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Manual Digital Activation ( MDA) is a simple, fast and cost-effective technique to agitate irrigants inside the root canal system. A 2 mm in-and-out movement inside the irrigating solution is used with the master cone grasped 1 mm set back from the working length.
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In this study, it was aimed to evaluate the smear and debris removal efficiency of laser and ultrasonic irrigation activation methods in traditional and conservative endodontic access cavity preparations. 60 freshly extracted human mandibular molar teeth were randomly divided into 2 groups according to the access cavity preparation (n = 30): Tradit...
Background: The success of endodontic therapy is governed by qualitative instrumentation and meticulous cleaning of the root canal system with irrigants. An irrigant is indeed required to reach the optimum ideal requirements without any side effects. The present study was designed to evaluate and compare the efficacy of a commercially available sup...
Background. This study compared the effect of smear layer on the penetration depth and push-out bond strength of various root canal sealers.
Methods. A total of 90 extracted human mandibular premolars were assigned into 2 groups: smear layer preserved and smear layer removed. Then the roots were further divided into 3 subgroups according to the sea...
Statement of the problem:
The smear layer may harbor microorganisms and necrotic pulp tissue, jeopardizing irrigant penetration. Recently, Dual Rinse®, a weak chelating agent, has been introduced to the market. However, its chelating capacity in the final irrigation protocol with different activation systems has not yet been deeply analyzed.
Purp...
Aim: To determine the minimum hand K-file instrumentation size required for the effective penetration of irrigants and elimination of debris and smear layer from the apical third of the root canals. Methodology: Sixty freshly extracted human mandibular premolar teeth were instrumented using the step-back technique. The teeth were divided into four...
Citations
... Manual dynamic agitation was used in the present study following the final rinse of the irrigating solutions inside the root canal for irrigant activation as it is simple, fast and cost effective method for irrigant activation (17). It also allows the fresh mixed solution to reach the apical stagnant solution in the apical few millimeters of the canal (33). ...
... The effectiveness of individual IATs on an irrigant penetration was analyzed further using subgroup analysis. MDA creates higher intracanal pressure changes by using vertical strokes of a GP cone in the canal which leads to the displacement of the apical air bubble that is responsible for the vapour lock effect resulting in better irrigant penetration (41). However, the major drawback of this method was operator-dependent which could not be standardized, and the frequency of irrigant extru-sion was higher, resulting in postoperative pain (42). ...
Objective: This review aims to establish whether various irrigant activation techniques (IATs) result in greater penetration of irrigant up to the working length.
Methods: The MEDLINE, Scopus and Cochrane Library electronic databases were searched to determine the difference in irrigant penetration depth in the main canal following the use of
manual dynamic activation (MDA), sonic irrigation (SI), passive ultrasonic irrigation (PUI), and apical negative pressure irrigation technique (ANP) in comparison with conventional needle irrigation technique (CNI) in mature permanent teeth. Meta-analysis was performed for straight canals as well as curved canals in addition to subgroup analyses for a) Individual IATs in comparison with CNI, b) Comparison of PUI v ANP and SI v ANP in the straight canals, c) comparison of different IATs performed in straight and curved canals. The outcome was presented as effect size: standardized mean difference (SMD) and percentage difference (% diff) of irrigant penetration up to the working length (WL) alongside 95% confidence intervals using chi-square analysis.
Results: Of the 840 records screened, 20 studies were included in the systematic review and 17 studies were included in the meta-analysis. It revealed IATs had significant improvement in irrigant delivery up to the WL in straight (% diff: 51.94%, 95% CI: 39.20–64.67%) and curved canals (SMD: 1.08, 95% CI: 0.64–1.52) over CNI. The subgroup analysis revealed ANP was the most effective and significant technique followed by PUI, SI and MDA techniques in straight canals (% diff: 91.70%, 95% CI: 75.63–107.77%) and curved canals (SMD: 1.45, 95% CI: 0.77–2.13).
Conclusion: IATs improve irrigant penetration when compared to CNI technique. In both straight and curved canals, ANP is the most effective in delivering the irrigant up to the WL followed by PUI, SI and MDA techniques. Hence adaptation of recent IATs in routine endodontic practice is recommended.
... MDA involves the activation of NaOCl hydrodynamically by the repeated movements of master GP cone using short vertical strokes, creating high intracanal pressure. This change in pressure aids in the displacement of the apical vapour lock, resulting in maximum irrigant penetration (Machtou, 2018). The major drawback of MDA is that it is operator-dependent and cannot be standardized. ...
Objective
This review aimed to systematically review the effectiveness of various irrigant activation techniques (IATs) on the penetration of sodium hypochlorite (NaOCl) into the lateral canals of mature permanent teeth.
Methods
Electronic databases including MEDLINE (via PubMed), Scopus, ProQuest, and Cochrane Library were searched to identify laboratory studies evaluating the penetration of NaOCl into lateral canals following the use of apical negative pressure irrigation (ANP), passive ultrasonic irrigation (PUI), sonic irrigation (SI), and/or manual dynamic activation (MDA) techniques. Meta-analysis was performed for individual IATs in comparison with CNI into the lateral canals of both straight and curved root canals. On the basis of the previous literature and parameters, the risk of bias of the selected studies was evaluated with the help of a customized tool.
Results
Of the 983 records screened, 12 studies were selected to include in the systematic review, and 10 studies were selected for the meta-analysis. The total quality assessment across the included studies indicated a high quality (83.3%). Overall, the meta-analysis demonstrated IATs had significant improvement in the penetration of NaOCl into the lateral canals of straight canals (34.3%) over CNI. The subgroup analysis of individual IATs demonstrated PUI (60.9%) to be superior in the penetration into lateral canals of straight canals.
Conclusions
IATs improved the irrigant penetration into lateral canals and therefore their use during routine endodontic practice is recommended. In straight canals, PUI is the most effective IAT followed by ANP, SI, and MDA techniques.
... Only delivering irrigation solution with needle conventionally is not sufficient to clean untouched root canal areas [3][4][5][6]. There are many different activation devices and methods recommended to increase the debris and smear layer removal efficiency of the irrigation solutions [7][8][9][10][11]. Among these, the most investigated are sonic, ultrasonic and laser systems [4,5,[11][12][13]. ...
... Manual dynamic activation (MDA) is a simple, fast, and cost-effective technique applied to increase the efficiency of irrigation solutions in the root canal system by agitation. To apply this technique, gutta-percha cone is placed in the root canal 1 mm behind the working length and moved in and out of a 2-mm area inside the irrigation solution [9]. Although this technique's antimicrobial activity, ability to penetrate root canals and effects on the removal of the smear layer have been found to be adequate [6,8,12,17], it has also been reported that it may increase postoperative pain [7]. ...
To investigate the efficacy of a new laser irrigation activation system [shock wave-enhanced emission photo-acoustic streaming (SWEEPS)] in terms of postoperative pain after primary root canal treatment compared with other techniques, namely photon-induced photo-acoustic streaming (PIPS), sonic system with EDDY, passive ultrasonic system (PUI), and manual dynamic activation (MDA). Two hundred patients with symptomatic irreversible pulpitis in mandibular premolar teeth were enrolled and randomly allocated to five different irrigation activation groups (n = 40) after chemo-mechanical root canal preparation. For irrigation activation, the SWEEPS and PIPS tips were attached to the Er-YAG laser system in the respective groups, while the Irrisafe tip was used in the PUI group and the EDDY tip in the sonic group. In the MDA group, irrigation was agitated with the master gutta-percha cone. At postoperative hours 8, 24, and 48 and on day 7, pain intensity was evaluated using the 10-mm Visual Analog Scale (VAS) and analgesic intake was recorded. The Kruskal-Wallis test was used to analyze the VAS scores, and pain prevalence and analgesic intake were examined with the Pearson's chi-square test at the 5% significance level. The PIPS and SWEEPS groups had the lowest level and prevalence of pain when compared to the remaining groups (P < 0.001). The PUI, sonic and MDA groups did not differ in terms of pain scores at hours 8 and 48 (P > 0.05). On day 7, the highest score and pain prevalence were recorded in the MDA group (P < 0.001). There was no difference between the groups in terms of analgesic intake (P > 0.05). Laser-activated irrigation systems provided lower postoperative pain scores and levels compared to the other activation systems. The MDA group had the highest pain scores and incidence at the end of the seventh day.
... 31 It creates an increased intracanal pressure change within the canal during the forward and backward movement of the gutta-percha cone within the canal which creates turbulences that enhance the diffusion of shear stresses. 32 A previous study showed the risk of apical extrusion during MDA, 33 and this can be strongly avoided by the agitation of the gutta-percha cone 1 mm short of the WL. 32 In the current study, MDA achieved better penetration of the irrigant compared with 26-gauge CN and 30-gauge SVN. ...
... 32 A previous study showed the risk of apical extrusion during MDA, 33 and this can be strongly avoided by the agitation of the gutta-percha cone 1 mm short of the WL. 32 In the current study, MDA achieved better penetration of the irrigant compared with 26-gauge CN and 30-gauge SVN. ...
Objective The objective of this study was to evaluate the irrigant penetration using iohexol dye with four irrigation techniques.
Methodology Single-rooted premolars were recently extracted and preserved in physiological saline solution. All the samples were standardized to 16 mm. Standard endodontic access was prepared using endoaccess bur (Dentsply Maillefer, Switzerland). The initial patency was established using #10 k file (Mani, Utsunomiya, Tochigi, Japan) to the working length. The cleaning and shaping were performed using the file system ProFit S3 in the following sequence: P0 (orifice enlarger), PF1 (yellow), PF2 (red) #25, and PF3 (blue) #30. The samples were randomly allocated in concealed opaque envelopes into four groups. This was performed by a trained dentist. Fifteen samples were allocated to one group. The groups were divided as follows: Group A—conventional needle (CN), Group B—side-vented needle (SVN), Group C—manual dynamic agitation (MDA), and Group D—EndoActivator (EA). The radiopaque dye irrigant agitation/activation was performed by one operator to prevent operator bias. Following irrigation using the different techniques, digital radiographs were taken, and the measurement was taken from the apical foramen to the point where the dye had penetrated apically for each tooth and the data were entered into an Excel sheet for all the four groups.
Results Comparing the four groups, there was a statistically significant difference among the four groups (p < 0.05), thus, favoring the alternate hypothesis. EA had resulted in better penetration of the irrigant compared with the other three groups (p < 0.05).
Conclusion It was evident that irrigant penetration was best achieved with the use of an EA followed by MDA, SVNs, and then the CN when the preparation was done till size 30 (PF3 #30) using ProFit S3 rotary file system.
... technique uses the master cone in an instrumented, irrigant filled canal. The master cone is placed 1mm short of working length and activated in up and down motion with 2mm amplitude and frequency of 100 strokes per minute [54]. This technique was very effective in avoiding the vapour lock effect caused by sodium hypochlorite [55]. ...
Introduction: Pain management during endodontic therapy has been a major concern among the dentists since many years. Patients often associate endodontic treatment with pain. The incidence of post-operative pain following root canal treatment is in the range of 3-58% [1, 2]. This review of literature analyzes the various irrigant activation techniques and their effectiveness in pain management. Materials and Methods: A search was performed in electronic database (i.e. PUBMED CENTRAL, Google and Hand Search) using following search terms alone and in combination by means of PUBMED search builder till March 2021. The various irrigant activation techniques were reviewed and all randomized clinical trials evaluating post operative pain following endodontic irrigation were analyzed. Results: Randomised clinical trials using irrigation activation techniques resulted in lesser post operative pain then conventional needle irrigation. Though manual dynamic agitation was capable of removing the vapor lock effect, it still had the tendency to push the irrigant beyond apex resulting in increased postoperative pain compared to other irrigation techniques. Conclusion: All the clinical studies concluded that irrigant activation with sonic, ultrasonic, laser activated irrigation and manual dynamic agitation produced lesser post operative pain. EndoVac which is a negative pressure irrigation system also proves to be better than conventional needle irrigation in terms of post operative pain.
... Manual dynamic agitation was used after irrigating the canal with the tested solutions to increase the efficacy of the irrigants inside the root canal with a simple and costeffective technique (7). The penetration of NaOCl (2.5%) labeled with Alizarin red dye was utilized as an indicator for evaluating the ability of the various irrigating solutions to remove the smear layer through tracing the dye through the dentinal tubules under CLSM. ...
Introduction:
The efficacy of sodium hypochlorite (NaOCl) as an intracanal irrigant is widely debated in endodontic therapy. This study aimed to analyze and compare the penetration abilities of different modes of NaOCl application and assess the impact of various agitation strategies on promoting root canal cleanliness.
Materials and methods:
This study included 168 single-rooted mandibular premolars that were randomly divided into eight groups. The two modes of application of 5% NaOCl evaluated were intracanal heating and preheating, and the agitation strategies included ultrasonic, sonic, and manual dynamic agitations (MDAs). The samples were sectioned and observed at a magnification of 1000× under a scanning electron microscope.
Results:
The analysis of variance test showed a statistically significant difference among the various groups of agitation (P < 0.05). The post hoc Tukey test confirmed that preheated NaOCl with ultrasonic agitation, intracanal-heated NaOCl with sonic agitation, and MDA had significantly higher debris scores of 1, 4, and 5, respectively, in the apical third of the canal.
Conclusion:
The results indicated that the combination of intracanal-heated NaOCl and ultrasonic agitation is an effective method for reducing debris in the root canal system. These findings highlight the importance of considering both the mode of application and the agitation strategies when optimizing the use of NaOCl as an intracanal irrigant in endodontic therapy.
Introduction: The aim of this study was to to evaluate and compare the efficacy of manual dynamic activation, passive ultrasonic irrigation and laser in removal of triple antibiotic paste (TAP) from root canal walls. Methods: Thirty-six extracted human mandibular premolars were prepared using ProTaper rotary files up to size F3. The roots were divided longitudinally and a standardized groove was prepared in the apical part of one segment. The root halves were assembled after inserting TAP into the grooves. According to the irrigation protocol used, the specimens were randomly divided into three experimental groups: manual dynamic activation, passive ultrasonic irrigation (PUI) and laser activated irrigation using with 5.25% NaOCl and 17% EDTA. The root segments were separated, and a four-grade grading system was used to determine the remaining TAP under a stereomicroscope at 10x magnification. The data were evaluated statistically using Student t test and ANOVA test with a 95% confidence level (P = 0.05). Results: There were significant differences amongst the groups (P < 0.001). Passive ultrasonic irrigation (PUI) and laser assisted irrigation removed significantly more TAP than manual dynamic activation. However, no significant difference was seen among the passive ultrasonic irrigation and laser assisted irrigation. Conclusions:PUI was most successful at removing TAP from root canal artificial grooves. However, TAP could not be totally eliminated from root canals.
This article provides a contemporary synopsis of effective cleaning of the root canal system, an essential stage of root canal treatment. It provides a clinical update on the current state of knowledge on cleaning of the root canal system, and presents an outline of essential theory and practical tips for achieving effective and safe cleaning of the root canal system.
