Multisonic Ultracleaning and Laser-Activated Irrigation Effect Compared to Passive Ultrasonic Activation for Debridement in Minimally Invasive Instrumentation of Necrotic Oval Root Canals: An Ex Vivo Histological Analysis
Gündoğar M. Özdemir O. Gündoğar Ö. Bektaş S. Demir F.N. Bolat N.
April 2025Multidisciplinary Digital Publishing Institute (MDPI)
Journal of Clinical Medicine
2025#14Issue 8
Objectives: This study aims to evaluate the effectiveness of current conventional and advanced irrigation techniques after minimally invasive instrumentation in necrotic oval root canals by histological analysis. Methods: Seventy extracted necrotic lower premolars with single oval canals classified utilizing bidirectional radiographs (mesiodistal diameter 2.5 times larger than buccolingual) were prepared up to 20.04 v. The samples were assigned to five experimental groups (n = 14) using the complementary irrigation technique: needle (control), passive ultrasonic, and shockwave-enhanced emission photo-acoustic streaming activation using Er:YAG laser (SWEEPS), Er,Cr:YSGG laser (Waterlase iPlus), and multisonic ultracleaning technology (GentleWave). After irrigation protocols, the roots were demineralized and the apical 5 mm was multi-sliced and processed for histologic examination. The residual necrotic tissue and debris percentage was calculated via image analysis software. One-way ANOVA and Tukey’s test were used to verify the variables influencing debridement (p < 0.05). Results: The mean value of the GentleWave group was the record low at 1.54 ± 1.46, and the utmost was needle irrigation with 15.64 ± 7.23. The main effect of techniques on the debridement was statistically significant (p < 0.001). The course of debridement effectiveness, according to the levels of significance between the groups, was as follows: Multisonic ultracleaning > Er:YAG > Er,Cr:YSGG > Passive ultrasonic irrigation > Needle irrigation (p <0.05). Conclusions: In necrotic oval-shaped canals after minimally invasive instrumentation, multisonic ultracleaning with updated software was considerably more effective in removing remnants in the apical level. Er:YAG and Er,Cr:YSGG lasers were highly promising, with results close to multisonic ultracleaning. It should be considered that needle irrigation and passive ultrasonic activation may not be able to provide competent debridement in treating such types of root canals.
GentleWave system , histological analysis , irrigation activation , laser-activated irrigation , passive ultrasonic activation , root canal debridement
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Department of Endodontics, Faculty of Dentistry, Istanbul Medipol University, Istanbul, 34815, Turkey
Department of Endodontics, Faculty of Dentistry, Karabük University, Karabük, 78050, Turkey
Department of Pathology, Gaziosmanpaşa Training and Research Hospital, University of Health Science, Istanbul, 34255, Turkey
Department of Endodontics, Faculty of Dentistry, Suleyman Demirel University, Türkiye, Isparta, 32260, Kazakhstan
Department of Endodontics
Department of Endodontics
Department of Pathology
Department of Endodontics
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