Conventional to EndoVac: A

Comparative Evaluation of Two

Irrigation Systems in Microbial
Reduction of Primary Root
Canals Using Chemical Irrigants: An
In Vivo Study Int J Clin Pediatr Dent
2023;16(S-2):S113–S117

Dr Isha Mehta (MDS 2nd year)

 Madina Ahmadi

Authors
Somya Govil
Keywords
 Antibacterial efficacy
 Chlorhexidine
 EndoVac
 Sodium hypochlorite.
 Microorganisms cause the Pulpal and periapical
infections. Endodontic therapy has been advocated
as an effective way to eliminate microorganisms
from the root canal. This is achieved by optimally
cleaning, shaping, and obturating the root canals
hermetically, which is the principal purpose of
Introduction endodontic therapy.

But due complexity of the root canal system,

microbial penetration into the dentinal tubules and
the production of a smear layer during mechanical
instrumentation of the root canals make full cleaning
and shaping of the canals practically difficult.

The use of an irrigant becomes necessary to clean the

root canal system thoroughly.
 The randomly chosen
in vivo study investigated
patients were from the
80 deciduous posterior
outpatient section of the
teeth. The study
Department of
population included
Materials and
Pedodontics &
systemically healthy
Preventive Dentistry,
children between the
Babu Banarasi Das
ages of 3 and 9 requiring
College of Dental
endodontic treatment.
Sciences.
Methods

Before the inclusion of

It was approved by the each child in the study,
institutional ethics and the purpose of the study
research committee. was explained to their
parents.
 Healthy children with no systemic conditions
were considered.
Inclusion Criteria

The primary teeth should be asymptomatic

with necrotic pulp tissue

The roots should be intact, or less than two-

thirds of physiological root resorption should
be considered.
 Resorbing and mobile teeth with excessive root
resorption.
Exclusion Criteria Any patient with developmental anomalies, periodontal

Problems or traumatic injuries require pulp therapy.

Children with special healthcare needs.

Children who have received antibiotics within the last 3

months before treatment.
Teeth with periodontal pockets.

Teeth that need the operative intervention of the root

canals.
 Complete oral prophylaxis
Endodontic Access
Polishing with pumice was done

The tooth was isolated using a rubber dam after being injected with lignocaine
containing 1:80000 adrenaline.
Preparation of

A high-speed air turbine with a round diamond point was used to initiate the root
canal access opening, followed using a low-speed engine to gain the final access.

An inverted cone diamond point was used to modify the cavity walls.
Cavity

The root canal was accessed with a size 10 K-file and the working length was
determined.

The contents were debrided from the canal walls using circumferential filing
 Preoperative sterile paper point
samples (S1) were placed in the
canal for at least 60 seconds at the
same level to soak up the fluid in the
canal. The saturated paper points
Collection
were deposited into 10 mL of
thioglycolate broth and
immediately transferred to the
Sample

microbiology lab for microbial

culture. The working length was
estimated.
 In all the cases, chemomechanical
preparation was completed at the same
appointment. Hand nickel-titanium K-
files (Mani, Inc.,Tochigi, Japan) were used
for canal preparation to the working
Collection
length in a back-and-forth alternating
rotation motion using a circumferential
technique up to ISO#25 size file. The 20
Sample

teeth designated for each group were

irrigated with one of the following
irrigant and irrigation systems.
 1 2 3 4
GROUP I: AROUND GROUP II: AROUND GROUP III: AROUND GROUP IV: AROUND
2.5% NAOCL 2.5% NAOCL 2% CHX IRRIGANT 2% CHX IRRIGANT
IRRIGANT USING A IRRIGANT USING USING A USING ENDOVAC
CONVENTIONAL ENDOVAC SYSTEM. CONVENTIONAL SYSTEM.
NEEDLE. NEEDLE.
After irrigation, the postoperative paper point
samples (S2) were placed for 60 seconds and
immediately transferred to the microbiology lab
for microbial culture.
 Preoperative (S1) and Vortexed for one minute
Placed in 10 mL of
postoperative (S2) paper in an Eltek VM 301 vortex
thioglycolate broth
point samples mixer
Microbiological

The samples were Serial dilution: 10 mL

transferred from the test These test tubes were broth transferred to the
Processing

tube to the blood agar autoclaved at 121°C/15 first test tube and 9 mL
media using PSI for 15 minutes. in the rest of the 9 test
micropipettes. tubes.

The sample test tubes

were cultured at 30°C in
an incubator for 24–48
hours
 Colony Forming Units (CFU) was estimated in the sample test tubes
using a microbial colony counter
Microbiological
Processing

The following formula was used to record the observations:

CFU/mL = (number of colonies × dilution factor)/volume of culture plate

Statistical analysis was further performed.


Statistics were tabulated in a
Microsoft Excel sheet under the
guidance of a statistician.
Statistical
Analysis
A p-value of <0.05 was
considered significant.
Statistical analysis was
conducted using means and
standard deviations for each
group (Statistical Package for the
Social Sciences (SPSS) 22.00 for
Windows; SPSS Inc, Chicago,
United States of America).
The data were analyzed
statistically using a one-way
analysis of variance for each
assessment point. Student t-
tests were used to determine the
difference between the two
groups.
RESULT
Preoperative and postoperative mean Colony
Forming Units (CFU)
  The study found that EndoVac irrigation yielded
superior results in 2.5% NaOCl and 2% CHX compared
to traditional irrigation methods using a needle
technique.
Discussion

 Revealed that EndoVac reduced irrigant spills,

reducing suction needs and enhancing visibility and
ease of use in the working field.
 Compared 2.5% NaOCl with EndoVac and 2% CHX
with EndoVac, 2% CHX had superior antimicrobial
efficacy, but no significant difference was observed.
Sodium hypochlorite Chlorhexidine (CHX)
(NaOCl)
• Broad-spectrum antimicrobial action
 Gold standard
• Substantivity: attaches to human
 Most preferred tissues, sustained antimicrobial
 Wide clinical range from 0.5% to action
5.25% • Chemical plaque control- aqueous
 Primary root canal treatment, 2.5% solution of 0.1–0.2%
NaOCl -- total removal of viable
bacteria in the root canal system. • Root canal irrigation- 2% CHX

CHX showed superior antibacterial activity compared to NaOCl in this in vivo investigation, with
a mean CFU count of 1.16 for traditional systems and 0.93 for EndoVac systems.
 The present study demonstrates that the EndoVac system performs
significantly better than the conventional needle when it comes to
eliminating bacteria.

Although there was a statistically significant benefit of the EndoVac

system over the conventional system, they both have greatly reduced
Conclusions

the number of bacteria in the root canal system of primary teeth with
hopeful results.

The study is one of a kind, where they have conducted the first in vivo
study examining the antimicrobial efficacy of both the EndoVac system
and conventional needle irrigation system in primary teeth.

Using the EndoVac system to treat root canals in primary teeth requires
more research, both in vitro and in vivo.
  Oral prophylaxis and polishing was done.
 Use of rubber dam.
 Visual Representation- Figures 1, 2, 3, and 4 visually
enhance the comprehension of the results, offering
clear insights into the bacterial load comparisons
among systems and irrigants.
 Significant Reduction in Bacterial Load with EndoVac
 Improved Postoperative Efficacy with Various
Merits

Irrigants.
 Comparable Efficacy between CHX and NaOCI in
Both Systems
  Demerit 1: Short-Term Observations:
 The study primarily focuses on short-term
observations, providing insights into immediate
postoperative outcomes. However, a more
comprehensive understanding of the long-term
effects and success rates of both systems would
require extended follow-up periods.
 Demerit 2: Lack of Clinical Outcome Measures:
Demerits

 While the study assesses bacterial load reduction, it

does not delve into broader clinical outcomes such as
patient-reported pain, postoperative complications,
or the overall success of pulpectomy procedures.
Incorporating these measures would provide a more
holistic understanding of the systems' impact.
  Demerit 3: Potential Bias in Irrigant Selection could
impact the generalizability of the findings, and a more
standardized approach to irrigant selection would
strengthen the study's reliability.
 Demerit 4: Lack of Blinding:
The absence of blinding in the study design may introduce
Demerits

bias, as both the practitioners and patients are aware of

the system used. Blinding could minimize potential
sources of bias and enhance the study's internal validity
Demerit 5- Incomplete Data Reporting
.
  Demerit 6-no mention of consent taken by the parents
 Demerit 7- no caries risk assessment was done
 Demerit 8- Cost and commercial availability.
 Demerit 9- Absence of clinical pictures .
Demerits