Effect of Passive Ultrasonic Irrigation on Apical Extrusion of Irrigating Solution

ABSTRACT

Objectives: To determine the influence of passive ultrasonic irrigation (PUI) on apical extrusion of irrigating solution.

Methods: Twenty freshly extracted maxillary and mandibular incisors with single straight root canals were instrumented with ProTaper rotary files. During final irrigation, the root canals were filled with 2.5% sodium hypochlorite (NaOCl) solution and PUI was performed with a piezoelectronic unit. A stainless steel instrument (size 15) was inserted into the root canal and the irrigant was ultrasonically activated for one minute. This sequence was repeated three times, resultingin a total PUI time of three minutes. The volume of extruded irrigant was measured by Pipetman pipettes. The data were statistically analyzed with the Mann-Whitney U test.

Results: The mean volume of apical extruded irrigant was 2.15 �L for the PUI group and 14 �L forthe control group. The experimentalgroup extruded significantly smaller amounts of irrigant than the control group (P<.05).

Conclusions: The PUI procedure as a final irrigation was associated with less apical extrusion of the irrigating solution. (Eur J Dent 2008;2:198-203)

Key Words:

Apical extrusion - Passive - Ultrasonic - Irrigation

• REFERENCES

• 1 Hülsmann M, Hahn W. Complications during root canal irrigation-literature review and case reports. Int Endod J 2000; 33: 186-193
• 2 Zehnder M. Root canal irrigants. J Endod 2006; 32: 389-398
• 3 Zehnder M, Kosicki D, Luder H, Sener B, Waltimo T. Tissue- dissolving capacity and antibacterial effect of buffered and unbuffered hypochlorite solutions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94: 756-762
• 4 Naenni N, Thoma K, Zehnder M. Soft tissue dissolution capacity of currently used and potential endodontic irrigants. J Endod 2004; 30: 785-787
• 5 Sirtes G, Waltimo T, Schaetzle M, Zehnder M. The effects of temperature on sodium hypochlorite short-term stability, pulp dissolution capacity, and antimicrobial efficacy. J Endod 2005; 31: 669-671
• 6 Gatot A, Arbelle J, Leiberman A, Yanai-Inbar I. Effects of sodium hypochlorite on soft tissues after its inadvertent injection beyond the root apex. J Endod 1991; 17: 573-574
• 7 Gernhardt CR, Eppendorf K, Kozlowski A, Brandt M. Toxicity of concentrated sodium hypochlorite used as an endodontic irrigant. Int Endod J 2004; 37: 272-280
• 8 Witton R, Henthorn K, Ethunandan M, Harmer S, Brennan PA. Neurological complications following extrusion of sodium hypochlorite solution during root canal treatment. Int Endod J 2005; 38: 843-848
• 9 Bowden JR, Ethunandan M, Brennan PA. Life-threatening airway obstruction secondary to hypochlorite extrusion during root canal treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101: 402-404
• 10 Richman MJ. The use of ultrasonics in root canal therapy and root resection. J Dental Med 1957; 12: 12-18
• 11 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
• 12 Kielt LW, Montgomery S. The effect of endosonic instrumentation in simulated curved root canals. J Endod 1987; 13: 215-219
• 13 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
• 14 Yamaguchi M, Matsumori M, Ishikawa H, Sakurai T, Nakamura H, Naitoh M, Shiojima M, Kikuchi A. The use of ultrasonic instrumentation in the cleansing and enlargement of the root canal. Oral Surg Oral Med Oral Pathol 1988; 65: 349-353
• 15 Cymerman JJ, Jerome LA, Moodnik RM. A scanning electron microscope study comparing the efficacy of hand instrumentation with ultrasonic instrumentation of the root canal. J Endod 1983; 9: 327-331
• 16 Cunningham WT, Martin H, Pelleu Jr GB, Stoops DE. A comparison of antimicrobial effectiveness of endosonic and hand root canal therapy. Oral Surg Oral Med Oral Pathol 1982; 54: 238-241
• 17 Cunningham WT, Martin H, Forrest WR. Evaluation of root canal débridement by the endosonic ultrasonic synergistic system. Oral Surg Oral Med Oral Pathol 1982; 53: 401-404
• 18 Cunningham WT, Martin H. A scanning electron microscope evaluation of root canal debridement with the endosonic ultrasonic synergistic system. Oral Surg Oral Med Oral Pathol 1982; 53: 527-531
• 19 Loushine RJ, Weller RN, Hartwell GR. Stereomicroscopic evaluation of canal shape following hand, sonic, and ultrasonic instrumentation. J Endod 1989; 15: 417-421
• 20 Ahmad M, Pitt Ford TR, Crum LA. Ultrasonic debridement of root canals: an insight into the mechanisms involved. J Endod 1987; 13: 93-101
• 21 Ahmad M, Pitt Ford TJ, Crum LA. Ultrasonic debridement of root canals: acoustic streaming and its possible role. J Endod 1987; 13: 490-499
• 22 van der Sluis LWM, Wu MK, Wesselink PR. A comparison between a smooth wire and a K-file in removing artificially placed dentine debris from root canals in resin blocks during ultrasonic irrigation. Int Endod J 2005; 38: 593-596
• 23 Weller RN, Brady JM, Bernier WE. Efficacy of ultrasonic cleaning. J Endod 1980; 6: 740-743
• 24 Himel VT, McSpadden J, Goodis HE. Instrument, materials and devices. In: Cohen S, Hargreves K, Keiser K. Pathways of the Pulp, 9th ed.. St. Louis: Mosby; 2006: pp. 233-289
• 25 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
• 26 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
• 27 Lee SJ, Wu MK, Wesselink PR. The effectiveness of syringe irrigation and ultrasonics to remove debris from simulated irregularities within prepared root canal walls. Int Endod J 2004; 37: 672-678
• 28 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
• 29 Plotino G, Pameijer CH, Grande NM, Somma F. Ultrasonics in endodontics: a review of the literature. J Endod 2007; 33: 81-95
• 30 Munley PJ, Goodell GG. Comparison of passive ultrasonic debridement between fluted and nonfluted instruments in root canals. J Endod 2007; 33: 578-580
• 31 Spoleti P, Siragusa M, Spoleti MJ. Bacteriological evaluation of passive ultrasonic activation. J Endod 2003; 29: 12-14
• 32 Carver K, Nusstein J, Reader A, Beck M. In vivo antibacterial efficacy of ultrasound after hand and rotary instrumentation in human mandibular molars. J Endod 2007; 33: 1038-1043
• 33 van der Sluis LWM, Shemesh H, Wu MK, Wesselink PR. An evaluation of the influence of passive ultrasonic irrigation on the seal of root canal fillings. Int Endod J 2007; 40: 356-361
• 34 Kenee DM, Allemang JD, Johnson JD, Hellstein J, Nichol BK. A quantitative assessment of efficacy of various calcium hydroxide removal techniques. J Endod 2006; 32: 563-565
• 35 van der Sluis LWM, Wu MK, Wesselink PR. The evaluation of removal of calcium hydroxide paste from an artificial standardized groove in the apical root canal using different irrigation methodologies. Int Endod J 2007; 40: 52-57
• 36 Myers GL, Montgomery S. A comparison of weights of debris extruded apically by conventional filing and Canal Master techniques. J Endod 1991; 17: 275-279
• 37 van der Sluis LWM, 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
• 38 van der Sluis LWM, Wu MK, Wesselink PR. The efficacy of ultrasonic irrigation to remove artificially placed dentine debris from human root canals prepared using instruments of varying taper. Int Endod J 2005; 38: 764-768
• 39 van der Sluis LWM, Versluis M, Wu MK, Wesselink PR. Passive ultrasonic irrigation of the root canal: a review of the literature. Int Endod J 2007; 40: 415-426