Endodontik Tedavide Kullanılan Aktivasyon Yöntemleri
Özet
Endodontik tedavinin başarısında kök kanal sisteminin etkin şekilde temizlenmesi ve dezenfeksiyonu kritik bir rol oynamaktadır. Karmaşık kanal anatomisi ve mikroorganizma varlığı, yalnızca mekanik preparasyonun yeterli olmadığı durumları ortaya çıkarmakta; bu nedenle irrigasyon solüsyonlarının aktivasyonu modern endodontinin temel bileşenlerinden biri haline gelmiştir. Bu bölümde kök kanal irrigasyonunun etkinliğini artırmak amacıyla geliştirilen aktivasyon yöntemleri kapsamlı biçimde ele alınmaktadır. Manuel irrigasyon tekniklerinden başlayarak mekanik sistemler, sonik ve ultrasonik aktivasyon yöntemleri, negatif basınçlı irrigasyon sistemleri ve lazer destekli irrigasyon teknolojileri ayrıntılı olarak incelenmektedir. Her yöntemin çalışma prensibi, klinik uygulama protokolleri, avantajları ve sınırlılıkları güncel literatür ışığında değerlendirilmektedir. Ayrıca modern endodontide giderek önem kazanan multisonik ve lazer tabanlı irrigasyon teknolojilerinin kök kanal sisteminin kompleks anatomik bölgelerinde sağladığı temizleme ve dezenfeksiyon potansiyeli de tartışılmaktadır. Bu bölüm, endodontik irrigasyon aktivasyon yöntemlerinin klinik etkinliğini anlamak ve uygun teknik seçimini desteklemek amacıyla güncel bilimsel verileri derleyerek klinisyenlere ve araştırmacılara kapsamlı bir bakış açısı sunmayı hedeflemektedir.
Effective cleaning and disinfection of the root canal system are critical determinants of the success of endodontic treatment. Due to the complex anatomy of root canals and the persistence of microorganisms, mechanical instrumentation alone is often insufficient. Therefore, activation of irrigation solutions has become a fundamental component of modern endodontic practice. This chapter comprehensively reviews the various activation techniques developed to enhance the effectiveness of root canal irrigation. Starting with manual irrigation methods, the chapter examines mechanical activation systems, sonic and ultrasonic techniques, negative pressure irrigation systems, and laser-assisted irrigation technologies. The mechanisms of action, clinical protocols, advantages, and limitations of each method are discussed in light of current scientific literature. Particular attention is given to emerging technologies such as multisonic irrigation and laser-based activation systems, which have demonstrated significant potential in improving debridement and disinfection within complex root canal anatomies. By synthesizing contemporary evidence, this chapter aims to provide clinicians and researchers with a comprehensive understanding of irrigation activation strategies and to support evidence-based decision-making in endodontic treatment.
Referanslar
Kahn FH, Rosenberg PA, Gliksberg J, 1995. An in vitro evaluation of the irrigating characteristics of ultrasonic and subsonic handpieces and irrigating needles and probes. J. Endod., 21, 5, 277-280.
Mamootil K ve Messer H, 2007. Penetration of dentinal tubules by endodontic sealer cements in extracted teeth and in vivo. Int. Endod. J., 40, 11, 873-881.
Van der Sluis L, Gambarini G, Wu M, Wesselink P, 2006. The influence of volume, type of irrigant and flushing method on removing artificially placed dentine debris from the apical root canal during passive ultrasonic irrigation. Int. Endod. J., 39, 6, 472-476.
Wu MK, Dummer P, Wesselink P, 2006. Consequences of and strategies to deal with residual post‐treatment root canal infection. Int. Endod. J., 39, 5, 343-356.
Wu MK ve Wesselink P, 2001. A primary observation on the preparation and obturation of oval canals. Int. Endod. J., 34, 2, 137-141.
Ram Z, 1977. Effectiveness of root canal irrigation. Oral Surg. Oral Med. Oral Pathol., 44, 2, 306-312.
Psimma Z, Boutsioukis C, Vasiliadis L, Kastrinakis E, 2013. A new method for real‐ time quantification of irrigant extrusion during root canal irrigation ex vivo. Int. Endod. J., 46, 7, 619-631.
Boutsioukis C, Verhaagen B, Versluis M, Kastrinakis E, Wesselink PR, van der Sluis LW, 2010. Evaluation of irrigant flow in the root canal using different needle types by an unsteady computational fluid dynamics model. J. Endod., 36, 5, 875-879.
Oswal P, Martande SS, Shenvi S, 2020. To Evaluate the Efficacy of New Brush Covered Irrigation Needle in Removing Root Canal Debris In Vitro: A Scanning Electron Microscopy Study. International Journal of Dentistry and Oral Science, 7, 12, 1211-1215.
Al-Hadlaq SM, Al-Turaiki SA, Al-Sulami U, Saad AY, 2006. Efficacy of a new brushcovered irrigation needle in removing root canal debris: a scanning electron microscopic study. J. Endod., 32, 12, 1181-1184.
Gu L-s, Kim JR, Ling J, Choi KK, Pashley DH, Tay FR, 2009. Review of contemporary irrigant agitation techniques and devices. J. Endod., 35, 6, 791-804.
Keir DM, Senia ES, Montgomery S, 1990. Effectiveness of a brush in removing postinstrumentation canal debris. J. Endod., 16, 7, 323-327.
Jiang L-M, Lak B, Eijsvogels LM, Wesselink P, van der Sluis LW, 2012. Comparison of the cleaning efficacy of different final irrigation techniques. J. Endod., 38, 6, 838-841.
Andrabi SMUN, Kumar A, Mishra SK, Tewari RK, Alam S, Siddiqui S, 2013. Effect of manual dynamic activation on smear layer removal efficacy of ethylenediaminetetraacetic acid and SmearClear: an in vitro scanning electron microscopic study. Aust. Endod. J., 39, 3, 131-136.
Tay FR, Gu L-s, Schoeffel GJ, Wimmer C, Susin L, Zhang K ve ark. 2010. Effect of vapor lock on root canal debridement by using a side-vented needle for positive-pressure irrigant delivery. J. Endod., 36, 4, 745-750.
Setlock J, Fayad MI, BeGole E, Bruzick M, 2003. 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., 96, 5, 614-617.
Hof R, Perevalov V, Eltanani M, Zary R, Metzger Z, 2010. The self-adjusting file (SAF). Part 2: mechanical analysis. J. Endod., 36, 4, 691-696.
Metzger Z, Teperovich E, Zary R, Cohen R, Hof R, 2010. The self-adjusting file (SAF). Part 1: respecting the root canal anatomy—a new concept of endodontic files and its implementation. J. Endod., 36, 4, 679-690.
Metzger Z, Solomonov M, Kfir A, 2013. The role of mechanical instrumentation in the cleaning of root canals. Endodontic Topics, 29, 1, 87-109.
Vaz-Garcia ES, Vieira VTL, Petitet NPdSF, Moreira EJL, Lopes HP, Elias CN ve ark. 2018. Mechanical properties of anatomic finishing files: XP-Endo Finisher and XP-Clean. Braz. Dent. J., 29, 2, 208-213.
Sağlam BC, Hazar E, Koçak MM, Koçak S, Türker SA, 2021. The Cleaning Efficacy of Passive Ultrasonic Irrigation and XP-Endo Finisher After Post Space Preparation.
FKG Dentaire SA, 2016. XP-endo Finisher file brochure.
Ragul P, Dhanraj M, Jain AR, 2018. Irrigation technique used in cleaning and shaping during endodontic treatment-A review. Drug Invent. Today, 10, 5, 739-743.
Hülsmann M, Peters OA, Dummer PM, 2005. Mechanical preparation of root canals: shaping goals, techniques and means. Endodontic Topics, 10, 1, 30-76.
Weller RN, Brady JM, Bernier WE, 1980. Efficacy of ultrasonic cleaning. J. Endod., 6, 9, 740-743.
Souza CC, Bueno CE, Kato AS, Limoeiro AG, Fontana CE, Pelegrine RA, 2019. Efficacy of passive ultrasonic irrigation, continuous ultrasonic irrigation versus irrigation with reciprocating activation device in penetration into main and simulated lateral canals. J. Conserv. Dent. Endod., 22, 2, 155-159.
Lee B-S, Lin C-P, Hung Y-L, Lan W-H, 2004. Structural changes of Er: YAG laser– irradiated human dentin. Photomed. Laser Ther., 22, 4, 330-334.
Van der Sluis L, Versluis M, Wu M, Wesselink P, 2007. Passive ultrasonic irrigation of the root canal: a review of the literature. International Endodontic Journal, 40, 6, 415-426.
Tronstad L, Barnett F, Schwartzben L, Frasca P, 1985. Effectiveness and safety of a sonic vibratory endodontic instrument. Dent. Traumatol., 1, 2, 69-76.
Ahmad M, Ford TRP, Crum LA, 1987. Ultrasonic debridement of root canals: an insight into the mechanisms involved. J. Endod., 13, 3, 93-101.
Kanter V, Weldon E, Nair U, Varella C, Kanter K, Anusavice K ve ark. 2011. A quantitative and qualitative analysis of ultrasonic versus sonic endodontic systems on canal cleanliness and obturation. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod., 112, 6, 809-813.
Rödig T, Bozkurt M, Konietschke F, Hülsmann M, 2010. Comparison of the Vibringe system with syringe and passive ultrasonic irrigation in removing debris from simulated root canal irregularities. J. Endod., 36, 8, 1410-1413.
Plotino G, Grande NM, Mercade M, Cortese T, Staffoli S, Gambarini G ve ark. 2019. Efficacy of sonic and ultrasonic irrigation devices in the removal of debris from canal irregularities in artificial root canals. J. Appl. Oral Sci., 27.
Conde A, Estevez R, Loroño G, Valencia de Pablo Ó, Rossi‐Fedele G, Cisneros R, 2017. Effect of sonic and ultrasonic activation on organic tissue dissolution from simulated grooves in root canals using sodium hypochlorite and EDTA. Int. Endod. J., 50, 10, 976-982.
Neuhaus KW, Liebi M, Stauffacher S, Eick S, Lussi A, 2016. Antibacterial efficacy of a new sonic irrigation device for root canal disinfection. J. Endod., 42, 12, 1799-1803.
Urban K, Donnermeyer D, Schäfer E, Bürklein S, 2017. Canal cleanliness using different irrigation activation systems: a SEM evaluation. Clin. Oral Investig., 21, 2681-2687.
Toljan I, Bago I, Anić I, 2016. Eradication of intracanal Enterococcus faecalis biofilm by passive ultrasonic irrigation and RinsEndo system. Acta Stomatologica Croatica, 50, 1, 14.
Vivan RR, Bortolo MV, Duarte MAH, Moraes IGd, Tanomaru-Filho M, Bramante CM, 2010. Scanning electron microscopy analysis of RinsEndo system and conventional irrigation for debris removal. Brazilian Dental Journal, 21, 305-309.
Adorno C, Fretes V, Ortiz C, Mereles R, Sosa V, Yubero M ve ark. 2016. Comparison of two negative pressure systems and syringe irrigation for root canal irrigation: an ex vivo study. Int. Endod. J., 49, 2, 174-183.
Boutsioukis C, Psimma Z, Van der Sluis L, 2013. Factors affecting irrigant extrusion during root canal irrigation: a systematic review. Int. Endod. J., 46, 7, 599-618.
Haapasalo M, Shen Y, Qian W, Gao Y, 2010. Irrigation in endodontics. Br. Dent. J., 216, 6, 299-303.
Kimura Y, Wilder‐Smith P, Matsumoto K, 2000. Lasers in endodontics: a review. Int. Endod. J., 33, 3, 173-185.
Matsumoto H, Yoshimine Y, Akamine A, 2011. Visualization of irrigant flow and cavitation induced by Er: YAG laser within a root canal model. J. Endod., 37, 6, 839-843.
Schoop U, Moritz A, Kluger W, Patruta S, Goharkhay K, Sperr W ve ark. 2002. The Er: YAG laser in endodontics: results of an in vitro study. Lasers Surg. Med., 30, 5, 360-364.
Blanken J, De Moor RJG, Meire M, Verdaasdonk R, 2009. Laser induced explosive vapor and cavitation resulting in effective irrigation of the root canal. Part 1: a visualization study. Lasers Surg. Med., 41, 7, 514-519.
Su Z, Li Z, Shen Y, Bai Y, Zheng Y, Pan C ve ark. 2021. Characteristics of the Irrigant flow in a simulated Lateral Canal under two typical laser‐activated irrigation regimens. Lasers Surg. Med., 53, 4, 587-594.
Yavari HR, Rahimi S, Shahi S, Lotfi M, Barhaghi MH, Fatemi A ve ark. 2010. Effect of Er, Cr: YSGG laser irradiation on Enterococcus faecalis in infected root canals. Photomed. Laser Surg., 28, S1, S-91-S-96.
Haapasalo M, Wang Z, Shen Y, Curtis A, Patel P, Khakpour M, 2014. Tissue dissolution by a novel multisonic ultracleaning system and sodium hypochlorite. J. Endod., 40, 8, 1178-1181.
Akcay M, Arslan H, Durmus N, Mese M, Capar ID, 2016. 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., 48, 1, 70-76.
Coaguila-Llerena H, Gaeta E, Faria G, 2022. Outcomes of the GentleWave system on root canal treatment: a narrative review. Restor. Dent. Endod., 47, 1.
Referanslar
Kahn FH, Rosenberg PA, Gliksberg J, 1995. An in vitro evaluation of the irrigating characteristics of ultrasonic and subsonic handpieces and irrigating needles and probes. J. Endod., 21, 5, 277-280.
Mamootil K ve Messer H, 2007. Penetration of dentinal tubules by endodontic sealer cements in extracted teeth and in vivo. Int. Endod. J., 40, 11, 873-881.
Van der Sluis L, Gambarini G, Wu M, Wesselink P, 2006. The influence of volume, type of irrigant and flushing method on removing artificially placed dentine debris from the apical root canal during passive ultrasonic irrigation. Int. Endod. J., 39, 6, 472-476.
Wu MK, Dummer P, Wesselink P, 2006. Consequences of and strategies to deal with residual post‐treatment root canal infection. Int. Endod. J., 39, 5, 343-356.
Wu MK ve Wesselink P, 2001. A primary observation on the preparation and obturation of oval canals. Int. Endod. J., 34, 2, 137-141.
Ram Z, 1977. Effectiveness of root canal irrigation. Oral Surg. Oral Med. Oral Pathol., 44, 2, 306-312.
Psimma Z, Boutsioukis C, Vasiliadis L, Kastrinakis E, 2013. A new method for real‐ time quantification of irrigant extrusion during root canal irrigation ex vivo. Int. Endod. J., 46, 7, 619-631.
Boutsioukis C, Verhaagen B, Versluis M, Kastrinakis E, Wesselink PR, van der Sluis LW, 2010. Evaluation of irrigant flow in the root canal using different needle types by an unsteady computational fluid dynamics model. J. Endod., 36, 5, 875-879.
Oswal P, Martande SS, Shenvi S, 2020. To Evaluate the Efficacy of New Brush Covered Irrigation Needle in Removing Root Canal Debris In Vitro: A Scanning Electron Microscopy Study. International Journal of Dentistry and Oral Science, 7, 12, 1211-1215.
Al-Hadlaq SM, Al-Turaiki SA, Al-Sulami U, Saad AY, 2006. Efficacy of a new brushcovered irrigation needle in removing root canal debris: a scanning electron microscopic study. J. Endod., 32, 12, 1181-1184.
Gu L-s, Kim JR, Ling J, Choi KK, Pashley DH, Tay FR, 2009. Review of contemporary irrigant agitation techniques and devices. J. Endod., 35, 6, 791-804.
Keir DM, Senia ES, Montgomery S, 1990. Effectiveness of a brush in removing postinstrumentation canal debris. J. Endod., 16, 7, 323-327.
Jiang L-M, Lak B, Eijsvogels LM, Wesselink P, van der Sluis LW, 2012. Comparison of the cleaning efficacy of different final irrigation techniques. J. Endod., 38, 6, 838-841.
Andrabi SMUN, Kumar A, Mishra SK, Tewari RK, Alam S, Siddiqui S, 2013. Effect of manual dynamic activation on smear layer removal efficacy of ethylenediaminetetraacetic acid and SmearClear: an in vitro scanning electron microscopic study. Aust. Endod. J., 39, 3, 131-136.
Tay FR, Gu L-s, Schoeffel GJ, Wimmer C, Susin L, Zhang K ve ark. 2010. Effect of vapor lock on root canal debridement by using a side-vented needle for positive-pressure irrigant delivery. J. Endod., 36, 4, 745-750.
Setlock J, Fayad MI, BeGole E, Bruzick M, 2003. 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., 96, 5, 614-617.
Hof R, Perevalov V, Eltanani M, Zary R, Metzger Z, 2010. The self-adjusting file (SAF). Part 2: mechanical analysis. J. Endod., 36, 4, 691-696.
Metzger Z, Teperovich E, Zary R, Cohen R, Hof R, 2010. The self-adjusting file (SAF). Part 1: respecting the root canal anatomy—a new concept of endodontic files and its implementation. J. Endod., 36, 4, 679-690.
Metzger Z, Solomonov M, Kfir A, 2013. The role of mechanical instrumentation in the cleaning of root canals. Endodontic Topics, 29, 1, 87-109.
Vaz-Garcia ES, Vieira VTL, Petitet NPdSF, Moreira EJL, Lopes HP, Elias CN ve ark. 2018. Mechanical properties of anatomic finishing files: XP-Endo Finisher and XP-Clean. Braz. Dent. J., 29, 2, 208-213.
Sağlam BC, Hazar E, Koçak MM, Koçak S, Türker SA, 2021. The Cleaning Efficacy of Passive Ultrasonic Irrigation and XP-Endo Finisher After Post Space Preparation.
FKG Dentaire SA, 2016. XP-endo Finisher file brochure.
Ragul P, Dhanraj M, Jain AR, 2018. Irrigation technique used in cleaning and shaping during endodontic treatment-A review. Drug Invent. Today, 10, 5, 739-743.
Hülsmann M, Peters OA, Dummer PM, 2005. Mechanical preparation of root canals: shaping goals, techniques and means. Endodontic Topics, 10, 1, 30-76.
Weller RN, Brady JM, Bernier WE, 1980. Efficacy of ultrasonic cleaning. J. Endod., 6, 9, 740-743.
Souza CC, Bueno CE, Kato AS, Limoeiro AG, Fontana CE, Pelegrine RA, 2019. Efficacy of passive ultrasonic irrigation, continuous ultrasonic irrigation versus irrigation with reciprocating activation device in penetration into main and simulated lateral canals. J. Conserv. Dent. Endod., 22, 2, 155-159.
Lee B-S, Lin C-P, Hung Y-L, Lan W-H, 2004. Structural changes of Er: YAG laser– irradiated human dentin. Photomed. Laser Ther., 22, 4, 330-334.
Van der Sluis L, Versluis M, Wu M, Wesselink P, 2007. Passive ultrasonic irrigation of the root canal: a review of the literature. International Endodontic Journal, 40, 6, 415-426.
Tronstad L, Barnett F, Schwartzben L, Frasca P, 1985. Effectiveness and safety of a sonic vibratory endodontic instrument. Dent. Traumatol., 1, 2, 69-76.
Ahmad M, Ford TRP, Crum LA, 1987. Ultrasonic debridement of root canals: an insight into the mechanisms involved. J. Endod., 13, 3, 93-101.
Kanter V, Weldon E, Nair U, Varella C, Kanter K, Anusavice K ve ark. 2011. A quantitative and qualitative analysis of ultrasonic versus sonic endodontic systems on canal cleanliness and obturation. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod., 112, 6, 809-813.
Rödig T, Bozkurt M, Konietschke F, Hülsmann M, 2010. Comparison of the Vibringe system with syringe and passive ultrasonic irrigation in removing debris from simulated root canal irregularities. J. Endod., 36, 8, 1410-1413.
Plotino G, Grande NM, Mercade M, Cortese T, Staffoli S, Gambarini G ve ark. 2019. Efficacy of sonic and ultrasonic irrigation devices in the removal of debris from canal irregularities in artificial root canals. J. Appl. Oral Sci., 27.
Conde A, Estevez R, Loroño G, Valencia de Pablo Ó, Rossi‐Fedele G, Cisneros R, 2017. Effect of sonic and ultrasonic activation on organic tissue dissolution from simulated grooves in root canals using sodium hypochlorite and EDTA. Int. Endod. J., 50, 10, 976-982.
Neuhaus KW, Liebi M, Stauffacher S, Eick S, Lussi A, 2016. Antibacterial efficacy of a new sonic irrigation device for root canal disinfection. J. Endod., 42, 12, 1799-1803.
Urban K, Donnermeyer D, Schäfer E, Bürklein S, 2017. Canal cleanliness using different irrigation activation systems: a SEM evaluation. Clin. Oral Investig., 21, 2681-2687.
Toljan I, Bago I, Anić I, 2016. Eradication of intracanal Enterococcus faecalis biofilm by passive ultrasonic irrigation and RinsEndo system. Acta Stomatologica Croatica, 50, 1, 14.
Vivan RR, Bortolo MV, Duarte MAH, Moraes IGd, Tanomaru-Filho M, Bramante CM, 2010. Scanning electron microscopy analysis of RinsEndo system and conventional irrigation for debris removal. Brazilian Dental Journal, 21, 305-309.
Adorno C, Fretes V, Ortiz C, Mereles R, Sosa V, Yubero M ve ark. 2016. Comparison of two negative pressure systems and syringe irrigation for root canal irrigation: an ex vivo study. Int. Endod. J., 49, 2, 174-183.
Boutsioukis C, Psimma Z, Van der Sluis L, 2013. Factors affecting irrigant extrusion during root canal irrigation: a systematic review. Int. Endod. J., 46, 7, 599-618.
Haapasalo M, Shen Y, Qian W, Gao Y, 2010. Irrigation in endodontics. Br. Dent. J., 216, 6, 299-303.
Kimura Y, Wilder‐Smith P, Matsumoto K, 2000. Lasers in endodontics: a review. Int. Endod. J., 33, 3, 173-185.
Matsumoto H, Yoshimine Y, Akamine A, 2011. Visualization of irrigant flow and cavitation induced by Er: YAG laser within a root canal model. J. Endod., 37, 6, 839-843.
Schoop U, Moritz A, Kluger W, Patruta S, Goharkhay K, Sperr W ve ark. 2002. The Er: YAG laser in endodontics: results of an in vitro study. Lasers Surg. Med., 30, 5, 360-364.
Blanken J, De Moor RJG, Meire M, Verdaasdonk R, 2009. Laser induced explosive vapor and cavitation resulting in effective irrigation of the root canal. Part 1: a visualization study. Lasers Surg. Med., 41, 7, 514-519.
Su Z, Li Z, Shen Y, Bai Y, Zheng Y, Pan C ve ark. 2021. Characteristics of the Irrigant flow in a simulated Lateral Canal under two typical laser‐activated irrigation regimens. Lasers Surg. Med., 53, 4, 587-594.
Yavari HR, Rahimi S, Shahi S, Lotfi M, Barhaghi MH, Fatemi A ve ark. 2010. Effect of Er, Cr: YSGG laser irradiation on Enterococcus faecalis in infected root canals. Photomed. Laser Surg., 28, S1, S-91-S-96.
Haapasalo M, Wang Z, Shen Y, Curtis A, Patel P, Khakpour M, 2014. Tissue dissolution by a novel multisonic ultracleaning system and sodium hypochlorite. J. Endod., 40, 8, 1178-1181.
Akcay M, Arslan H, Durmus N, Mese M, Capar ID, 2016. 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., 48, 1, 70-76.
Coaguila-Llerena H, Gaeta E, Faria G, 2022. Outcomes of the GentleWave system on root canal treatment: a narrative review. Restor. Dent. Endod., 47, 1.
