Spectrophotometric Determination of Irrigant Extrusion Using Passive Ultrasonic Irrigation, EndoActivator or Conventional Irrigation.
Carolina Rodriguez DDS, Walter Bowles DDS MS PhD, Scott McClanahan DDS MS
Introduction: Sodium hypochorite (NaOCl) is the irrigant most often used in endodontics due to its antimicrobial activity and tissue dissolution ability. Irrigation is critical to endodontic success and several new methods have been developed [Passive Ultrasonic Irrigation (PUI); EndoActivator (EA)] to improve irrigation efficacy. Using a novel spectrophotometric method, this study evaluated NaOCL irrigant extrusion during endodontic treatment.
Methods: 114 single rooted extracted teeth were decoronated to leave 15 mm of root length for each tooth. Cleaning and shaping of teeth was completed using hand and rotary instrumentation (ProTaper[Dentsply]) to apical file size #40/0.04 taper. Root ends were sealed (not apex) and placed into a microcentrifuge tube with the coronal aspect sealed (Imprint [3M] and Revolution [Kerr]) to prevent inadvertent NaOCl leakage anywhere but from the canal. 54 straight roots (0° up to 20° curvature; n=18/group) and 60 curved roots (>20° curvature; n=20/group) were included. Teeth were irrigated with 5.25% NaOCl by one of three methods: conventional syringe irrigation; passive ultrasonic irrigation (PUI), or Endoactivator (EA) irrigation. Extrusion of NaOCl was evaluated using pH sensitive dye and a spectrophotometer (Synegy HT [BioTek]). Standard curves were prepared with known amounts of irrigant to quantify amounts in unknown samples.
Results: Irrigant extrusion was minimal with all methods, with most teeth showing no sodium hypochlorite extrusion (conventional 61.1%, PUI 72%, EA 78%) or minimal sodium hypochlorite extrusion (<1µl)conventional 16.7%, PUI 16.6%, EA 11%. Minor irrigant extrusion (1-3µl) occurred in 11% of teeth in all three irrigant methods of the straight root sample. One tooth in the PUI group extruded 41µl of irrigant due to an apical anomaly and was replaced to maintain n=18/group. Curved root sample showed minimal irrigant extrusion with all methods, with most teeth showing no sodium hypochlorite extrusion (conventional 65%, PUI 75%, EA 75%) or minimal sodium hypochlorite extrusion (<1µl) conventional 25%, PUI 15%, EA 5%. Minor irrigant extrusion (1-3µl) occurred in 10% of teeth in all groups of the curved root sample. Two teeth in the EA group extruded 3-10 µl of sodium hypochlorite.
Conclusion: Using the PUI or EA tip to within 1 mm of the working length appears to be fairly safe, yet apical anatomy can vary, allowing extrusion of irrigant. The spectrophotometric method used here is very sensitive and can detect <1µl of sodium hypochlorite extrusion, while providing quantification of irrigant levels extruded. Use of sodium hypochlorite has been cautioned in cases of an open apex, perforation and vertical root factures, but apical anatomy should also be evaluated.
University of Minnesota M.S. thesis. August 2013. Major: Dentistry. advisor: Dr. Scott B. McClanahan. 1 computer file (PDF); v, 38 pages.
Spectrophotometric determination of irrigant extrusion using passive ultrasonic irragation, endoactivator or conventional irrigation.
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