Comparison of the effectiveness of three irrigation techniques in reducing intracanal Enterococcus faecalis populations: an in vitro study. Effect of different irrigant activation protocols on push-out bond strength Effect of passive ultrasonic irrigation and manual dynamic irrigation on smear layer removal from root canals in a closed apex in vitro model. Effect of continuous ultrasonic irrigation on postoperative pain in mandibular molars with nonvital pulps: a randomized clinical trial Antimicrobial efficacy of two irrigation techniques in tapered and nontapered canal preparations: an in vitro study. A comparative study of the debridement efficacy and apical extrusion of dynamic and passive root canal irrigation systems Effect of apical preparation size and preparation taper on irrigant volume delivered by using negative pressure irrigation system. Comparative evaluation of postoperative pain after using endodontic needle and EndoActivator during root canal irrigation: A randomised controlled trial. Improved outcomes after low-concentration hypochlorous acid nasal irrigation in pediatric chronic sinusitis. Influence of an apical negative pressure irrigation system on bacterial elimination during endodontic therapy: a prospective randomized clinical study. In vivo efficacy of three different endodontic irrigation systems for irrigant delivery to working length of mesial canals of mandibular molars. A Scanning electron microscopic evaluation of intracanal smear layer removal by two different final irrigation activation systems Smear layer removal with passive ultrasonic irrigation and the NaviTip FX: a scanning electron microscopic study. Efficacy of four different irrigation techniques combined with 60°C 3% sodium hypochlorite and 17% EDTA in smear layer removal Comparison of irrigant penetration up to working length and into simulated lateral canals using various irrigating techniques. Reduction in intracanal bacteria during root canal preparation with and without apical enlargement. Hard tissue debris removal from the mesial root canal system of mandibular molars with ultrasonically and laser-activated irrigation: a micro-computed tomography study 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. Ozone as an adjunct to conventional nonsurgical therapy in chronic periodontitis: a randomized controlled clinical trial. Postoperative pain after the application of two different irrigation devices in a prospective randomized clinical trial. Tissue response to root canal irrigation systems in dogs’ teeth with apical periodontitis Smear Layer Evaluation on Root Canal Preparation with Manual and Rotary Techniques using EDTA as an Irrigant: A Scanning Electron Microscopy Study. Effects of sulfurous, salty, bromic, iodic thermal water nasal irrigations in nonallergic chronic rhinosinusitis: a prospective, randomized, double-blind, clinical, and cytological study.
INTRODUCTION Several irrigation techniques have been recently introduced with the main objective of improving root canal disinfection . This in vitro study aim ed at comparing the intracanal bacterial reduction promoted by chemomechanical preparation with 3 different irrigation techniques . METHODS Root canals from extracted teeth were contaminated with Enterococcus faecalis ATCC 29212 for 7 days and then r and omly distributed into 3 experimental groups of 20 teeth each : group 1 , conventional irrigation with NaviTip needles inserted up to 3 mm short of the working length ; group 2 , same as group 1 , but supplemented with final irrigant activation by the EndoActivator system ; and group 3 , irrigation with the EndoVac system . NaOCl and ethylenediaminetetraacetic acid ( EDTA ) were the irrigants used in all experimental groups . The overall preparation time was kept constant for the groups , but the total volume ranged from 20 mL ( groups 1 and 2 ) to 43 mL ( group 3 ) . The control group was irrigated with saline solution ( total volume , 43 mL ) . Sample s taken before and after chemomechanical procedures were cultured , and the colony-forming units ( CFUs ) were counted . RESULTS Reduction in the bacterial population s was highly significant for all groups . The 3 experimental groups with NaOCl and EDTA as irrigants were significantly more effective than the control group with saline in reducing CFU counts . There were no significant differences between the 3 techniques tested . CONCLUSIONS There was no evident antibacterial superiority of any of the irrigation techniques evaluated in the present in vitro model The study aim ed to evaluate the effect of various final irrigant activation protocol s on push-out bond strength of fiber post . Thirty-two single-rooted human maxillar central teeth were sectioned below the cementoenamel junction , instrumented and obturated . Post-space preparation was performed , and roots were r and omly divided into eight groups ( n = 4 ) according to the final irrigant activation protocol s ; distilled water was used as an irrigant in group 1 . The other groups were treated with 2.5 % NaOCl and 17 % EDTA . Conventional syringe irrigation ( CSI , no activation ) was used in group 2 . Irrigation solutions were activated using passive ultrasonic irrigation ( PUI , group 3 ) , EndoVac apical negative pressure ( ANP , group 4 ) , diode laser ( group 5 ) , neodymium : yttrium – aluminum-garnet ( Nd : YAG ) laser ( group 6 ) , erbium : yttrium – aluminum-garnet ( Er : YAG ) laser ( group 7 ) , and Er : YAG laser using with photon-induced photoacoustic streaming ( PIPS ™ ) technique ( group 8) . In all groups , fiber posts ( White Post DC , FGM ) were luted using Panavia F 2.0 ( Kuraray , Osaka , Japan ) . The specimens were transversally sectioned , and all slices from coronal and apical regions were subjected to push-out tests . The data were calculated as megapascals and analyzed by using two-way analysis of variance followed by post hoc Tukey honestly significant difference ( HSD ) tests . Removing the smear layer increased the bond strength to dentine when compared with the control group ( p < 0.05 ) . The highest bond strength was obtained in the PIPS laser-activated irrigation group ( p < 0.05 ) . Coronal root region presented significantly higher bond strength than the apical region ( p < 0.05 ) . PIPS laser-activated irrigation showed higher efficiency as a final irrigant activation protocol on push-out bond strength of fiber post AIM To compare the effect of passive ultrasonic irrigation with manual dynamic irrigation on smear layer removal from root canals using a closed apex in vitro model . METHODS The root canals of 45 freshly-extracted human single-rooted m and ibular premolar teeth were prepared by the Pro-Taper rotary system to an apical preparation of F4 size . Prepared teeth were r and omly divided into three groups ; two experimental groups and one control group ( n = 15 ) on the basis of the type of activation of final irrigation as follows : ( a ) Group A , 3 % sodium hypochlorite ( NaOCl ) and 17 % ethylenediaminetetraacetic acid ( EDTA ) , no activation received ; ( b ) Group B , 3 % NaOCl and 17 % EDTA , ultrasonic activation with a small file ; and ( c ) Group C , 3 % NaOCl and 17 % EDTA , manual activation with a master gutta-percha point . The prepared teeth were decoronated and split into two halves longitudinally , and observed under a scanning electron microscope to assess the removal of the smear layer . RESULTS In the apical-third region , the mean smear scores for groups B and C were significantly less than those of Group A ( control group ) ( P < 0.05 ) . CONCLUSION Both activation techniques are important adjuncts in removing the smear layer , with manual dynamic activation being a simpler , safer , and more cost-effective technique AIM To evaluate via a r and omized clinical trial the effect of continuous ultrasonic irrigation ( CUI ) on  postoperative pain in m and ibular molars with nonvital pulps . METHODOLOGY Seventy m and ibular molars with nonvital pulps and apical periodontitis were treated endodontically using two different irrigation techniques . The patients were r and omly allocated to one of two groups , CUI ( n = 35 ) and syringe irrigation ( SI ) ( n = 35 ) . The CUI group received irrigant activation using a Proultra Piezoflow ultrasonic needle as the final irrigation protocol , whilst in the SI group , the final irrigation was performed using 27-gauge needle . All the patients were prescribed ibuprofen 400 mg to be taken every 8 h , if required . Postoperative pain using a visual analog scale and analgesic intake were recorded everyday for 7 days . Data were analysed using chi-Square , Mann-Whitney and multiple linear regression tests . RESULTS Mean postoperative pain was lower in the CUI as compared to SI group , but the difference was significant on the first day only ( P = 0.032 ) . The overall 24-h pain prevalence was 41.4 % . CUI had a lower incidence of pain ( 31.4 % ) as compared to the SI group ( 51.4 % ) , but the difference was not significant ( P > 0.05 ) . No significant difference was observed in analgesic consumption between the groups ( P > 0.05 ) . Regression analysis revealed a significant association of mean postoperative pain at 24 h with the irrigant protocol ( P = 0.017 ) and preoperative pain ( P = 0.000 ) . CONCLUSION A significant difference was observed between CUI and syringe irrigation on the first postoperative day following chemo-mechanical preparation . However , the benefit observed was not clinical ly relevant The aim of this in vitro study was to determine whether irrigation with apical negative pressure was more effective than traditional positive-pressure irrigation in eradicating Enterococcus faecalis from preshaped root canals . Fifty-four extracted m and ibular molars were instrumented to produce either a non-tapered or tapered preparation , sterilized , inoculated with E. faecalis for 30 days , and then r and omly assigned into the following groups : group 1 - -non-tapered preparation and negative-pressure irrigation , group 2 - -non-tapered preparation and positive-pressure irrigation , group 3 - -tapered preparation and positive-pressure irrigation , and group 4 - -tapered preparation and negative-pressure irrigation .  Mesial canals were sample d before and after final irrigation and sample s incubated aerobically for 48 hours at 37 degrees C. Scanning electron microscopic analysis confirmed dense bacterial colonies in the positive control , consistent with biofilm formation . A statistically significant difference was evident when comparing apical negative-pressure irrigation to positive-pressure irrigation ( p=0.004 ) . There was no statistically significant difference in colony-forming units ( CFUs ) between sizes # 35 and # 45 , nor between tapered and non-tapered preparation . The results of this in vitro study showed that apical negative-pressure irrigation has the potential to achieve better microbial control than traditional irrigation delivery systems Background Root canal irrigation carries a risk of extrusion of irrigant into the periapical tissues which can be associated with pain , swelling , and tissue damage . Studies have shown less extrusion with sonic or apical negative pressure devices compared with syringe and side-port needle or passive ultrasonic irrigation with continuous irrigant flow . This study aim ed to evaluate the effectiveness of the EndoVac irrigation system , regarding 1 ) debris removal and 2 ) the control of apically extruded irrigating solution . Methods Fifty extracted human single-rooted teeth were used in this study . The teeth were then r and omly divided into three experimental groups according to the type of irrigation used and one control group . In group 1 , irrigation was performed using the EndoVac irrigation system . In group 2 , irrigation was performed using a 30-gauge , tip-vented irrigation needle . In group 3 , irrigation was performed using a 30-gauge , side-vented irrigation needle . The control group received instrumentation with no irrigation to serve as a control for cleaning efficiency . Root canal instrumentation was performed using the Profile NiTi rotary system with a crown-down technique . All of the experimental teeth were irrigated with the same amount of 5.25 % sodium hypochlorite . The amount of extruded irrigating solution was then measured by subtracting the post-instrumentation weight from the pre-instrumentation weight using an electronic balance . The cleanliness of debris removal was evaluated using scanning electron microscopy . Results EndoVac irrigation had the least amount of extrusion followed by the side-vented and tip-vented method . The difference between the groups was statistically significant ( P < 0.01 ) . As for the cleaning results , the debris collection in the EndoVac and tip-vented groups was the least in the apical third . In the control and the side-vented groups , the debris was the greatest in the apical third , but this difference was not significant among the three experimental groups . Conclusions The EndoVac irrigation system extruded significantly less irrigant solution than either needle irrigation system . Debris collection was the least in the apical third for the EndoVac irrigation system . No significant difference was found in the cleaning efficiency among the three irrigation systems INTRODUCTION The purpose of this investigation was to determine the effect that apical preparation size and preparation taper had on the volume of irrigant delivered to the working length of a root canal preparation in a clinical ly relevant amount of time . METHODS Forty intact human single-rooted teeth were r and omly distributed into 2 separate phases . The first phase aim ed to determine the smaller apical size that will allow more volume of irrigant at working length . All sample s had the same taper and were sequentially instrumented to sizes of 30.06 , 35.06 , 40.06 , and 45.06 . The second phase aim ed to determine the taper that will allow more volume of irrigant at working length . Teeth were sequentially instrumented to 40.02 , 40.04 , 40.06 , and 40.08 . All sample s were irrigated by using the micro-cannula , and the volume of sodium hypochlorite suctioned at working length under negative pressure was measured during a period of 30 seconds by using a custom recovery device . RESULTS An increase in size from ISO # 35 to ISO # 40 result ed in a percentage gain of approximately 44 % in mean irrigant volume , whereas an increase in size from ISO # 40 to ISO # 45 result ed in a percentage gain of approximately 4 % . An increase in taper from 0.02 through 0.08 result ed in percentage gains of approximately 74 % , 5.4 % , and 2.4 % increase , respectively . CONCLUSIONS The data demonstrated that an increase in apical preparation size and taper result ed in a statistically significant increase in the volume of irrigant . In addition , an apical enlargement to ISO # 40 with a 0.04 taper will allow for tooth structure preservation and maximum volume of irrigation at the apical third when using the apical negative pressure irrigation system The purpose of this study was to evaluate and compare the postoperative level of pain after activation of irrigants using EndoActivator with conventional needle irrigation during root canal therapy . In this prospect i ve r and omised clinical trial , 72 symptomatic irreversible pulpitis patients were selected . Based on block r and omisation after routine root canal preparation , patients were assigned to two groups . In group EN , procedures were performed with endodontic irrigating needle ( n = 36 ) while group EA received activation using EndoActivator ( n = 36 ) in the final irrigation protocol . All the participants were called through phone at 8 , 24 and 48 h to analyse pain score using visual analogue scale . Those patients who developed pain were prescribed ibuprofen 200 mg . Pain score and frequency of tablet intake were recorded and statistically analysed . Results showed that group EA result ed in significantly less postoperative pain and analgesics intake than group EN . In conclusion , within the limitations of this study , the activation of irrigants using EndoActivator can be considered an effective method for reducing postoperative pain OBJECTIVES /HYPOTHESIS We aim ed to evaluate the effectiveness of low-concentration hypochlorous acid ( HOCl ) nasal irrigation compared to isotonic normal saline for pediatric chronic rhinosinusitis . STUDY DESIGN This was a r and omized , prospect i ve , active-controlled study . METHODS This study investigated the effectiveness of 4 weeks of low-concentration hypochlorous irrigation by analyzing five categorized subjective symptoms and x-ray findings in pediatric patients with rhinosinusitis . Thirty-seven patients were enrolled , and 26 patients successfully completed the study . RESULTS Total symptom scores significantly improved with both HOCl and normal saline nasal irrigation , but there was no difference between the two groups . X-ray scores also improved in both groups ; improvement was much greater in the HOCl group than the placebo group . CONCLUSIONS Nasal irrigation with HOCl is an effective adjuvant treatment compared to isotonic normal saline for pediatric sinusitis . LEVEL OF EVIDENCE 1b INTRODUCTION Recent in vitro studies that use an apical negative pressure irrigation system , EndoVac , have demonstrated promising results in the production of debris-free root canals , while also preventing potential extrusion of irrigants into the periapical region . We conducted a r and omized , controlled , prospect i ve clinical study to determine whether the use of EndoVac irrigation ( EndoVac group ) was more efficient compared with st and ard needle irrigation ( control group ) in obtaining canals from which microbes could not be cultivated . METHODS Routine endodontic therapy was performed in 48 patients with necrotic , single-rooted , single-canal teeth . The patients were r and omly assigned to either the EndoVac group ( n = 25 ) or control group ( n = 23 ) . Irrigation with either method was carried out with 0.5 % sodium hypochlorite . After surface disinfection , before instrumentation and on completion of chemomechanical preparation , intracanal microbial sample s were obtained and cultured under anaerobic conditions . The frequency of microbial cultivability by using either irrigation system was analyzed . RESULTS The frequency of obtaining culture-negative root canals was 90.9 % and 82.6 % for the control group and EndoVac group , respectively . There was no significant difference in the antimicrobial efficacy of either control group or EndoVac group ( Fisher exact test , P = .665 ) . Furthermore , no significant association between study variables and the irrigation systems ' antimicrobial efficacy was found ( P > .05 ) . CONCLUSIONS The results of this prospect i ve in vivo study demonstrate that the antimicrobial efficacy of EndoVac irrigation is comparable to that of st and ard irrigation INTRODUCTION Many in vitro studies have debated over the ability of different irrigant delivery and /or agitation systems to reach the apical third of curved root canals ; however , little is known about irrigant penetration in vivo . Therefore , the purpose of this study was to compare the efficacy of the conventional endodontic irrigation needle , passive ultrasonic irrigation ( PUI ) , and a negative pressure system for irrigant delivery to working length ( WL ) of mesial canals of m and ibular molars . METHODS Thirty mesial canals of 30 vital m and ibular first or second molars were r and omly assigned into 3 groups ( n = 10 ) : ( 1 ) Monoject syringe with 27-gauge needle ; ( 2 ) PUI with IrriSafe tip ; and ( 3 ) EndoVac system . All canals were treated following the same preparation protocol to size 35/0.04 by using 5.25 % NaOCl as irrigant during preparation procedure . Before obturation , canals were irrigated with 1 mL of a radiopaque solution by using the assigned irrigation system , and a digital radiograph was taken by using a parallel technique . With the aid of image editing software the distance between WL and maximum irrigant penetration was measured . RESULTS Mean distances for Monoject , PUI , and EndoVac groups were 1.51 mm , 0.21 mm , and 0.42 mm , respectively . Analysis of variance test showed statistically significant differences between groups ( P < .001 ) . Tukey honestly significant difference test showed statistically significant differences between the Monoject group and the other 2 groups ( P < .001 ) but no significant differences between PUI and EndoVac groups ( P = .06 ) . CONCLUSIONS PUI and EndoVac are more effective than the conventional endodontic needle in delivering irrigant to WL of root canals Aim : The aim of this study was to compare smear layer removal at apical 1 mm level after final irrigation activation with an EndoVac system and Max-I probe . Material s and Methods : Fifty freshly extracted maxillary central incisors were r and omly divided into two groups after completing cleaning and shaping with ProTaper rotary files . In one group , final irrigation was performed with an EndoVac system while in the other group final irrigation was performed with a 30 gauge Max-I probe . 3 % sodium hypochlorite and 17 % ethylenediaminetetracetic acid were used as final irrigants in all teeth . After instrumentation and irrigation , the teeth were sectioned longitudinally into buccal and palatal halves and viewed under a scanning electron microscope for evaluation of the smear layer . Statistical analysis was performed using the Kruskal Wallis and Mann-Whitney U tests . Results : The EndoVac group showed significantly better smear layer removal compared with the Max-I probe at the apical 1 mm level . Conclusion : An apical negative pressure system ( EndoVac ) results in better debridement at apical 1 mm when compared with side-vented closed ended needle irrigation ( Max-I probe ) OBJECTIVE The aim of this study was to compare the effect of continuous , intermittent passive ultrasonic irrigation ( PUI ) and active scrubbing of irrigants with NaviTip FX ( Ultradent , South Jordan , UT ) in removing smear layer . STUDY DESIGN Forty single-rooted teeth were r and omly divided into 5 test groups and subjected to final irrigation with 17 % EDTA followed by 2.5 % NaOCl for 1 minute each using different activation methods : no activation ( control ) , brushing with NaviTip FX , continuous PUI with irrigant delivered at pulp chamber , continuous PUI with irrigant delivered through the ultrasonic unit , and intermittent PUI . Specimens were examined under scanning electron microscope , and the data were analyzed using Friedman 2-way analysis of variance , Kruskal-Wallis , and Mann-Whitney U tests . RESULTS NaviTip FX and intermittent PUI showed significantly lower smear score than other groups at the 3 mm level ( P < .05 ) . CONCLUSIONS Both brush and intermittent ultrasonic activation were effective in the removal of smear layer from the apical third Background Efforts to improve the efficacy of smear layer removal by applying irrigant activation at the final irrigation or by elevating the temperature of the irrigant have been reported . However , the combination of such activation protocol s with 60 ° C 3 % sodium hypochlorite ( NaOCl ) has seldom been mentioned . The aim of this study was to compare the efficacy in smear layer removal of four different irrigation techniques combined with 60 ° C 3 % NaOCl and 17 % EDTA . Methods Fifty single-rooted teeth were r and omly divided into five groups ( n = 10 ) according to the irrigant agitation protocol s used during chemomechanical preparation(Dentsply Maillefer , Ballaigues , Switzerl and ): a side-vented needle group , a ultrasonic irrigation ( UI ) group , a NaviTip FX group , an EndoActivator group , and a control group ( no agitation ) . After each instrumentation , the root canals were irrigated with 1 mL of 3 % NaOCl at 60 ° C for 1 minute , and after the whole instrumentation , the root canals were rinsed with 1 mL of 17 % EDTA for 1 minute . Both NaOCl and EDTA were activated with one of the five irrigation protocol s. The efficacy of smear layer removal was scored at the apical , middle and coronal thirds . The Data were statistically analyzed using SAS version 9.2 for Windows ( rank sum test for a r and omised block design and ANOVA ) . Results No significant differences among the NaviTip FX group , EndoActivator group and control groups , and each of these groups showed a lower score than that of UI group ( P < 0.05 ) . Within each group , all three thirds were ranked in the following order : coronal > middle > apical ( P < 0.05 ) . In the coronal third , the NaviTip FX group was better than UI group . In the middle and apical third , the differences were not significant among any of the groups . Conclusions Even without any activation , the combination of 60 ° C 3 % NaOCl and 17 % EDTA  could remove the smear layer effectively , similar to NaviTip FX or EndoActivator , and these three protocol s were more effective than UI . However , regardless of different types of irrigation technique applied , complete removal of the smear layer was not achieved , particularly in the apical third AIM To evaluate the effect of an apical negative pressure system , a passive ultrasonic irrigation system and a combination of both apical negative pressure and passive ultrasonic irrigation on the penetration of the  irrigating contrast solution ( ICS ) up to working length and into simulated lateral canals . METHODOLOGY The root canals of 64 single-rooted teeth were instrumented using the ProTaper rotary system . In each sample , three simulated lateral canals were created at 2 , 4 and 6 mm levels from the root apex using a 06-size C+ file ( Dentsply Maillefer , Ballaigues , Switzerl and ) . Sample s were r and omly assigned into 4 experimental groups ( n = 16 ) : group I - conventional needle irrigation , group II - passive ultrasonic irrigation , group III - apical negative irrigation system and group IV - combination of passive ultrasonic irrigation and apical negative pressure irrigation system . To examine irrigating solution penetration , Indian ink was mixed with 5.25 % NaOCl and delivered into the root canals . Sample s were then assessed by direct observation of the images taken using Canon EOS rebel T3 . The depth of penetration of ICS up to the working length and into the simulated lateral canals was analysed using chi-squared tests . RESULTS The combination ( ANP and PUI ) and ANP group had significantly deeper ICS penetration up to the working length ( P < 0.001 ) . The combination ( ANP and PUI ) and the PUI group exhibited significantly greater ICS penetration into lateral canals at the 6 mm level ( P < 0.001 ) . At the 4 and 2 mm levels , the combination of ANP and PUI had significantly greater ICS penetration into the lateral canals than the other groups ( P < 0.001 ) . CONCLUSIONS The combination of ANP and PUI was the only group able to achieve irrigating contrast solution penetration both up to the working length and into lateral canals AIM To compare in vitro intracanal bacterial reduction using nickel-titanium rotary instruments with and without apical enlargement . METHODOLOGY Thirty-eight palatal roots of maxillary molar teeth , with mature apices were subdivided according to lengths and then r and omly assigned to two experimental and one control groups . The roots were sterilized and then reinfected with Enterococcus faecalis , which served as a bacteriological marker . All roots in the experimental groups were prepared in a step-down sequence with engine-driven GT rotary files at 350 rpm . In experimental group A ( n = 16 ) additional apical enlargement to ISO size 35 was performed . In group B ( n = 16 ) a serial step-back technique was followed with no apical enlargement . This was combined in groups A and B with irrigation with NaOCl and EDTA . In the control group ( group C , n = 6 ) irrigation only was carried out , with no mechanical preparation . Sample s were then taken from the root canals to determine the numbers of remaining bacteria . RESULTS In groups A and B , 15 ( 94 % ) and 13 ( 81 % ) specimens were rendered bacteria-free , respectively . In the control group C none of the specimens were bacteria-free . There was a significant difference ( P < 0.001 ) in the antibacterial effects of experimental and control regimens . There was , however , no significant difference ( P = 0.276 ) between the preparation methods used in the experimental groups . CONCLUSIONS There was no significant difference in intracanal bacterial reduction when Ni-Ti GT rotary preparation with NaOCl and EDTA irrigation was used with or without apical enlargement preparation technique . It may therefore not be necessary to remove dentine in the apical part of the root canal when a suitable coronal taper is achieved to allow satisfactory irrigation of the root canal system with antimicrobial agents This study is to investigate the efficacy of different irrigant activation techniques on removal of accumulated hard tissue debris ( AHTD ) in mesial roots of human m and ibular molars . Extracted human m and ibular molars with an isthmus between the mesial root canals were selected based on micro-CT ( μCT ) scans . The mesial canals were instrumented to an apical diameter ISO30 using ProTaper rotary files . Teeth were r and omly assigned to three irrigant activation groups ( n = 10 ) : ultrasonically activated irrigation ( UAI ) using a size 20 Irrisafe for 3 × 20 s , laser-activated irrigation ( LAI ) with an Er : YAG laser ( 2940 nm ) and plain 300 μm fiber tip inside the canal ( 20 mJ , 20 Hz , 3 × 20 s ) , and laser-activated irrigation with identical parameters with a 400 μm photon-induced photoacoustic streaming ( PIPS ) tip held at the canal entrance . All teeth were scanned with μCT before and after instrumentation and after irrigant activation . After reconstruction and image processing , the canal system volume filled with hard tissue debris before and after irrigant activation was calculated . Changes in hard tissue debris volumes were compared between groups using one-way ANOVA . The percentage volume of hard tissue debris ( vol% ) was significantly lower after irrigant activation in all groups . Although the lowest debris values were observed in the laser groups , no significant differences in the vol% of accumulated hard tissue debris after activation were observed between groups . Accumulated hard tissue debris was reduced significantly in all activation groups . Ultrasonically and laser-activated irrigation regimens performed similarly in this respect . None of the tested methods was able to render the root canal systems free of debris AIM To compare the efficacy of three irrigation protocol s using an established ex vivo bio-molecular film model . METHODOLOGY Thirty human teeth with single straight canals were r and omly allocated to three groups [ static , manual-dynamic , automated-dynamic ( RinsEndo ] ; each with a sub-group ( n = 5 ) for needle position at 4 or 10 mm short of the working length ( WL ) . The root canals were prepared to apical size 40 , taper 0.08 . The teeth were split longitudinally into two halves and a st and ard coat of stained-collagen was applied to the canal surfaces . The re-assembled teeth were irrigated using one of the protocol s with the irrigation needle at one of two positions . Digital images of the canal surfaces , before and after irrigation with 18 mL of 2.5 % NaOCl , were used to score surface coverage with stained-collagen using image-analyses ( ipWin4 ) . The data were analysed using linear regression models . RESULTS The canal area covered with stained-collagen was significantly ( P < 0.001 ) less after dynamic irrigation ( manual/automated ) compared with static irrigation ; but automated-dynamic irrigation was significantly ( P = 0.037 ) less effective than manual-dynamic irrigation . The ' orientation of needle port ' , ' corono-apical level of canal ' and ' apical extent of needle placement ' were significant ( P < 0.001 ) factors influencing efficacy of irrigation . Residual collagen was most evident in the coronal third . Deeper penetration of the needle tip result ed in significantly ( P < 0.001 ) more effective collagen removal . CONCLUSIONS Automated-dynamic irrigation was significantly more effective ( 16 % ) than static irrigation but significantly less effective ( 5 % ) than manual-dynamic irrigation . Irrigation was more effective ( 7 % ) when the needle was placed closer to WL BACKGROUND AND OBJECTIVE Currently , only limited data are available from controlled clinical trials regarding the effect of irrigation by ozonated water in the treatment of periodontitis . The aim of the present study was to determine the clinical and biological effects of the adjunctive use of ozone in nonsurgical periodontal treatment . MATERIAL AND METHODS Forty-one patients with chronic periodontitis were r and omized to treatment with either subgingival scaling and root planing ( SRP ) followed by irrigation with ozonated water ( test ) or subgingival SRP followed by irrigation with distilled water irrigation ( control ) . The following parameters were evaluated at baseline ( T0 ) , 3 mo ( T1 ) : plaque index ; gingival index ; bleeding on probing ; probing pocket depth ; gingival recession ; and clinical attachment loss . In addition , the serum concentrations of high sensitivity C-reactive protein were measured at T0 and T1 . RESULTS Forty-one patients with chronic periodontitis were included in the analysis ( 20 in the test group and 21 in the control group ) . There was statistically significant improvement in the study parameters in both groups between T0 and T1 , except for gingival index . However , there were no significant differences in any study parameter between test and control groups . CONCLUSION Irrigation with ozonated water as an adjunctive therapy to SRP produces no statistically significant benefit compared with SRP plus distilled water irrigation INTRODUCTION The extrusion of irrigation solutions beyond the apical constriction may result in postoperative pain .  Sodium hypochlorite can cause severe tissue irritation and necrosis outside the root canal system if extruded into the periodontal ligament ( PDL ) space . Different delivery techniques were discussed to reduce this potential risk . The aim of this study was to compare the postoperative level of pain after root canal therapy using either endodontic needle irrigation or a negative apical pressure device . MATERIAL AND METHODS In a prospect i ve r and omized clinical trial , 110 asymptomatic single-rooted anterior and premolar teeth were treated endodontically with two different irrigation techniques . The teeth were r and omly assigned to two groups . In the MP group ( n = 55 ) , procedures were performed using an endodontic irrigating syringe ( Max-i-Probe ; Dentsply Rinn , Elgin , IL ) . The EV group ( n = 55 ) used an irrigation device based on negative apical pressure ( EndoVac ; Discus Dental , Culver City , CA ) . Postoperatively , the patients were prescribed ibuprofen 200 mg to take every 8 hours if required . Pain levels were assessed by an analog scale question naire after 4 , 24 , and 48 hours . The amount of ibuprofen taken was recorded at the same time intervals . RESULTS During the 0- to 4- , 4- to 24- , and 24- to 48-hour intervals after treatment , the pain experience with the negative apical pressure device was significantly lower than when using the needle irrigation ( p < 0.0001 [ 4 , 24 , 48 hours ] ) . Between 0 and 4 and 4 and 24 hours , the intake of analgesics was significantly lower in the group treated by the negative apical pressure device ( p < 0.0001 [ 0 - 4 hours ] , p = 0.001 [ 4 - 24 hours ] ) . The difference for the 24- to 48-hour period was not statistically different ( p = 0.08 ) . The Pearson correlation coefficient revealed a strongly positive and significant relationship for the MP group ( r = 0.851 , p < 0.001 ) and the EV group ( r = 0.596 , p < 0.0001 ) between pain intensity and the amount of analgesics . CONCLUSION The outcome of this investigation indicates that the use of a negative apical pressure irrigation device can result in a significant reduction of postoperative pain levels in comparison to conventional needle irrigation Objectives The aim of this study was to compare the efficacy of apical negative pressure irrigation ( ANP ) and passive ultrasonic irrigation ( PUI ) with apical positive pressure irrigation ( PP — conventional irrigation ) in the periapical repair of dogs ’ teeth with apical periodontitis . Methods Forty-nine mesial and distal root canals of premolars of three dogs with experimentally induced periapical lesions were subjected to a single-session root canal treatment . The teeth were r and omly assigned to three groups : ANP , PUI , and PP ( control ) . After 180 days , the animals were euthanized , and the anatomic pieces were removed and subjected to histotechnical processing for morphological and morphometric histological analyses of hematoxylin and eosin (HE)-stained sections under conventional and fluorescence microscopy . Periapical lesion size before and 180 days after root canal treatment was measured by periapical radiographic examination . Tartrate-resistant acid phosphatase ( TRAP ) histoenzymology was performed for osteoclast counting and Brown and Brenn staining to assess bacteria . Data were analyzed statistically by the Kruskal-Wallis test ( α = 5 % ) . Result There were no statistically significant differences among the groups regarding periapical lesion size in the radiographic evaluation ( p = 0.91 ) . In the comparison of histopathological parameters , group ANP presented more homogeneous results . There was a statistically significant difference ( p = 0.02 ) between groups ANP and PP , with better results for group ANP in which milder infiltrate inflammatory was observed . No statistically significant difference ( p > 0.05 ) was found among the groups with respect to periodontal ligament space , presence of mineralized tissue resorption , size of the periapical lesions , and number of osteoclasts . Conclusion Although the three irrigation systems elicited similar periapical tissue response with respect to almost all evaluated parameters , ANP presented the mildest inflammatory infiltrate , suggesting an advantage over PP in the indication for clinical use . Clinical relevance Irrigation of the root canal systems is an extremely important step in root canal treatment . Therefore , it is of relevance to evaluate the efficacy of these systems by in vivo experimental models to provide scientific background for the clinical practice INTRODUCTION The aim of any root canal treatment is to achieve a canal free of micro organisms , residual pulp remnants , debris and smear layer for the long term success of the procedure . Manual and automated instrumentation techniques along with proper irrigation regime is used to arrive at the aforementioned goal . Many authors focused on the preparation capabilities of various manual and rotary instruments but very few investigators stressed on the actual cleaning abilities of these instruments . AIMS AND OBJECTIVES This study was undertaken to evaluate the cleaning efficiency of manual K flex files and rotary Pro File systems in the root canals using a scanning electron microscope . MATERIAL AND METHODS Thirty single rooted m and ibular first premolars were divided into two groups and r and omized ( the manual group-M and the ProFile group-P ) with respect to the preparation technique . The Manual group was h and instrumented with stainless steel K- Flexofiles by means of a conventional filing technique . The Pro File group was instrumented according to the manufacturer 's instructions using a rotary h and piece . All canals were shaped and cleaned under frequent irrigation with EDTA . Final irrigation was carried out with 3 mL of normal saline solution to neutralize the action of the irrigant . The roots were split , one half of each tooth was selected for further SEM technique analysis and examined under the scanning electron microscope . The canal walls were quantitatively evaluated for the amount of debris and smear layer . The apical , middle and coronal regions of the canal surface , were grade d ( 1 - 5 ) for debris and smear layer . A statistical analysis was performed using a Mann-Whitney Rank Sum test . ProFile performed least effective cleaning . Manual K-Flexofiles led to a grooved pattern . RESULTS AND CONCLUSION A statistically significant difference was observed ( p<0.05 ) between the two instrumentation techniques concerning the amount of debris and smear layer at the apical level . The manually filed canals had less debris and smear layer than those using a rotary technique . It was concluded from this study that none of the instrumentation techniques employed , produced the canal walls which were free of surface debris and smear layer . The manual instrumentation technique was better in cleaning the canals compared to the ProFile rotary Ni-Ti instruments despite the step-back technique used for manual instrumentation . How to cite this article : Manjunatha M , Kini A , Sudhakar V , Sunil K V C , Hiremath V K , Shah A. Smear Layer Evaluation on Root Canal Preparation with Manual and Rotary Techniques using EDTA as an Irrigant : A Scanning Electron Microscopy Study . J Int Oral Health 2013 ; 5(1):66 - 78 OBJECTIVES Nasal irrigations are mentioned among the adjunctive measures for treating several sinonasal conditions . Hyperchromatic supranuclear stria ( HSS ) in the ciliated cells ( CCs ) has recently been suggested as a potential cytological marker of the anatomofunctional integrity of nasal mucosa . The aim of this study was to compare the effects of nasal irrigations with sulfurous , salty , bromic , iodic ( SSBI ) thermal water or isotonic sodium chloride solution ( ISCS ) in patients with nonallergic chronic rhinosinusitis , considering the endoscopic , functional , microbiological , and cytological evidence ( including the ratio of HSS-positive CCs to total CCs [ the HSS+ rate ] ) . METHODS In a prospect i ve , r and omized , double-blind setting , 80 patients were recruited for nasal irrigations with SSBI water or ISCS for 1 month . RESULTS An endoscopically assessed significant clinical improvement was seen after both SSBI thermal water and ISCS irrigations . Before treatment , Staphylococcus aureus was isolated in 5 patients in the SSBI thermal water group and 4 in the ISCS group . After the nasal irrigations , there was no sign of the bacteria in either group . Only the SSBI water irrigations significantly reduced total nasal resistance , as determined by rhinomanometry . Mild nasal irritation ( 6 cases ) and episodes of extremely limited epistaxis ( 5 cases ) were only reported after SSBI thermal water irrigations . Neither type of nasal irrigation significantly increased the mean HSS+ rate at cytological control after 1 month . CONCLUSIONS Both types of nasal irrigation improved the endoscopic and microbiological features of patients with nonallergic chronic rhinosinusitis , whereas only SSBI irrigations significantly reduced total nasal resistance . Further investigations are needed based on longer treatments and follow-up periods to establish whether the HSS+ rate is useful for monitoring clinical improvements in chronic rhinosinusitis treated with nasal irrigations
Results showed that mechanical active irrigation reduces post-operative pain .
It improved debridement , canal/isthmus cleanliness .
It also improved delivery of irrigant up to working length .
Bacterial count was more with active irrigation , though not significant .
There is no effect on long-term periapical healing .
Conclusion It may be concluded that mechanical active irrigation devices are beneficial in reducing post-operative pain and improving canal and isthmus cleanliness during Endodontics
Objective Irrigant activation has been cl aim ed to be beneficial in in vitro and clinical studies .
This systematic review aims to investigate the clinical efficiency of mechanically activated irrigants and conventional irrigation .