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ePaper created 2017-09-12, 09:26:18 | version 1.38.0
airlock is eliminated, the partial vacuum force helps in distributing irrigants into the totality of the root canal system, including the depth of the dentinal tubules. Thirdly, negative pressure irrigation allows for intro- ducing a significantly larger volume of irrigating solutions over a shorter period of time, increasing the efficiency and decreasing the length of the procedure. These unique properties result in a faster and better chemical preparation of the entire internal space. Sleiman-Iandolo testing used freshly extracted premolars, removed due to periodontal pathology, impregnated with methylene blue dye in a centri- fuge; this resulted in pushing the dye deeply into the dentinal tubules (Fig. 2a). To compare commonly used irrigant delivery techniques, a negative pressure irrigation unit was used (EndoVac) as well as a lateral- vented needle, manual activation of the solution, and passive ultrasonic irrigation in combination with the Sleiman irrigation sequence. EndoVac + Sleiman sequence was shown to be the only approach that allowed for a complete removal of the methylene blue dye from the entire root canal system and den- tinal tubules over the total time of 25 minutes, while the other approaches failed to achieve a completely clean system (Figs. 2b & c). The Sleiman sequence goes beyond using water as an intermediate between the two alternating solu- tions and as the final irrigant (water cooled to be- tween 2.5°C and 4°C and used for postoperative pain control or in a cryotherapy modality also suggested by Sleiman8 and investigated by Vera et al.9)—it also stipulates that when using the macro- or the micro-cannula of the negative pressure irrigation unit for chemical preparation, every five seconds a two-to-three-second pause should be made when no irrigant is added. It is during this pause that the partial vacuum is created by the cannula, which will | technique root canal preparation Fig. 2c Fig. 2c: Sleiman-Iandolo testing. Results of the dye removal with PUI access cavity into the root canal system and then suctions them out of the system. (left) and a negative pressure irrigation unit used at the intervals suggested as part of the Sleiman sequence (right). Note the extreme cleanliness of the deepest recesses of the dentinal tubules in the image on the right. Fig. 3: A necrotic/infected case: Lower premolar of the patient complaining of dull and pulsating pain. The infection was not limited to the apical part, but was also located in the lateral mid-root section. Postoperative X-ray shows a 3-D sealing of the apical area with its anastomosis and of the lateral and accessory canals in mid root. Fig. 4: Complexity of the apical area manifests itself after it was treated chemically, dried, and sealed by way of the warm vertical technique. Fig. 5: The case was referred for retreatment due to the failure of the previous root canal therapy. Following the shaping (TF-adaptive) and cleaning (Sleiman protocol), and upon the challenging but successful search for the distal canal, a 3-D obturation was performed, which allows showing the isthmus between the mesial and distal canals as well as a very coronally located lateral canal in the palatal root. 34 roots 3 2017 Using the macro- and the micro-cannulas of the negative pressure irrigation unit in, correspondingly, the coronal-middle and apical parts of the root canal system, leads to the creation of a vacuum, or a partial vacuum, to be more specific, inside the root canal space. Though its main role is to attract solutions deeper and deeper into the system and safely remove them from within, the partial vacuum created by the negative pressure has a number of other important benefits as Sleiman-Iandolo testing has shown. First of all, it can eliminate the airlock (better known in endodontics as vapor lock) inevitably resulting from bubbly chemical reactions between irrigating solutions and the content of the root canal space in- side the main canal—mainly in the apical part—as well as inside lateral canals and dentinal tubules and pre- venting the irrigants from reaching these areas and performing their best (Figs. 1a & b). Secondly, once the Fig. 3 Fig. 5 Fig. 4