23 August 2023

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Cleaning efficiency of irrigation techniques in simulated complex root canal systems

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Introduction

To compare the biofilm-mimicking hydrogel removal efficiency of laser-activated irrigation (LAI, AdvErl Evo, Morita) with five other irrigation techniques in simulated curved root canals with lateral canals.

Methods

3D-printed root canal models (60°-curvature, radius 5mm; dimension 25/.06) with a total length of 20mm and lateral canals in all directions at 2, 5 and 8mm (diameter 0.2mm) from the apex were filled with a colored biofilm-mimicking hydrogel. The following protocols (each 3x20s continuous irrigation with distilled water 3ml/20s; n=20) were carried out: conventional needle irrigation (=NI); manual agitation (=MA, gutta-percha point 25/.06); EndoActivator (=SAI-EA, 25/.04); EDDY (=SAI-E; 25/.04); ultrasonically activated irrigation (=UAI) and LAI (Er:YAG-laser; P400FL tip at canal entrance; 25pps, 50mJ, 300μs). Standardized photos were taken with a microscope and the removal of the hydrogel was determined as a percentage for the entire system, the main canal and the lateral canals. Statistical analysis was performed using ANOVA and Scheffé test (P=.05).

Results

LAI (89.3±5.9%) showed the greatest hydrogel removal followed by SAI-E (65.5±3.3%) and UAI (59.1±4.7%), with significant differences between these groups (P<.05). NI, MA and SAI-EA performed equally (P>.05) and obtained the significantly lowest values (P<.05). LAI and SAI-E showed the significantly best hydrogel removal from the main canal (P<.05). At all three levels, LAI removed significantly more hydrogel from the lateral canals than all other techniques (P<.05).

Conclusion

LAI was superior to other techniques in both the entire system and the lateral canals in removing the hydrogel. SAI-E achieved comparable results in the main canal.

David Donnermeyer et al. "Cleaning efficiency of different irrigation techniques in simulated severely curved complex root canal systems." Journal of Endodontics. 14 August 2023. DOI: https://doi.org/10.1016/j.joen.2023.08.006