Endodontide İrrigasyon Aktivasyon Yöntemleri
Özet
Başarılı bir kök kanal tedavisinin en kritik aşamalarından olan mekanik preparasyon ve kimyasal irrigasyon süreçlerinde, kök kanal sisteminin karmaşık anatomik yapısı nedeniyle solüsyonların etkinliğini artırmak amacıyla çeşitli aktivasyon yöntemleri kullanılmaktadır. Bu yöntemler; geleneksel enjektörler, fırçalar ve gutaperkanın ileri geri hareketiyle değişken basınç oluşturan Manuel Dinamik Aktivasyon gibi manuel tekniklerin yanı sıra, sürekli solüsyon akışı sağlayan Quantec-E ve mekanik ovma hareketiyle oval ile C şekilli kanallarda etkili temizlik sunan Self Adjusting File (SAF) gibi döner sistemleri içermektedir. Ayrıca, 2-3 kHz frekansta çalışan EndoActivator, Sonic Air MM 1500 ve postoperatif ağrıyı azaltmada başarılı olan Eddy gibi sonik sistemlerin yanı sıra, akustik dalgalar ve kavitasyon yaratarak derin penetrasyon sağlayan pasif ultrasonik aktivasyon (PUI) teknikleri de mevcuttur. Ardışık düzenli basınç ve vakum prensibiyle çalışan RinsEndo ile negatif basınç uygulayan EndoVac sistemleri apikal bölgedeki debrisi ve bakterileri uzaklaştırırken; Er:YAG lazer tabanlı Photon Induced Photoacoustic Streaming (PIPS) gibi lazerli yöntemler fotoakustik etkilerle derin tübül penetrasyonu sağlar. Son olarak, multisonik dalgalarla dokuları çok daha hızlı çözen GentleWave sistemi de güncel yaklaşımlar arasında yer alsa da, günümüzde kök kanalından bakteri ve debrisi %100 oranında uzaklaştırabilen mükemmel bir yöntem henüz bulunmamaktadır.
Two of the most critical stages of successful root canal treatment are mechanical preparation and chemical irrigation; however, due to the complex anatomical structure of the root canal system, various activation methods are used to enhance the efficacy of irrigation solutions. These methods include manual techniques such as conventional syringes, brushes, and Manual Dynamic Activation, which creates variable pressure through the reciprocating motion of gutta-percha, as well as rotary systems like Quantec-E, which provides continuous irrigant flow, and Self Adjusting File (SAF), which offers effective cleaning in oval and C-shaped canals via mechanical scrubbing. Additionally, sonic systems operating at 2-3 kHz, such as EndoActivator, Sonic Air MM 1500, and Eddy—which is successful in reducing postoperative pain—are available alongside passive ultrasonic irrigation (PUI) techniques that ensure deep penetration by creating acoustic waves and cavitations. Systems that generate sequential regular pressure, such as RinsEndo, and the negative pressure-based EndoVac system remove apical debris and bacteria, whereas laser-driven methods like Photon Induced Photoacoustic Streaming (PIPS) utilizing an Er:YAG laser trigger photoacoustic effects for deep tubule penetration. Finally, the GentleWave system, which dissolves tissues much faster using multisonic waves, is among the contemporary approaches; nevertheless, no single method developed to date has been found to be 100% effective in completely eliminating bacteria and debris from the root canal system.
Referanslar
Haapasalo M, Shen Y, Wang Z, et al. Irrigation in endodontics. Br Dent J, 2014;216:299-303.
Abuhaimed T.S, Abou Neel E.A. Sodium Hypochlorite Irrigation and Its Effect on Bond Strength to Dentin. Biomed Res Int. 2017: p. 1930360. Doi:10.1155/2017/1930360.
Wang Z, Shen Y, Haapasalo M. Effectiveness of endodontic disinfecting solutions against young and old Enterococcus faecalis biofilms in dentin canals. J Endod, 2012;38:1376-9.
Ma J, Wang Z, Shen Y, et al. A new noninvasive model to study the effectiveness of dentin disinfection by using confocal laser scanning microscopy. J Endod, 2011;37:1380-5.
Guivarc'h M, Ordioni U, Ahmed H.M, et al. Sodium Hypochlorite Accident: A Systematic Review. J Endod, 2017;43:16-24.
Haapasalo M, Shen Y, Qian W, et al. Irrigation in endodontics. Dent Clin North Am, 2010;54:291-312.
https://www.dentrealmarket.com/urun/irrigation-probe-irrigasyon-ignesi-100luk-cift-delikli. (erişim tarihi:12.09.2021).
Al-Hadlaq S.M, Al-Turaiki S.A, Al-Sulami U, et al. Efficacy of a new brush-covered irrigation needle in removing root canal debris: a scanning electron microscopic study. J Endod, 2006;32:1181-4.
Gu L.S, Kim J.R, Ling J, et al. Review of contemporary irrigant agitation techniques and devices. J Endod, 2009;35:791-804.
Setlock J, Fayad M.I, BeGole E, et al. Evaluation of canal cleanliness and smear layer removal after the use of the Quantec-E irrigation system and syringe: a comparative scanning electron microscope study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2003;96:614-7.
Metzger Z. The self-adjusting file (SAF) system: An evidence-based update. J Conserv Dent, 2014;17:401-19.
Neves M.A, Rocas I.N, Siqueira J.F.Jr. Clinical antibacterial effectiveness of the self-adjusting file system. Int Endod J, 2014;47:356-65.
Kfir A, Blau-Venezia N, Goldberger T, et al. Efficacy of self-adjusting file, XP-endo finisher and passive ultrasonic irrigation on the removal of calcium hydroxide paste from an artificial standardized groove. Aust Endod J, 2018;44:26-31.
Tronstad L, Barnett F, Schwartzben L, et al. Effectiveness and safety of a sonic vibratory endodontic instrument. Endod Dent Traumatol, 1985;1: 69-76.
Ruddle C. (2002) Pathways of the Pulp. 8th Ed. St Louis; Mosby, I.p.231-91.
Karade P, Johnson A, Baeten J, et al. Smear Layer Removal Efficacy Using EndoActivator and EndoUltra Activation Systems: An Ex Vivo SEM Analysis. Compend Contin Educ Dent, 2018;39:9-12.
Bryce G, MacBeth N, Gulabivala K, et al. The efficacy of supplementary sonic irrigation using the EndoActivator((R)) system determined by removal of a collagen film from an ex vivo model. Int Endod J, 2018;51: 489-497.
Kumar S, Desai K, Palekar A, et al. Comparison of the Efficacy of CanalBrush, EndoActivator, and Passive Ultrasonic Irrigation on the Removal of Triple Antibiotic Paste from Root Canal Walls: An In Vitro Study. J Int Soc Prev Community Dent, 2020;10:424-430.
https://www.endoruddle.com/EndoActivatord. (Erişim tarihi: 16.09.2021)
Küçük M, Kermeoğlu F, Kalender A. Endodontide Kullanılan Güncel İrrigasyon Solüsyonları, Sistem ve Cihazları İnönü Üniversitesi Sağlık Bilimleri Dergisi 2016;5:29-37.
Donnermeyer D, Wyrsch H, Burklein S, et al. Removal of Calcium Hydroxide from Artificial Grooves in Straight Root Canals: Sonic Activation Using EDDY Versus Passive Ultrasonic Irrigation and XPendo Finisher. J Endod, 2019;45:322-326.
Urban K. Donnermeyer D, Schafer E, et al. Canal cleanliness using different irrigation activation systems: a SEM evaluation. Clin Oral Investig, 2017;21:2681-2687.
Conde A.J, Estevez R, Lorono G, et al. Effect of sonic and ultrasonic activation on organic tissue dissolution from simulated grooves in root canals using sodium hypochlorite and EDTA. Int Endod J, 2017;50:976-982.
Salas H, Castrejon A, Fuentes D, et al. Evaluation of the penetration of CHX 2% on dentinal tubules using Conventional Irrigation, Sonic Irrigation (EDDY) and Passive Ultrasonic Irrigation (PUI) techniques: An in vitro study. J Clin Exp Dent, 2021;13:37-42.
İnce Yusufoglu S, Keskin N.B, Sarıçam E, et al. Comparison of apical debris extrusion using EDDY, passive ultrasonic activation and photon-initiated photoacoustic streaming irrigation activation devices. Aust Endod J, 2020;46:400-404.
Gündoğar M, Sezgin G.P, Kaplan S.S, et al. Postoperative pain after different irrigation activation techniques: a randomized, clinical trial. Odontology, 2021;109:385-392.
https://www.dental-tribune.com/prod/peace-of-mind-included-the-endo-system-by-vdw/. (Erişim tarihi: 20.09.2021).
Richman R.J. The Use Of Ultrasonics in Root Canal Therapy and Root Resection. Medicine Dentistry Journal, 1957;12:12-8.
van der Sluis L.W, Versluis M, Wu M.K, et al. Passive ultrasonic irrigation of the root canal: a review of the literature. Int Endod J, 2007;40:415-26.
https://www.vdw-dental.com/en/products/detail/vdwultra/. (Erişim tarihi: 23.09.2021)
Weller R.N, Brady J.M, Bernier W.E. Efficacy of ultrasonic cleaning. J Endod, 1980;6:740-3.
Toljan I, Bago I, Juric, et al. Eradication of Intracanal Enterococcus Faecalis Biofilm by Passive Ultrasonic Irrigation and RinsEndo System. Acta Stomatol Croat, 2016;50:14-22.
Vivan R.R, Bortolo M.V, Duarte M.A, et al. Scanning electron microscopy analysis of RinsEndo system and conventional irrigation for debris removal. Braz Dent J, 2010;21:305-9.
https://www.aegisdentalnetwork.com/id/2007/05/rinsendo-a-unique-instrument-for-root-canal-debridement. (Erişim tarihi: 25.09.2021).
Yılmaz M, Yılmaz S, Dumani A, et al. Effects of seven different irrigation techniques on debris and the smear layer: a scanning electron microscopy study. Niger J Clin Pract, 2017;20:328-334.
Thulaseedharan S, Kabbinale P, Vallabhdas A.K, et al. In Vitro Comparative Evaluation of Effectiveness of Sodium Hypochlorite with Conventional Irrigation Method versus EndoVac and Ultrasonic Irrigation in the Elimination of Enterococcus faecalis from Root Canals. J Pharm Bioallied Sci, 2020;12:105-108.
Schoop U, Kluger W, Dervisbegovic S, et al. Innovative wavelengths in endodontic treatment. Lasers Surg Med, 2006;38:624-30.
Beer F, Buchmair A, Wernisch J, et al. Comparison of two diode lasers on bactericidity in root canals--an in vitro study. Lasers Med Sci, 2012;27: 361-4.
Akyüz Ekim Ş.N, Erdemir A. Endodontide İrrigasyon Aktivasyon Yöntemleri. J Dent Fac Atatürk Uni, 2015;10:98-104.
Peters O.A, Bardsley S, Fong J, et al. Disinfection of root canals with photon-initiated photoacoustic streaming. J Endod, 2011;37:1008-12.
https://endopracticeus.com/industry-news/laser-enhanced-endodontic-treatment/. (Erişim tarihi: 27.09.2021)
Akcay M, Arslan H, Durmuş N, et al. Dentinal tubule penetration of AH Plus, iRoot SP, MTA fillapex, and guttaflow bioseal root canal sealers after different final irrigation procedures: A confocal microscopic study. Lasers Surg Med, 2016;48:70-6.
Mandras N, Pasqualini D, Roana J, et al. Influence of Photon-Induced Photoacoustic Streaming (PIPS) on Root Canal Disinfection and Post-Operative Pain: A Randomized Clinical Trial. J Clin Med, 2020;9:3915. doi:10.3390/jcm9123915.
Arslan H, Akçay M, Çapar I.D, et al. Efficacy of needle irrigation, EndoActivator, and photon-initiated photoacoustic streaming technique on removal of double and triple antibiotic pastes. J Endod, 2014;40:1439-42.
Haapasalo M, Wang Z, Shen Y, et al. Tissue dissolution by a novel multisonic ultracleaning system and sodium hypochlorite. J Endod, 2014;40:1178-81.
Mohammadi Z, Jafarzadeh H, Shalavi S, et al. Recent Advances in Root Canal Disinfection: A Review. Iran Endod J, 2017;12:402-406.
Wright C.R, Glickman G.N, Jalali P, et al. Effectiveness of Gutta-percha/Sealer Removal during Retreatment of Extracted Human Molars Using the GentleWave System. J Endod, 2019;45:808-812.
Sigurdsson A, Garland R.W, Le K.T, et al. Healing of Periapical Lesions after Endodontic Treatment with the GentleWave Procedure: A Prospective Multicenter Clinical Study. J Endod, 2018;44:510-517.
https://sonendo.com/technology/mechanism-of-action. (Erişim tarihi 28.09.2021).
