An in-vitro study evaluating the efficacy of the ultrasonic bypass system™, using different intracanal irrigating solutions

Abstract

This in-vitro, prospective, randomized study microscopically compared the debridement efficacy of passive ultrasonic irrigation (PUI) using the Ultrasonic Bypass System and different irrigating protocols. Eighty extracted maxillary anterior teeth were randomly assigned to four groups. Teeth were instrumented using EndoSequence rotary instrument system and treated with passive ultrasonic irrigation with different irrigating regimens for one minute. Group one (control) was treated with hand/rotary instrumentation. Group two was treated with hand/rotary instrumentation followed by a one-minute PUI using the Ultrasonic Bypass System with 6.0-percent NaOCl. Group three was treated with hand/rotary instrumentation followed by a one-minute PUI using the Ultrasonic Bypass System with 17-percent EDTA. Group four was treated with hand/rotary instrumentation followed by a one-minute PUI using the Ultrasonic Bypass System with 30 seconds of 6.0-percent NaOCl and 30 seconds of 17-percent EDTA. Teeth were sectioned longitudinally and each half was divided into three equal parts from the anatomic apex. The half with the most visible part of the apex was used for SEM evaluation. A scoring system for debris and smear layer removal was used. Statistical analysis was performed using a Kruskal-Wallis test, which determines if there are any differences among the four groups. Following this test, a Wilcoxon Rank Sum test was used to compare each pair of groups. The addition of a one-minute PUI with the Ultrasonic Bypass System significantly enhanced the removal of smear layer when compared with the hand/rotary instrumentation with conventional irrigating solutions. The Ultrasonic Bypass System when used with the combination of 6.0-percent NaOCl and 17-percent EDTA after hand/rotary instrumentation significantly removed smear layer at the coronal, middle, and apical areas of a tooth when compared with all other groups. A one-minute PUI with the Ultrasonic Bypass System combined with NaOCl and EDTA is significantly better in smear removal and ultimately will result cleaner canal wall.