PIPS Outperforms Traditional Irrigation in Complex Canal Systems

Objective

The study compared the effectiveness of three irrigation techniques-photon-induced photoacoustic streaming (PIPS) with Er:YAG laser, passive ultrasonic irrigation (PUI), and standard needle irrigation (SNI)-for removing calcium hydroxide [Ca(OH)22] from the mesial roots of mandibular molars with Weine Type II canal configurations.

Materials and Methods

• Thirty mandibular molars with complex mesial root anatomy were prepared and filled with Ca(OH)22 paste.
• Teeth were divided into three groups (n=10 each):
  • PIPS (Er:YAG laser, 15 Hz, 20 mJ, 9 mm tip)
  • PUI (EndoUltra, 15/.02 tip)
  • SNI (30 Ga. side-vented needle)
• All groups used equal volumes of 8.25% NaOCl and 17% EDTA.
• Micro-CT was used to measure the initial and residual Ca(OH)22 volumes after irrigation.

Key Results

• All three methods removed Ca(OH)22 similarly in the coronal and middle canal thirds.
• In the apical third:
  • PIPS achieved significantly greater Ca(OH)22 removal (median 0% residual) than PUI (median 100% residual) and SNI (median 47% residual) (p<0.001).
• PIPS was the only technique to consistently remove Ca(OH)22 from the apical and complex isthmus areas.

Conclusion

Unlike SNI and PUI, the PIPS tip remains in the access cavity providing, expanding, and collapsing cavitational bubbles that progress as shear forces along the canal walls. Our results showed no remaining Ca(OH)2 throughout the root canal system in mesial roots of mandibular molars with Weine Type II canal anatomy and isthmuses. Even the most apical area of the root canal, which normally imposes increased irrigation difficulties was free of Ca(OH)2.

ACCESS THE FULL ARTICLE HERE