title: Efficacy of needle irrigation, EndoActivator, and photon-initiated photoacoustic streaming technique on removal of double and triple antibiotic pastes.
abstract: BACKGROUND
  Photon-induced photoacoustic streaming (PIPS) is a novel technique used for the removal of material on root canal walls, such as bacteria and the smear layer. This study evaluated the efficacy of needle irrigation, the EndoActivator System (Dentsply Tulsa Dental Specialties, Tulsa, OK), and PIPS on the removal of antibiotic pastes from an artificial groove created in a root canal.
  
  
  METHODS
  Root canal preparation was performed up to size #40 on 84 extracted single-rooted teeth using ProTaper rotary instruments (Dentsply Maillefer, Ballaigues, Switzerland). The specimens were then split longitudinally, and 2 standardized grooves were prepared in the coronal and apical part of each segment. Double (DAP) and triple antibiotic pastes (TAP) were placed in the grooves for 4 weeks, and the root halves were reassembled. Needle irrigation, the EndoActivator System, and PIPS were used for the removal of DAP and TAP. The root segments were disassembled, and the amount of remaining antibiotic pastes was evaluated under a stereomicroscope at 20× magnification using a 4-grade scoring system. The data were evaluated statistically using Mann-Whitney U tests with a 95% confidence level (P = .05).
  
  
  RESULTS
  PIPS removed significantly more antibiotic pastes than the EndoActivator and needle irrigation (P < .001). The EndoActivator was superior to needle irrigation in removing antibiotic pastes (P < .001). There were no statistically significant differences between DAP and TAP and between coronal and apical thirds in their removing from artificially created grooves (P > .05).
  
  
  CONCLUSIONS
  PIPS was more effective in removing both DAP and TAP from artificial grooves in root canals than the EndoActivator System and needle irrigation. The EndoActivator was also more effective than needle irrigation. It is difficult to completely remove antibiotic pastes from root canals.
authors.affiliation: Department of Endodontics, Faculty of Dentistry, Ataturk University, Erzurum. Electronic address: hakan.arslan@ikc.edu.tr.
authors.forename: Hakan
authors.initials: H
authors.lastname: Arslan
authors.affiliation: Department of Pedodontics, Faculty of Dentistry, Katip Çelebi University, İzmir, Turkey.
authors.forename: Merve
authors.initials: M
authors.lastname: Akcay
authors.affiliation: Department of Endodontics, Faculty of Dentistry, Katip Çelebi University, İzmir, Turkey.
authors.forename: Ismail Davut
authors.initials: ID
authors.lastname: Capar
authors.affiliation: Department of Endodontics, Faculty of Dentistry, Katip Çelebi University, İzmir, Turkey.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Ertas
authors.affiliation: Department of Endodontics, Faculty of Dentistry, Şifa University, İzmir, Turkey.
authors.forename: Evren
authors.initials: E
authors.lastname: Ok
authors.affiliation: Department of Endodontics, Faculty of Dentistry, Katip Çelebi University, İzmir, Turkey.
authors.forename: Banu
authors.initials: B
authors.lastname: Uysal
mesh_terms: D000900:Anti-Bacterial Agents / Q000737:chemistry*; D002939:Ciprofloxacin / Q000737:chemistry; D003786:Dental Pulp Cavity / Q000033:anatomy & histology*; D006801:Humans; D053844:Lasers, Solid-State; D028022:Low-Level Light Therapy / Q000295:instrumentation; D008422:Materials Testing; D008795:Metronidazole / Q000737:chemistry; D008911:Minocycline / Q000737:chemistry; D009339:Needles; D061088:Photoacoustic Techniques / Q000295:instrumentation* / Q000379:methods; D010781:Photography / Q000379:methods; D011897:Random Allocation; D012388:Root Canal Irrigants / Q000737:chemistry*; D018915:Root Canal Preparation / Q000295:instrumentation* / Q000379:methods; D013499:Surface Properties; D007507:Therapeutic Irrigation / Q000295:instrumentation* / Q000379:methods; D019227:Tooth Apex / Q000033:anatomy & histology
chemical_list: D000900:Anti-Bacterial Agents; D012388:Root Canal Irrigants; D008795:Metronidazole; D002939:Ciprofloxacin; D008911:Minocycline
keywords: Double antibiotic paste; EndoActivator; endodontics; photon-induced photoacoustic streaming; regenerative; triple antibiotic paste