title: Evaluation of 4 Different Irrigating Systems for Apical Extrusion of Sodium Hypochlorite.
abstract: BACKGROUND
  The aim of this study was to evaluate NaOCl apical extrusion by using negative apical pressure (EndoVac), sonic agitation (EndoActivator), side-vented needle (Max-i-Probe), and photon induced photoacoustic streaming (PIPS 10 mJ and PIPS 20 mJ) laser irrigation in an in vitro gel model.
  
  
  METHODS
  Extracted mandibular and maxillary central incisors (n = 18) were prepared to size 35/.04 and 55/.04, respectively. Teeth were mounted in transparent containers with clear acrylic and suspended in a color-changing pH-sensitive gel, creating a closed system. By using a crossover design, each tooth was sequentially irrigated by using 6% NaOCl with each device following manufacturers' recommendations. Each tooth served as its own control. Pre-irrigation and post-irrigation buccal and proximal view photographs served to measure the longest distance of extrusion and were analyzed with ImageJ software. Mean results were analyzed by using Kruskal-Wallis and Dunn post hoc test (P < .05).
  
  
  RESULTS
  There were no significant differences between EndoVac, EndoActivator, and the passive extrusion groups. The EndoVac and EndoActivator groups produced significantly less extrusion than PIPS irrigation. Max-i-Probe extrusion results were more variable than those of EndoActivator but had no significant difference. Across all irrigation systems, there were no significant differences with respect to apical preparation size.
  
  
  CONCLUSIONS
  Under the in vitro conditions of this study, no difference was found between the 10 mJ and 20 mJ PIPS laser groups. EndoVac demonstrated significantly less potential for apical extrusion than PIPS and Max-i-Probe, whereas apical preparation size did not significantly affect extrusion of irrigant. The potential for apical extrusion of endodontic irrigants should be a consideration when selecting a system for final irrigation.
authors.affiliation: Keesler Medical Center, Keesler Air Force Base, Mississippi.
authors.forename: Ross A
authors.initials: RA
authors.lastname: Yost
authors.affiliation: Georgia Regents University, Augusta, Georgia.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Bergeron
authors.affiliation: Keesler Medical Center, Keesler Air Force Base, Mississippi. Electronic address: timothy.kirkpatrick@us.af.mil.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Kirkpatrick
authors.affiliation: Keesler Medical Center, Keesler Air Force Base, Mississippi.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Roberts
authors.affiliation: Keesler Medical Center, Keesler Air Force Base, Mississippi.
authors.forename: Howard W
authors.initials: HW
authors.lastname: Roberts
authors.affiliation: Louisiana State University, New Orleans, Louisiana.
authors.forename: Van T
authors.initials: VT
authors.lastname: Himel
authors.affiliation: Louisiana State University, New Orleans, Louisiana.
authors.forename: Kent A
authors.initials: KA
authors.lastname: Sabey
mesh_terms: D006801:Humans; D010486:Periapical Tissue / Q000187:drug effects*; D010865:Pilot Projects; D012388:Root Canal Irrigants / Q000008:administration & dosage*; D018915:Root Canal Preparation / Q000295:instrumentation / Q000379:methods*; D012973:Sodium Hypochlorite; D007507:Therapeutic Irrigation / Q000379:methods*
chemical_list: D012388:Root Canal Irrigants; D012973:Sodium Hypochlorite
keywords: Apical extrusion; EndoActivator; EndoVac; PIPS; irrigation; sodium hypochlorite