title: Root canal debridement using manual dynamic agitation or the EndoVac for final irrigation in a closed system and an open system.
abstract: OBJECTIVE
  This study examined canal debridement efficacy by testing the null hypothesis that there is no difference between a 'Closed' and an 'Open' system design in smear layer and debris removal using either manual dynamic agitation or the EndoVac for irrigant delivery.
  
  
  METHODS
  Forty teeth were divided into four groups and submitted to a standardized instrumentation protocol. Final irrigation was performed with either manual dynamic agitation or the EndoVac on groups of teeth with or without a sealed apical foramen. Smear and debris scores were evaluated using SEM and analysed using Cochran-Mantel-Haenszel statistic.
  
  
  RESULTS
  The ability of manual dynamic agitation to remove smear layer and debris in a closed canal system was significantly less effective than in an open canal system and significantly less effective than the EndoVac (P<0.001).
  
  
  CONCLUSIONS
  The null hypothesis was rejected; the presence of a sealed apical foramen adversely affected debridement efficacy when using manual dynamic agitation but not the EndoVac. Apical negative pressure irrigation is an effective method to overcome the fluid dynamics challenges inherent in closed canal systems.
authors: Department of Endodontics, School of Dentistry, Medical College of Georgia, Augusta, GA 30912-1129, USA.
authors: J M
authors: JM
authors: Parente
authors: R J
authors: RJ
authors: Loushine
authors: L
authors: L
authors: Susin
authors: L
authors: L
authors: Gu
authors: S W
authors: SW
authors: Looney
authors: R N
authors: RN
authors: Weller
authors: D H
authors: DH
authors: Pashley
authors: F R
authors: FR
authors: Tay
mesh_terms: D002614:Chelating Agents / Q000008:administration & dosage; D003646:Debridement; D003786:Dental Pulp Cavity / Q000473:pathology; D003804:Dentin / Q000473:pathology; D004492:Edetic Acid / Q000008:administration & dosage; D004867:Equipment Design; D006801:Humans; D008422:Materials Testing; D008855:Microscopy, Electron, Scanning; D011312:Pressure; D012212:Rheology; D012388:Root Canal Irrigants / Q000008:administration & dosage*; D018915:Root Canal Preparation / Q000295:instrumentation / Q000379:methods*; D016369:Smear Layer; D012973:Sodium Hypochlorite / Q000008:administration & dosage; D013396:Suction / Q000295:instrumentation; D007507:Therapeutic Irrigation / Q000295:instrumentation; D013997:Time Factors; D019227:Tooth Apex / Q000473:pathology; D014618:Vacuum
chemical_list: D002614:Chelating Agents; D012388:Root Canal Irrigants; D004492:Edetic Acid; D012973:Sodium Hypochlorite