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      Review of ultrasonic irrigation in endodontics: increasing action of irrigating solutions

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          Abstract

          Introduction: Effective irrigant delivery and agitation are prerequisites for successful endodontic treatment. Ultrasonic irrigation can be performed with or without simultaneous ultrasonic instrumentation. Existing literature reveals that ultrasonic irrigation may have a very positive effect on chemical, biological and physical debridement of the root canal system as investigated in many in vitro studies. Objective: The purpose of this review article was to summarize and discuss the available information concerning ultrasonic irrigation in endodontics. Methods: This article presents an overview of ultrasonic irrigation methods and their debridement efficacy. In this paper the relevant literature on passive ultrasonic irrigation is reviewed. Information from original scientific papers or reviews listed in MEDLINE and Cochrane were included in the review. Results: The use of ultrasound in the irrigation procedure results in improved canal cleanliness, better irrigant transfer to the canal system, soft tissue debridement, and removal of smear layer and bacteria. There are many in vitro studies, but there is a need to standardize protocols, and correlate the clinical efficacy of ultrasonic devices with improved treatment outcomes. Understanding the basis of ultrasonic irrigation is fundamental for clinicians and researchers to improve the design and use of ultrasonic irrigation.

          Key words:Ultrasonic irrigation, ultrasound, smear layer, endodontics.

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          Passive ultrasonic irrigation of the root canal: a review of the literature.

          Michael Ameringen, Mu-Shiang Wu, M Versluis … (2007)
          Ultrasonic irrigation of the root canal can be performed with or without simultaneous ultrasonic instrumentation. When canal shaping is not undertaken the term passive ultrasonic irrigation (PUI) can be used to describe the technique. In this paper the relevant literature on PUI is reviewed from a MEDLINE database search. Passive ultrasonic irrigation can be performed with a small file or smooth wire (size 10-20) oscillating freely in the root canal to induce powerful acoustic microstreaming. PUI can be an important supplement for cleaning the root canal system and, compared with traditional syringe irrigation, it removes more organic tissue, planktonic bacteria and dentine debris from the root canal. PUI is more efficient in cleaning canals than ultrasonic irrigation with simultaneous ultrasonic instrumentation. PUI can be effective in curved canals and a smooth wire can be as effective as a cutting K-file. The taper and the diameter of the root canal were found to be important parameters in determining the efficacies of dentine debris removal. Irrigation with sodium hypochlorite is more effective than with water and ultrasonic irrigation is more effective than sonic irrigation in the removal of dentine debris from the root canal. The role of cavitation during PUI remains inconclusive. No detailed information is available on the influence of the irrigation time, the volume of the irrigant, the penetration depth of the instrument and the shape and material properties of the instrument. The influence of irrigation frequency and intensity on the streaming pattern as well as the complicated interaction of acoustic streaming with the adherent biofilm needs to be clarified to reveal the underlying physical mechanisms of PUI.
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            Review of contemporary irrigant agitation techniques and devices.

            Li-sha Gu, Jong Kim, Junqi Ling … (2009)
            Effective irrigant delivery and agitation are prerequisites for successful endodontic treatment. This article presents an overview of the irrigant agitation methods currently available and their debridement efficacy. Technological advances during the last decade have brought to fruition new agitation devices that rely on various mechanisms of irrigant transfer, soft tissue debridement, and, depending on treatment philosophy, removal of smear layers. These devices might be divided into the manual and machine-assisted agitation systems. Overall, they appear to have resulted in improved canal cleanliness when compared with conventional syringe needle irrigation. Despite the plethora of in vitro studies, no well-controlled study is available. This raises imperative concerns on the need for studies that could more effectively evaluate specific irrigation methods by using standardized debris or biofilm models. In addition, no evidence-based study is available to date that attempts to correlate the clinical efficacy of these devices with improved treatment outcomes. Thus, the question of whether these devices are really necessary remains unresolved. There also appears to be the need to refocus from a practice management perspective on how these devices are perceived by clinicians in terms of their practicality and ease of use. Understanding these fundamental issues is crucial for clinical scientists to improve the design and user-friendliness of future generations of irrigant agitation systems and for manufacturers' contentions that these systems play a pivotal role in contemporary endodontics.
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              Irrigation in endodontics.

              Markus Haapasalo, Ya Shen, Wei Qian … (2010)
              The success of endodontic treatment depends on the eradication of microbes from the root-canal system and prevention of reinfection. The root canal is shaped with hand and rotary instruments under constant irrigation to remove the inflamed and necrotic tissue, microbes/biofilms, and other debris from the root-canal space. Irrigants have traditionally been delivered into the root-canal space using syringes and metal needles of different size and tip design. Clinical experience and research have shown, however, that this classic approach typically results in ineffective irrigation. Many of the compounds used for irrigation have been chemically modified and several mechanical devices have been developed to improve the penetration and effectiveness of irrigation. This article summarizes the chemistry, biology, and procedures for safe and efficient irrigation and provides cutting-edge information on the most recent developments. Copyright 2010 Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Med Oral Patol Oral Cir Bucal
                Journal ID (iso-abbrev): Med Oral Patol Oral Cir Bucal
                Journal ID (publisher-id): Medicina Oral S.L.
                Title: Medicina Oral, Patología Oral y Cirugía Bucal
                Publisher: Medicina Oral S.L.
                ISSN (Print): 1698-4447
                ISSN (Electronic): 1698-6946
                Publication date (Print): May 2012
                Publication date (Electronic): 6 December 2011
                Volume: 17
                Issue: 3
                Pages: e512-e516
                Affiliations
                [1 ]Postgraduate Endodontics Program. Department of Stomatology, University of Valencia, Spain
                [2 ]Professor. Department of Stomatology, University of Valencia, Spain. Primary Care Dentist, Department 9, Valencian Health Service, Spain
                [3 ]Professor. Department of Stomatology, University of Valencia. Spain
                Author notes
                Clínica Odontològica. Universitat de València C/ Gascó Oliag, 1 46010 Valencia (Spain) , E-mail: forner@ 123456uv.es
                Article
                Publisher ID: 17621
                DOI: 10.4317/medoral.17621
                PMC ID: 3476090
                PubMed ID: 22143738
                SO-VID: cb373f17-4b9c-4005-bf3b-090d44d40fc6
                Copyright © Copyright: © 2012 Medicina Oral S.L.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date accepted : 12 June 2011
                Date received : 23 March 2011
                Categories
                Subject: Research-Article
                Subject: Endodontics

                ScienceOpen disciplines: Surgery
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                ScienceOpen disciplines: Surgery

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