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      Biofilm removal from a simulated isthmus and lateral canal during syringe irrigation at various flow rates: a combined experimental and Computational Fluid Dynamics approach

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          Abstract

          Aim

          (i) To quantify biofilm removal from a simulated isthmus and a lateral canal in an artificial root canal system during syringe irrigation with NaOCl at different concentrations and delivered at various flow rates (ii) to examine whether biofilm removal is further improved by a final high‐flow‐rate rinse with an inert irrigant following irrigation with NaOCl. (iii) to simulate the irrigant flow in these areas using a computer model (iv) to examine whether the irrigant velocity calculated by the computer model is correlated to biofilm removal.

          Methodology

          Ninety‐six artificial root canals with either a simulated isthmus or lateral canal were used. A dual‐species in vitro biofilm was formed in these areas using a Constant Depth Film Fermenter. NaOCl at various concentrations (2, 5 and 10%) or adhesion buffer (control) was delivered for 30 s by a syringe and an open‐ended needle at 0.033, 0.083, or 0.166 mL s −1 or passively deposited in the main root canal (phase 1). All specimens were subsequently rinsed for 30 s with adhesion buffer at 0.166 mL s −1 (phase 2). The biofilm was scanned by Optical Coherence Tomography to determine the percentage of the remaining biofilm. Results were analysed by two 3‐way mixed‐design ANOVAs (α = 0.05). A Computational Fluid Dynamics model was used to simulate the irrigant flow inside the artificial root canal system.

          Results

          The flow rate during phase 1 and additional irrigation during phase 2 had a significant effect on the percentage of the remaining biofilm in the isthmus ( P = 0.004 and P < 0.001). Additional irrigation during phase 2 also affected the remaining biofilm in the lateral canal significantly ( P ≤ 0.007) but only when preceded by irrigation at medium or high flow rate during phase 1. The effect of NaOCl concentration was not significant ( > 0.05). Irrigant velocity in the isthmus and lateral canal increased with increasing flow rate and it was substantially correlated to biofilm removal from those areas.

          Conclusions

          The irrigant flow rate affected biofilm removal in vitro more than NaOCl concentration. Irrigant velocity predicted by the computer model corresponded with the pattern of biofilm removal from the simulated isthmus and lateral canal.

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          Most cited references36

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          Fiji: an open-source platform for biological-image analysis.

          Fiji is a distribution of the popular open-source software ImageJ focused on biological-image analysis. Fiji uses modern software engineering practices to combine powerful software libraries with a broad range of scripting languages to enable rapid prototyping of image-processing algorithms. Fiji facilitates the transformation of new algorithms into ImageJ plugins that can be shared with end users through an integrated update system. We propose Fiji as a platform for productive collaboration between computer science and biology research communities.
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            G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences

            G*Power (Erdfelder, Faul, & Buchner, 1996) was designed as a general stand-alone power analysis program for statistical tests commonly used in social and behavioral research. G*Power 3 is a major extension of, and improvement over, the previous versions. It runs on widely used computer platforms (i.e., Windows XP, Windows Vista, and Mac OS X 10.4) and covers many different statistical tests of the t, F, and chi2 test families. In addition, it includes power analyses for z tests and some exact tests. G*Power 3 provides improved effect size calculators and graphic options, supports both distribution-based and design-based input modes, and offers all types of power analyses in which users might be interested. Like its predecessors, G*Power 3 is free.
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              Root canal irrigants.

              Local wound debridement in the diseased pulp space is the main step in root canal treatment to prevent the tooth from being a source of infection. In this review article, the specifics of the pulpal microenvironment and the resulting requirements for irrigating solutions are spelled out. Sodium hypochlorite solutions are recommended as the main irrigants. This is because of their broad antimicrobial spectrum as well as their unique capacity to dissolve necrotic tissue remnants. Chemical and toxicological concerns related to their use are discussed, including different approaches to enhance local efficacy without increasing the caustic potential. In addition, chelating solutions are recommended as adjunct irrigants to prevent the formation of a smear layer and/or remove it before filling the root canal system. Based on the actions and interactions of currently available solutions, a clinical irrigating regimen is proposed. Furthermore, some technical aspects of irrigating the root canal system are discussed, and recent trends are critically inspected.
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                Author and article information

                Contributors
                l.w.m.van.der.sluis@umcg.nl
                Journal
                Int Endod J
                Int Endod J
                10.1111/(ISSN)1365-2591
                IEJ
                International Endodontic Journal
                John Wiley and Sons Inc. (Hoboken )
                0143-2885
                1365-2591
                18 November 2020
                March 2021
                : 54
                : 3 ( doiID: 10.1111/iej.v54.3 )
                : 427-438
                Affiliations
                [ 1 ] Department of Dentistry, Endodontics and Dental Materials Bauru School of Dentistry University of São Paulo Bauru Brazil
                [ 2 ] Center for Dentistry and Oral Hygiene University Medical Center Groningen University of Groningen Groningen The Netherlands
                [ 3 ] Department of Endodontology Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands
                [ 4 ] Physics of Fluids group Technical Medical (TechMed) Center and MESA+ Institute for Nanotechnology, University of Twente Enschede The Netherlands
                [ 5 ] Department of Orthodontics University Medical Center Groningen University of Groningen Groningen The Netherlands
                [ 6 ] Department of Biomedical Engineering University Medical Center Groningen University of Groningen Groningen The Netherlands
                [ 7 ] Conservative Dentistry Department School of Dentistry Federal University of Rio Grande do Sul Porto Alegre‐Rio Grande do Sul Brazil
                Author notes
                [*] [* ] Correspondence: Luc van der Sluis, Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (e‐mail: l.w.m.van.der.sluis@ 123456umcg.nl ).

                Author information
                https://orcid.org/0000-0002-3390-9371
                https://orcid.org/0000-0002-1347-1034
                https://orcid.org/0000-0002-3449-231X
                https://orcid.org/0000-0002-2296-1860
                https://orcid.org/0000-0002-1238-2160
                https://orcid.org/0000-0002-1393-5900
                Article
                IEJ13420
                10.1111/iej.13420
                7894139
                32990985
                727e679c-0fa1-4bbd-93c1-3fe3dadca8f8
                © 2020 The Authors. International Endodontic Journal published by John Wiley & Sons Ltd on behalf of British Endodontic Society

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 20 December 2019
                : 21 September 2020
                : 22 September 2020
                Page count
                Figures: 5, Tables: 0, Pages: 12, Words: 6926
                Funding
                Funded by: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
                Funded by: Conselho Nacional de Desenvolvimento Científico e Tecnológico
                Funded by: Abel Tasman Talent Program
                Funded by: European Society of Endodontology
                Funded by: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
                Funded by: the Abel Tasman Talent Program (ATTP) of the Graduate School of Medical Sciences of the University of Groningen
                Funded by: CNPq
                Categories
                Original Article
                Basic Research ‐ Technical
                Custom metadata
                2.0
                March 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.7 mode:remove_FC converted:19.02.2021

                Dentistry
                biofilm,isthmus,lateral canal,sodium hypochlorite,velocity
                Dentistry
                biofilm, isthmus, lateral canal, sodium hypochlorite, velocity

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