Indiana University-Purdue University Indianapolis (IUPUI) / The purpose of this study was to evaluate and compare the debridement efficacy of the EndoActivator (Dentsply Tulsa Dental, Tulsa, OK) versus the Ultrasonic Bypass system (Vista Dental) following hand-rotary instrumentation in anterior teeth. Sixty extracted human, maxillary anterior teeth were randomly assigned to three groups. Teeth were instrumented using (ISO k-flex) hand files and EndoSequence nickel-titanium rotary files (Brasseler, Savannah, GA) to a size 40/.06 taper. Group 1 served as the control group and had no additional treatment performed. Groups 2 and 3 were subjected to a final irrigating regimen that consisted of 6-percent sodium hypochlorite for a 1- minute duration. For group 2 the irrigation solution was activated for 1 minute using the EndoActivator system (DENTSPLY). For group 3, the irrigation solution was activated for 1 minute using the Ultrasonic Bypass System (Vista Dental). The teeth were then sectioned longitudinally and each half was divided into three equal parts 3 mm from the anatomic apex. The sample with the most visibly identifiable section of the apex was used for SEM evaluation. A scoring system to measure the efficacy of debris removal was utilized to quantify the results. Statistical analysis was performed using the Kruskal- Wallis test. If the overall test is significant, a Wilcoxon Rank Sum tests was used to compare each pair of groups. The results of this study indicate that both the EndoActivator and Ultrasonic Bypass groups had a smaller percentage of canal space occupied by smear layer and debris when compared with the control group at all three levels. This difference was statistically significant for the Ultrasonic Bypass System when compared with the control at both the coronal and middle thirds of the samples evaluated. This difference was not statistically significant in the apical third. When compared with the EndoActivator, the Ultrasonic Bypass System produced cleaner canals in the coronal and middle thirds, with the difference being statistically significant in the middle third only. These results of this research support the use of either of these two devices when compared with the controls. Smear layer removal and debridement efficacy was greatly increased when using either sonic or ultrasonic activation of sodium hypochlorite. More research is warranted concerning these two devices. Examining the antimicrobial efficacy with the use of these two devices could lend additional validation to their use in non-surgical endodontic therapy.

Indiana University School of Dentistry located on the campus of Indiana University-Purdue University Indianapolis (IUPUI) / This in-vitro, prospective, randomized study microscopically compared the debridement efficacy of negative pressure irrigation with the EndoVac (Discus Dental, Culver City, CA) versus the Canal CleanMax (Maximum Dental, Inc., Secaucus, NJ). Sixty extracted human canines were instrumented using a combination of hand-instrumentation with Lexicon K-type files and rotary instrumentation with ProTaper files. All canals were irrigated with 6.0-percent sodium hypochlorite and 17- percent ethylenediaminetetraacetic acid (EDTA). However, the irrigation/aspiration techniques differed among three groups of 20 randomly selected teeth. Group one (control) was irrigated with only a 12-ml Monoject syringe via 30-gauge side-vented, closed-end needle. Group two was irrigated with the EndoVac system. Group three was irrigated similar to group one, but with the adjunct of the Canal CleanMax system. All teeth were sectioned longitudinally, and the more intact sections were divided into coronal, middle, and apical thirds. Each portion of the canal was photographed with a scanning electron microscope (SEM). The photographs were scored by two independent examiners according to relative amount of debris and/or smear layer present, as well as relative number of patent dentinal tubules. These scores were statistically analyzed using a Krustal-Wallis test and Wilcoxon Rank Sum tests to determine differences between groups. The coronal aspect of root canal walls irrigated with the EndoVac system exhibited significantly less debris and/or smear layer present when compared to the coronal aspect of root canals irrigated with only a standard 12-ml Monoject syringe equipped with 30-gauge ProRinse side-vented, closed-end needle (control). There were no other significant differences in scores between any groups at any location. For all locations combined, the EndoVac system produced significantly cleaner root canal walls as compared to the control. No significant differences were seen between the Canal CleanMax and Control or Canal CleanMax and EndoVac. This study suggested negative pressure irrigation delivery with the EndoVac system during and after hand-rotary instrumentation is more effective in removal of debris and smear layer from the coronal third and combined thirds of root canal walls compared to irrigation with a standard 12-ml Monoject syringe equipped with 30-gauge ProRinse side-vented, closed-end needle.