Endodontic Irrigation System Helps Improve Outcomes

The last few decades have been prolific in terms of the development of innovative products in dentistry, and endodontics is no exception. Advances in root canal therapy include engine-driven files and heat-treated nickel-titanium (NiTi) instruments that offer increased efficiency and safety compared to the first generation of NiTi rotary files.

Nevertheless, while the advent of high-performance engine-driven file systems shortened the operative time of root canal mechanical preparation, it also reduced the volume of the irrigating solution — mainly sodium hypochlorite — inside the canal. The irrigant is also present in the canal for shorter periods.¹ This imbalance has been noted in the scientific literature,² which emphasizes the importance of time, volume, activation, and renewal of the irrigating solution in the disinfection phase.

FUNDAMENTAL IRRIGATION PRINCIPLES

Thus, the endodontic literature highlights three fundamental irrigation principles³ regarding its mechanical action mechanism and delivery. The first says that irrigants must reach the entire path of the root canal, particularly the apical third, without extruding beyond the apical foramen. The second is the mechanical activation of the liquid to improve its interaction with the dentin wall. The third concerns the constant renewal of the irrigant, ensuring that an active agent continuously interacts with the root canal’s content.

Pac-Dent’s iVac Apical Negative Pressure Irrigation and Activation System⁴ was developed to fulfill the three principles of mechanical irrigation in a practical, efficient and safe manner (Figure 1).

The iVac System is designed to be connected to a piezo ultrasonic handpiece and used during the root canal treatment irrigation/disinfection phase. The first and second concepts are addressed by the device’s ultrasonic vibration and negative pressure. Ultrasonic vibration acts as a mechanical catalyst of the irrigating solutions in conjunction with the transient cavitation and microstreaming effects. This produces a chemical-mechanical cleaning action — even in difficult-to-access canals and the critical apical third. In addition, the use of negative pressure effectively moves the irrigation fluid from the pulp chamber to the apical limit without extruding beyond the foramen. The third concept is concomitant irrigation, whereby the volume of irrigating liquid is continuously renewed.

The iVac system unites these three irrigation fundamentals in a single, safe device that protects against the risk of liquid extrusion into the periapical tissue while simultaneously activating the renewed irrigants inside the canal.

The system comprises an aspiration/activation cannula with two outside diameter options, 0.35 and 0.50 mm. The iVac ultrasonic connector is designed to hold the cannula and deliver the irrigating liquid properly while transmitting the vibration from the piezo ultrasonic handpiece. In addition, tubes and connections allow the ordinary vacuum outlet to be coupled, adding negative pressure to the system.

CONCLUSION

Offering intuitive operation, the iVac System’s synergistic action represents an improvement to any irrigation protocol. For example, the apical negative pressure with concomitant irrigation avoids the risk of fluid extrusion while allowing the irrigant to clean and disinfect the entire root canal to the working length. In clinical practice, Pac-Dent’s system is ideal in cases where irrigation depth control is essential, such as when treating apexification, regeneration, apical foramen resorptions, or young teeth.

Ultimately, by allowing the continuous exchange of ultrasonically activated irrigants, iVac technology effectively cleans and disinfects irregularities throughout the entire root canal system.

References

1. Siqueira JF, Rocas IN, Santos SRLD, Lima KC, Magalhaes FAC, de Uzeda M. Efficacy of instrumentation techniques and irrigation regimens in reducing the bacterial population within root canals. J Endod. 2002;28:181–184.
2. Lima CO, Barbosa AFA, Ferreira CM, et al. The impact of minimally invasive root canal preparation strategies on the shaping ability of mandibular molars. Int Endod J. 2020;53:1680–1688.
3. Haapasalo M, Shen Y, Wang Z. Gao Y. Irrigation in endodontics. Br Dent J. 2014;216:299–303.
4. Ramos, CAS. Ultrasonic Negative Pressure Irrigation and Evacuation High-Performance Polymer Micro-Capillary Cannula (U.S. Patent No. 63221851). U.S. Patent and Trademark Office. 2021.

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From Decisions in Dentistry. April 2023;9(4):24.