Influence of Various Application Systems on the Amount of Extruded Irrigant in Simulated Immature Teeth With Regard to Gravity: An ex-vivo Study

Abstract

Background: Gravity impact has been mainly evaluated in mature teeth related to debris extrusion, even though it may affect the amount of apically  extruded irrigant. In the literature the influence of gravity on the amount of apically extruded irrigant in immature teeth has been studied by a 45^o  inclined plate to mimic the position of the maxillary teeth and 90^o for the mandibular teeth. However, patients are positioned horizontally in the dental  chair while treatment. There is no study in the literature testing the horizontal position to mimic the clinical settings realistically.

Aim: The aim of this study was to evaluate the influence of various irrigation systems on the amount of extruded irrigant in simulated immature maxillary  and mandibular teeth irrigated in vertical and horizontal positions.

Materials and Methods: Twenty‑five maxillary central incisors with an apical opening of 1.3 mm in diameter were included. Irrigation procedures were performed with EndoVac, closed-ended, and open-ended needles using a VATEA peristaltic pump. The amount of apically extruded irrigant was  determined using a microbalance. Statistical analysis was performed using the Kruskal–Wallis test.

Results: The EndoVac system caused almost no irrigant extrusion in all tested positions (P > 0.05); however, closed-ended and open-ended needles  extruded more irrigant in a mandibular vertical position compared to maxillary vertical (P < 0.05) and maxillary horizontal positions (P < 0.05). Open- ended needles extruded the highest amount of irrigant. 

Conclusion: The EndoVac macrocannula is a more reliable and safer irrigation system as it  prevents irrigant extrusion independent of the position of the tooth.