Abstract
Objectives: This study aimed to evaluate the effects of different irrigation systems on the removal of intracanal medicament used in regenerative endodonti treatment.
Materials and Methods: Following standardized preparation to obtain an immature tooth model, modified triple antibiotic paste (mTAP) consisting of metronidazole, ciprofloxacin and clindamycin was applied to the root canals of single-rooted human maxillar teeth and waited for three weeks. A total of 50 teeth with standardized preparation and intracanal medicament were randomly divided into five groups according to the irrigation method to be applied (n=10); Group 1: Conventional Syringe Irrigation (CSI), Group 2: Passive Ultrasonic Irrigation (PUI), Group 3: EndoActivator (EA), Group 4: EndoVac (EV) Group 5: Nd:YAG laser (LSR). Following the removal of the mTAP with different irrigation systems, the teeth were divided along their bukko-lingual axis. The impact roots were examined under the stereomicroscope with the 4-grade scoring scale for the presence of residual intracanal medicaments. Scores for coronal, middle and apical regions of each root were recorded.
Results: In terms of total scores, PUI group showed higher intracanal medicament removal efficacy compared to the other groups (p<0.05). In the intra-group comparison of the root canal third, less intracanal medicament was found in the apical third (p <0.05). The highest intracanal medicament removal efficacy was found in PUI and LSR groups in the coronal third, PUI group in the middle third, and PUI and EV groups in the apical third (p<0.05).
Conclusions: Intracanal medicament removal scores were significanlty associated with irrigation system. PUI showed statistically significantly higher intracanal medicament removal efficiency than other irrigation methods. While there was no difference between the coronal and middle thirds, statistically significantly less intracanal medicament removal was found in the apical third compared to the other regions.
Keywords
Bond strength Biodentine irrigation intracanal medicament regenerative endodontic treatment
Project Number
DİŞ-211
References
- 1. Rafter M. Apexification: a review. Dent Traumatol 2005;21:1-8.
- 2. Murray PE. Review of guidance for the selection of regenerative endodontics, apexogenesis, apexification, pulpotomy, and other endodontic treatments for immature permanent teeth. Int Endod J 2022;
- 3. Hargreaves KM, Diogenes A, Teixeira FB. Treatment options: biological basis of regenerative endodontic procedures. Pediatr Dent 2013;35:129-140.
- 4. Bose R, Nummikoski P, Hargreaves K. A retrospective evaluation of radiographic outcomes in immature teeth with necrotic root canal systems treated with regenerative endodontic procedures. J Endod 2009;35:1343-1349.
- 5. Nagas E, Cehreli Z, Uyanik M, Vallittu P, Lassila L. Effect of several intracanal medicaments on the push‐out bond strength of ProRoot MTA and Biodentine. Int Endod J 2016;49:184-188.
- 6. Aguiar BA, Frota L, Taguatinga DT, et al. Influence of ultrasonic agitation on bond strength, marginal adaptation, and tooth discoloration provided by three coronary barrier endodontic materials. Clin Oral Investig 2019;23:4113-4122.
- 7. Prather BT, Ehrlich Y, Spolnik K, Platt JA, Yassen GH. Effects of two combinations of triple antibiotic paste used in endodontic regeneration on root microhardness and chemical structure of radicular dentine. J Oral Sci 2014;56:245-251.
- 8. Babu KG, Kavyashree GH. Evaluation of the clinical efficiency of rotary and manual files for root canal instrumentation in primary teeth pulpectomies: A comparative randomized clinical trial. Contemp Pediatr Dent 2021;2:21-34.
- 9. Nandini S, Velmurugan N, Kandaswamy D. Removal efficiency of calcium hydroxide intracanal medicament with two calcium chelators: volumetric analysis using spiral CT, an in vitro study. J Endod 2006;32:1097-1101.
- 10. Zhou J, Liu T, Guo L. Effectiveness of XP-Endo Finisher and passive ultrasonic irrigation on intracanal medicament removal from root canals: a systematic review and meta-analysis. BMC Oral Health 2021;21:1-15.
- 11. Chou K, George R, Walsh LJ. Effectiveness of different intracanal irrigation techniques in removing intracanal paste medicaments. Aust Dent J 2014;40:21-25.
- 12. Topçuoğlu H, Düzgün S, Ceyhanlı K, et al. Efficacy of different irrigation techniques in the removal of calcium hydroxide from a simulated internal root resorption cavity. Int Endod J 2015;48:309-316.
- 13. Antov H, Duggal M, Nazzal H. Management of discolouration following revitalization endodontic procedures: A case series. Int Endod J 2019;52:1660-1670.
- 14. Aydin MN, Buldur B. The effect of intracanal placement of various medicaments on the bond strength of three calcium silicate-based cements to root canal dentin. J Adhes Sci Technol 2018;32:542-552.
- 15. Çelik D, Er K, Serper A, Taşdemir T, Ceyhanlı KT. Push-out bond strength of three calcium silicate cements to root canal dentine after two different irrigation regimes. Clin Oral Investig 2014;18:1141-1146.
- 16. El-Ma’aita AM, Qualtrough AJ, Watts DC. The effect of smear layer on the push-out bond strength of root canal calcium silicate cements. Dent Mater 2013;29:797-803.
- 17. Buldur B, Kapdan A. Comparison of the EndoVac system and conventional needle irrigation on removal of the smear layer in primary molar root canals. Niger J Clin Pract 2017;20:1168-1174.
- 18. Buldur B, Kapdan A. Comparison of the antimicrobial efficacy of the EndoVac system and conventional needle irrigation in primary molar root canals. J Clin Pediatr Dent 2017;41:284-288.
- 19. Hoshino E, Kurihara‐Ando N, Sato I, et al. In‐vitro antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline. Int Endod J 1996;29:125-130.
- 20. Schoop U, Kluger W, Moritz A, et al. Bactericidal effect of different laser systems in the deep layers of dentin. Lasers Surg Med 2004;35:111-116.
- 21. Van der Sluis L, Gambarini G, Wu M, Wesselink P. The influence of volume, type of irrigant and flushing method on removing artificially placed dentine debris from the apical root canal during passive ultrasonic irrigation. Int Endod J 2006;39:472-476.
- 22. Chen BK-J, George R, Walsh LJ. Discoloration of roots caused by residual endodontic intracanal medicaments. Sci World J 2014;2014:
- 23. Topçuoğlu H, Demirbuga S, Topçuoğlu G. Evaluation of apically extruded debris during the removal of canal filling material using three different Ni‐Ti systems and hand files in teeth with simulated apical root resorption. Int Endod J 2020;53:403-409.
- 24. Topçuoğlu HS, Arslan H, Akçay M, et al. The effect of medicaments used in endodontic regeneration technique on the dislocation resistance of mineral trioxide aggregate to root canal dentin. J Endod 2014;40:2041-2044.
- 25. Khoshkhounejad M, Shokouhinejad N, Pirmoazen S. Regenerative endodontic treatment: report of two cases with different clinical management and outcomes. J Dent (Tehran) 2015;12:460.
- 26. Nosrat A, Homayounfar N, Oloomi K. Drawbacks and unfavorable outcomes of regenerative endodontic treatments of necrotic immature teeth: a literature review and report of a case. J Endod 2012;38:1428-1434.
- 27. Pashley E, Birdsong N, Bowman K, Pashley DH. Cytotoxic effects of NaOCl on vital tissue. J Endod 1985;11:525-528.
- 28. Trevino EG, Patwardhan AN, Henry MA, et al. Effect of irrigants on the survival of human stem cells of the apical papilla in a platelet-rich plasma scaffold in human root tips. J Endod 2011;37:1109-1115.
- 29. Martin DE, De Almeida JF, Henry MA, et al. Concentration-dependent effect of sodium hypochlorite on stem cells of apical papilla survival and differentiation. J Endod 2014;40:51-55.
- 30. Buldur B, Öznurhan F, Kaptan A. The effect of different chelating agents on the push-out bond strength of proroot mta and endosequence root repair material. Eur Oral Res 2019;53:88-93.
- 31. Buldur B, Oznurhan F, Kayabası M, Sahin F. Shear bond strength of two calcium silicate-based cements to compomer. Cumhuriyet Dent J 2018;21:18-23.
- 32. Jiang LM, Lak B, Eijsvogels LM, Wesselink P, van der Sluis LW. Comparison of the cleaning efficacy of different final irrigation techniques. J Endod 2012;38:838-841.
- 33. Arslan D, Guneser MB, Dincer AN, et al. Comparison of Smear Layer Removal Ability of QMix with Different Activation Techniques. J Endod 2016;42:1279-1285.
- 34. Plotino G, Grande NM, Mercade M, et al. Efficacy of sonic and ultrasonic irrigation devices in the removal of debris from canal irregularities in artificial root canals. J Appl Oral Sci 2019;27:e20180045.
- 35. Akman M, Akbulut MB, Aydinbelge HA, Belli S. Comparison of different irrigation activation regimens and conventional irrigation techniques for the removal of modified triple antibiotic paste from root canals. J Endod 2015;41:720-724.
- 36. Berkhoff JA, Chen PB, Teixeira FB, Diogenes A. Evaluation of triple antibiotic paste removal by different irrigation procedures. J Endod 2014;40:1172-1177.
Abstract
Amaç: Bu çalışmanın amacı farklı irrigasyon sistemlerinin rejeneratif endodonti tedavisinde kullanılan kanal içi ilaçların uzaklaştırılması üzerindeki etkilerini değerlendirmektir.
Gereç ve Yöntem: İmmatür diş modeli elde etmek için standardize edilmiş preparasyonun ardından, tek köklü üst insan dişlerinin kök kanallarına metronidazol, siprofloksasin ve klindamisinden oluşan modifiye üçlü antibiyotik pat (mTAP) uygulanmış ve üç hafta beklendi. Standart preparasyon ve kanal içi ilaç uygulanan toplam 50 diş, uygulanacak irrigasyon yöntemine göre (n=10) rastgele beş gruba ayrıldı; Grup 1: Gelenekel Şırınga İrrigasyonu (GSI), Grup 2: Pasif Ultrasonik İrrigasyon (PUI), Grup 3: EndoActivator (EA), Grup 4: EndoVac (EV) Grup 5: Nd:YAG lazer (LZR). Farklı irrigasyon sistemleri ile mTAP'ın uzaklaştırılmasını takiben dişler bukko-lingual ekseni boyunca ayrıldı. Darbe kökleri, artık intrakanal ilaç varlığı için 4 dereceli puanlama skalası ile stereomikroskop altında incelendi. Her kökün koronal, orta ve apikal bölgeleri için skorlar kaydedildi.
Bulgular: Toplam puanlar açısından, PUI grubu diğer gruplara göre daha yüksek kanal içi ilaç uzaklaştırma etkinliği gösterdi (p<0.05). Kök kanal üçlüsünün grup içi karşılaştırmasında, apikal üçlüde daha az kanal içi ilaç bulundu (p <0.05). En yüksek kanal içi ilaç uzaklaştırma etkinliği PUI ve LZR gruplarında koronal üçlüde, PUI grubunda orta üçlüde ve PUI ve EV gruplarında apikal üçlüde bulundu (p<0,05).
Sonuçlar: Kanal içi ilaç uzaklaştırma skorları, irrigasyon sistemi ile istatistiksel olarak anlamlı şekilde ilişkiliydi. PUI, diğer irrigasyon yöntemlerine göre istatistiksel olarak anlamlı derecede daha yüksek kanal içi ilaç uzaklaştırma etkinliği gösterdi. Koronal ve orta üçlü arasında fark yokken, apikal üçlüde diğer bölgelere göre istatistiksel olarak anlamlı derecede daha az kanal içi ilaç uzaklaştırma saptandı.
Supporting Institution
SİVAS CUMHURİYET ÜNİVERSİTESİ BİLİMSEL ARAŞTIRMA PROJELERİ
Project Number
DİŞ-211
References
- 1. Rafter M. Apexification: a review. Dent Traumatol 2005;21:1-8.
- 2. Murray PE. Review of guidance for the selection of regenerative endodontics, apexogenesis, apexification, pulpotomy, and other endodontic treatments for immature permanent teeth. Int Endod J 2022;
- 3. Hargreaves KM, Diogenes A, Teixeira FB. Treatment options: biological basis of regenerative endodontic procedures. Pediatr Dent 2013;35:129-140.
- 4. Bose R, Nummikoski P, Hargreaves K. A retrospective evaluation of radiographic outcomes in immature teeth with necrotic root canal systems treated with regenerative endodontic procedures. J Endod 2009;35:1343-1349.
- 5. Nagas E, Cehreli Z, Uyanik M, Vallittu P, Lassila L. Effect of several intracanal medicaments on the push‐out bond strength of ProRoot MTA and Biodentine. Int Endod J 2016;49:184-188.
- 6. Aguiar BA, Frota L, Taguatinga DT, et al. Influence of ultrasonic agitation on bond strength, marginal adaptation, and tooth discoloration provided by three coronary barrier endodontic materials. Clin Oral Investig 2019;23:4113-4122.
- 7. Prather BT, Ehrlich Y, Spolnik K, Platt JA, Yassen GH. Effects of two combinations of triple antibiotic paste used in endodontic regeneration on root microhardness and chemical structure of radicular dentine. J Oral Sci 2014;56:245-251.
- 8. Babu KG, Kavyashree GH. Evaluation of the clinical efficiency of rotary and manual files for root canal instrumentation in primary teeth pulpectomies: A comparative randomized clinical trial. Contemp Pediatr Dent 2021;2:21-34.
- 9. Nandini S, Velmurugan N, Kandaswamy D. Removal efficiency of calcium hydroxide intracanal medicament with two calcium chelators: volumetric analysis using spiral CT, an in vitro study. J Endod 2006;32:1097-1101.
- 10. Zhou J, Liu T, Guo L. Effectiveness of XP-Endo Finisher and passive ultrasonic irrigation on intracanal medicament removal from root canals: a systematic review and meta-analysis. BMC Oral Health 2021;21:1-15.
- 11. Chou K, George R, Walsh LJ. Effectiveness of different intracanal irrigation techniques in removing intracanal paste medicaments. Aust Dent J 2014;40:21-25.
- 12. Topçuoğlu H, Düzgün S, Ceyhanlı K, et al. Efficacy of different irrigation techniques in the removal of calcium hydroxide from a simulated internal root resorption cavity. Int Endod J 2015;48:309-316.
- 13. Antov H, Duggal M, Nazzal H. Management of discolouration following revitalization endodontic procedures: A case series. Int Endod J 2019;52:1660-1670.
- 14. Aydin MN, Buldur B. The effect of intracanal placement of various medicaments on the bond strength of three calcium silicate-based cements to root canal dentin. J Adhes Sci Technol 2018;32:542-552.
- 15. Çelik D, Er K, Serper A, Taşdemir T, Ceyhanlı KT. Push-out bond strength of three calcium silicate cements to root canal dentine after two different irrigation regimes. Clin Oral Investig 2014;18:1141-1146.
- 16. El-Ma’aita AM, Qualtrough AJ, Watts DC. The effect of smear layer on the push-out bond strength of root canal calcium silicate cements. Dent Mater 2013;29:797-803.
- 17. Buldur B, Kapdan A. Comparison of the EndoVac system and conventional needle irrigation on removal of the smear layer in primary molar root canals. Niger J Clin Pract 2017;20:1168-1174.
- 18. Buldur B, Kapdan A. Comparison of the antimicrobial efficacy of the EndoVac system and conventional needle irrigation in primary molar root canals. J Clin Pediatr Dent 2017;41:284-288.
- 19. Hoshino E, Kurihara‐Ando N, Sato I, et al. In‐vitro antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline. Int Endod J 1996;29:125-130.
- 20. Schoop U, Kluger W, Moritz A, et al. Bactericidal effect of different laser systems in the deep layers of dentin. Lasers Surg Med 2004;35:111-116.
- 21. Van der Sluis L, Gambarini G, Wu M, Wesselink P. The influence of volume, type of irrigant and flushing method on removing artificially placed dentine debris from the apical root canal during passive ultrasonic irrigation. Int Endod J 2006;39:472-476.
- 22. Chen BK-J, George R, Walsh LJ. Discoloration of roots caused by residual endodontic intracanal medicaments. Sci World J 2014;2014:
- 23. Topçuoğlu H, Demirbuga S, Topçuoğlu G. Evaluation of apically extruded debris during the removal of canal filling material using three different Ni‐Ti systems and hand files in teeth with simulated apical root resorption. Int Endod J 2020;53:403-409.
- 24. Topçuoğlu HS, Arslan H, Akçay M, et al. The effect of medicaments used in endodontic regeneration technique on the dislocation resistance of mineral trioxide aggregate to root canal dentin. J Endod 2014;40:2041-2044.
- 25. Khoshkhounejad M, Shokouhinejad N, Pirmoazen S. Regenerative endodontic treatment: report of two cases with different clinical management and outcomes. J Dent (Tehran) 2015;12:460.
- 26. Nosrat A, Homayounfar N, Oloomi K. Drawbacks and unfavorable outcomes of regenerative endodontic treatments of necrotic immature teeth: a literature review and report of a case. J Endod 2012;38:1428-1434.
- 27. Pashley E, Birdsong N, Bowman K, Pashley DH. Cytotoxic effects of NaOCl on vital tissue. J Endod 1985;11:525-528.
- 28. Trevino EG, Patwardhan AN, Henry MA, et al. Effect of irrigants on the survival of human stem cells of the apical papilla in a platelet-rich plasma scaffold in human root tips. J Endod 2011;37:1109-1115.
- 29. Martin DE, De Almeida JF, Henry MA, et al. Concentration-dependent effect of sodium hypochlorite on stem cells of apical papilla survival and differentiation. J Endod 2014;40:51-55.
- 30. Buldur B, Öznurhan F, Kaptan A. The effect of different chelating agents on the push-out bond strength of proroot mta and endosequence root repair material. Eur Oral Res 2019;53:88-93.
- 31. Buldur B, Oznurhan F, Kayabası M, Sahin F. Shear bond strength of two calcium silicate-based cements to compomer. Cumhuriyet Dent J 2018;21:18-23.
- 32. Jiang LM, Lak B, Eijsvogels LM, Wesselink P, van der Sluis LW. Comparison of the cleaning efficacy of different final irrigation techniques. J Endod 2012;38:838-841.
- 33. Arslan D, Guneser MB, Dincer AN, et al. Comparison of Smear Layer Removal Ability of QMix with Different Activation Techniques. J Endod 2016;42:1279-1285.
- 34. Plotino G, Grande NM, Mercade M, et al. Efficacy of sonic and ultrasonic irrigation devices in the removal of debris from canal irregularities in artificial root canals. J Appl Oral Sci 2019;27:e20180045.
- 35. Akman M, Akbulut MB, Aydinbelge HA, Belli S. Comparison of different irrigation activation regimens and conventional irrigation techniques for the removal of modified triple antibiotic paste from root canals. J Endod 2015;41:720-724.
- 36. Berkhoff JA, Chen PB, Teixeira FB, Diogenes A. Evaluation of triple antibiotic paste removal by different irrigation procedures. J Endod 2014;40:1172-1177.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Original Research Articles |
| Authors | |
| Project Number | DİŞ-211 |
| Publication Date | June 23, 2023 |
| Submission Date | January 17, 2023 |
| Published in Issue | Year 2023 |
Cumhuriyet Dental Journal (Cumhuriyet Dent J, CDJ) is the official publication of Cumhuriyet University Faculty of Dentistry. CDJ is an international journal dedicated to the latest advancement of dentistry. The aim of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments in different areas of dentistry. First issue of the Journal of Cumhuriyet University Faculty of Dentistry was published in 1998. In 2010, journal's name was changed as Cumhuriyet Dental Journal. Journal’s publication language is English.
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