Ex Vivo Evaluation of Four Final Irrigation Protocols on the Removal of Hard-tissue Debris from the Mesial Root Canal System of Mandibular First Molars

G.B. Leoni, M.A. Versiani, Y.T. Silva-Sousa, J.F. Bruniera, J.D. Pecora, M.D. Sousa-Neto

International Endodontic Journal. 2017 Apr;50(4):398-406


AIM: To evaluate the efficacy of four final irrigation protocols on the reduction of hard-tissue debris accumulated within the mesial root canal system of mandibular first molars using micro-CT analysis.

METHODOLOGY: Forty mesial roots of mandibular molars with a single and continuous isthmus connecting the mesiobuccal and mesiolingual canals (Vertucci's Type I configuration) were selected and scanned at a resolution of 8.6 μm. Canals were enlarged sequentially using WaveOne Small and Primary instruments activated in reciprocating motion without intracanal irrigation to allow debris to accumulate within the mesial root canal system. Then, specimens were anatomically matched and distributed into 4 groups (n=10), according to the final irrigation protocol: apical positive pressure (APP), passive ultrasonic irrigation (PUI), Self-adjusting File (SAF), and XP-endo Finisher (XPF). The final irrigation procedures were performed over 2 minutes using a total of 5.5 mL of 2.5% NaOCl per canal. Reconstructed datasets were co-registered and the mean percentage reduction of accumulated hard-tissue debris after the final irrigation procedures were compared statistically between groups using the ANOVA post hoc Tukey test with a significance level set at 5%.

RESULTS: Reduction of accumulated hard-tissue debris was observed in all groups after the final irrigation protocol. Overall, PUI and XPF groups had higher mean percentage reductions of accumulated hard-tissue debris (94.1% and 89.7%, respectively) than APP and SAF groups (45.7% and 41.3%, respectively) (p < 0.05). No significant differences were found when comparing the results of PUI and XPF groups (p > 0.05) or APP and SAF groups (p > 0.05).

CONCLUSION: The PUI technique and XP-endo Finisher instruments were associated with significantly lower levels of AHTD compared with conventional irrigation and modified SAF system protocol in the mesial root canals of mandibular molars. This article is protected by copyright. All rights reserved.


The full article is available online: ResearchGate

Leoni iej 2017


Additional Info

  • ReDent Nova’s note:

    Drawing any conclusion from this article about the SAF System would be very far fetched, as the protocol used here is not only far away from the one required for the SAF, but also irrelevant for clinical use for the other instruments that were examined.

    The researchers blocked the apical foramen, made an excessive glidepath preparation (Reciproc #25/.08) while avoiding the use of any irrigation, then dried the canals, and in the group of the Self-Adjusting File used the SAF for only 1 minute instead of 4 minutes. The only conclusion that can be reached is that the SAF System should not be used according to this malformed protocol.

  • publisher: publisher
  • View abstract on PubMed. PMID: 26992452