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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 6  |  Page : 1390-1393  

Comparison of efficacy of various intracanal irrigants with ultrasonic bypass system


1 Senior Lecturer, Department of Conservative Dentistry and Endodontics, Dr. B. R. Ambedkar Institute of Dental Sciences and Hospital, Patna, Bihar, India
2 Senior Lecturer, Department of Conservative and Endodontics, Government Dental College, Silchar, Assam, India
3 Assistant Professor, Department of Conservative Dentistry and Endodontics, Government College of Dentistry, Indore, Madhya Pradesh, India
4 Senior Resident, Department of Dentistry, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India
5 Dental Surgeon Department of Conservative Dentistry and Endodontics, Community Health Center, Sarajgarha, Lakhisarai, Bihar, India
6 Reader Department of Conservative Dentistry and Endodontics, Himachal Institute of Dental Sciences, Paonta Sahib, Sirmour, Himachal Pradesh, India

Date of Submission23-Mar-2021
Date of Decision12-Apr-2021
Date of Acceptance09-May-2021
Date of Web Publication10-Nov-2021

Correspondence Address:
Santosh Kumar
Department of Conservative Dentistry and Endodontics, Community Health Center, Surajgarh, Lakhaisarai, Bihar, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.jpbs_223_21

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   Abstract 


Background: The long-term success of root canal therapy depends on the effective debridement and removal of smear layer and debris from the canal. Root canals with difficult anatomy and complex systems pose great challenge to achieve this. Mechanical therapy alone cannot achieve this goal, various intracanal chemicals also have their own limitations along with the difficulty in reaching the farfetched and difficult areas, and hence, introduction of ultrasonic bypass system has been a boon for the endodontic therapy. Objectives: The aim of this study is to compare the various root canal medicaments along with ultrasonic bypass system in effectively cleaning the debris and smear layer from the various parts of the root canal system. Materials and Methods: Forty single-rooted anterior maxillary and mandibular human teeth were collected for this study, after disinfection, they were sectioned into three equal parts coronal, middle, and apical and these parts were later studies under SEM (Scanning Electron Microscope) and scoring as per the scoring criteria set before the study was done and results were then compared statistically. Results: Group with both ethylenediaminetetraacetic acid (EDTA) and NaOCl with ultrasonic bypass system was the most effective one, when compared with sterile water, NaOCl + ultrasonic bypass system, EDTA + ultrasonic bypass system. NaOCl + ultrasonic bypass system was more effective as compared with the EDTA + ultrasonic bypass system. Conclusion: Ultrasonic bypass system is a useful tool for debris and smear layer removal from a root canal system, but its effectiveness increases when both EDTA and NaOCl are used along with it.

Keywords: Ethylenediaminetetraacetic acid, hypochlorite, intracanal medicament, root canal therapy, ultrasonic bypass system


How to cite this article:
Sinha S, Barua AN, Rana KS, Singh K, Kumar S, Saini R. Comparison of efficacy of various intracanal irrigants with ultrasonic bypass system. J Pharm Bioall Sci 2021;13, Suppl S2:1390-3

How to cite this URL:
Sinha S, Barua AN, Rana KS, Singh K, Kumar S, Saini R. Comparison of efficacy of various intracanal irrigants with ultrasonic bypass system. J Pharm Bioall Sci [serial online] 2021 [cited 2022 Jun 26];13, Suppl S2:1390-3. Available from: https://www.jpbsonline.org/text.asp?2021/13/6/1390/330018




   Introduction Top


The success of an endodontic therapy depends on the efficient cleaning of the root canal so that it can be as sterile as possible. This is achieved by mechanical and chemical means.[1] If this goal is achieved the rate of long-term success of endodontically treated teeth, however, the cleaning of root canal system is not that easy process and have many hindrances, like the complex canal anatomy, lateral canals, accumulation of smear layer formed during mechanical cleansing of the root canal walls. The endodontic failures are mostly attributed to the persistent bacterial infection caused by inadequate root canal debridement.[2]

Smear layer is both organic and inorganic in nature and its removal is a challenge, just one type of irrigating solution is not sufficient to remove this smear layer, hence irrigating solutions with varying properties are needed to thoroughly clean it.[3]

According to the study conducted by Burleson A et al.,[4] the irrigating solutions travel only 1 mm into the canal from the place where they are expressed by a syringe.

Canal curvature, fins, and irregular root canal walls pose a challenge for adequate and proper irrigation of the root canal system.

This penetration of irrigating solutions through the root canal is seen to be increased by ultrasonics.[5]

The Ultrasonic Bypass System works by expressing a continual flow of irrigating solutions in combination with ultrasonic vibrations. Both of these can significantly cleanse the smear layer from the canal walls. This works on the mechanism of cavitation and acoustic streaming.[6],[7]

This study compares the efficacy of different irrigating solutions with ultrasonic By Pass system in root canal debridement.


   Materials and Methods Top


Forty human, single-rooted, anterior maxillary and mandibular were collected for this study. Only teeth with single canals were included in this study, radiographs were taken to ensure that. Teethe with abnormal root canal anatomy, teeth having curvature <30° as evaluated by the Schneider's method and pulp calcifications were excluded from the study. All the collected teeth were put in 6% sodium hypochlorite solution for 2 weeks for sterilization.

Later these teeth were divided into four groups.

Root canal preparation of all these teeth was done by the crown down method by using rotary instruments. RcPrep and 2 ml of 6% sodium hypochlorite solution was used as lubricant between each file. Canals were then dried by using paper points, and the teeth were divided into four groups:

  • Group 1: Sterile water group
  • Group 2: Ultrasonic bypass system with 6% sodium hypochlorite solution
  • Group 3: Ultrasonic bypass system with 17% ethylenediaminetetraacetic acid (EDTA)
  • Group 4: Ultrasonic bypass system with 6% sodium hypochlorite and 17% EDTA.


All the teeth were then sectioned into apical, middle, and coronal third and were examined under SEM under ×500 to ×1000 magnification.

Scoring was done as per the scoring criteria:

Scoring criteria

  • Score 1: A clean root canal with only few or small debris and smear particles
  • Score 2: Debris or smear covering 25% or less of the root canal wall
  • Score 3: Debris or smear covering more than or equal to 25% but <50% of the root canal wall
  • Score 4: More than 50% of the root canal wall is covered by debris or smear layer.


Statistical analysis

Kruskal–Wallis test was used to compare the four groups and Wilcoxon rank sum tests was used to compare each pair of groups.


   Results Top


Each group consists of 10 teeth and was sectioned into three parts coronal, middle and apical and then were scored as per the scoring criteria mentioned above.

The results of this study showed that the ultrasonic bypass system is more effective in debris removal as compared to conventional method, the efficacy of this system reaches to maximum when the intracanal medicament includes both EDTA and 6% sodium hypochlorite solution.

When the coronal location was compared [Table 1], a significant difference in debris scores among groups (P ≤ 0.0001) was found and significantly lower scores for Groups 4, 2, 3, and then 1 with P ≤ 0.0001, 0.0006, and < 0.0001, respectively.
Table 1: Statistical comparison of coronal one-third of all four groups

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When Group 2 was compared with Group 3, no significant difference was observed with P = 0.2140.

When the middle locations were compared [Table 2], it was found that Group 4 was significantly more effective in debris removal followed by Group 2, Group 3, and then Group 1 with P < 0.0001, 0.0259, and < 0.0001, respectively.
Table 2: Statistical comparison of middle one-third of all four groups

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When Group 2 was compared with Group 3 significantly higher score for Group 2 was seen as compared to Group 3, suggesting that NaOcl is more effective when compared with EDTA (P = 0.012).

When the apical location was compared [Table 3], similar trend was found with P < 0.0001, 0.0001, 0.0001, and 0.0005 for Groups 4, 3, 2, and 1, respectively, but no significant difference was found in the Groups 2, 3, and 1 when compared with each other. P =0.4113 and 0.2318 for Groups 2 and 3 and 2 and 1 and P = 0.5021 for Groups 3 and 1.
Table 3: Statistical comparison of apical one-third of all four groups

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   Discussion Top


The goal for endodontic therapy is the removal of debris and smear layer effectively, as the ultimate success of the therapy depends on it. Various techniques are used for this purpose.

Through debridement of the root canal system is not achieved by mechanical preparation with hand instrumentation alone, especially in the apical third of roots, fins, and isthmus.[8],[9]

Incorporation of sodium hypochlorite in chemomechanical preparation of the root canal wall has shown better results as compared to the mechanical preparation alone due to the tissue dissolution and bacteria elimination property of sodium hypochlorite.[10],[11] Carver et al.[12] estimated the role of in vivo antibacterial efficacy of ultrasound after hand and rotary instrumentation in human mandibular molars. Furthermore, enumerated the biggest limitation of reaching difficult areas and ineffective removal of smear layer which raised the need for search of better irrigating system and solutions, thus EDTA came into the picture. It acts by removing inorganic components of the smear layer, exposing bacteria to the antimicrobial effects of sodium hypochlorite by opening the dentinal tubules and hence helps in the removal of microbial biofilm.[12]

Guerisoli et al.[13] in their study also stated that passive ultrasonic irrigation was also used to increase the reach of these chemicals to difficult and farfetched areas such as Fins, isthmuses, and apical third areas of the root canal systems.

Metzler et al.[14] successfully estimated the effectiveness of ultrasonic and calcium hydroxide for the debridement of human mandibular molars.

Group 4 was most successful in removing the smear layer in the middle and coronal areas of the root canal system. Our results are in consistence with the study conducted by Cameron,[15] Ciucchi et al.,[16] and Abbott et al.[17] in these studies also the ultrasonic bypass system was not able to remove the smear layer completely from the apical third of the root canal system.

Effective removal of the smear layer and debris from the root canal system is the ultimate goal of endodontic therapy. Mechanical debridement alone is insufficient to achieve this goal; hence, various intracanal medicaments were introduced but the difficulty arises with the complex root canal systems where these medicaments have limited access; hence, ultrasonic bypass system has evolved as an effective tool to overcome this limitation.


   Conclusion Top


As per our study, the ultrasonic bypass system along with both 6% sodium hypochlorite solution and 7% ETDA is most effective in the removal of smear layer and debris from all areas of tooth, but complete removal of smear layer from the apical region was not achieved.

Among the four groups, Group 4 was most effective followed by Group 2 showing that the 6% sodium hypochlorite solution is more effective then EDTA and plain sterile water was the least effective, but in the apical one third portion of tooth, there was no significant difference between Groups 2, 3, and 1.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Byström A, Sundqvist G. Bacteriologic evaluation of the efficacy of mechanical root canal instrumentation in endodontic therapy. Scand J Dent Res 1981;89:321-8.  Back to cited text no. 1
    
2.
Hsu YY, Kim S. The resected root surface. The issue of canal isthmuses. Dent Clin North Am 1997;41:529-40.  Back to cited text no. 2
    
3.
Ram Z. Effectiveness of root canal irrigation. Oral Surg Oral Med Oral Pathol 1977;44:306-12.  Back to cited text no. 3
    
4.
Burleson A, Nusstein J, Reader A, Beck M. The in vivo evaluation of hand/rotary/ultrasound instrumentation in necrotic, human mandibular molars. J Endod 2007;33:782-7.  Back to cited text no. 4
    
5.
Ahmad M, Pitt Ford TJ, Crum LA. Ultrasonic debridement of root canals: Acoustic streaming and its possible role. J Endod 1987;13:490-9.  Back to cited text no. 5
    
6.
Ahmad M, Pitt Ford TR, Crum LA. Ultrasonic debridement of root canals: An insight into the mechanisms involved. J Endod 1987;13:93-101.  Back to cited text no. 6
    
7.
Ingle JI, Zeldow BJ. An evaluation of mechanical instrumentation and the negative culture in endodontic therapy. J Am Dent Assoc 1958;57:471-6.  Back to cited text no. 7
    
8.
Gutiérrez JH, Garciá J. Microscopic and macroscopic investigation on results of mechanical preparation of root canals. Oral Surg Oral Med Oral Pathol 1968;25:108-16.  Back to cited text no. 8
    
9.
Radcliffe CE, Potouridou L, Qureshi R, Habahbeh N, Qualtrough A, Worthington H, et al. Antimicrobial activity of varying concentrations of sodium hypochlorite on the endodontic microorganisms Actinomyces israelii, A. naeslundii, Candida albicans and Enterococcus faecalis. Int Endod J 2004;37:438-46.  Back to cited text no. 9
    
10.
Senia ES, Marshall FJ, Rosen S. The solvent action of sodium hypochlorite on pulp tissue of extracted teeth. Oral Surg Oral Med Oral Pathol 1971;31:96-103.  Back to cited text no. 10
    
11.
Clegg MS, Vertucci FJ, Walker C, Belanger M, Britto LR. The effect of exposure to irrigant solutions on apical dentin biofilms in vitro. J Endod 2006;32:434-7.  Back to cited text no. 11
    
12.
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;33:1038-43.  Back to cited text no. 12
    
13.
Guerisoli DM, Marchesan MA, Walmsley AD, Lumley PJ, Pecora JD. Evaluation of smear layer removal by EDTAC and sodium hypochlorite with ultrasonic agitation. Int Endod J 2002;35:418-21.  Back to cited text no. 13
    
14.
Metzler RS, Montgomery S. Effectiveness of ultrasonics and calcium hydroxide for the debridement of human mandibular molars. J Endod 1989;15:373-8.  Back to cited text no. 14
    
15.
Cameron JA. The use of ultrasonics in the removal of the smear layer: A scanning electron microscope study. J Endod 1983;9:289-92.  Back to cited text no. 15
    
16.
Ciucchi B, Khettabi M, Holz J. The effectiveness of different endodontic irrigation procedures on the removal of the smear layer: A scanning electron microscopic study. Int Endod J 1989;22:21-8.  Back to cited text no. 16
    
17.
Abbott PV, Heijkoop PS, Cardaci SC, Hume WR, Heithersay GS. An SEM study of the effects of different irrigation sequences and ultrasonics. Int Endod J 1991;24:308-16.  Back to cited text no. 17
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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