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ePaper created 2016-05-18, 11:28:18 | version 1.38.0
canal disinfection review | 21 roots 2 2016 Noninstrumentation techniques The first trial of a method of cleaning without canal preparation was the noninstrumentation technique conceived by Lussi et al.40 This tech- nique did not provide for the enlargement of the root canals because there was no mechanical in- strumentation of the root canal walls. In fact, rootcanalcleaningwasexclusivelyobtainedwith the use of NaOCl at low concentration, intro- duced and removed from the canal using a vac- uum pump and an electric piston that created fields of alternating pressure inside the canal. Thesecausedtheimplosionoftheproducedbub- bles and hydrodynamic turbulence that facili- tatedthepenetrationofNaOClintotherootcanal ramifications. At the end of this procedure, the canals were filled with a cement conveyed by the same vacuum pump. This system did not prove to be of substantial effectiveness and was never marketed. Recently, a method has been developed for cleaningtheentirerootcanalsystemthroughthe use of a broad spectrum of sound waves trans- mitted within an irrigating solution to remove pulp tissue, debris and micro-organisms quickly. One study showed that this technique was able to dissolve the tissue tested at a rate significantly higher than that of conventional irrigation.4 More research is needed to determine whether this ap- proach is effective in the root canal system with minimally invasive or no canal preparation. Conclusion According to current knowledge, endodontic pathology is an infection mediated by bacteria and in particular by biofilm. From a biological perspective, endodontic therapy must then be directed toward the elimination of micro-or- ganisms and the prevention of possible reinfec- tion. Unfortunately, the root canal system, with its anatomical complexity, represents a chal- lenging environment for the effective removal of bacteria and biofilm adherent to the canal walls. Chemomechanical preparation involves mechanical instrumentation and antibacterial irrigation, and it is the most important phase of the disinfection of the endodontic space. The technological advances of instruments have brought significant improvements in the ability to shape the root canals, with fewer procedural complications. In the management of the in- fected root canal system, various antimicrobial agents have been employed. Furthermore, some clinical measures, such as an increase in apical preparation and a more effective system of irrigant delivery and activation of irrigant, can promote and make more predictable the reduc- tionofintracanalbacteria,especiallyincomplex anatomical and noninstrumented portions of the root canal system._ Editorial note: A list of references is available from the publisher. about Dr Gianluca Plotino is a senior lecturer in the Department of Endodontics 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 journals,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 isAssistant Professor of Endodontics at Università Cattolica del Sacro Cuore in Rome. He completed his PhD at the same university in 2009,with a thesis on an innovative technique he developed for the restoration of endodontically treated teeth.He has contributed to the development of various instrumentation systems and new techniques,and holds international patents in the fields of endodontics and oral surgery. Dr Grande has published extensively in international peer-reviewed journals and has contributed to several books of endodontic interest.He serves on the editorial boards of several international peer-reviewed journals,and he has lectured both nationally and internationally as a keynote speaker in the fields of endodontics,microsurgery and restorative dentistry.He works in a private practice limited to endodontic and microsurgery in Rome. Prof.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. 22016