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VOLUME 22 , ISSUE 3 ( March, 2021 ) > List of Articles


Efficacy of Different Endodontic Irrigant Activation Techniques on Debris Removal from the Mesial Root Canal System of Mandibular Molars

Sara Alsubait, Yara Al-Shibani, Nouf Al-Shehri, Norah AlNowaiser, Tagreed Alojaymi, Nassr Almuflehi, Mazen Alkahtany

Keywords : Debris removal, Isthmus, Root canal irrigation, Sonically activated irrigation, Ultrasonically activated irrigation, XP-endo Finisher

Citation Information : Alsubait S, Al-Shibani Y, Al-Shehri N, AlNowaiser N, Alojaymi T, Almuflehi N, Alkahtany M. Efficacy of Different Endodontic Irrigant Activation Techniques on Debris Removal from the Mesial Root Canal System of Mandibular Molars. J Contemp Dent Pract 2021; 22 (3):231-236.

DOI: 10.5005/jp-journals-10024-3054

License: CC BY-NC 4.0

Published Online: 27-01-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Aim and objective: This study was conducted to compare debris removal from the mesial canal system with four different irrigation techniques: sonic activation with EDDY, passive ultrasonic irrigation (PUI), mechanical activation with the XP-endo Finisher (XPF), and manual dynamic irrigation (MDI) with gutta-percha. Materials and methods: Fifty-six extracted mandibular molars with isthmus in the apical 5 mm in mesial roots were sectioned horizontally at 3 mm and 5 mm from the apex. The sections were reassembled, and the mesial canals were prepared chemomecahanically. Specimens were allocated randomly into four groups according to the final irrigation technique. Standardized images of the coronal aspect of cross sections were obtained using a digital stereomicroscope before and after final irrigation protocols to calculate the percentage of debris elimination from the canal system after final irrigation. Results: The use of EDDY, PUI, and XPF exhibited significant reductions in debris compared with MDI at 5 mm (p <0.00) and at 3 mm (p <0.00). Furthermore, no significant difference was noted among EDDY, PUI, and XPF. For intragroup analysis, no statistically significant difference in the percentage of debris elimination was noted between 3 mm and 5 mm in all four groups. Conclusion: All groups showed a reduction in debris after the final irrigation protocol. However, the use of EDDY, PUI, and XPF after cleaning and shaping yielded a significant reduction in debris compared with MDI. Clinical significance: The use of PUI, XPF, and EDDY as an adjunctive irrigation step presented similar results in improving canal cleanliness, which is hypothesized to affect the treatment outcome.

  1. Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surg Oral Med Oral Pathol 1984;58(5):589–599. DOI: 10.1016/0030-4220(84)90085-9.
  2. Zuolo ML, Zaia AA, Belladonna FG, et al. Micro-CT assessment of the shaping ability of four root canal instrumentation systems in oval-shaped canals. Int Endod J 2018;51(5):564–571. DOI: 10.1111/iej.12810.
  3. Zhao D, Shen Y, Peng B, et al. Root canal preparation of mandibular molars with 3 nickel-titanium rotary instruments: a micro-computed tomographic study. J Endod 2014;40(11):1860–1864. DOI: 10.1016/j.joen.2014.06.023.
  4. Ricucci D, Siqueira JF, Bate AL, et al. Histologic investigation of root canal-treated teeth with apical periodontitis: a retrospective study from twenty-four patients. J Endod 2009;35(4):493–502. DOI: 10.1016/j.joen.2008.12.014.
  5. Haapasalo M, Shen Y, Wang Z, et al. Irrigation in endodontics. Br Dent J 2014;216:299–303. DOI: 10.1038/sj.bdj.2014.204.
  6. Dutner J, Mines P, Anderson A. Irrigation trends among American association of endodontists members: a web-based survey. J Endod 2012;38(1):37–40. DOI: 10.1016/j.joen.2011.08.013.
  7. Jiang LM, Lak B, Eijsvogels LM, et al. Comparison of the cleaning efficacy of different final irrigation techniques. J Endod 2012;38(6):838–841. DOI: 10.1016/j.joen.2012.03.002.
  8. 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(1):60–71. DOI: 10.1111/j.1365-2591.2007.01317.x.
  9. Ahmad M, Pitt Ford TJ, Crum LA. Ultrasonic debridement of root canals: acoustic streaming and its possible role. J Endod 1987;13(10):490–499. DOI: 10.1016/s0099-2399(87)80016-x.
  10. Roy RA, Ahmad M, Crum LA. Physical mechanisms governing the hydrodynamic response of an oscillating ultrasonic file. Int Endod J 1994;27(4):197–207. DOI: 10.1111/j.1365-2591.1994.tb00254.x.
  11. Leoni GB, Versiani MA, Silva-Sousa YT, et al. Ex vivo evaluation of four final irrigation protocols on the removal of hard-tissue debris from the mesial root canal system of mandibular first molars. Int Endod J 2017;50(4):398–406. DOI: 10.1111/iej.12630.
  12. Passalidou S, Calberson F, De Bruyne M, et al. Debris removal from the mesial root canal system of mandibular molars with laser-activated irrigation. J Endod 2018;44(11):1697–1701. DOI: 10.1016/j.joen.2018.06.007.
  13. De-Deus G, Belladonna FG, Zuolo ADS, et al. Micro-CT comparison of XP-endo Finisher and passive ultrasonic irrigation as final irrigation protocols on the removal of accumulated hard-tissue debris from oval shaped-canals. Clin Oral Investig 2019;23(7):3087–3093. DOI: 10.1007/s00784-018-2729-y.
  14. 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(10):674–678. DOI: 10.1097/00004770-200310000-00016.
  15. Haupt F, Meinel M, Gunawardana A, et al. Effectiveness of different activated irrigation techniques on debris and smear layer removal from curved root canals: a SEM evaluation. Aust Endod J 2020;46(1):40–46. DOI: 10.1111/aej.12342.
  16. Linden D, Boone M, De Bruyne M, et al. Adjunctive steps for the removal of hard tissue debris from the anatomic complexities of the mesial root canal system of mandibular molars: a micro-computed tomographic study. J Endod 2020;46(10):1508–1514. DOI: 10.1016/j.joen.2020.05.009.
  17. Plotino G, Grande NM, Mercade M, et al. Efficacy of sonic and ultrasonic irrigation devices in the removal of debris from canal irregularities in artificial root canals. J Appl Oral Sci 2019;27:e20180045. DOI: 10.1590/1678-7757-2018-0045.
  18. Urban K, Donnermeyer D, Schafer E, et al. Canal cleanliness using different irrigation activation systems: a SEM evaluation. Clin Oral Investig 2017;21(9):2681–2687. DOI: 10.1007/s00784-017-2070-x.
  19. Rodig T, Koberg C, Baxter S, et al. Micro-CT evaluation of sonically and ultrasonically activated irrigation on the removal of hard-tissue debris from isthmus-containing mesial root canal systems of mandibular molars. Int Endod J 2019;52(8):1173–1181. DOI: 10.1111/iej.13100.
  20. Schneider SW. A comparison of canal preparations in straight and curved root canals. Oral Surg Oral Med Oral Pathol 1971;32(2):271–275. DOI: 10.1016/0030-4220(71)90230-1.
  21. Silva E, Belladonna FG, Zuolo AS, et al. Effectiveness of XP-endo Finisher and XP-endo Finisher R in removing root filling remnants: a micro-CT study. Int Endod J 2018;51(1):86–91. DOI: 10.1111/iej.12788.
  22. Weller RN, Niemczyk SP, Kim S. Incidence and position of the canal isthmus. Part 1. Mesiobuccal root of the maxillary first molar. J Endod 1995;21(7):380–383. DOI: 10.1016/s0099-2399(06)80975-1.
  23. Estrela C, Rabelo LE, de Souza JB, et al. Frequency of root canal isthmi in human permanent teeth determined by cone-beam computed tomography. J Endod 2015;41(9):1535–1539. DOI: 10.1016/j.joen.2015.05.016.
  24. Teixeira FB, Sano CL, Gomes BP, et al. A preliminary in vitro study of the incidence and position of the root canal isthmus in maxillary and mandibular first molars. Int Endod J 2003;36(4):276–280. DOI: 10.1046/j.1365-2591.2003.00638.x.
  25. Khademi A, Yazdizadeh M, Feizianfard M. Determination of the minimum instrumentation size for penetration of irrigants to the apical third of root canal systems. J Endod 2006;32(5):417–420. DOI: 10.1016/j.joen.2005.11.008.
  26. Paque F, Laib A, Gautschi H, Zehnder M. Hard-tissue debris accumulation analysis by high-resolution computed tomography scans. J Endod 2009;35(7):1044–1047. DOI: 10.1016/j.joen.2009.04.026.
  27. Duque JA, Duarte MA, Canali LC, et al. Comparative effectiveness of new mechanical irrigant agitating devices for debris removal from the canal and isthmus of mesial roots of mandibular molars. J Endod 2017;43(2):326–331. DOI: 10.1016/j.joen.2016.10.009.
  28. Thomas AR, Velmurugan N, Smita S, et al. Comparative evaluation of canal isthmus debridement efficacy of modified EndoVac technique with different irrigation systems. J Endod 2014;40(10):1676–1680. DOI: 10.1016/j.joen.2014.05.014.
  29. Shahravan A, Haghdoost AA, Adl A, et al. Effect of smear layer on sealing ability of canal obturation: a systematic review and meta-analysis. J Endod 2007;33(2):96–105. DOI: 10.1016/j.joen.2006.10.007.
  30. Ribeiro EM, Silva-Sousa YT, Souza-Gabriel AE, et al. Debris and smear removal in flattened root canals after use of different irrigant agitation protocols. Microsc Res Tech 2012;75(6):781–790. DOI: 10.1002/jemt.21125.
  31. Capar ID, Aydinbelge HA. Effectiveness of various irrigation activation protocols and the self-adjusting file system on smear layer and debris removal. Scanning 2014;36(6):640–647. DOI: 10.1002/sca.21171.
  32. Boutsioukis C, Tzimpoulas N. Uncontrolled removal of dentin during in vitro ultrasonic irrigant activation. J Endod 2016;42(2):289–293. DOI: 10.1016/j.joen.2015.09.017.
  33. Hristov K, Gateva N, Stanimirov P, et al. Comparative analysis of root dentin loss when using modern mechanical cleaning instruments in immature permanent teeth. Folia Med (Plovdiv) 2020;62(2):352–357. DOI: 10.3897/folmed.62.e39515.
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