The influence of volume, type of irrigant and flushing method on removing artificially placed dentine debris from the apical root canal during passive ultrasonic irrigation. Int Endod J. 2006. 39:472–476.
12. Sedgley C, Applegate B, Nagel A, Hall D. Real-time imaging and quantification of bioluminescent bacteria in root canals in vitro. J Endod. 2004. 30:893–898.
13. Shen Y, Gao Y, Qian W, Ruse ND, Zhou X, Wu H, Haapasalo M. Three-dimensional numeric simulation of root canal irrigant flow with different irrigation needles. J Endod. 2010. 36:884–889.
14. Yamada RS, Armas A, Goldman M, Lin PS. A scanning electron microscopic comparison of a high volume final flush with several irrigating solutions: Part 3. J Endod. 1983. 9:137–142.
15. Huang TY, Gulabivala K, Ng YL. A bio-molecular film ex-vivo model to evaluate the influence of canal dimensions and irrigation variables on the efficacy of irrigation. Int Endod J. 2008. 41:60–71.
16. Falk KW, Sedgley CM. The influence of preparation size on the mechanical efficacy of root canal irrigation in vitro. J Endod. 2005. 31:742–745.
17. Albrecht LJ, Baumgartner JC, Marshall JG. Evaluation of apical debris removal using various sizes and tapers of ProFile GT files. J Endod. 2004. 30:425–428.
18. Tay FR, Gu LS, Schoeffel GJ, Wimmer C, Susin L, Zhang K, Arun SN, Kim J, Looney SW, Pashley DH. Effect of vapor lock on root canal debridement by using a side-vented needle for positive-pressure irrigant delivery. J Endod. 2010. 36:745–750.
19. McGill S, Gulabivala K, Mordan N, Ng YL. The efficacy of dynamic irrigation using a commercially available system (RinsEndo) determined by removal of a collagen 'bio-molecular film' from an ex vivo model. Int Endod J. 2008. 41:602–608.
20. Tronstad L, Barnett F, Schwartzben L, Frasca P. Effectiveness and safety of a sonic vibratory endodontic instrument. Endod Dent Traumatol. 1985. 1:69–76.
21. Ruddle CJ. Endodontic disinfection: tsunami irrigation. Endo Prac. 2008. 11:7–16.
22. Rödig T, Döllmann S, Konietschke F, Drebenstedt S, Hu¨lsmann M. Effectiveness of different irrigant agitation techniques on debris and smear layer removal in curved root canals: a scanning electron microscopy study. J Endod. 2010. 36:1983–1987.
23. Huffaker SK, Safavi K, Spangberg LS, Kaufman B. Influence of a passive sonic irrigation system on the elimination of bacteria from root canal systems: a clinical study. J Endod. 2010. 36:1315–1318.
24. Uroz-Torres D, Gonzàlez-Rodríguez MP, Ferrer-Luque CM. Effectiveness of the EndoActivator System in removing the smear layer after root canal instrumentation. J Endod. 2010. 36:308–311.
25. Sabins RA, Johnson JD, Hellstein JW. A comparison of the cleaning efficacy of short-term sonic and ultrasonic passive irrigation after hand instrumentation in molar root canals. J Endod. 2003. 29:674–678.
26. Stamos DE, Sadeghi EM, Haasch GC, Gerstein H. An in vitro comparison study to quantitate the debridement ability of hand, sonic, and ultrasonic instrumentation. J Endod. 1987. 13:434–440.
27. Jensen SA, Walker TL, Hutter JW, Nicoll BK. Comparison of the cleaning efficacy of passive sonic activation and passive ultrasonic activation after hand instrumentation in molar root canals. J Endod. 1999. 25:735–738.
28. Richman MJ. The use of ultrasonics in root canal therapy and root resection. J Dent Med. 1957. 12:12–18.
29. Martin H, Cunningham WT, Norris JP, Cotton WR. Ultrasonic versus hand filing of dentin: a quantitative study. Oral Surg Oral Med Oral Pathol. 1980. 49:79–81.
30. Ahmad M, Pitt Ford TR, Crum LA. Ultrasonic debridement of root canals: an insight into the mechanisms involved. J Endod. 1987. 13:93–101.
31. Reynolds MA, Madison S, Walton RE, Krell KV, Rittman BR. An in vitro histological comparison of the step-back, sonic, and ultrasonic instrumentation techniques in small, curved root canals. J Endod. 1987. 13:307–314.
32. Walker TL, del Rio CE. Histological evaluation of ultrasonic and sonic instrumentation of curved root canals. J Endod. 1989. 15:49–59.
33. Gu LS, Kim JR, Ling J, Choi KK, Pashley DH, Tay FR. Review of contemporary irrigant agitation techniques and devices. J Endod. 2009. 35:791–804.
34. Walker TL, del Rio CE. Histological evaluation of ultrasonic debridement comparing sodium hypochlorite and water. J Endod. 1991. 17:66–71.
35. Lee SJ, Wu MK, Wesselink PR. The efficacy of ultrasonic irrigation to remove artificially placed dentine debris from different-sized simulated plastic root canals. Int Endod J. 2004. 37:607–612.
36. Sjögren U, Sundqvist G. Bacteriologic evaluation of ultrasonic root canal instrumentation. Oral Surg Oral Med Oral Pathol. 1987. 63:366–370.
37. Ahmad M. Effect of ultrasonic instrumentation on Bacteroides intermedius. Endod Dent Traumatol. 1989. 5:83–86.
38. DeNunzio MS, Hicks ML, Pelleu GB Jr, Kingman A, Sauber JJ. Bacteriological comparison of ultrasonic and hand instrumentation of root canals in dogs. J Endod. 1989. 15:290–293.
39. Siqueira JF Jr, Machado AG, Silveira RM, Lopes HP, de Uzeda M. Evaluation of the effectiveness of sodium hypochlorite used with three irrigation methods in the elimination of Enterococcus faecalis from the root canal, in vitro. Int Endod J. 1997. 30:279–282.
40. Weber CD, McClanahan SB, Miller GA, Diener-West M, Johnson JD. The effect of passive ultrasonic activation of 2% chlorhexidine or 5.25% sodium hypochlorite irrigant on residual antimicrobial activity in root canals. J Endod. 2003. 29:562–564.
41. Cameron JA. The synergistic relationship between ultrasound and sodium hypochlorite: a scanning electron microscope evaluation. J Endod. 1987. 13:541–545.
42. Alaçam T. Scanning electron microscope study comparing the efficacy of endodontic irrigating systems. Int Endod J. 1987. 20:287–294.
43. Huque J, Kota K, Yamaga M, Iwaku M, Hoshino E. Bacterial eradication from root dentine by ultrasonic irrigation with sodium hypochlorite. Int Endod J. 1998. 31:242–250.
44. Cheung GS, Stock CJ. In vitro cleaning ability of root canal irrigants with and without endosonics. Int Endod J. 1993. 26:334–343.
45. Abbott PV, Heijkoop PS, Cardaci SC, Hume WR, Heithersay GS. An SEM study of the effects of different irrigation sequences and ultrasonics. Int Endod J. 1991. 24:308–316.
46. van der Sluis L, Wu MK, Wesselink P. Comparison of 2 flushing methods used during passive ultrasonic irrigation of the root canal. Quintessence Int. 2009. 40:875–879.
47. Jiang LM, Verhaagen B, Versluis M, Zangrillo C, Cuckovic D, van der Sluis LW. An evaluation of the effect of pulsed ultrasound on the cleaning efficacy of passive ultrasonic irrigation. J Endod. 2010. 36:1887–1891.
48. Ruddle CJ. Microbrush for endodontic use. 2001. Washington DC: United States Patent;179. 617.
49. Weise M, Roggendorf MJ, Ebert J, Petschelt A, Frankenberger R. Four methods for cleaning simulated lateral extensions of curved root canals: a SEM evaluation. Int Endod J. 2007. 40:991–992.
50. Garip Y, Sazak H, Gunday M, Hatipoglu S. Evaluation of smear layer removal after use of a canal brush: an SEM study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010. 110:e62–e66.
51. Lee SY, Son WJ, Lee WC, Kum KY, Bae KS, Baek SH. In vitro evaluation of cleaning efficacy of various irrigation methods in mandibular molars. J Korean Acad Conserv Dent. 2009. 34:215–222.
52. Hauser V, Braun A, Frentzen M. Penetration depth of a dye marker into dentine using a novel hydrodynamic system (RinsEndo). Int Endod J. 2007. 40:644–652.
53. Nielsen BA, Craig Baumgartner J. Comparison of the EndoVac system to needle irrigation of root canals. J Endod. 2007. 33:611–615.
54. Siu C, Baumgartner JC. Comparison of the debridement efficacy of the EndoVac irrigation system and conventional needle root canal irrigation in vivo. J Endod. 2010. 36:1782–1785.
55. Miller TA, Baumgartner JC. Comparison of the antimicrobial efficacy of irrigation using the EndoVac to endodontic needle delivery. J Endod. 2010. 36:509–511.
56. Desai P, Himel V. Comparative safety of various intracanal irrigation systems. J Endod. 2009. 35:545–549.
57. De Moor RJ, Meire M, Goharkhay K, Moritz A, Vanobbergen J. Efficacy of ultrasonic versus laser-activated irrigation to remove artificially placed dentin debris plugs. J Endod. 2010. 36:1580–1583.
58. Hmud R, Kahler WA, George R, Walsh LJ. Cavitational effects in aqueous endodontic irrigants generated by near-infrared lasers. J Endod. 2010. 36:275–278.
59. de Groot SD, Verhaagen B, Versluis M, Wu MK, Wesselink PR, van der Sluis LW. Laser-activated irrigation within root canals: cleaning efficacy and flow visualization. Int Endod J. 2009. 42:1077–1083.
60. George R, Walsh LJ. Apical extrusion of root canal irrigants when using Er:YAG and Er,Cr:YSGG lasers with optical fibers: an in vitro dye study. J Endod. 2008. 34:706–708.
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