AIM

           To determine and compare the delivery of irrigating solution (depth of penetration) to the working length using the conventional needle syringe, manual dynamic agitation, endovac, and endo activator.

MATERIALS AND METHODS

            A total of 80 patients, in the range of 20 -40 yrs, irrespective of gender,   requiring root canal treatment mandibular first permanent molars will be randomly selected after taking informed consent. After access opening and working length determination, all mesiobuccal canals will be sequentially prepared with Hyflex CM  rotary files to size 35/.04. The prepared mesiobuccal canals will then be assigned into 4 different groups of 20 each for evaluation of irrigant delivery using radiographic dye.

Group 1- Conventional needle syringe irrigation 

Group 2- Manual Dynamic Agitation with well-fitted GP cone

Group 3- EndoVac irrigation system 

Group 4- Endoactivator 

With the contrast media inside the canal, a digital image for each tooth will be taken and the difference between working length and maximum irrigant penetration will then  be measured and evaluated on RVG software.

PROCEDURE FOR MAKING RADIOGRAPHIC CONTRAST MEDIA-

A  sterile intravascular contrast medium containing iodine (Diatrizoate meglumine and Diatrizoate sodium) TRAZOGRAF 76% will be mixed with 5% sodium hypochlorite in the ratio of 45:55 to have an irrigating solution with a viscosity and surface tension similar to 5% sodium hypochlorite.

CLINICAL IMPLICATION

Successful endodontic therapy depends on the complete elimination of necrotic pulp, microorganisms, and debris from the root canal system. Efficient irrigation techniques should be able to completely debride the root canal system by delivering the irrigant to reach the entire working length. Newer irrigation techniques appear to have resulted in improved canal cleanliness when compared with conventional needle irrigation. Apical vapor lock effect hinders irrigants from penetrating the apical third of the root canals. Elimination of apical vapor lock may be achieved by activation of the irrigant by various methods like manual dynamic agitation, sonic or ultrasonic agitation. The apical negative pressure technique is another effective method to eliminate apical vapor lock. Endovac not only avoids air entrapment but is also able to deliver irrigants to working length without causing their undue extrusion to periapex. These techniques significantly increase the success rate of root canal treatment and improve the long-term prognosis of the tooth.