Modifiye Üçlü Antibiyotik Patının Uzaklaştırılmasında Fotonla İndüklenmiş Fotoakustik Dalgalanma ile Farklı İrrigasyon Aktivasyon Rejimlerinin Kombinasyonunun Karşılaştırılması

Year 2023, Volume: 10 Issue: 2, 474 - 478, 21.08.2023

Melek Akman , Arslan Terlemez , Makbule Bilge Akbulut , Hale Arı Aydınbelge

https://doi.org/10.15311/selcukdentj.1194259

Abstract

Amaç: Bu çalışmanın amacı, kök kanallarından modifiye üçlü antibiyotik patının (mTAP) çıkarılmasında foton kaynaklı fotoakustik dalgalanma (PIPS) tekniği ile farklı irrigasyon aktivasyon rejimlerinin kombinasyonunun etkinliğini karşılaştırmaktır.
Gereç ve Yöntemler: Yüz beş adet çekilmiş insan mandibular-premolar dişler ProTaper döner eğe kullanarak prepare edildi. Kök kanalları mTAP medikamenti ile dolduruldu ve 4 hafta sonra kökler kullanılan irrigasyon rejimlerine göre rastgele 7 gruba (n=15) ayrıldı: Self-Adjusting File (SAF), Pasif-Ultrasonik-İrrigasyon (PUI) , EndoAktivatör (EA), SAF+EA, SAF+PUI, PUI+EA, PIPS. 3 dişte mTAP kaldırılmadı (pozitif kontrol) ve diğer 3 diş mTAP ile doldurulmadı (negatif kontrol). Kökler uzunlamasına ikiye ayrıldı ve kalan mTAP miktarı, 4 dereceli bir skorlama sistemi kullanılarak 20x büyütme ile değerlendirildi. Veriler Kruskal-Wallis ve Mann-Whitney U testleri kullanılarak değerlendirildi.
Bulgular: Tüm deney grupları arasında istatistiksel olarak anlamlı farklılık tespit edildi. PIPS, SAF, SAF+EA ve SAF+PUI, mTAP'yi kök kanalından çıkarmada PUI ve PUI+EA'dan önemli ölçüde daha iyi performans gösterdi (P=0.000). EA orta etkinlik gösterdi. Apikal ve orta üçte birlik kısımda PUI ve PUI+EA ve koronal üçte birlik kısımda PUI önemli ölçüde daha kötü performans gösterdi (P<0.05).
Sonuç: Genel olarak, antibiyotik patlarını kök kanallarından tamamen çıkarmak zordur. Yalnızca PIPS tekniği, apikal üçte birlik kısımda mTAP'ın %100'ünü çıkardı.

Keywords

Endoaktivatör, Foton kaynaklı fotoakustik dalgalanma, self-adjusting file, ultrasonik

Comparison of the Photon-initiated Photoacoustic Streaming Technique and a Combination of Different Irrigation Activation Regimens on the Removal of Modified Triple Antibiotic Paste

Abstract

Background: The aim of this study was to compare the efficacy of the combination of different irrigation activation regimens, and the photon-induced photoacoustic streaming (PIPS) technique, in the removal of modified triple antibiotic paste (mTAP) from the root canals.
Methods: One-hundred and five extracted human mandibular-premolars were prepared using ProTaper Rotary-Files. The root canals were filled with mTAP medicament, and after 4 weeks, the roots were randomly assigned to 7 groups (n=15) according to the irrigation regimens used: Self-Adjusting File (SAF), Passive-Ultrasonic-Irrigation (PUI), EndoActivator (EA), SAF+EA, SAF+PUI, PUI+EA, PIPS. In 3 teeth, the mTAP was not removed (positive-controls), and another 3 teeth were not filled with mTAP (negative-controls). The roots were sectioned and the amount of remaining medicament was evaluated upon 20x magnification, using a 4-grade scoring system. The data was evaluated using the Kruskal-Wallis and Mann-Whitney U tests.
Results: There were statistically significant differences among all of the experimental groups. The PIPS, SAF, SAF+EA, and the SAF+PUI showed significantly better performances than the PUI and the PUI+EA in removing the mTAP from the root canal (P=0.000). The EA showed mid-effectiveness. At the apical and middle-third, the PUI and the PUI+EA, and at the coronal-third, the PUI showed significantly worse performances (P<0.05).
Conclusions: Overall, it is difficult to completely remove antibiotic pastes from root canals. Only the PIPS technique removed 100% of the mTAP at the apical-third.

References

• 1. Trope M. Treatment of the immature tooth with a non-vital pulp and apical periodontitis. Dent Clin North Am 2010;54:313-24.
• 2. Diogenes A, Henry MA, Teixeria FB, Hargreaves KM. An update on clinical regenerative endodontics. Endod Top 2013;28:2-23.
• 3. Jeeruphan T, Jantarat J, Yanpiset K, Suwannapan L, Khewsawai P, Hargreaves KM. Mahidol study 1: comparison of radiographic and survival outcomes of immature teeth treated with either regenerative endodontic or apexification methods: a retrospective study. J Endod 2012;38:1330-6.
• 4. Hoshino E, Kurihara-Ando N, Sato I, et al. In-vitro antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline. Int Endod J 1996;29:125–30.
• 5. Windley W, Teixeira F, Levin L, et al. Disinfection of immature teeth with a triple antibiotic paste. J Endod 2005;31:439–43.
• 6. Thibodeau B, Trope M. Pulp revascularization of a necrotic infected immature permanent tooth: case report and review of the literature. Pediatr Dent 2007;29:47-50.
• 7. Ruparel NB, Teixeira FB, Ferraz CC, Diogenes A. Direct effect of intracanal medicaments on survival of stem cells of the apical papilla. J Endod 2012;38:1372-5.
• 8. Ruddle CJ. Hydrodynamic disinfection: tsunami endodontics. Dent Today 2007;26:4-7
• 9. Van der Sluis LW, Versluis M, Wu MK, et al. Passive ultrasonic irrigation of the root canal: a review of the literature. Int Endod J 2007;40:415–26.
• 10. Metzger Z, Teperovich E, Zary R, Cohen R, Hof R. The self-adjusting file (SAF). Part 1: respecting the root canal anatomy--a new concept of endodontic files and its implementation. J Endod 2010;36:679-90.
• 11. DiVito E, Lloyd A. ER: YAG laser for 3-dimensional debridement of canal systems: use of photon-induced photoacoustic streaming. Dent Today 2012;31:4-7.
• 12. Arslan H, Akcay M, Capar ID, 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.
• 13. Van der Sluis LW, Wu MK, Wesselink PR. The evaluation of removal of calcium hydroxide paste from an artificial standardized groove in the apical root canal using different irrigation methodologies. Int Endod J 2007;40:52–7.
• 14. Ahmad M, Pitt Ford TJ, Crum LA. Ultrasonic debridement of root canals: acoustic streaming and its possible role. J Endod 1987;13:490-9.
• 15. Kim SK, Kim YO. Influence of calcium hydroxide intracanal medication on apical seal. Int Endod J 2002;35:623-8.
• 16. Lambrianidis T, Kosti E, Boutsioukis C, Mazinis M. Removal efficacy of various calcium hydroxide/chlorhexidine medicaments from the root canal. Int Endod J 2006;39:55-61.
• 17. De Groot SD, Verhaagen B, Versluis M, Wu MK, Wesselink PR, Van der Sluis LW. Laser-activated irrigation within root canals: cleaning efficacy and flow visualization. Int Endod J 2009;42:1077-83.
• 18. Arslan H, Capar I, Saygili G, Gok T, Akcay M. Effect of photon-initiated photoacoustic streaming on removal of apically placed dentinal debris. Int Endod J 2014. doi:10.1111/iej.12251.
• 19. Arslan H, Capar ID, Saygili G, Uysal B, Gok T, Ertas H, Topcuoglu HS. Efficacy of various irrigation protocols on the removal of triple antibiotic paste. Int Endod J 2013; 47:594-599.
• 20. Akman M, Akbulut MB, Aydınbelge HA, Belli S. Comparison of Different Irrigation Activation Regimens and Conventional Irrigation Techniques for the Removal of Modified Triple Antibiotic Paste from Root Canals. J Endod 2015;41:720-4.
• 21. Berkhoff JA, Chen PB, Teixeira FB, Diogenes A. Evaluation of triple antibiotic paste removal by different irrigation procedures. J Endod 2014;40:1172-7.
• 22. Hof R, Perevalov V, Eltanani M, Zary R, Metzger Z. The self-adjusting file (SAF). Part 2: mechanical analysis. J Endod 2010;36:691-6.
• 23. Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod 2004;30:196–200.
• 24. Petrino JA, Boda KK, Shambarger S, et al. Challenges in regenerative endodontics: a case series. J Endod 2010;36:536–41.
• 25. Tay FR, Gu LS, Schoeffel GJ et al. Effect of vapor lock on root canal debridement by using a side-vented needle for positive-pressure irrigant delivery. J Endod 2010;36:745-50.