Endodontic disinfection: You can do it!

Oct. 1, 2010
There is considerable international attention focused on methods to improve endodontic disinfection within a complex anatomical space.

Clifford J. Ruddle, DDS

For more on this topic, go to www.dentaleconomics.com and search using the following key words: EndoActivator System, endodontic disinfection, ultrasonic, Dr. Clifford Ruddle.

There is considerable international attention focused on methods to improve endodontic disinfection within a complex anatomical space. Irrefutable scientific evidence supports that active irrigation significantly improves disinfection as compared to traditional passive irrigation.

Some dentists have adopted active irrigation methods, recognizing that filling root canal systems depends solely on removing the pulp, bacteria when present, and the smear layer. However, many dentists are only now becoming aware of the concept of active irrigation and its role in complete endodontics. The EndoActivator System is an active irrigation technology that is effective and safe for improving endodontic disinfection.

EndoActivator System

The EndoActivator System (DENTSPLY Tulsa Dental Specialties) is comprised of a cordless, contra-angled, battery-operated handpiece that uses sonic energy to drive strong, flexible, and noncutting medical-grade polymer tips. The handpiece and tips are designed to vigorously agitate and effectively exchange an intracanal irrigant and thereby clean the inaccessible aspects of a root canal system.

When the EndoActivator is used in a well-shaped canal and according to the Directions for Use (DFU), there is a growing body of evidence that supports this method of disinfection. During clinical use, the action of the vibrating tip frequently produces a "cloud" of debris that can be visually observed in a fluid-filled pulp chamber. Together, scientific and clinical evidence validate that the EndoActivator System represents a significant breakthrough in both active irrigation and endodontic disinfection.

Sonic vs. ultrasonic energy

When selecting an active irrigation method, it is important to understand the critical differences between sonic and ultrasonic energy. There is currently no consensus in the published scientific literature regarding which form of energy is best suited for endodontic disinfection. However, clinical analysis strongly supports the EndoActivator System and sonic energy as an effective, safe, and affordable method for endodontically disinfecting root canal systems.

Sonic energy can be used to vigorously activate highly flexible, noncutting, and inexpensive EndoActivator polymer tips. On the contrary, ultrasonic energy is used to drive rigid and significantly more expensive active and nonactive metal insert tips. Second, the EndoActivator's sonically driven polymer tips produce an amplitude that is exponentially larger than that produced by ultrasonically driven metal tips. The large amplitude of a vibrating polymer tip provides a superior mechanical action against the shaped dentinal walls of a canal. This mechanical action, in conjunction with fluid agitation, serves to synergistically disrupt and move residual tissue and debris into solution. Third, a sonically driven and loosely prefitted EndoActivator polymer tip will continuously move in a back-and-forth manner, even when any aspect of the tip contacts dentin, regardless of the degree of canal curvature.

On the other hand, ultrasonic energy is virtually lost when any part of a metal insert tip contacts dentin. Even when a metal insert tip is precurved, as has been advocated, in more curved canals the tip will certainly contact dentin upon activation, dampening tip movement. Finally, a sonically driven polymer tip will not cut dentin, produce an unwanted smear layer, or create iatrogenic events. On the contrary, ultrasonically driven metal tips will cut dentin upon contact and produce a smear layer. Of greatest concern, ultrasonically vibrating a metal insert tip, especially in a curved canal, predisposes to iatrogenic events such as ledges, apical transportations, perforations, and broken instruments.

In summary, ultrasonic energy is the energy of choice for cutting dentin or removing intracanal obstructions when performing many conventional, nonsurgical retreatment, or surgical procedures. Sonic energy is the energy of choice for active irrigation because it is clinically effective, and most importantly, safe.

The EndoActivator System is an effective, safe, easy, and inexpensive method for powerfully generating intracanal fluid dynamics. This active irrigation method serves to improve the penetration, circulation, and flow of irrigant into the more inaccessible regions of the root canal system. Cleaning root canal systems provides an opening for three-dimensional obturation and long-term success.

Disclosure: Dr. Ruddle has a financial interest in products he has designed and developed, which includes the EndoActivator System.

Dr. Clifford J. Ruddle is founder and director of Advanced Endodontics, an international educational source in Santa Barbara, Calif. He teaches at various dental schools, has authored many articles, and has designed several instruments. He is best known for his lectures, DVDs, and training courses in Santa Barbara. For more information, go to www.endoruddle.com.

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