C. Boutsioukis

Irrigant flow within a prepared root canal using various flow rates: a Computational Fluid Dynamics study

AIM To study using computer simulation the effect of irrigant flow rate on the flow pattern within a prepared root canal, during final irrigation with a syringe and needle. METHODOLOGY Geometrical characteristics of a side-vented endodontic needle and clinically realistic flow rate values were obtained from previous and preliminary studies. A Computational Fluid Dynamics (CFD) model was created using FLUENT 6.2 software. Calculations were carried out for five selected flow rates (0.02-0.79 mL sec(-1)) and velocity and turbulence quantities along the domain were evaluated. RESULTS Irrigant replacement was limited to 1-1.5 mm apical to the needle tip for all flow rates tested. Low-Reynolds number turbulent flow was detected near the needle outlet. Irrigant flow rate affected significantly the flow pattern within the root canal. CONCLUSIONS Irrigation needles should be placed to within 1 mm from working length to ensure fluid exchange. Turbulent flow of irrigant leads to more efficient irrigant replacement. CFD represents a powerful tool for the study of irrigation.

Evaluation of Irrigant Flow in the Root Canal Using Different Needle Types by an Unsteady Computational Fluid Dynamics Model

INTRODUCTION The aim of this study was to evaluate the effect of needle tip design on the irrigant flow inside a prepared root canal during final irrigation with a syringe using a validated Computational Fluid Dynamics (CFD) model. METHODS A CFD model was created to simulate the irrigant flow inside a prepared root canal. Six different types of 30-G needles, three open-ended needles and three close-ended needles, were tested. Using this CFD model, the irrigant flow in the apical root canal was calculated and visualized. As a result, the streaming velocity, the apical pressure, and the shear stress on the root canal wall were evaluated. RESULTS The open-ended needles created a jet toward the apex and maximum irrigant replacement. Within this group, the notched needle appeared less efficient in terms of irrigant replacement than the other two types. Within the close-ended group, the side-vented and double side-vented needle created a series of vortices and a less efficient irrigant replacement; the side-vented needle was slightly more efficient. The multi-vented needle created almost no flow apically to its tip, and wall shear stress was concentrated on a limited area, but the apical pressure was significantly lower than the other types. CONCLUSIONS The flow pattern of the open-ended needles was different from the close-ended needles, resulting in more irrigant replacement in front of the open-ended needles but also higher apical pressure.

Ex Vivo Study of the Efficiency of Two Techniques for the Removal of Mineral Trioxide Aggregate Used as a Root Canal Filling Material

The purpose of this study was to evaluate the removal efficiency of mineral trioxide aggregate (MTA) used as a root filling material. Ninety-three human teeth prepared with a step-back technique were randomly assigned to 2 groups and filled with vertically compacted MTA (group A) or MTA and a gutta-percha cone (group B). Fillings were removed by using ultrasonics and/or rotary nickel-titanium instruments. Roots were split into halves, and a 1 to 4 scoring system was used to assess the amount of residue. Data were analyzed with Kruskal-Wallis and Mann-Whitney tests. Remnants were found in all specimens. Rotary instruments were unable to penetrate canals in group A. The combination of rotary instruments and ultrasonics was superior in group B. Dark discoloration of most MTA fillings was evident. The results suggest that MTA cannot be completely removed from the root canal system by any of the methods examined.

The effect of apical preparation size on irrigant flow in root canals evaluated using an unsteady Computational Fluid Dynamics model

AIM To evaluate the effect of apical preparation size on irrigant flow inside a root canal during final irrigation with a syringe and two different needles types, using a Computational Fluid Dynamics (CFD) model. METHODOLOGY A validated CFD model was used to simulate the irrigant flow from either a side-vented or a flat 30G needle positioned inside root canals having sizes of 25, 35, 45 and 55, all with a .06 taper, at 3 mm short of working length (WL). Velocity, pressure and shear stress in the root canal were evaluated. RESULTS Different preparation sizes resulted in minor differences in the flow pattern in the apical root canal. Major differences were observed between the two needle types. The side-vented needle could not achieve irrigant replacement to the WL even in a size 55, .06 taper root canal. Significant irrigant replacement was evident almost to the WL in size 35, 45 and 55, .06 taper root canals with the flat needle. The maximum shear stress decreased as the preparation size increased. The flat needle developed higher mean pressure at the apical foramen. Both needles led to a similar gradual decrease in apical pressure as the preparation size increased. CONCLUSIONS Apical preparation size affected irrigant replacement, the shear stress on the canal wall and the pressure at the apical foramen. Root canal enlargement to sizes larger than 25 appeared to improve the performance of syringe irrigation. Adequate space between the needle and the canal wall should be ensured to allow for an effective reverse flow of the irrigant towards the canal orifice.

The effect of needle-insertion depth on the irrigant flow in the root canal: evaluation using an unsteady computational fluid dynamics model

INTRODUCTION The aim of this study was to evaluate the effect of needle-insertion depth on the irrigant flow inside a prepared root canal during final irrigation with a syringe and two different needle types using a Computational Fluid Dynamics (CFD) model. METHODS A validated CFD model was used to simulate irrigant flow from either a side-vented or an open-ended flat 30-G needle positioned inside a prepared root canal (45 .06) at 1, 2, 3, 4, or 5 mm short of the working length (WL). Velocity, pressure, and shear stress in the root canal were evaluated. RESULTS The flow pattern in the apical part of the root canal was similar among different needle positions. Major differences were observed between the two needle types. The side-vented needle achieved irrigant replacement to the WL only at the 1-mm position, whereas the open-ended flat needle was able to achieve complete replacement even when positioned at 2 mm short of the WL. The maximum shear stress decreased as needles moved away from the WL. The flat needle led to higher mean pressure at the apical foramen. Both needles showed a similar gradual decrease in apical pressure as the distance from the WL increased. CONCLUSIONS Needle-insertion depth was found to affect the extent of irrigant replacement, the shear stress on the canal wall, and the pressure at the apical foramen for both needle types.

Irrigant flow in the root canal: experimental validation of an unsteady Computational Fluid Dynamics model using high-speed imaging.

AIM To compare the results of a Computational Fluid Dynamics (CFD) simulation of the irrigant flow within a prepared root canal, during final irrigation with a syringe and a needle, with experimental high-speed visualizations and theoretical calculations of an identical geometry and to evaluate the effect of off-centre positioning of the needle inside the root canal. METHODOLOGY A CFD model was created to simulate irrigant flow from a side-vented needle inside a prepared root canal. Calculations were carried out for four different positions of the needle inside a prepared root canal. An identical root canal model was made from poly-dimethyl-siloxane (PDMS). High-speed imaging of the flow seeded with particles and Particle Image Velocimetry (PIV) were combined to obtain the velocity field inside the root canal experimentally. Computational, theoretical and experimental results were compared to assess the validity of the computational model. RESULTS Comparison between CFD computations and experiments revealed good agreement in the velocity magnitude and vortex location and size. Small lateral displacements of the needle inside the canal had a limited effect on the flow field. CONCLUSIONS High-speed imaging experiments together with PIV of the flow inside a simulated root canal showed a good agreement with the CFD model, even though the flow was unsteady. Therefore, the CFD model is able to predict reliably the flow in similar domains.

Ex-vivo area-metric analysis of root canal obturation using gutta-percha cones of different taper.

AIM To evaluate the percentage of gutta-percha and sealer-filled canal area when four different types of master gutta-percha cones were used. METHODOLOGY Sixty mandibular premolars with straight canals were instrumented using System ProTaper rotary instruments with a crown-down technique and assigned to four groups. Canals were obturated with AH-26 sealer either using lateral condensation and 0.02 taper gutta-percha cones (group A), 0.04 taper gutta-percha cones (group B), nonstandardized F- medium (group C) master gutta-percha cones, or a single System ProTaper gutta-percha cone (group D). The percentage of gutta-percha and sealer-filled area was calculated in horizontal sections of the apical portion of each canal, using image analysis software. The data was statistically analysed using Kruskal-Wallis test. RESULTS The distribution of filling materials amongst groups was not significantly different at each level of sectioning (P > 0.05). CONCLUSION The percentage of gutta-percha and sealer-filled canal area was similar when canals were filled with different master cones using lateral condensation or single cone techniques.

The effect of flow rate and agitation technique on irrigant extrusion ex vivo

AIM To evaluate (i) the effect of irrigant flow rate, needle type, needle insertion depth and apical constriction diameter and (ii) the effect of ultrasonic, sonic and manual dynamic agitation on irrigant extrusion using a recently introduced method. METHODOLOGY Thirty-two human teeth with a straight root canal were prepared to size 35, 0.06 taper and assigned to group A or B. The apical constriction diameter was 0.15-0.25 mm. Specimens were mounted on a plastic vial filled with distilled water to simulate a periapical lesion. A point-conductivity probe was used to determine the volume of irrigant extruded into the vial. Within group A, NaOCl was delivered at 0.14 or 0.26 mL s(-1) by an open-ended or a closed-ended needle at 1 or 3 mm short of working length (WL). In group B, NaOCl was agitated at high or low power either by an ultrasonically or sonically oscillating instrument inserted at 1 or 3 mm short of WL or by manual push-pull strokes of a gutta-percha cone. Results were analysed by repeated-measures anovas, at 0.05 significance. RESULTS An increase in the flow rate resulted in increased extrusion (P < 0.001). The open-ended needle extruded significantly more irrigant than the closed-ended (P < 0.001). Extrusion decreased as needles moved away from WL (P < 0.001). The effect of apical constriction diameter was not significant (P > 0.454). Manual dynamic agitation extruded significantly more irrigant than sonic and ultrasonic agitation (P < 0.001). CONCLUSIONS Irrigant flow rate, needle type and insertion depth and agitation technique had a significant effect on extrusion.

A new method for real-time quantification of irrigant extrusion during root canal irrigation ex vivo

AIM (i) To introduce a new method of quantifying extruded irrigant during root canal irrigation ex vivo. (ii) to evaluate the effect of periapical tissue simulation and pressure equalization and (iii) to determine the effect of needle type, apical preparation size and apical constriction diameter on irrigant extrusion. METHODOLOGY Sixteen human single-rooted teeth were sequentially prepared to sizes 25-45, 0.06 taper and mounted on a plastic vial simulating a periapical lesion. The apical constriction diameter was standardized to 0.15-0.35 mm. The vial was filled with distilled water or air and was either open to the environment or closed. A point-conductivity probe was used to determine the volume of extruded irrigant into the vial. NaOCl was delivered by an open-ended or a closed-ended needle at 3 mm short of working length. Results were analysed by two 3-way repeated-measures ANOVAs. RESULTS The open-ended needle extruded significantly more irrigant than the closed-ended in the majority of cases (P < 0.002). An increase in the apical size was related to decreased irrigant extrusion (P < 0.024). The effect of constriction diameter was not significant. The water-closed and water-open methods were related to less extrusion than the air-closed and air-open methods, respectively (P < 0.005). Open systems (water-open, air-open) allowed extrusion of larger amounts of irrigant than corresponding closed systems (water-closed, air-closed) (P < 0.005). CONCLUSIONS The conductivity probe is a reliable method for real-time quantification of irrigant extrusion ex vivo. Not simulating tissue resistance in ex vivo experiments may lead to significant overestimation of irrigant extrusion.

Formation and removal of apical vapor lock during syringe irrigation: a combined experimental and Computational Fluid Dynamics approach

AIM (i) To evaluate the effect of needle type and insertion depth, root canal size and irrigant flow rate on the entrapment of air bubbles in the apical part of a root canal (apical vapor lock) during syringe irrigation using experiments and a Computational Fluid Dynamics (CFD) model, (ii) to investigate whether the irrigant contact angle affects bubble entrapment, (iii) to examine if an established vapor lock can be removed by syringe irrigation. METHODOLOGY Bubble entrapment during irrigation of straight artificial root canals of size 35 or 50 was evaluated by real-time visualizations. The irrigant was delivered by a closed-ended or an open-ended needle positioned at 1 or 3 mm short of working length (WL) and at a flow rate of 0.033-0.260 mL s(-1) . Results were analysed by nonparametric tests at 0.05 significance. Selected cases were also simulated by a two-phase CFD model. RESULTS A vapor lock was observed in 48% of the cases investigated experimentally. Increasing the apical size, using an open-ended needle, positioning the needle closer to WL and delivering the irrigant at higher flow rate resulted in significantly smaller vapor lock. An increased contact angle resulted in the entrapment of a larger bubble when a low flow rate was used. Both brief insertion of the needle to WL whilst irrigating at a flow rate of 0.083 mL s(-1) and delivering the irrigant at 0.260 mL s(-1) without changing the needle position were capable of removing an established vapor lock. CONCLUSIONS Apical vapor lock may occur under certain conditions, but appears to be easily prevented or removed by syringe irrigation.