The irrigating effect before and after coronal flaring

Ho-Keel Hwang; Seong-Chul Bae; Young-Lin Cho

doi:10.5395/JKACD.2003.28.1.072

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Original Article The irrigating effect before and after coronal flaring: Ho-Keel Hwang, Seong-Chul Bae, Young-Lin Cho; 2003;28(1):-79.
DOI: https://doi.org/10.5395/JKACD.2003.28.1.072
Published online: January 31, 2003

Department of Conservative Dentistry, Oral Biology Research Institute, College of Dentistry, Chosun University, Korea.

Corresponding author (rootcanal@hanmail.net)

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Abstract
REFERENCES

Abstract

The objective of this in vitro study was to evaluate the efficacy of a Ca(OH)₂ removal before and after early coronal flaring using different types of instruments. 100 plastic blocks with 30° artificial curved canals were used in this study and randomly divided into a control group and 4 experimental groups(GG, OS, GT, PT Group) 20 teeth each. The canals were instrumented, and Ca(OH)₂ was temporary filled into the each canal. Irrigation was performed with Max-i-Probe 25-, 30-gauge probes before and after recapitulation.

The results of this study were as follows:

1. There were no significant difference among the groups in size of irrigating needle(p<0.05).

2. There was a significant difference between before and after recapitulation regardless size of irrigating needle(p<0.05).

3. Before recapitulation, there was a significant difference between 25- and 30-gauge needle in all groups(p<0.05).

4. After recapitulation, there was a significant difference between 25- and 30-gauge needle in the control group(p<0.05). But there were no significant difference among the experimental groups.

It is concluded that the effectiveness of canal irrigation was decided to the depth of irrigating needle into the canal. The effect of canal irrigation tend to facilitate by the early coronal flaring. The recapitulation was the most effective during canal irrigation regardless the size of irrigating needle. Therefore, the recapitulation is a mandatory way to facilitate the effectiveness of canal irrigation during canal enlargement.
Keywords: Coronal Flaring; Irrigation; Recapitulation; Canal enlargement

Fig. 1

The device for taking a standard radiograph at same position

Fig. 2

Evaluation of remaining Ca(OH)₂ by steroscope

Fig. 3

Average extent of remaining Ca(OH)₂ before recapitulation

Fig. 4

Average extent of remaining Ca(OH)₂ after recapitulation

^*: Significantly different at p<0.05(paired t-test)

Table 1

Group classification according to instruments

Table 2

Average extent of remaining Ca(OH)2 after canal irrigation (unit: mm)

A: before recapitulation B: after recapitulation

^*: Significantly different at p<0.05(paired t-test)

REFERENCES

1. Cohen S, Burns R. Pathways of the pulp. 1994;6th ed. St. Louis: CV Mosby; 179-218.
2. Gambarini G. Shaping and cleaning the root canal system: A scanning electron microscopic evaluation of a new instrumentation and irrigation technique. J Endod. 1999;25(12):800-803.Article PubMed
3. Siqueira JF Jr, Rocas IN, Snatos SR, Lima KC, Magalhaes FA, Uzeda M. Efficacy of instrumentation techniques and irrigation regimens in reducing the bacterial population within root canals. J Endod. 2002;28(3):181-184.Article PubMed
4. Hoen MM, LaBounty GL, Struttmatter EJ. Conservative treatment of persistent periradicular lesions using aspiration and irrigation. J Endod. 1990;16(4):182-186.Article PubMed
5. Jeansonne MJ, White RR. A comparison of 2.0% chlorhexidine gluconate and 5.25% sodium hypochlorite as antimicrobial endodontic irrigants. J Endod. 1994;20(6):276-278.Article PubMed
6. Valera MC, Rego JM, Jorge AOC. Effect of sodium hypochlorite and five intracanal medicants on candida albicans in root canals. J Endod. 2001;27(6):401-403.PubMed
7. Doğan H, Calt S. Effects of chelating agents and sodium hypochlorite on mineral content of root dentin. J Endod. 2001;27(9):578-580.Article PubMed
8. Kuruvilla JR, Kamath MP. Antimicrobial activity of 2.5% sodium hypochlorite and 0.2% chlorhexidine gluconate separately and combined, as endodontic irrignats. J Endod. 1998;24(7):472-476.PubMed
9. Scelza MF, Antoniazzi JH, Scelza P. Efficacy of final irrigation-a scanning electron microscopic Evaluation. J Endod. 2000;26(6):355-358.Article PubMed
10. Siqueira JF Jr, Machado AG, Silveira RM, Lopes HP, Uzeda MD. Evaluation of the effectiveness of sodium hypochlorite used with three irrigation methods in the elimination of enterococcus faecalis from the root canal, in vitro. Int Endod J. 1997;30: 279-282.Article PubMed
11. Siqueira JF Jr, Rocas IN, Favieri A, Lima KC. Chemomechanical reduction of the bacterial population in the root canal after instrumentation and irrigation with 1%, 2.5%, and 5.25% sodium hypochlorite. J Endod. 2000;26(6):331-334.PubMed
12. Tanomaru Filho M, Leonardo MR, Silva LAB. Effect of irrigating solution and calcium hydroxide root canal dressing on the repair of apical and periapical tissues of teeth with periapical lesion. J Endod. 2002;28(4):295-299.Article PubMed
13. Hülsmann M, Hahn W. Complications during root canal irrigation-literature review and case reports. Int Endod J. 2000;33: 186-193.Article PubMed
14. Sukawat C, Srisuwan T. A comparison of the antimicrobial efficacy of three calcium hydroxide formulations on human dentin infected with Enterococcus faecalis. J Endod. 2002;28(2):102-104.Article PubMed
15. Siqueira JF Jr, Rocas IN, Magalhaes FA, de Uzeda M. Antifungal effects of endodontic medicaments. Aust Endod J. 2001;27(3):112-114.PubMed
16. Peters LB, Winkelhoff AJ, Buijs JF, Wesselink PR. Effects of instrumentation, irrigation and dressing with calcium hydroxide on infection in pulpless teeth with periapical bone lesions. Int Endod J. 2002;35: 13-21.Article PubMed
17. Ferguson JW, Hatton JF, Gillespie MJ. Effectiveness of intracanal irrigants and medications against the yeast Candida albicans. J Endod. 2002;28(2):68-71.Article PubMed
18. Goldberg F, Artaza LP, De S. Influence of calcium hydroxide dressing on the obturation of simulated lateral canals. J Endod. 2002;28(2):99-101.Article PubMed
19. Miletić I, Ribaric SP, Karlovic Z, Jukic S, Bosnjak A, Anic I. Apical leakage of five root canal sealers after one year of storage. J Endod. 2002;28(6):431-432.PubMed
20. Murray PE, Hafez AA, Smith AJ, Cox CF. Bacterial microleakage and pulp inflammation associated with various restorative materials. Dent Mater. 2002;18(6):470-478.Article PubMed
21. Lee KW, Willams MC, Camps JJ, Pashley DH. Adhesion of endodontic sealers to dentin and gutta-percha. J Endod. 2002;28(10):684-688.Article PubMed
22. Siqueira JF Jr, Lima KC, Magalhaes FA, Lopes HP, Uzeda M. Mechanical reduction of the bacterial population in the root canal by three instrumentation techniques. J Endod. 1999;25(5):332-335.Article PubMed
23. Pataky L, Ivanyi I, Grigar A, Fazekas A. antimicrobial efficacy of various root canal preparation techniques: an in vitro comparative study. J Endod. 2002;28(8):603-605.PubMed
24. Coldero LG, McHugh S, MacKenzie D, Saunders WP. Peduction in intracanal bacteria during root canal preparation with and without apical enlargement. Int Endod J. 2002;35: 437-446.PubMed
25. Lim SS. Clinical Endodontology. 1999;2nd ed. Seoul: Uichihaksa; 137-141.
26. Baumgartner JC, Cuenin PR. Efficacy of several concentrations of sodium hypochlorite for root canal irrigation. J Endod. 1992;18(12):605-612.Article PubMed
27. Haikel Y, Gorce F, Allemann C, Voegel JC. In vitro efficiency of endodontic irrigation solutions on protein desorption. Int Endod J. 1994;27: 16-20.Article PubMed
28. Shuping GB, Orstavik MD, Sigurdsson A, Trope M. Reduction of intracanal bacteria using nickel titanium rotary instrumentation and various medications. J Endod. 2000;26(12):751-755.PubMed
29. Almyroudi A, Mackenzie D, McHugh S, Saunders WP. The effectiveness of various disinfectants used as endodontic intracanal medications: an in vitro study. J Endod. 2002;28(3):163-167.Article PubMed
30. Andreasen JO, Farik B, Munksgaard EC. Long-term calcium hydroxide as a root canal dressing may increase risk of root fracture. Dent Traumatol. 2002;18(3):134-137.Article PubMed PDF
31. Dalton BC, Phillips C, Pettiette M, Trope M. Bacterial reduction with nickel-titanium rotary instrumentation. J Endod. 1998;24(11):763-767.Article PubMed
32. Evans GE, Speight PM, Gulabivala K. The influence of preparation technique and sodium hypochlorite on removal of pulp and predentine from root canals of posterior teeth. Int Endod J. 2001;34: 322-330.PubMed
33. Heard F, Walton RE. Scanning electron microscope study comparing four root canal preparation techniques in small curved canals. Int Endod J. 1997;30: 323-331.Article PubMed
34. Hinrichs RE, Walker WA, Schindler WG. A comparison of amounts of extruded debris using handpiece-driven nickel-titanium instrument systems. J Endod. 1998;24: 102-106.PubMed
35. Peters OA, Barbakow F. Effects of irrigation on debris and smear layer on canal walls prepared by two rotary techniques: a scanning electron microscopic study. J Endod. 2000;26(1):6-10.Article PubMed
36. Lambrianidis T, Tosounidou DE, Tzoanopoulou M. The effect of maintaining apical patency on periapical extrusion. J Endod. 2001;27: 696-698.PubMed
37. Williams CE, Reid JS, Sharkey SW, Saunders WP. In-vitro measurement of apically extruded irrigant in primary molars. Int Endod J. 1995;28: 221-225.PubMed
38. Bradford CE, Eleazer PD, Downs KE, Scheetz JP. Apical pressures developed by needles for canal irrigation. J Endod. 2002;28: 333-335.Article PubMed
39. Brown DC, Moore BK, Brown CE, Newton CW. An in vitro study of apical extrusion of sodium hypochlorite during endodontic canal preparation. J Endod. 1995;21(12):587-591.Article PubMed
40. Kahn FH, Rosenberg PA, Gliksberg J. An in vitro evaluation of the irrigating characteristics of ultrasonic and subsonic handpieces and irrigating needles and probes. J Endod. 1995;21(5):277-280.PubMed

Tables & Figures

Fig. 1

The device for taking a standard radiograph at same position

Fig. 2

Evaluation of remaining Ca(OH)₂ by steroscope

Fig. 3

Average extent of remaining Ca(OH)₂ before recapitulation

Fig. 4

Average extent of remaining Ca(OH)₂ after recapitulation

^*: Significantly different at p<0.05(paired t-test)

Table 1

Group classification according to instruments

Table 2

Average extent of remaining Ca(OH)2 after canal irrigation (unit: mm)

A: before recapitulation B: after recapitulation

^*: Significantly different at p<0.05(paired t-test)

REFERENCES

1. Cohen S, Burns R. Pathways of the pulp. 1994;6th ed. St. Louis: CV Mosby; 179-218.
2. Gambarini G. Shaping and cleaning the root canal system: A scanning electron microscopic evaluation of a new instrumentation and irrigation technique. J Endod. 1999;25(12):800-803.Article PubMed
3. Siqueira JF Jr, Rocas IN, Snatos SR, Lima KC, Magalhaes FA, Uzeda M. Efficacy of instrumentation techniques and irrigation regimens in reducing the bacterial population within root canals. J Endod. 2002;28(3):181-184.Article PubMed
4. Hoen MM, LaBounty GL, Struttmatter EJ. Conservative treatment of persistent periradicular lesions using aspiration and irrigation. J Endod. 1990;16(4):182-186.Article PubMed
5. Jeansonne MJ, White RR. A comparison of 2.0% chlorhexidine gluconate and 5.25% sodium hypochlorite as antimicrobial endodontic irrigants. J Endod. 1994;20(6):276-278.Article PubMed
6. Valera MC, Rego JM, Jorge AOC. Effect of sodium hypochlorite and five intracanal medicants on candida albicans in root canals. J Endod. 2001;27(6):401-403.PubMed
7. Doğan H, Calt S. Effects of chelating agents and sodium hypochlorite on mineral content of root dentin. J Endod. 2001;27(9):578-580.Article PubMed
8. Kuruvilla JR, Kamath MP. Antimicrobial activity of 2.5% sodium hypochlorite and 0.2% chlorhexidine gluconate separately and combined, as endodontic irrignats. J Endod. 1998;24(7):472-476.PubMed
9. Scelza MF, Antoniazzi JH, Scelza P. Efficacy of final irrigation-a scanning electron microscopic Evaluation. J Endod. 2000;26(6):355-358.Article PubMed
10. Siqueira JF Jr, Machado AG, Silveira RM, Lopes HP, Uzeda MD. Evaluation of the effectiveness of sodium hypochlorite used with three irrigation methods in the elimination of enterococcus faecalis from the root canal, in vitro. Int Endod J. 1997;30: 279-282.Article PubMed
11. Siqueira JF Jr, Rocas IN, Favieri A, Lima KC. Chemomechanical reduction of the bacterial population in the root canal after instrumentation and irrigation with 1%, 2.5%, and 5.25% sodium hypochlorite. J Endod. 2000;26(6):331-334.PubMed
12. Tanomaru Filho M, Leonardo MR, Silva LAB. Effect of irrigating solution and calcium hydroxide root canal dressing on the repair of apical and periapical tissues of teeth with periapical lesion. J Endod. 2002;28(4):295-299.Article PubMed
13. Hülsmann M, Hahn W. Complications during root canal irrigation-literature review and case reports. Int Endod J. 2000;33: 186-193.Article PubMed
14. Sukawat C, Srisuwan T. A comparison of the antimicrobial efficacy of three calcium hydroxide formulations on human dentin infected with Enterococcus faecalis. J Endod. 2002;28(2):102-104.Article PubMed
15. Siqueira JF Jr, Rocas IN, Magalhaes FA, de Uzeda M. Antifungal effects of endodontic medicaments. Aust Endod J. 2001;27(3):112-114.PubMed
16. Peters LB, Winkelhoff AJ, Buijs JF, Wesselink PR. Effects of instrumentation, irrigation and dressing with calcium hydroxide on infection in pulpless teeth with periapical bone lesions. Int Endod J. 2002;35: 13-21.Article PubMed
17. Ferguson JW, Hatton JF, Gillespie MJ. Effectiveness of intracanal irrigants and medications against the yeast Candida albicans. J Endod. 2002;28(2):68-71.Article PubMed
18. Goldberg F, Artaza LP, De S. Influence of calcium hydroxide dressing on the obturation of simulated lateral canals. J Endod. 2002;28(2):99-101.Article PubMed
19. Miletić I, Ribaric SP, Karlovic Z, Jukic S, Bosnjak A, Anic I. Apical leakage of five root canal sealers after one year of storage. J Endod. 2002;28(6):431-432.PubMed
20. Murray PE, Hafez AA, Smith AJ, Cox CF. Bacterial microleakage and pulp inflammation associated with various restorative materials. Dent Mater. 2002;18(6):470-478.Article PubMed
21. Lee KW, Willams MC, Camps JJ, Pashley DH. Adhesion of endodontic sealers to dentin and gutta-percha. J Endod. 2002;28(10):684-688.Article PubMed
22. Siqueira JF Jr, Lima KC, Magalhaes FA, Lopes HP, Uzeda M. Mechanical reduction of the bacterial population in the root canal by three instrumentation techniques. J Endod. 1999;25(5):332-335.Article PubMed
23. Pataky L, Ivanyi I, Grigar A, Fazekas A. antimicrobial efficacy of various root canal preparation techniques: an in vitro comparative study. J Endod. 2002;28(8):603-605.PubMed
24. Coldero LG, McHugh S, MacKenzie D, Saunders WP. Peduction in intracanal bacteria during root canal preparation with and without apical enlargement. Int Endod J. 2002;35: 437-446.PubMed
25. Lim SS. Clinical Endodontology. 1999;2nd ed. Seoul: Uichihaksa; 137-141.
26. Baumgartner JC, Cuenin PR. Efficacy of several concentrations of sodium hypochlorite for root canal irrigation. J Endod. 1992;18(12):605-612.Article PubMed
27. Haikel Y, Gorce F, Allemann C, Voegel JC. In vitro efficiency of endodontic irrigation solutions on protein desorption. Int Endod J. 1994;27: 16-20.Article PubMed
28. Shuping GB, Orstavik MD, Sigurdsson A, Trope M. Reduction of intracanal bacteria using nickel titanium rotary instrumentation and various medications. J Endod. 2000;26(12):751-755.PubMed
29. Almyroudi A, Mackenzie D, McHugh S, Saunders WP. The effectiveness of various disinfectants used as endodontic intracanal medications: an in vitro study. J Endod. 2002;28(3):163-167.Article PubMed
30. Andreasen JO, Farik B, Munksgaard EC. Long-term calcium hydroxide as a root canal dressing may increase risk of root fracture. Dent Traumatol. 2002;18(3):134-137.Article PubMed PDF
31. Dalton BC, Phillips C, Pettiette M, Trope M. Bacterial reduction with nickel-titanium rotary instrumentation. J Endod. 1998;24(11):763-767.Article PubMed
32. Evans GE, Speight PM, Gulabivala K. The influence of preparation technique and sodium hypochlorite on removal of pulp and predentine from root canals of posterior teeth. Int Endod J. 2001;34: 322-330.PubMed
33. Heard F, Walton RE. Scanning electron microscope study comparing four root canal preparation techniques in small curved canals. Int Endod J. 1997;30: 323-331.Article PubMed
34. Hinrichs RE, Walker WA, Schindler WG. A comparison of amounts of extruded debris using handpiece-driven nickel-titanium instrument systems. J Endod. 1998;24: 102-106.PubMed
35. Peters OA, Barbakow F. Effects of irrigation on debris and smear layer on canal walls prepared by two rotary techniques: a scanning electron microscopic study. J Endod. 2000;26(1):6-10.Article PubMed
36. Lambrianidis T, Tosounidou DE, Tzoanopoulou M. The effect of maintaining apical patency on periapical extrusion. J Endod. 2001;27: 696-698.PubMed
37. Williams CE, Reid JS, Sharkey SW, Saunders WP. In-vitro measurement of apically extruded irrigant in primary molars. Int Endod J. 1995;28: 221-225.PubMed
38. Bradford CE, Eleazer PD, Downs KE, Scheetz JP. Apical pressures developed by needles for canal irrigation. J Endod. 2002;28: 333-335.Article PubMed
39. Brown DC, Moore BK, Brown CE, Newton CW. An in vitro study of apical extrusion of sodium hypochlorite during endodontic canal preparation. J Endod. 1995;21(12):587-591.Article PubMed
40. Kahn FH, Rosenberg PA, Gliksberg J. An in vitro evaluation of the irrigating characteristics of ultrasonic and subsonic handpieces and irrigating needles and probes. J Endod. 1995;21(5):277-280.PubMed

Citations

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