Comparison of the effectiveness of different ırrigation activation methods on biofilm removal in lateral canals – an ın vitro study
DOI:
https://doi.org/10.2340/aos.v84.43737Keywords:
Biofilm mimicking, EndoActivator, hydrogel, self-adjusting file, ultrasonic systemAbstract
Objectives: Activation of sodium hypochlorite (NaOCl) to remove biofilm from lateral canal is important for the success of endodontic treatment. This study aimed to compare the biofilm dissolving capacity of different irrigation techniques in resin blocks with two lateral canals manufactured with 3D printers.
Materials and methods: Biofilm-mimicking hydrogel was placed in the upper and lower lateral canals of 75 resin blocks. Main canals of the blocks were irrigated with 5% NaOCl. Then, the blocks were randomly divided into five groups: sonic activation (SA), passive ultrasonic irrigation (PUI), intracanal heating (ICH), self-adjusting file (SAF) and control. The amount of hydrogel removed was measured by weighing the blocks before and after the treatment and further visually scored. Data were analyzed using Kruskall Wallis H, Wilcoxon, Tukey Post-hoc HSD (Honestly Significant Difference) and one-way ANOVA tests.
Results: The SAF group showed the highest hydrogel scores compared to other groups (p < 0.05). The hydrogel dissolution capacity of the SA group was lower compared to SAF, PUI and ICH techniques (p < 0.05). Based on visual scoring, SAF group was superior to other activation methods (p < 0.05) which are similar to each other (p > 0.05) in both upper and lower lateral canals.
Conclusion: All activation methods were superior than the control group. The SAF system demonstrated superior hydrogel dissolving ability, while SA, PUI, and ICH groups showed similar effectiveness.
Downloads
References
Sjögren U, Fıgdor D, Persson S, Sundqvıst G. Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis. Int Endod J. 1997;30(5):297–306. https://doi.org/10.1046/j.1365-2591.1997.00092.x DOI: https://doi.org/10.1111/j.1365-2591.1997.tb00714.x
Nair PNR, Henry S, Cano V, Vera J. Microbial status of apical root canal system of human mandibular first molars with primary apical periodontitis after ‘one-visit’ endodontic treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol. 2005;99(2):231–252. https://doi.org/10.1016/j.tripleo.2004.10.005 DOI: https://doi.org/10.1016/j.tripleo.2004.10.005
Vera J, Arias A, Romero M. Dynamic movement of ıntracanal gas bubbles during cleaning and shaping procedures: the effect of maintain-ing apical patency on their presence in the middle and cervical thirds of human root canals – an ın vivo study. J Endod. 2012;38(2):200–203. https://doi.org/10.1016/j.joen.2011.10.026 DOI: https://doi.org/10.1016/j.joen.2011.10.026
Gu L, Kim JR, Ling J, Choi KK, Pashley DH, Tay FR. Review of contemporary ırrigant agitation techniques and devices. J Endod. 2009;35(6):791–804. https://doi.org/10.1016/j.joen.2009.03.010 DOI: https://doi.org/10.1016/j.joen.2009.03.010
de Paz LC. Redefining the persistent ınfection in root canals: possible role of biofilm communities. J Endod. 2007;33(6):652–662. https://doi.org/10.1016/j.joen.2006.11.004 DOI: https://doi.org/10.1016/j.joen.2006.11.004
Stewart PS, Franklin MJ. Physiological heterogeneity in biofilms. Nat Rev Microbiol. 2008;6(3):199–210. https://doi.org/10.1038/nrmicro1838 DOI: https://doi.org/10.1038/nrmicro1838
Ceri H, Olson ME, Stremick C, Read RR, Morck D, Buret A. The calgary biofilm device: new technology for rapid determination of antibiotic susceptibilities of bacterial biofilms. J Clin Microbiol. 1999;37(6):1771–1776. https://doi.org/10.1128/JCM.37.6.1771-1776.1999 DOI: https://doi.org/10.1128/JCM.37.6.1771-1776.1999
Ricucci D, Siqueira JF. Biofilms and apical periodontitis: study of prevalence and association with clinical and histopathologic findings. J Endod. 2010;36(8):1277–1288. https://doi.org/10.1016/j.joen.2010.04.007 DOI: https://doi.org/10.1016/j.joen.2010.04.007
Haapasalo M, Endal U, Zandi H, Coil JM. Eradication of endodontic infection by instrumentation and irrigation solutions. Endod Topics. 2005;10(1):77–102. https://doi.org/10.1111/j.1601-1546.2005.00135.x DOI: https://doi.org/10.1111/j.1601-1546.2005.00135.x
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(4):137–142. https://doi.org/10.1016/S0099-2399(83)80032-6 DOI: https://doi.org/10.1016/S0099-2399(83)80032-6
Zehnder M. Root canal ırrigants. J Endod. 2006;32(5):389–398. https://doi.org/10.1016/j.joen.2005.09.014 DOI: https://doi.org/10.1016/j.joen.2005.09.014
Fidan ME, Erdemir A. Effect of different irrigation activation techniques on irrigation penetration into the simulated lateral canals. Odon-tology.2023;111(1):132–141.https://doi.org/10.1007/s10266-022-00729-1 DOI: https://doi.org/10.1007/s10266-022-00729-1
Bürklein S, Abdi I, Schäfer E, Appel C, Donnermeyer D. Influence of pulse energy, tip design and insertion depth during Er: YAG ‐activated irrigation on cleaning efficacy in simulated severely curved complex root canal systems in vitro. Int Endod J. 2024;57(1):87–99. https://doi.org/10.1111/iej.13992 DOI: https://doi.org/10.1111/iej.13992
Hoshihara Y, Watanabe S, Kouno A, Yao K, Okiji T. Effect of tip insertion depth and irradiation parameters on the efficacy of cleaning calci-um hydroxide from simulated lateral canals using Er:YAG laser- or ultrasonic-activated irrigation. J Dent Sci. 2021;16(2):654–660. https://doi.org/10.1016/j.jds.2020.10.004 DOI: https://doi.org/10.1016/j.jds.2020.10.004
Lee S‐J, Wu M‐K, Wesselink PR. The effectiveness of syringe irrigation and ultrasonics to remove debris from simulated irregularities with-in prepared root canal walls. Int Endod J. 2004;37(10):672–678. https://doi.org/10.1111/j.1365-2591.2004.00848.x DOI: https://doi.org/10.1111/j.1365-2591.2004.00848.x
Weller RN, Brady JM, Bernier WE. Efficacy of ultrasonic cleaning. J Endod. 1980;6(9):740–743. https://doi.org/10.1016/S0099-2399(80)80185-3 DOI: https://doi.org/10.1016/S0099-2399(80)80185-3
Ahmad M, Pitt Ford TR, Crum LA. Ultrasonic debridement of root canals: acoustic streaming and its possible role. J Endod. 1987;13(10):490–499. https://doi.org/10.1016/S0099-2399(87)80016-X DOI: https://doi.org/10.1016/S0099-2399(87)80016-X
Urban K, Donnermeyer D, Schäfer E, Bürklein S. Canal cleanliness using different irrigation activation systems: a SEM evaluation. Clin Oral Investig. 2017;21(9):2681–2687. https://doi.org/10.1007/s00784-017-2070-x DOI: https://doi.org/10.1007/s00784-017-2070-x
Ruddle CJ. Hydrodynamic disinfection: tsunami endodontics. Dent Today. 2007;26(5):110, 112, 114–117.
Metzger Z, Teperovich E, Cohen R, Zary R, Paqué F, Hülsmann M. The Self-adjusting File (SAF). Part 3: removal of debris and smear layer – a scanning electron microscope study. J Endod. 2010;36(4):697–702. https://doi.org/10.1016/j.joen.2009.12.037 DOI: https://doi.org/10.1016/j.joen.2009.12.037
Metzger Z, Teperovich E, Zary R, Cohen R, Hof R. The Self-adjusting File (SAF). Part 1: respecting the root canal anatomy – a new concept of endodontic files and ıts ımplementation. J Endod. 2010;36(4):679–690. https://doi.org/10.1016/j.joen.2009.12.036 DOI: https://doi.org/10.1016/j.joen.2009.12.036
Siqueira JF, Alves FRF, Almeida BM, Machado de Oliveira JC, Rôças IN. Ability of chemomechanical preparation with either rotary ınstru-ments or self-adjusting file to disinfect oval-shaped root canals. J Endod. 2010;36(11):1860–1865. https://doi.org/10.1016/j.joen.2010.08.001 DOI: https://doi.org/10.1016/j.joen.2010.08.001
Woodmansey KF. Intracanal heating of sodium hypochlorite solution: an improved endodontic irrigation technique. Dent Today. 2005;24(10):114, 116.
Stojicic S, Zivkovic S, Qian W, Zhang H, Haapasalo M. Tissue dissolution by sodium hypochlorite: effect of concentration, temperature, agitation, and surfactant. J Endod. 2010;36(9):1558–1562. https://doi.org/10.1016/j.joen.2010.06.021 DOI: https://doi.org/10.1016/j.joen.2010.06.021
D.K. Rechenberg, T. Thurnheer & M. Zehnder. Wladimir Adlivankine European Society of Endodontology Research Prize. Int Endod J. 2011;44(12):1176–1221. https://doi.org/10.1111/j.1365-2591.2011.01914.x DOI: https://doi.org/10.1111/j.1365-2591.2011.01914.x
Papageorgopoulou L. Pilot studies to develop an artificial tooth model with standardized apical anatomies for the evaluation of the effica-cy of root canal irrigation. London. Unpublished master’s thesis. Eastman Dental Institute 2013
Macedo RG, et al. A novel methodology providing insights into removal of biofilm‐mimicking hydrogel from lateral morphological features of the root canal during irrigation procedures. Int Endod J. 2014;47(11):1040–1051. https://doi.org/10.1111/iej.12246 DOI: https://doi.org/10.1111/iej.12246
Fuat Ahmetoglu AKNS. Effectiveness of the severel ırrigation techniques for removal of calcium hydroxide-based ıntracanal medication from an artificial standardized groove in the apical root canal. Marmara Dental J. 2013;1(2): 53 - 56
Retsas A, Boutsioukis C. An update on ultrasonic irrigantactivation. ENDO-Endodontic Practice Today, 2019; pp. 115–129.
Jaiswal S, Gupta S, Nikhil V, Bhadoria A, Raj S. Effect of intracanal and extracanal heating on pulp dissolution property of continuous che-lation irrigant. J Conserv Dent. 2021;24(6):544. https://doi.org/10.4103/jcd.jcd_230_21 DOI: https://doi.org/10.4103/jcd.jcd_230_21
Wolfaardt GM, Lawrence JR, Robarts RD, Caldwell SJ, Caldwell DE. Multicellular organization in a degradative biofilm community. Appl Environ Microbiol. 1994;60(2):434–446. https://doi.org/10.1128/aem.60.2.434-446.1994 DOI: https://doi.org/10.1128/aem.60.2.434-446.1994
Jiang Z, Diggle B, Tan ML, Viktorova J, Bennett CW, Connal LA. Extrusion 3D Printing of polymeric materials with advanced properties. Adv Sci. 2020;7(17): 1-32. https://doi.org/10.1002/advs.202001379 DOI: https://doi.org/10.1002/advs.202001379
Bhuva B, Patel S, Wilson R, Niazi S, Beighton D, Mannocci F. The effectiveness of passive ultrasonic irrigation on intraradicular Enterococ-cus faecalis biofilms in extracted single‐rooted human teeth. Int Endod J. 2010;43(3):241–250. https://doi.org/10.1111/j.1365-2591.2009.01672.x DOI: https://doi.org/10.1111/j.1365-2591.2009.01672.x
Patricia R R Brito, Leticia C Souza, Julio C Machado de Oliveira, Flavio R F Alves, Gustavo De-Deus, Helio P Lopes, Jose F Siqueira Jr. Com-parison of the effectiveness of three ırrigation techniques in reducing ıntracanal enterococcus faecalis populations: an ın vitro study. J Endod. 2009;35(10):1422–1427. https://doi.org/10.1016/j.joen.2009.07.001 DOI: https://doi.org/10.1016/j.joen.2009.07.001
Al‐Jadaa A, Paqué F, Attin T, Zehnder M. Necrotic pulp tissue dissolution by passive ultrasonic irrigation in simulated accessory canals: impact of canal location and angulation. Int Endod J. 2009;42(1):59–65. https://doi.org/10.1111/j.1365-2591.2008.01497.x DOI: https://doi.org/10.1111/j.1365-2591.2008.01497.x
de Gregorio C, Estevez R, Cisneros R, Paranjpe A, Cohenca N. Efficacy of different ırrigation and activation systems on the penetration of sodium hypochlorite into simulated lateral canals and up to working length: an ın vitro study. J Endod. 2010;36(7):1216–1221. https://doi.org/10.1016/j.joen.2010.02.019 DOI: https://doi.org/10.1016/j.joen.2010.02.019
C de Gregorio, A Paranipe, A Garcia, N Navarrete, R Estevez, E O Espulugues, N Cohenca. Efficacy of irrigation systems on penetration of sodium hypochlorite to working length and to simulated uninstrumented areas in oval shaped root canals. Int Endod J. 2012;45(5):475–481. https://doi.org/10.1111/j.1365-2591.2011.01999.x DOI: https://doi.org/10.1111/j.1365-2591.2011.01999.x
Joyce Tiong T, Price GJ. Ultrasound promoted reaction of Rhodamine B with sodium hypochlorite using sonochemical and dental ultrasonic instruments. Ultrason Sonochem. 2012;19(2):358–364. https://doi.org/10.1016/j.ultsonch.2011.06.022 DOI: https://doi.org/10.1016/j.ultsonch.2011.06.022
J P Robinson, R G Macedo, B Verhaagen, M Versluis, P R Couper, L W M van der Sluis, A D Walmsley. Cleaning lateral morphological fea-tures of the root canal: the role of streaming and cavitation. Int Endod J. 2018;51(S1): 55-64. https://doi.org/10.1111/iej.12804 DOI: https://doi.org/10.1111/iej.12804
Bai R, Yang J, Suo Z. Fatigue of hydrogels. Eur J Mechanics – A/Solids. 2019;74:337–370. https://doi.org/10.1016/j.euromechsol.2018.12.001 DOI: https://doi.org/10.1016/j.euromechsol.2018.12.001
Retsas A, Dijkstra RJB, van der Sluis L, Boutsioukis C. The effect of the ultrasonic ırrigant activation protocol on the removal of a dual-species biofilm from artificial lateral canals. J Endod. 2022;48(6):775–780. https://doi.org/10.1016/j.joen.2022.03.005 DOI: https://doi.org/10.1016/j.joen.2022.03.005
Verhaagen B, Boutsioukis C, Heijnen GL, van der Sluis LWM, Versluis M. Role of the confinement of a root canal on jet impingement during endodontic irrigation. Exp Fluids. 2012;53(6):1841–1853. https://doi.org/10.1007/s00348-012-1395-0 DOI: https://doi.org/10.1007/s00348-012-1395-0
Mohmmed SA, Vianna ME, Penny MR, Hilton ST, Mordan NJ, Knowles JC. Investigations into in situ Enterococcus faecalis biofilm removal by passive and active sodium hypochlorite irrigation delivered into the lateral canal of a simulated root canal model. Int Endod J. 2018;51(6):649–662. https://doi.org/10.1111/iej.12880 DOI: https://doi.org/10.1111/iej.12880
Renslow RS, Majors PD, McLean JS, Fredrickson JK, Ahmed B, Beyenal H. In situ effective diffusion coefficient profiles in live biofilms using pulsed‐field gradient nuclear magnetic resonance. Biotechnol Bioeng. 2010;106(6):928–937. https://doi.org/10.1002/bit.22755 DOI: https://doi.org/10.1002/bit.22755
Moorer WR, Wesselınk PR. Factors promoting the tissue dissolving capability of sodium hypochlorite. Int Endod J. 1982;15(4):187–196. https://doi.org/10.1111/j.1365-2591.1982.tb01277.x DOI: https://doi.org/10.1111/j.1365-2591.1982.tb01277.x
Jiang L-M, Verhaagen B, Versluis M, van der Sluis LWM. Evaluation of a sonic device designed to activate ırrigant in the root canal. J Endod. 2010;36(1):143–146. https://doi.org/10.1016/j.joen.2009.06.009 DOI: https://doi.org/10.1016/j.joen.2009.06.009
Dammaschke T, Witt M, Ott K, Schäfer E. Scanning electron microscopic investigation of incidence, location, and size of accessory foramina in primary and permanent molars. Quintessence Int. 2004;35(9):699–705.
Abou-Rass M, Oglesby SW. The effects of temperature, concentration, and tissue type on the solvent ability of sodium hypochlorite. J Endod. 1981;7(8):376–377. https://doi.org/10.1016/S0099-2399(81)80059-3 DOI: https://doi.org/10.1016/S0099-2399(81)80059-3
Alfredo Iandolo, Massimo Amato, Alberto Dagna, Claudio Poggio, Dina Abdellatif, Vittorio Franco, Giuseppe Panteleo. Intracanal heating of sodium hypochlorite: scanning electron microscope evaluation of root canal walls. J Conserv Dent. 2018;21(5):569. https://doi.org/10.4103/JCD.JCD_245_18 DOI: https://doi.org/10.4103/JCD.JCD_245_18
Boutsioukis C, Arias‐Moliz MT. Present status and future directions – irrigants and irrigation methods. Int Endod J. 2022;55(S3):588–612. https://doi.org/10.1111/iej.13739 DOI: https://doi.org/10.1111/iej.13739
Meire MA, Havelaerts S, De Moor RJ. Influence of lasing parameters on the cleaning efficacy of laser-activated irrigation with pulsed erbium lasers. Lasers Med Sci. 2016;31(4):653–658. https://doi.org/10.1007/s10103-016-1892-0 DOI: https://doi.org/10.1007/s10103-016-1892-0
De Meyer S, Meire MA, Coenye T, De Moor RJG. Effect of laser‐activated irrigation on biofilms in artificial root canals. Int Endod J. 2017;50(5):472–479. https://doi.org/10.1111/iej.12643 DOI: https://doi.org/10.1111/iej.12643
Melchels FPW, Feijen J, Grijpma DW. A review on stereolithography and its applications in biomedical engineering. Biomaterials. 2010;31(24):6121–6130. https://doi.org/10.1016/j.biomaterials.2010.04.050 DOI: https://doi.org/10.1016/j.biomaterials.2010.04.050
Layton G, Wu W-I, Selvaganapathy PR, Friedman S, Kishen A. Fluid dynamics and biofilm removal generated by syringe-delivered and 2 ultrasonic-assisted ırrigation methods: a novel experimental approach. J Endod. 2015;41(6):884–889. https://doi.org/10.1016/j.joen.2015.01.027 DOI: https://doi.org/10.1016/j.joen.2015.01.027
Published
Issue
Section
License
Copyright (c) 2025 Uğur Aydın, Bilal Turan, Emre Çulha, Muazzez Naz Baştürk Özer, Melih Özdemir
This work is licensed under a Creative Commons Attribution 4.0 International License.
Acta Odontologica Scandinavica publishes original research papers as well as critical reviews relevant to the diagnosis, epidemiology, health service, prevention, aetiology, pathogenesis, pathology, physiology, microbiology, development and treatment of diseases affecting tissues of the oral cavity and associated structures including papers on cause and effect or explanatory/associative relationships for experimental or observational studies.
