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70 — issue 2016 Endodontics Article NEW TECHNOLOGIES — to improve root canal disinfection — Dr. Gianluca Plotino is a senior lecturer in the Department of Endodon- tics and adjunct professor in the School of Dental Hygiene at the Sapienza University of Rome in Italy. He serves on the editorial boards of and is an official reviewer for several jour- nals, and has organized several research groups worldwide. He is the author and co-author of more than 70 articles in international scientific peer-reviewed journals with high impact factors on different endodontic and restorative topics. Dr. Plotino has given several lectures and courses worldwide, and he works in a private practice limited to endodontics and restorative dentistry in Rome. — Dr. Nicola M. Grande is Assistant Professor of Endodontics at Università Cattolica del Sacro Cuore in Rome. He completed his Ph.D. at the same university in 2009, with a thesis on an innovative technique he de- veloped for the restoration of endodontically treated teeth. He has contributed to the development of vari- ous instrumentation sys- tems and new techniques, and holds international patents in the fields of en- dodontics and oral surgery. Dr. Grande has published extensively in international peer-reviewed journals and has contributed to several books of endodontic inter- est. He serves on the edito- rial boards of several inter- national peer-reviewed journals, and he has lec- tured both nationally and internationally as a keynote speaker in the fields of endodontics, microsurgery and restorative dentistry. He works in a private prac- tice limited to endodontic and microsurgery in Rome. — Gianluca Gambarini is Professor of Endodontics at the Sapienza University of Rome’s dental school. He is an international lecturer and researcher, and actively collaborates with a number of manufacturers all over the world to develop new technologies, operative procedures and materials for root canal treatment. Prof. Gambarini also works in a private endodontics practice in Rome. Dr. Gianluca Plotino, Dr. Nicola M. Grande & Prof. Gianluca Gambarini, Italy Introduction The major causative role of micro-organ- isms in the pathogenesis of pulp and peri- apical diseases has clearly been demon- strated.1 The main aim of endodontic therapyistodisinfecttheentirerootcanal system, which requires the elimination of micro-organisms and microbial compo- nentsandthepreventionofitsreinfection during and after treatment. This goal is pursued through chemomechanical de- bridement, for which mechanical systems are used with irrigating solutions. Standard endodontic irrigation protocol — Sodium hypochlorite Sodium hypochlorite (NaOCl) is the main endodonticirrigantused,owingtoitsanti- bacterial properties and its ability to dis- solveorganictissue.2 NaOClisusedduring the instrumentation phase to increase its time of action within the canal as much as possible without it being chemically al- tered by the presence of other sub- stances.3 Theeffectivenessofthisirrigant has been shown to depend on its concen- tration, temperature, pH solution and storage conditions.3 Heated solutions (45–60 °C) and higher concentrations (5–6%) have greater tissue-dissolving properties.2 However, the greater the concentration, the more severe the po- tential reaction if some of the irrigant is inadvertently forced into the periapical tissue.4 Inordertoreducethisrisk,theuse of specially designed endodontic needles and an injection technique without pres- sure is recommended.5 — EDTA The main disadvantage of NaOCl is its in- ability to remove the smear layer. For this reason, combination of NaOCl with EDTA (ethylenediaminetetraacetic) is recom- mended.2 EDTA has the ability to decom- pose the inorganic component of intra- canal debris and is generally used in a percentageequalto17%.EDTAappearsto reducetheantibacterialandsolventactiv- ity of NaOCl; thus, these two liquids should not be present in the canal at same time.6 For this reason, during mechanical preparation, abundant and frequent rins- ing with NaOCl is performed, while the EDTA is used for 2 min at the end of the preparation phase to remove the inor- ganic debris and the smear layer from the canal walls completely. — Ultrasonic activation of NaOCl The use of ultrasound during and at the end of the root canal preparation phase is an indispensable step in improving en- dodontic disinfection. The range of fre- quencies used in the ultrasonic unit is be- tween 25 and 40 kHz.7 The effectiveness of ultrasound in irrigation is determined by its ability to produce cavitation and acoustic streaming. Cavitation is mini- mized and limited to the tip of the instru- ment used, while the effect of acoustic streaming is more significant.7 Ultrasound creates bubbles of positive and negative pressure in the molecules of theliquidwithwhichitcomesintocontact. The bubbles become unstable, collapse andcauseanimplosionsimilartoavacuum decompression. Exploding and imploding Article_Plotino_00-00.qxp_Layout 1 02.03.16 22:18 Seite 1 Article_Plotino_00-00.qxp_Layout 102.03.1622:18 Seite 1