IN VITRO EVALUATION OF CLEANING EFFICACY OF VARIOUS IRRIGATION METHODS IN MANDIBULAR MOLARS

So-Young Lee; Won-Jun Son; WooCheol Lee; Kee-Yeon Kum; Kwang-Shik Bae; Seung-Ho Baek

doi:10.5395/JKACD.2009.34.3.215

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Original Article IN VITRO EVALUATION OF CLEANING EFFICACY OF VARIOUS IRRIGATION METHODS IN MANDIBULAR MOLARS: So-Young Lee, Won-Jun Son, WooCheol Lee, Kee-Yeon Kum, Kwang-Shik Bae, Seung-Ho Baek^,*; J Korean Acad Conserv Dent 2009;34(3):-222.
DOI: https://doi.org/10.5395/JKACD.2009.34.3.215
Published online: January 14, 2009

Department of Conservative Dentistry, School of Dentistry, Seoul National University

*Corresponding Author: Seung-Ho Baek, Dept of Conservative Dentistry, School of Dentistry, Seoul National University, 28 Yeongon-dong, Jongno-gu, Seoul, Korea, Tel: 82-2-2072-3820 Fax: 82-2-747-0958 E-mail: shbaek@snu.ac.kr

• Received: April 6, 2009 • Revised: April 24, 2009 • Accepted: April 29, 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

The aim of this in vitro study was to evaluate the cleaning efficacy of various irrigation methods in the mandibular mesial roots. The forty five mesial root canals were shaped by Profile .06 instruments to apical size #30 and irrigated with 5 ml of 3.5% NaOCl. The teeth were divided into 3 groups and irrigated finally for 1 minute; Group 1: syringe irrigation, Group 2: ultrasonic irrigation, Group 3: RinsEndo irrigation.

After histological processing, the cross sections of apical 1, 3, and 5 mm level were examined with an optical microscope. The cleanliness values of canals and isthmuses were calculated and analyzed by Mann-Whitney U test.
1. There were no significant differences in both canal and isthmus cleanliness between syringe irrigation and ultrasonic irrigation except 5 mm level of isthmus.
2. RinsEndo irrigation had significantly higher canal cleanliness values than syringe irrigation at 1 mm and 3 mm levels (p < 0.05). Also, RinsEndo irrigation had significantly higher isthmus cleanliness values than syringe irrigation at all levels evaluated (p < 0.05).
3. There were no statistical differences in both canal and isthmus cleanliness between ultrasonic irrigation and RinsEndo irrigation except 3 mm level of canal. From this study, RinsEndo irrigation can be useful as an additional irrigation procedure.
Keywords: canal irrigation; cleanliness; mesial canal

Figure 1.

Graph of mean percentage of canal cleanliness at 1, 3, and 5 mm levels

* Statistically significant (p < 0.05).

Figure 2.

Graph of mean percentage of isthmus cleanliness at 1, 3, and 5 mm levels

* Statistically significant (p < 0.05).

Figure 3.

Photomicrograph of cross section of the mesial root at the 5 mm level (group 1): 100% mesiobuccal canal (right) and 100% mesiolingual canal (left) cleanliness, with 41.1% isthmus cleanliness (40×, H&E stain)

Figure 4.

Photomicrograph of cross section of the mesial root at the 1 mm level (group 2): 100% mesiobuccal canal (right) and 100% mesiolingual canal (left) cleanliness, with 89.2% isthmus cleanliness (40×, H&E stain)

Figure 5.

Photomicrograph of cross section of the mesial root at the 1 mm level (group 3): 100% mesiobuccal canal (right) and 100% mesiolingual canal (left) cleanliness, with 100% isthmus cleanliness (40×, H&E stain)

Table 1.

Mean percentage of canal cleanliness at 1, 3, and 5 mm levels

Level	n	Group 1 (%)	n	Group 2 (%)	n	Group 3 (%)
1 mm	25	91.7±12.7	29	93.5±10.2	21	97.3±9.9
3 mm	30	98.5± 3.0	30	98.4± 5.3	28	100.0±0.0
5 mm	30	99.7± 1.0	28	99.1±14.6	30	99.8±0.7

Table 2.

Mean percentage of isthmus cleanliness at 1, 3, and 5 mm levels

Level	n	Group 1 (%)	n	Group 2 (%)	n	Group 3 (%)
1 mm	8	46.3±35.6	10	59.0±30.5	8	82.5±26.4
3 mm	11	56.6±30.5	11	69.3±32.0	13	87.6±19.5
5 mm	10	51.0±33.2	15	85.4±29.6	13	88.1±21.5

REFERENCES

1. Baugh D, Wallace J. The role of apical instrumentation in root canal treatment: A review of the literature. J Endod 31(5):333-340. 2005.Article PubMed
2. Grossman LI. Endodontic practice. 7^th ed.. Philadelphia: Lea & Febiger; 1970.
3. Schilder H. Cleaning and shaping the root canal. Dent Clin North Am 18(2):269-290. 1974.Article PubMed
4. Wu MK, Wesselink PR. A primary observation on the preparation and obturation of oval canals. Int Endod J 34(2):137-141. 2001.Article PubMed PDF
5. Peters OA. Current challenges and concepts in the preparation of root canal systems: a review. J Endod 30(8):559-567. 2004.Article PubMed
6. Wu MK, van der Sluis LWM, Wesselink PR. The capability of two hand instrumentation techniques to remove the inner layer of dentin in oval canals. Int Endod J 36(3):218-224. 2003.PubMed
7. Meyer BE, Peters OA, Barbakow F. Effects of rotary instruments and ultrasonic irrigation on debris and smear layer score: a scanning electron microscopic study. Int Endod J 35(7):582-589. 2002.PubMed
8. Teixeira FB, Sano CL, Gomes BPFA, Zaia AA, Ferraz CCR, Souza Filho FJ. A preliminary in vitro study of the incidence and position of the root canal isthmus in maxillary and mandibular first molars. Int Endod J 36(4):276-280. 2003.Article PubMed PDF
9. Hwang HK, Bae SC, Cho YL. The irrigating effect before and after coronal flaring. J Kor Acad Cons Dent 28(1):72-79. 2003.Article
10. Cunningham WT, Martin H, Forrest WR. Evaluation of root canal debridement by the endosonic ultrasonic synergistic system. Oral Surg Oral Med Oral Pathol 53(5):401-404. 1982.PubMed
11. Walters MJ, Baumgatner JC, Marshall JG. Efficacy of irrigation with rotary instrumentation. J Endod 28(12):837-839. 2002.Article PubMed
12. Lee SJ, Wu MK, Wesselink PR. The efficacy of ultrasonic irrigation to remove artificially placed dentin debris from different sized simulated plastic root canals. Int Endod J 37(9):607-612. 2004.PubMed
13. Lee SJ, Wu MK, Wesselink PR. The ability of using syringe irrigation and ultrasound irrigation to remove dentin debris from simulated extensions and irregularities in root canals. J Kor Acad Cons Dent 28(3):289. 2003.
14. 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 53(5):527-531. 1982.PubMed
15. Lumley PJ, Walmsley AD, Walton RE, Rippin JW. Cleaning oval canals using ultrasonic and sonic instrumentation. J Endod 19(9):453-457. 1993.PubMed
16. 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 37(10):672-678. 2004.Article PubMed
17. Goodman A, Reader A, Beck M, Melfi R, Meyers W. An in vitro comparison of the efficacy of the step-back technique versus a step-back/ultrasonic technique in human mandibular molars. J Endod 11(6):249-256. 1985.Article PubMed
18. Haidet J, Reader A, Beck M, Meyers W. An in vivo comparison of the step-back technique versus a step-back/ultrasonic technique in human mandibular molars. J Endod 15(5):195-199. 1989.Article PubMed
19. Archer R, Reader A, Nist R, Beck M, Meyers W. An in vivo evaluation of the efficacy of ultrasound after step-back preparation in mandibular molars. J Endod 18(11):549-552. 1992.PubMed
20. 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 31(3):166-170. 2005.Article PubMed
21. Schneider SW. A comparison of canal preparations in straight and curved root canals. Oral Surg Oral Med Oral Pathol 32(2):271-275. 1971.Article PubMed
22. Weller NR, Niemczyk SP, Kim S. Incidence and position of the canal isthmus. Part 1. Mesiobuccal root of maxillary first molar. J Endod 21(7):380-383. 1995.PubMed
23. Hwang HK, Shin YG. The effectiveness of obturating techniques in sealing isthmuses. J Kor Acad Cons Dent 26(6):499-506. 2001.
24. Hsu Y, Kim S. The resected root surface: the issue of canal isthmuses. Dent Clin North Am 41(3):529-540. 1997.PubMed
25. Nair PNR. Pathogenesis of apical periodontitis and the causes of endodontic failures. Crit Rev Oral Biol Med 15(6):348-381. 2004.PubMed
26. Mannocci F, Peru M, Sherriff M, Cook R, Pitt Ford TR. The isthmuses of the mesial root of mandibular molars: a micro-computered tomographic study. Int Endod J 38(8):558-563. 2005.PubMed
27. Ram Z. Effectiveness of root canal irrigation. Oral Surg Oral Med Oral Pathol 44(2):306-312. 1977.PubMed
28. Weller RN, Brady JM, Bernier WE. Efficacy of ultrasonic cleaning. J Endod 6(9):740-743. 1980.Article PubMed
29. Ahmad M, Pitt Ford TR, Crum LA. Ultrasonic debridement of root canals: acoustic streaming and its possible role. J Endod 13(10):490-499. 1987.Article PubMed
30. 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 40(6):415-426. 2007.Article PubMed
31. Moorer WR, Wesselink PR. Factors promoting the tissue dissolving capacity of sodium hypochlorite. Int Endod J 15(4):187-196. 1982.PubMed
32. Hulsmann M, Hahn W. Complications during root canal irrigation - literature review and case reports. Int Endod J 33(3):186-193. 2000.Article PubMed
33. Gernhardt CR, Eppendorf K, Kozlowski A, Brandt M. Toxicity of concentrated sodium hypochlorite used as endodontic irrigant. Int Endod J 37(4):272-280. 2004.PubMed
34. Hauser V, Braun A Frentzen. Penetration depth of a dye marker into dentine using a novel hydrodynamic system (RinsEndo). Int Endod J 40(8):644-652. 2007.Article PubMed

Tables & Figures

Figure 1.

Graph of mean percentage of canal cleanliness at 1, 3, and 5 mm levels

* Statistically significant (p < 0.05).

Figure 2.

Graph of mean percentage of isthmus cleanliness at 1, 3, and 5 mm levels

* Statistically significant (p < 0.05).

Figure 3.

Figure 4.

Figure 5.

Table 1.

Mean percentage of canal cleanliness at 1, 3, and 5 mm levels

Level	n	Group 1 (%)	n	Group 2 (%)	n	Group 3 (%)
1 mm	25	91.7±12.7	29	93.5±10.2	21	97.3±9.9
3 mm	30	98.5± 3.0	30	98.4± 5.3	28	100.0±0.0
5 mm	30	99.7± 1.0	28	99.1±14.6	30	99.8±0.7

Table 2.

Mean percentage of isthmus cleanliness at 1, 3, and 5 mm levels

Level	n	Group 1 (%)	n	Group 2 (%)	n	Group 3 (%)
1 mm	8	46.3±35.6	10	59.0±30.5	8	82.5±26.4
3 mm	11	56.6±30.5	11	69.3±32.0	13	87.6±19.5
5 mm	10	51.0±33.2	15	85.4±29.6	13	88.1±21.5

REFERENCES

1. Baugh D, Wallace J. The role of apical instrumentation in root canal treatment: A review of the literature. J Endod 31(5):333-340. 2005.Article PubMed
2. Grossman LI. Endodontic practice. 7^th ed.. Philadelphia: Lea & Febiger; 1970.
3. Schilder H. Cleaning and shaping the root canal. Dent Clin North Am 18(2):269-290. 1974.Article PubMed
4. Wu MK, Wesselink PR. A primary observation on the preparation and obturation of oval canals. Int Endod J 34(2):137-141. 2001.Article PubMed PDF
5. Peters OA. Current challenges and concepts in the preparation of root canal systems: a review. J Endod 30(8):559-567. 2004.Article PubMed
6. Wu MK, van der Sluis LWM, Wesselink PR. The capability of two hand instrumentation techniques to remove the inner layer of dentin in oval canals. Int Endod J 36(3):218-224. 2003.PubMed
7. Meyer BE, Peters OA, Barbakow F. Effects of rotary instruments and ultrasonic irrigation on debris and smear layer score: a scanning electron microscopic study. Int Endod J 35(7):582-589. 2002.PubMed
8. Teixeira FB, Sano CL, Gomes BPFA, Zaia AA, Ferraz CCR, Souza Filho FJ. A preliminary in vitro study of the incidence and position of the root canal isthmus in maxillary and mandibular first molars. Int Endod J 36(4):276-280. 2003.Article PubMed PDF
9. Hwang HK, Bae SC, Cho YL. The irrigating effect before and after coronal flaring. J Kor Acad Cons Dent 28(1):72-79. 2003.Article
10. Cunningham WT, Martin H, Forrest WR. Evaluation of root canal debridement by the endosonic ultrasonic synergistic system. Oral Surg Oral Med Oral Pathol 53(5):401-404. 1982.PubMed
11. Walters MJ, Baumgatner JC, Marshall JG. Efficacy of irrigation with rotary instrumentation. J Endod 28(12):837-839. 2002.Article PubMed
12. Lee SJ, Wu MK, Wesselink PR. The efficacy of ultrasonic irrigation to remove artificially placed dentin debris from different sized simulated plastic root canals. Int Endod J 37(9):607-612. 2004.PubMed
13. Lee SJ, Wu MK, Wesselink PR. The ability of using syringe irrigation and ultrasound irrigation to remove dentin debris from simulated extensions and irregularities in root canals. J Kor Acad Cons Dent 28(3):289. 2003.
14. 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 53(5):527-531. 1982.PubMed
15. Lumley PJ, Walmsley AD, Walton RE, Rippin JW. Cleaning oval canals using ultrasonic and sonic instrumentation. J Endod 19(9):453-457. 1993.PubMed
16. 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 37(10):672-678. 2004.Article PubMed
17. Goodman A, Reader A, Beck M, Melfi R, Meyers W. An in vitro comparison of the efficacy of the step-back technique versus a step-back/ultrasonic technique in human mandibular molars. J Endod 11(6):249-256. 1985.Article PubMed
18. Haidet J, Reader A, Beck M, Meyers W. An in vivo comparison of the step-back technique versus a step-back/ultrasonic technique in human mandibular molars. J Endod 15(5):195-199. 1989.Article PubMed
19. Archer R, Reader A, Nist R, Beck M, Meyers W. An in vivo evaluation of the efficacy of ultrasound after step-back preparation in mandibular molars. J Endod 18(11):549-552. 1992.PubMed
20. 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 31(3):166-170. 2005.Article PubMed
21. Schneider SW. A comparison of canal preparations in straight and curved root canals. Oral Surg Oral Med Oral Pathol 32(2):271-275. 1971.Article PubMed
22. Weller NR, Niemczyk SP, Kim S. Incidence and position of the canal isthmus. Part 1. Mesiobuccal root of maxillary first molar. J Endod 21(7):380-383. 1995.PubMed
23. Hwang HK, Shin YG. The effectiveness of obturating techniques in sealing isthmuses. J Kor Acad Cons Dent 26(6):499-506. 2001.
24. Hsu Y, Kim S. The resected root surface: the issue of canal isthmuses. Dent Clin North Am 41(3):529-540. 1997.PubMed
25. Nair PNR. Pathogenesis of apical periodontitis and the causes of endodontic failures. Crit Rev Oral Biol Med 15(6):348-381. 2004.PubMed
26. Mannocci F, Peru M, Sherriff M, Cook R, Pitt Ford TR. The isthmuses of the mesial root of mandibular molars: a micro-computered tomographic study. Int Endod J 38(8):558-563. 2005.PubMed
27. Ram Z. Effectiveness of root canal irrigation. Oral Surg Oral Med Oral Pathol 44(2):306-312. 1977.PubMed
28. Weller RN, Brady JM, Bernier WE. Efficacy of ultrasonic cleaning. J Endod 6(9):740-743. 1980.Article PubMed
29. Ahmad M, Pitt Ford TR, Crum LA. Ultrasonic debridement of root canals: acoustic streaming and its possible role. J Endod 13(10):490-499. 1987.Article PubMed
30. 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 40(6):415-426. 2007.Article PubMed
31. Moorer WR, Wesselink PR. Factors promoting the tissue dissolving capacity of sodium hypochlorite. Int Endod J 15(4):187-196. 1982.PubMed
32. Hulsmann M, Hahn W. Complications during root canal irrigation - literature review and case reports. Int Endod J 33(3):186-193. 2000.Article PubMed
33. Gernhardt CR, Eppendorf K, Kozlowski A, Brandt M. Toxicity of concentrated sodium hypochlorite used as endodontic irrigant. Int Endod J 37(4):272-280. 2004.PubMed
34. Hauser V, Braun A Frentzen. Penetration depth of a dye marker into dentine using a novel hydrodynamic system (RinsEndo). Int Endod J 40(8):644-652. 2007.Article PubMed

Citations

Citations to this article as recorded by

Multivariate analysis of the cleaning efficacy of different final irrigation techniques in the canal and isthmus of mandibular posterior teeth
Yeon-Jee Yoo, WooCheol Lee, Hyeon-Cheol Kim, Won-Jun Shon, Seung-Ho Baek
Restorative Dentistry & Endodontics.2013; 38(3): 154. CrossRef
Review of root canal irrigant delivery techniques and devices
Yeon-Jee Yoo, Su-Jeong Shin, Seung-Ho Baek
Journal of Korean Academy of Conservative Dentistry.2011; 36(3): 180. CrossRef

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IN VITRO EVALUATION OF CLEANING EFFICACY OF VARIOUS IRRIGATION METHODS IN MANDIBULAR MOLARS

J Korean Acad Conserv Dent. 2009;34(3):215-222. Published online January 14, 2009

DOI: https://doi.org/10.5395/JKACD.2009.34.3.215

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Figure

IN VITRO EVALUATION OF CLEANING EFFICACY OF VARIOUS IRRIGATION METHODS IN MANDIBULAR MOLARS

Figure 1. Graph of mean percentage of canal cleanliness at 1, 3, and 5 mm levels

Figure 2. Graph of mean percentage of isthmus cleanliness at 1, 3, and 5 mm levels

Figure 3. Photomicrograph of cross section of the mesial root at the 5 mm level (group 1): 100% mesiobuccal canal (right) and 100% mesiolingual canal (left) cleanliness, with 41.1% isthmus cleanliness (40×, H&E stain)

Figure 4. Photomicrograph of cross section of the mesial root at the 1 mm level (group 2): 100% mesiobuccal canal (right) and 100% mesiolingual canal (left) cleanliness, with 89.2% isthmus cleanliness (40×, H&E stain)

Figure 5. Photomicrograph of cross section of the mesial root at the 1 mm level (group 3): 100% mesiobuccal canal (right) and 100% mesiolingual canal (left) cleanliness, with 100% isthmus cleanliness (40×, H&E stain)

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

IN VITRO EVALUATION OF CLEANING EFFICACY OF VARIOUS IRRIGATION METHODS IN MANDIBULAR MOLARS

Level	n	Group 1 (%)	n	Group 2 (%)	n	Group 3 (%)
1 mm	25	91.7±12.7	29	93.5±10.2	21	97.3±9.9
3 mm	30	98.5± 3.0	30	98.4± 5.3	28	100.0±0.0
5 mm	30	99.7± 1.0	28	99.1±14.6	30	99.8±0.7

Level	n	Group 1 (%)	n	Group 2 (%)	n	Group 3 (%)
1 mm	8	46.3±35.6	10	59.0±30.5	8	82.5±26.4
3 mm	11	56.6±30.5	11	69.3±32.0	13	87.6±19.5
5 mm	10	51.0±33.2	15	85.4±29.6	13	88.1±21.5

Table 1. Mean percentage of canal cleanliness at 1, 3, and 5 mm levels

Table 2. Mean percentage of isthmus cleanliness at 1, 3, and 5 mm levels