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International Endodontic Journal May 2022Irrigation is considered the primary means of cleaning and disinfection of the root canal system. The purpose of this review was to set the framework for the obstacles... (Review)
Review
Irrigation is considered the primary means of cleaning and disinfection of the root canal system. The purpose of this review was to set the framework for the obstacles that irrigation needs to overcome, to critically appraise currently used irrigants and irrigation methods, to highlight knowledge gaps and methodological limitations in the available studies and to provide directions for future developments. Organization of bacteria in biofilms located in anatomic intricacies of the root canal system and the difficulty to eliminate them is the main challenge for irrigants. Sodium hypochlorite remains the primary irrigant of choice, but it needs to be supplemented by a chelator. Delivery of the irrigants using a syringe and needle and activation by an ultrasonic file are the most popular irrigation methods. There is no evidence that any adjunct irrigation method, including ultrasonic activation, can improve the long-term outcome of root canal treatment beyond what can be achieved by instrumentation and syringe irrigation. It is necessary to redefine the research priorities in this field and investigate in greater depth the penetration of the irrigants, their effect on the biofilm and the long-term treatment outcome. New studies must also focus on clinically relevant comparisons, avoid methodological flaws and have sufficiently large sample sizes to reach reliable conclusions. Future multidisciplinary efforts combining the knowledge from basic sciences such as Chemistry, Microbiology and Fluid Dynamics may lead to more effective antimicrobials and improved activation methods to bring them closer to the residual biofilm in the root canal system.
Topics: Dental Pulp Cavity; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Therapeutic Irrigation
PubMed: 35338652
DOI: 10.1111/iej.13739 -
Medicina Oral, Patologia Oral Y Cirugia... May 2012Effective irrigant delivery and agitation are prerequisites for successful endodontic treatment. Ultrasonic irrigation can be performed with or without simultaneous... (Review)
Review
INTRODUCTION
Effective irrigant delivery and agitation are prerequisites for successful endodontic treatment. Ultrasonic irrigation can be performed with or without simultaneous ultrasonic instrumentation. Existing literature reveals that ultrasonic irrigation may have a very positive effect on chemical, biological and physical debridement of the root canal system as investigated in many in vitro studies.
OBJECTIVE
The purpose of this review article was to summarize and discuss the available information concerning ultrasonic irrigation in endodontics.
METHODS
This article presents an overview of ultrasonic irrigation methods and their debridement efficacy. In this paper the relevant literature on passive ultrasonic irrigation is reviewed. Information from original scientific papers or reviews listed in MEDLINE and Cochrane were included in the review.
RESULTS
The use of ultrasound in the irrigation procedure results in improved canal cleanliness, better irrigant transfer to the canal system, soft tissue debridement, and removal of smear layers and bacteria. There are many in vitro studies, but there is a need to standardize protocols, and correlate the clinical efficacy of ultrasonic devices with improved treatment outcomes. Understanding the basis of ultrasonic irrigation is fundamental for clinicians and researchers to improve the design and use of ultrasonic irrigation.
Topics: Humans; Root Canal Therapy; Solutions; Therapeutic Irrigation; Ultrasonics
PubMed: 22143738
DOI: 10.4317/medoral.17621 -
Brazilian Dental Journal 2023Root canal infections are typically polymicrobial and involve strong bacterial interactions. The goal of endodontic treatment is to remove infected content from the root...
Root canal infections are typically polymicrobial and involve strong bacterial interactions. The goal of endodontic treatment is to remove infected content from the root canal system to allow the healing of a pre-existing periapical lesion or to prevent infection of the periradicular tissues. Instrumentation alone is not capable of touching all of the root canal walls. Therefore, the irrigation process is an essential step in the endodontic treatment. However, due to the complex anatomy of the root canal system, this cleaning is very challenging. Although syringe and needle irrigation associated with the use of chemical substances is still the most used method, it does not guarantee optimal cleaning of the root canals. As a result, not only alternative irrigating substances but also numerous activation systems - which are technologies that aim to optimize the action of irrigating substances, both chemically and physically - have been developed. This work aimed to review the characteristics of both classic and current alternatives of irrigating substances and irrigation activation systems.
Topics: Root Canal Irrigants; Endodontics; Root Canal Therapy; Root Canal Preparation; Therapeutic Irrigation; Dental Pulp Cavity; Sodium Hypochlorite
PubMed: 37909632
DOI: 10.1590/0103-6440202305577 -
Injury Jun 2021Bone grafting has over 100 years of successful clinical use. Despite the successes of autograft bone transplantation, complications of bone grafting are significant,... (Review)
Review
Bone grafting has over 100 years of successful clinical use. Despite the successes of autograft bone transplantation, complications of bone grafting are significant, mostly at the donor site. This article reviews the biology of fracture healing, the properties of bone grafts, and reviews the specific advantages and problems associated with autograft bone. Recent techniques such as the Reamer Irrigator Aspirator are described, which has dramatically reduced complications of bone autograft harvesting.
Topics: Autografts; Bone Transplantation; Fracture Healing; Humans; Therapeutic Irrigation; Tissue and Organ Harvesting; Transplantation, Autologous
PubMed: 33563416
DOI: 10.1016/j.injury.2021.01.043 -
BMJ Clinical Evidence Mar 2015Ear wax only becomes a problem if it causes a hearing impairment or other ear-related symptoms. Ear wax is more likely to accumulate and cause a hearing impairment when... (Review)
Review
INTRODUCTION
Ear wax only becomes a problem if it causes a hearing impairment or other ear-related symptoms. Ear wax is more likely to accumulate and cause a hearing impairment when normal extrusion is prevented; for example, by the use of hearing aids, or by the use of cotton buds to clean the ears. Ear wax can visually obscure the ear drum, and may need to be removed for diagnostic purposes.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of methods to remove ear wax? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found nine studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: ear irrigation (syringing); manual removal (other than ear irrigation); wax softeners prior to irrigation; and wax softeners alone.
Topics: Cerumen; Hearing Loss; Humans; Therapeutic Irrigation
PubMed: 25738938
DOI: No ID Found -
Indian Journal of Dental Research :... 2021Overzealous application of endodontic irrigants affects the root canal dentin mechanical properties. The effect of volume of endodontic irrigants on the microhardness of...
INTRODUCTION
Overzealous application of endodontic irrigants affects the root canal dentin mechanical properties. The effect of volume of endodontic irrigants on the microhardness of root canal dentin has not been studied.
AIM
This study assessed the effect of volume of endodontic irrigants used in different final irrigation activation techniques on root canal dentin microhardness (RCDM).
METHODOLOGY
Sixty human maxillary central incisors were embedded in acrylic resin in Kuttler's endodontic cube to the level of cementoenamel junction. The root samples were randomly divided into 4 experimental groups (n = 15): Group-NI-needle irrigation, Group-PUI-continuous passive ultrasonic irrigation, Group-EndoVac-apical negative pressure system, Group combination- EndoVac + PUI irrigation. Root canals were instrumented up to size 40 (F4). The resin mounted specimens were sectioned longitudinally into two halves and were reassembled in Kuttler's kube to carry out final irrigation activation. A predetermined standardized volume of irrigants was used in each group. The RCDM was measured after root canal instrumentation and after final irrigation using Vicker microhardness tester (coronal, middle, and apical third). The reduction in RCDM values (p < 0.0086) were analyzed using Kruskal Wallis and Mann Whitney-U tests.
RESULTS
Reduction in RCDM was observed with all the endodontic irrigating techniques tested. EndoVac and combination irrigation techniques showed maximum reduction in RCDM in all thirds of root canal.
CONCLUSION
It is concluded that the volume of irrigants and agitation plays a role in reducing RCDM. The overall volume of irrigants to cause maximum reduction was 25 ml, beyond which neither volume nor agitation affects RCDM.
Topics: Dental Pulp Cavity; Dentin; Humans; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Therapeutic Irrigation
PubMed: 34810395
DOI: 10.4103/ijdr.IJDR_709_18 -
Critical Care (London, England) Jan 2017Heparin saline (HS) is theoretically superior to normal saline (NS) for maintaining the patency of central venous catheters (CVCs), but the comparative efficacy of them... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Heparin saline (HS) is theoretically superior to normal saline (NS) for maintaining the patency of central venous catheters (CVCs), but the comparative efficacy of them remains controversial. The aim of this systematic review and meta-analysis was to assess the efficacy of NS versus HS in the maintenance of the patency of CVCs in adult patients.
METHODS
We searched PubMed, Embase and the Cochrane library databases. Randomized controlled trials (RCTs) evaluating the use of NS vs. HS to maintain the permeability of CVCs among adult patients were included in our meta-analysis. References of relevant papers were reviewed manually. No language restriction was applied. Non-human studies were excluded. Pooled relative risk (RR) was calculated using a Mantel-Haenszel random-effects model. We also performed subgroup analysis examining the effect of the duration of catheter placement on the outcome. All statistical tests were two-sided using a significance level of 0.05.
RESULTS
Ten RCTs involving 7875 subjects (with analysis at patient, catheter, lumen and line access level) were included in this meta-analysis. Whether in terms of pooled or local analysis (RR with 95% confidence interval spans 1), NS can be equally, if not more effective, in keeping the CVCs open. Of studies reporting secondary outcomes (maneuver needed, heparin-induced thrombocytopenia, haemorrhage, central venous thrombosis and catheter-related bloodstream infection), heparinised saline was shown not to be superior to non-heparinised solution. Subgroup analysis in patients with short vs long term CVC placement was consistent with the main outcome partly and in particular for maintenance of catheter patency in patients with a long-term placement i.e. >30 days, the RR was 0.97 (n = 6589; 95% CI = 0.76 to 1.23; P = 0.796). However, for patients in whom the catheter was in place for <30 days, the RR was 1.52 (n = 1286; 95% CI = 1.02 to 2.27; P = 0.041).
CONCLUSIONS
Based on the results of this meta-analysis, HS is not superior to NS in reducing CVCs occlusion. But in the short term, the use of HS is slightly superior to NS for flushing catheters from a statistical point of view.
Topics: Adult; Catheter Obstruction; Central Venous Catheters; Heparin; Humans; Sodium Chloride; Therapeutic Irrigation; Thrombosis
PubMed: 28063456
DOI: 10.1186/s13054-016-1585-x -
BMC Ophthalmology Feb 2022A simple technique to facilitate removal of subincisional cortex in cataract surgery is presented.
BACKGROUND
A simple technique to facilitate removal of subincisional cortex in cataract surgery is presented.
METHODS
A disposable 27-gauge blunt needle attached to a 5.0-ml syringe containing balanced salt solution (BSS) is introduced through the side port incision into the anterior chamber. The tip of the needle is directed toward the capsule fornix beneath the incision site, and BSS is flushed to disperse the remaining cortex. Thereafter, the coaxial irrigation/aspiration device is used to remove the loosened cortex.
RESULTS
This technique was used in 60 eyes of 60 patients with difficulty of removing cortical remnant in the subincisional space. Subincisional cortical material was successfully removed in 93.3% (56/60 eyes). There were no intraoperative and postoperative complications related to this procedure.
CONCLUSIONS
The hydro-dispersion technique is a simple and safe approach to remove the subincisional cortical material that is difficult to manage with the standard coaxial irrigation/aspiration device.
Topics: Anterior Chamber; Cataract Extraction; Humans; Lens, Crystalline; Phacoemulsification; Postoperative Complications; Therapeutic Irrigation
PubMed: 35177028
DOI: 10.1186/s12886-022-02314-0 -
Circulation. Arrhythmia and... Jun 2020The tissue selectivity of pulsed field ablation (PFA) provides safety advantages over radiofrequency ablation in treating atrial fibrillation. One-shot PFA catheters... (Clinical Trial)
Clinical Trial
BACKGROUND
The tissue selectivity of pulsed field ablation (PFA) provides safety advantages over radiofrequency ablation in treating atrial fibrillation. One-shot PFA catheters have been shown capable of performing pulmonary vein isolation, but not flexible lesion sets such as linear lesions. A novel lattice-tip ablation catheter with a compressible 9-mm nitinol tip is able to deliver either focal radiofrequency ablation or PFA lesions, each in 2 to 5 s.
METHODS
In a 3-center, single-arm, first-in-human trial, the 7.5F lattice catheter was used with a custom mapping system to treat paroxysmal or persistent atrial fibrillation. Toggling between energy sources, point-by-point pulmonary vein encirclement was performed using biphasic PFA posteriorly and either temperature-controlled irrigated radiofrequency ablation or PFA anteriorly (RF/PF or PF/PF, respectively). Linear lesions were created using either PFA or radiofrequency ablation.
RESULTS
The 76-patient cohort included 55 paroxysmal and 21 persistent atrial fibrillation patients undergoing either RF/PF (40 patients) or PF/PF (36 patients) ablation. The pulmonary vein isolation therapy duration time (transpiring from first to last lesion) was 22.6±8.3 min/patient, with a mean of 50.1 RF/PF lesions/patient. Linear lesions included 14 mitral (4 RF/2 RF+PF/8 PF), 34 left atrium roof (12 RF/22 PF), and 44 cavotricuspid isthmus (36 RF/8 PF) lines, with therapy duration times of 5.1±3.5, 1.8±2.3, and 2.4±2.1 min/patient, respectively. All lesion sets were acutely successful, using 4.7±3.5 minutes of fluoroscopy. There were no device-related complications, including no strokes. Postprocedure esophagogastroduodenoscopy revealed minor mucosal thermal injury in 2 of 36 RF/PF and 0 of 24 PF/PF patients. Postprocedure brain magnetic resonance imaging revealed diffusion-weighted imaging+/fluid-attenuated inversion recovery- and diffusion-weighted imaging+/fluid-attenuated inversion recovery+ asymptomatic lesions in 5 and 3 of 51 patients, respectively.
CONCLUSIONS
A novel lattice-tip catheter could safely and rapidly ablate atrial fibrillation using either a combined RF/PF approach (capitalizing on the safety of PFA and the years of experience with radiofrequency energy) or an entirely PF approach. Registration: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT04141007 and NCT04194307.
Topics: Action Potentials; Aged; Atrial Fibrillation; Cardiac Catheterization; Cardiac Catheters; Catheter Ablation; Czech Republic; Electrophysiologic Techniques, Cardiac; Equipment Design; Female; Heart Rate; Humans; Lithuania; Male; Middle Aged; Prospective Studies; Pulmonary Veins; Therapeutic Irrigation; Time Factors; Treatment Outcome
PubMed: 32383391
DOI: 10.1161/CIRCEP.120.008718 -
Asian Journal of Surgery Feb 2022
Topics: Humans; Therapeutic Irrigation
PubMed: 34969571
DOI: 10.1016/j.asjsur.2021.12.019