Effect Group Time
Point Group
Time
Point Estimate
Standard
Error Adj P
Group Control EndoVacTM -0.1191 0.2645 0.6561
Group Control PiezoFlowTM -0.9134 0.2645 0.0018
Group EndoVacTM PiezoFlowTM -0.7943 0.2645 0.0057
Time Point S1 S2 1.6002 0.2802 <0.0001
Time Point S1 S3 1.5023 0.3699 0.0004
Appendix II Figures
Figure 4. ProUltra PiezoFlowTM Ultrasonic Irrigation Needle with syringe and ultrasonic attachment
Figure 6. Mean bacteria count log 10 CFU by group at each time point 0 1 2 3 4 5 6 S1 S2 S3 Control EndoVac PiezoFlow
References Cited
1) Schilder, H. Cleaning and shaping the root canal. Dental Clinics of North America. 1974; 18: 269-296.
2) Kakehashi, S, Stanley, H, Fitzgerald, R. The effect of surgical exposures of dental pulps in germ-free and conventional laboratory rats. Oral Surgery Oral Medicine Oral Pathology. 1965; 25: 340-349.
3) Moller, AJR, Fabricius, L, Dahlen, G, Ohman, AE, Heyden, G. Influence on periapical tissues of indigenous oral bacteria and necrotic pulp tissue in monkeys. Scandinavian Journal of Dental Research. 1981; 89:475-484.
4) Miller, WD. The microorganisms of the human mouth. Philadelphia 1890, S.S. White Dental Co., 96.
5) Sjogren, U, Figdor, D, Persson, S, Sundqvist, G. Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis. International Endodontic Journal. 1997; 30(5): 297-306.
6) West, JD. Cleaning and shaping the root canal system. In Cohen, S, Bruns, RC (eds). Pathways of the Pulp. 7th ed. St. Louis: CV Mosby Company, 1998; 203-257.
7) Bystrom, A and Sundqvist, G. Bacteriologic evaluation of the efficacy of mechanical root canal instrumentation in endodontic therapy. Scandinavian Journal of Dental Research. 1981; 89(4): 321-328.
8) Bystrom, A and Sundqvist, G. Bacteriologic evaluation of the effect of 0.5 percent sodium hypochlorite in endodontic therapy. Oral surgery, Oral Medicine, and Oral Pathology. 1983; 55(3): 307-312.
9) Vertucci, FJ. Root canal anatomy of the human permanent teeth. Oral Surgery. 1984; 58: 589-599.
10)Pineda, F and Kuttler, Y. Mesiodistal and buccolingual roentgenographic investigation of 7,275 root canals. Oral Surgery. 1972; 33:101-110.
11)Solwey, RR. Root canal anatomy. Dental Clinics of North America. 1979; 23: 555- 573.
12)Abou-Rass, M and Piccinino, M. The effectiveness of four clinical irrigation methods on the removal of root canal debris. Oral Surgery, Oral Medicine, and Oral Pathology. 1982; 54(3): 323-328.
13)Sedgley CM, Nagel AC, Hall D, Applegate B. Influence of irrigant needle depth in removing bioluminescent bacteria inoculated into instrumented root canals using real- time imaging in vitro. International Endodontic Journal. 2005;38(2): 97–104.
14)Chow, TW. Mechanical effectiveness of root canal irrigation. Journal of Endodontics. 1983; 9: 475-479.
15)Huelsmann, M, and Hahn, W. Complications during root canal irrigation-literature review and case reports. International Endodontic Journal. 2000; 33: 186-193. 16)Cymbler, DM, Ardakani, P. Sodium hypochlorite injection into periapical tissues.
Dental Update. 1994; 21(8): 345-346.
17)Harrison, G, Svec, TA, Baumgartner, JC. Analysis of clinical toxicity of endodontic irrigants. Journal of Endodontics. 1978; 4(1): 6-11.
18)Sabala, CL, Powell, SE. Sodium hypochlorite injection into periapical tissues. Journal of Endodontics. 1989; 15(10): 490-492.
19)Baker, NA, Eleazer, PD, Averbach, RE, Selzer, S. Scanning electron microscopic study of the efficacy of various irrigation solutions. Journal of Endodontics. 1975; 1: 127-135.
20)Albrecht, LJ, Baumgartner, JC, Marshall, JG. Evaluation of apical debris removal using various sizes and tapers of ProFile GT files. Journal of Endodontics. 2004; 30(6): 425-428.
21)Falk, KW, Sedgley, CM. The influence of preparation size on the mechanical efficacy of root canal irrigation in vitro. Journal of Endodontics. 2005; 31(10): 742-745. 22)Boutsioukis, C, Gogos, C, Verhaagen, B, Versluis, M, Kastrinakis, E, Van der Sluis,
LW. The effect of apical preparation size on irrigant flow in root canals evaluated using an unsteady computational fluid dynamics model. International Endodontic Journal. 2010; 43(10): 874-881.
23)Ram, Z. Effectiveness of root canal irrigation. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology. 1977; 44(2): 306-312.
24)Van der Sluis, LWM, Wu MK, Wesselink, PR. The efficacy of ultrasonic irrigation to remove artificial placed dentin debris from human root canals prepared using
instruments of varying taper. International Endodontic Journal. 2005; 38: 764-768. 25)Zandbiglari, T, Davids, H, Schafer, E. Influence of instrument taper on the resistance
to fracture of endodontically treated roots. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2006; 101(1): 126-131.
26)McGurkin-Smith, R, Trope, M, Caplan, D, Sigurdsson, A. Reduction of intracanal bacteria using GT rotary instrumentation, 5.25% NaOCl, EDTA, and Ca(OH)2. Journal of Endodontics. 2005; 21(5): 359-363.
27)Card, SJ, Sigurdsson, A, Orstavik, D, Trope, M. The effectiveness of increased apical enlargement in reducing intracanal bacteria. Journal of Endodontics. 2002; 28(11): 779-783.
28)Bystrom, A and Sundqvist, G. The antibacterial action of sodium hypochlorite and EDTA in 60 cases of endodontic therapy. International Endodontic Journal. 1985; 18(1): 35-40.
29)Baumgartner, JC and Cuenin, PR. Efficacy of several concentrations of sodium hypochlorite for root canal irrigation. Journal of Endodontics. 1992; 18: 605-612. 30)Pashley, EL, Birdsong, NL, Bowman, K, Pashley, DH. Cytotoxic effects of sodium
hypochlorite on vital tissue. Journal of Endodontics. 1985; 11(12): 525-528. 31)Cunningham, WT, and Balekjian, AY. Effect of temperature on collagen-dissolving
ability of sodium hypochlorite endodontic irrigant. Oral Surgery Oral Medicine Oral Pathology. 1980; 49: 175-177.
32)Cunningham, WT, and Joseph, SW. Effect of temperature on the bactericidal action of sodium hypochlorite endodontic irrigant. Oral Surgery Oral Medicine Oral Pathology. 1980; 50: 569-571.
33)Chow, TW. Mechanical effectiveness of root canal irrigation. Journal of Endodontics. 1983; 9: 475-479.
34)Fukumoto, Y, Kikuchi, I, Yoshioka, T, Kobayashi,C, Suda, H. An ex vivo evaluation of a new root canal irrigation technique with intracanal aspiration. International Endodontic Journal. 2006; 39(2): 93-99.
35)Nielsen, BA and Baumgartner, C. Comparison of the EndoVac system to needle irrigation of root canals. Journal of Endodontics. 2007; 33(5): 611-615.
36)Siu, C and Baumgartner, C. Coomparison of the debridement efficacy of the EndoVac irrigation system and conventional needle root canal irrigation in vivo. Journal of Endodontics. 2010; 36(11): 1782-1785.
37)Mitchell, RP, Sung-Eun, Y, Baumgartner, C. Comparison of apical extrusion of NaOCl using the EndoVac or needle irrigation of root canals. Journal of Endodontics. 2010; 36(2): 338-341.
38)Carver, K, Nusstein, J, Reader, A, Beck, M. In vivo antibacterial efficacy of ultrasound after hand and rotary instrumentation in human mandibular molars. Journal of
Endodontics. 2007; 33(9): 1038-1043.
39)Burleson, A, Nusstein, J, Reader, A, Beck, M. The in vivo evaluation of hand/rotary/ ultrasound instrumentation in necrotic, human mandibular molars. Journal of
Endodontics. 2007; 33(7): 782-787.
40)Pafford, J, Nusstein, J, Reader, A, Beck, M, Drum, M. In vivo evaluation of
intraoperative and postoperative pain of a hand/rotary/ultrasound technique in the root canals of vital and necrotic teeth. Jounal of Endodontics. 2008; 34(3): 350.
41)Gutarts, R, Nusstein, J, Reader, A, Beck, M. In vivo debridement efficacy of ultrasonic irrigation following hand-rotary instrumentation in human mandibular molars. Journal of Endodontics. 2005; 31(3): 166-170.
42)Shuping, GB, Orstavik, D, Sigurdsson, A, Trope, M. Reduction of intracanal bacteria using nickel-titanium rotary instrumentation and various medications. Journal of Endodontics. 2000; 26(12): 751-755.
43)Pocock, SJ. Interim Analysis for randomized clinical trials: the group sequential approach. Biometrics. 1982; 38(1): 153-162.
44)O’Connell, MS, Morgan, LA, Beeler, WJ, Baumgartner, JC. A comparative study of smear layer removal using different salts of EDTA. Journal of Endodontics. 2000; 26(12): 739-743.
45)Orstavik, D, Kerekes, K, Molven, O. Effects of extensive apical reaming and calcium hydroxide dressing on bacterial infection during treatment of apical periodontitis: a pilot study. International Endodontic Journal. 1991; 24(1): 1-7.
46)Sjogren, U, Figdor, D, Spangberg, L, Sundqvist, G. The antimicrobial effect of calcium hydroxide as a short-term intracanal dressing. International Endodontic Journal. 1991; 24(3): 119-125.
47)Sathorn, C, Parashos, P, Messer, H. Antibacterial efficacy of calcium hydroxide intracanal dressing: a systematic review and meta-analysis. International Endodontic Journal. 2007; 40(1): 2-10.
48)Peters, LB and Wesselink, PR. Periapical healing of endodontically treated teeth in one and two visits obturated in the presence or absence of detectable microorganisms. International Endodontic Journal. 2002; 35(8): 660-667.
49)Waltimo, T, Trope, M, Haapasalo, M, Orstavik, D. Clinical efficacy of treatment procedures in endodontic infection control and one year follow-up of periapical healing. Journal of Endodontics. 2005; 31(12): 863-866.
50)Hockett, JL, Dommisch, JK, Johnson, JD, Cohenca, N. Antimicrobial efficacy of two irrigationtechniques in tapered and nontapered canal preparations: an in vitro study. Journal of Endodontics. 2008; 34(11): 1374-1377.