Abstract Objective To evaluate the efficacy of different sonic and ultrasonic devices in the elimination of debris from canal irregularities in artificial root canals. Materials and Methods A resin model of a transparent radicular canal filled with dentin debris was used. Five groups were tested, namely: Group 1 – ultrasonic insert 15.02; Group 2 – ultrasonic insert 25/25 IRRI K; Group 3 – ultrasonic insert 25/25 IRRI S; Group 4 – sonic insert 20/28 Eddy on a vibrating sonic air-scaler handpiece; Group 5 – 20.02 K-file inserted on a Safety M4 handpiece. Two different irrigants (5% sodium hypochlorite and 17% EDTA) and 3 different times of activation (20, 40, and 60 seconds) were tested. Means and standard deviations were calculated and statistically analyzed with the Kruskal-Wallis and Wilcoxon tests (p<0.05). Results No statistically significant differences were found between the two irrigants used. Group 4 removed more debris than the other groups (p<0.05). Groups 1, 2, and 3 removed more debris than group 5 (p<0.05). A statistically significant difference (p<0.05) was found for the time of activation in all groups and at all canal levels, except between 40 and 60 seconds in group 4 at coronal and middle third level (p>0.05). Conclusions No significant differences were found between 5% sodium hypochlorite and 17% EDTA. When the time of activation rises, the dentin debris removal increases in all groups. Both sonic and ultrasonic activation demonstrate high capacity for dentin debris removal.

Resumo A irrigação do canal radicular é coadjuvante na desinfecção e remoção de debris, contribuindo para o sucesso do tratamento endodôntico. Este artigo apresenta uma visão geral das tecnologias atuais indicadas para melhorar a limpeza e desbridamento do canal radicular. Foi realizado um levantamento bibliográfico eletrônico no site Pubmed utilizando palavras-chave específicas ao tema a fim de abordar literatura relevante. Após busca eletrônica, artigos completos foram revisados e os mais apropriados ao tema foram incluídos nesta revisão. Diferentes sistemas de ativação mecânica foram considerados: agitação manual com cone de guta-percha, instrumentos e escovas endodônticas, sistemas de vibração ativados por peças manuais em baixa rotação ou por energia sônica e subsônica, ultrassom, laser, assim como sistemas de irrigação que utilizam pressão apical negativa. Além disso, esta revisão descreve outros meios indicados para ampliar a descontaminação endodôntica por meio de agentes químicos como ozônio e desinfeção por meio de luz. A ativação ultrassônica do hipoclorito de sódio ainda permanece o padrão ouro e nos estudos é usada como controle na comparação aos demais sistemas que empregam agitação mecânica. A presente revisão mostra vantagens de diversos sistema de irrigação e associações entre eles, podendo aumentar a efetividade da irrigação endodôntica.

Abstract Effective irrigant delivery and agitation are prerequisites to promote root canal disinfection and debris removal and improve successful endodontic treatment. This paper presents an overview of the currently available technologies to improve the cleaning of the endodontic space and their debridement efficacy. A PubMed electronic search was conducted with appropriate key words to identify the relevant literature on this topic. After retrieving the full-text articles, all the articles were reviewed and the most appropriate were included in this review. Several different systems of mechanical activation of irrigants to improve endodontic disinfection were analysed: manual agitation with gutta-percha cones, endodontic instruments or special brushes, vibrating systems activated by low-speed hand-pieces or by sonic or subsonic energy, use of ultrasonic or laser energy to mechanically activate the irrigants and apical negative pressure irrigation systems. Furthermore, this review aims to describe systems designed to improve the intracanal bacterial decontamination by a specific chemical action, such as ozone, direct laser action or light-activated disinfection. The ultrasonic activation of root canal irrigants and of sodium hypochlorite in particular still remains the gold standard to which all other systems of mechanical agitation analyzed in this article were compared. From this overview, it is evident that the use of different irrigation systems can provide several advantages in the clinical endodontic outcome and that integration of new technologies, coupled with enhanced techniques and materials, may help everyday clinical practice.

The goal of the present article is to illustrate and analyze the applications and the potential of microcomputed tomography (micro-CT) in the analysis of tooth anatomy and root canal morphology. The authors performed a micro-CT analysis of the following different teeth: maxillary first molars with a second canal in the mesiobuccal (MB) root, mandibular first molars with complex anatomy in the mesial root, premolars with single and double roots and with complicated apical anatomy. The hardware device used in this study was a desktop X-ray microfocus CT scanner (SkyScan 1072, SkyScan bvba, Aartselaar, Belgium). A specific software ResolveRT Amira (Visage Imaging) was used for the 3D analysis and imaging. The authors obtained three-dimensional images from 15 teeth. It was possible to precisely visualize and analyze external and internal anatomy of teeth, showing the finest details. Among the 5 upper molars analyzed, in three cases, the MB canals joined into one canal, while in the other two molars the two mesial canals were separate. Among the lower molars two of the five samples exhibited a single canal in the mesial root, which had a broad, flat appearance in a mesiodistal dimension. In the five premolar teeth, the canals were independent; however, the apical delta and ramifications of the root canals were quite complex. Micro-CT offers a simple and reproducible technique for 3D noninvasive assessment of the anatomy of root canal systems.

L’obiettivo di questo articolo è stato quello di dimostrare la validità della microtomografia computerizzata (micro-CT) per visualizzare, analizzare e studiare l’anatomia dentaria ed endodontica in vitro. Sono stati selezionati 15 differenti elementi dentari umani estratti per motivi ortodontici o parodontali, selezionati tra primi molari dell’arcata superiore con un se-condo canale nella radice mesiovestibolare (MB2), tra primi molari inferiori in cui la radice mesiale avesse un cosiderevole grado di curvatura in senso mesiodistale o tra premolari con una o due radici aventi un’anatomia apicale particolarmente complicata. L’hardware utilizzato per la scansione è stato un micro tomografo computerizzato (SkyScan 1072, SkyScan bvba, Aartselaar, Belgium) mentre il software per la visualizzazione e l’analisi tridimensionale dei dati è stato ResolveRT Amira (Visage Imaging). Gli autori hanno ottenuto le ricostruzioni tridimensionali ottenute da analisi micro-CT di 15 elementi dentari umani estratti. È stato possibile osservare dettagliatamente sia l’anatomia endodontica fine che l’anatomia radicolare esterna degli elementi dentari analizzati. Tra i cinque molari superiori analizzati, in tre casi il canale mesiobuccale secondo (MB2) era confluente con il canale mesiobuccale principale, mentre negli altri due campioni dello stesso elemento analizzati essi erano indimìpendenti con forami apicali separati. Tra i molari inferiori due dei cinque analizzati avevano un unico canale nella radice mesiale di forma estremamente appiattita in senso mesiodistale. Tra gli elementi premolari analizzati, i canali se doppi erano indipendenti ma spesso hanno dimostrato possedere una complicata anatomia apicale con delta e ramificazioni molto intricate. La microtomografia offre una tecnica semplice e riproducibile per l’analisi tridimensionale non invasiva dell’anatomia endodontica.