L.W.M. van der Sluis

Laser-activated irrigation within root canals: cleaning efficacy and flow visualization.

AIM To test ex vivo the efficiency of laser-activated irrigation in removing dentine debris from the apical part of the root canal and to visualize in vitro the fluid dynamics during the activation of the irrigant by laser, using high-speed imaging at a relevant timescale. METHODOLOGY Root canals with a standardized groove in one canal wall filled with dentine debris were irrigated with syringe irrigation, ultrasonically or laser-activated irrigation (LAI) using 2% sodium hypochlorite as irrigant. The quantity of dentine debris after irrigation was determined. Visualization of the fluid dynamics during activation was achieved using a high-speed camera and a glass model. RESULTS Laser-activated irrigation was significantly more effective in removing dentine debris from the apical part of the root canal than passive ultrasonic irrigation or hand irrigation when the irrigant was activated for 20 s. CONCLUSIONS The in vitro recordings suggest that streaming, caused by the collapse of the laser-induced bubble, is the main cleaning mechanism of LAI.

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.

Reaction rate of NaOCl in contact with bovine dentine: effect of activation, exposure time, concentration and pH

AIM To determine the influence of activation method (ultrasound or laser), concentration, pH and exposure time on the reaction rate (RR) of NaOCl when in contact with dentinal walls. METHODOLOGY The walls from standardized root canals in bovine incisors were exposed to a standardized volume of sodium hypochlorite (NaOCl) with different concentrations (2% and 10%), pH (5 and 12) and exposure times (1 and 4min). Two irrigation protocols were tested: passive ultrasonic irrigation or laser activated irrigation with no activation as the control. The activation interval lasted 1min followed by a rest interval of 3 min with no activation. The RR was determined by measuring the iodine concentration using an iodine/thiosulfate titration method. RESULTS Exposure time, concentration and activation method influenced the reaction rate of NaOCl whereas pH did not. CONCLUSIONS Activation is a strong modulator of the reaction rate of NaOCl. During the rest interval of 3min, the consumption of available chlorine increased significantly. This effect seems to be more pronounced after irrigant activation by laser. pH did not affect the reaction rate of 2% NaOCl.

The effect of root canal taper on the irrigant flow: evaluation using an unsteady Computational Fluid Dynamics model

AIM To evaluate the effect of root canal taper on irrigant flow inside a prepared root canal during final irrigation with a syringe and two types of needles, using a Computational Fluid Dynamics (CFD) model. METHODOLOGY A validated CFD model was used to simulate irrigant flow from either a side-vented or a flat 30G needle positioned inside size 30, .02 taper, 30, .04, 30, .06, ProTaper F3 or size 60, .02 taper root canals, at 3 mm short of working length (WL). Velocity, pressure and shear stress in the root canal were evaluated. RESULTS The side-vented needle could not achieve irrigant replacement to the WL in any of the cases. Significant irrigant replacement was evident further than 2 mm apically to the tip of the flat needle in the size 30, .06 taper, F3 and size 60, .02 taper canal. A wider distribution of wall shear stress was noted as the canal taper increased but the maximum shear stress decreased. The flat needle led to higher mean pressure at the apical foramen. Both needles showed a similar gradual decrease in apical pressure as the taper increased, but the least pressure was calculated in the size 60, .02 taper canal. CONCLUSIONS An increase in root canal taper improved irrigant replacement and wall shear stress whilst reducing the risk for irrigant extrusion. Irrigant flow in a minimally tapered root canal with a large apical preparation size also improved irrigant replacement and wall shear stress and reduced the risk for irrigant extrusion, compared to the tapered root canals with a smaller apical preparation size.

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.

Effect of filling technique and root canal area on the percentage of gutta‐percha in laterally compacted root fillings

AIM To determine the influence of filling technique and root canal area on the percentage of gutta-percha (PGP) in laterally compacted root fillings. METHODOLOGY Sixty extracted canine teeth were accessed and the root canals instrumented to the same size. They were then divided in three groups and filled with laterally compacted gutta-percha cones and AH Plus using different techniques. A variation of cold lateral compaction using a sequence of spreaders prior to accessory cone placement was compared to two commonly-used techniques. Twenty additional canines with prepared root canals were used as negative controls in which gutta-percha was introduced into the canals but no compaction applied. The roots were sectioned horizontally at 3 and 6 mm from the apex and micro-photographs taken. Using software, the area of the canals and gutta-percha at each level were measured and PGP calculated. A Multivariate analysis was used to determine the variables influencing PGP. A linear regression test was used to verify the variation in PGP explained by canal area. RESULTS At each level the largest canal was two to three times wider than the smallest. Canal area significantly influenced the PGP at both levels (P < 0.05), however, the variation in PGP was only partially explained by canal area (r(2) = 0.154, 6 mm; r(2) = 0.119, 3 mm). The PGP at the 3 mm level was lower than at 6 mm (P = 0.003). The spreader-sequence technique achieved a higher PGP than the other two techniques (P = 0.00002). The control group had the lowest area of GP. CONCLUSIONS Variations in root canal filling technique and canal area influenced the percentage of gutta-percha of laterally compacted root fillings. The percentage of gutta-percha was lower at the 3 mm level compared to the 6 mm level.

Sonochemical and high-speed optical characterization of cavitation generated by an ultrasonically oscillating dental file in root canal models

Ultrasonically Activated Irrigation makes use of an ultrasonically oscillating file in order to improve the cleaning of the root canal during a root canal treatment. Cavitation has been associated with these oscillating files, but the nature and characteristics of the cavitating bubbles were not yet fully elucidated. Using sensitive equipment, the sonoluminescence (SL) and sonochemiluminescence (SCL) around these files have been measured in this study, showing that cavitation occurs even at very low power settings. Luminol photography and high-speed visualizations provided information on the spatial and temporal distribution of the cavitation bubbles. A large bubble cloud was observed at the tip of the files, but this was found not to contribute to SCL. Rather, smaller, individual bubbles observed at antinodes of the oscillating file with a smaller amplitude were leading to SCL. Confinements of the size of bovine and human root canals increased the amount of SL and SCL. The root canal models also showed the occurrence of air entrainment, resulting in the generation of stable bubbles, and of droplets, near the air-liquid interface and leading eventually to a loss of the liquid.

The effects of hyperosmosis or high pH on a dual-species biofilm of Enterococcus faecalis and Pseudomonas aeruginosa: an in vitro study

AIM To investigate the effect of hyperosmotic hyperosmosis or alkaline stress on a dual-species biofilm of Enterococcus faecalis and Pseudomonas aeruginosa. METHODOLOGY Biofilms were grown on glass cover slips suspended in bacterial inoculate for 96 h, after which the cover slips with attached biofilms were immersed in brain heart infusion broth (BHI-broth) with 6 mol L(-1) sodium chloride (NaCl) representing the hyperosmotic group or Ca(OH)(2), pH 12.1, representing the alkaline group. Two per cent sodium hypochlorite and BHI- broth served as positive and negative controls, respectively. After treatment, the biofilms were washed, harvested and plated on blood-agar plates after serial dilution. The bactericidal effect was assessed by determining the colony-forming units (CFU). The effect on the biofilm mass was imaged with confocal laser scanning microscopy (CLSM). RESULTS Hyperosmosis reduced the CFU of both species significantly after 72 h (P < 0.0001). After 168 h, P. aeruginosa was eradicated and the E. faecalis reduction was more than 99%. High pH could not induce a significant bacterial reduction. CLSM revealed dense flocculation of the biofilms incubated in alkaline broth. CONCLUSION Hyperosmosis effectively reduced a dual-species biofilm of E. faecalis and P. aeruginosa, whilst high pH had limited bactericidal effect in this model.

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.

Influence of refreshment/activation cycles and temperature rise on the reaction rate of sodium hypochlorite with bovine dentine during ultrasonic activated irrigation

AIM To evaluate the effect of multiple refreshment/activation cycles and temperature on the reaction rate of sodium hypochlorite (NaOCl) with bovine dentine during ultrasonic activated irrigation (UAI) under laboratory conditions. METHODOLOGY The root canal walls of 24 standardized root canals in bovine incisors were exposed to a standardized volume of NaOCl at different temperatures (24 °C and 38 °C) and exposure times (20, 60 and 180 s). The irrigant was refreshed and ultrasonically activated four times for 20 s followed by a 40 s rest interval, with no refreshment and no activation as the controls. The reaction rate was determined by measuring the amount of active chlorine in the NaOCl solution before and after being exposed to dentine during the specific experimental conditions. Calorimetry was used to measure the electrical-to-sonochemical conversion efficiency during ultrasonic activation. RESULTS Refreshment, activation and exposure time all increased the reaction rate of NaOCl (P < 0.05). During activation, the temperature of the irrigant increased up to 10 °C. Such temperature rise was insufficient to enhance the reaction rate of NaOCl (P > 0.125). CONCLUSIONS The reaction rate of NaOCl with dentine is enhanced by refreshment, ultrasonic activation and exposure time. Temperature rise of irrigant during ultrasonic activation was not sufficient to alter the reaction rate.