Korean Journal of Dental Materials (대한치과재료학회지)

Korean Society For Dental Materials (대한치과재료학회)
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Effect of needle tip design and position, and irrigant flow rate on apical pressure

주사침 말단의 형상과 위치, 세척액 주입속도가 치근단에 작용하는 압력에 미치는 영향

  • Lee, Chang-Ha (Department of Conservative Dentistry, Seoul National University) ;
  • Jo, Seol-Ah (Department of Conservative Dentistry, Seoul National University) ;
  • Lim, Bum-Soon (Dept. of Dental Biomaterials Science, Seoul National University) ;
  • Lee, In-Bog (Department of Conservative Dentistry, Seoul National University)
  • 이창하 (서울대학교 치의학대학원 치과보존학교실) ;
  • 조설아 (서울대학교 치의학대학원 치과보존학교실) ;
  • 임범순 (서울대학교 치의학대학원 치과생체재료과학교실) ;
  • 이인복 (서울대학교 치의학대학원 치과보존학교실)
  • Received : 2018.10.23
  • Accepted : 2018.11.28
  • Published : 2018.12.30
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Abstract

The purpose of this study was to evaluate the effect of needle tip design and position, and irrigant flow rate on apical pressure (AP) during root canal irrigation. Five human mandibular premolars were instrumented up to #35 (0.06 taper) using nickel-titanium rotary instruments. Three different needles according to change of needle tip design (notched, side-vented, and flat) were positioned at the point of 1, 3, and 5 mm from the apical constriction (needle tip position). For each needle tip design and position, APs were measured with varying flow rates of 0.05, 0.1, 0.2, and 0.3 ml/s. When the other conditions were controlled, AP increased with decreasing needle tip position or increasing irrigant flow rate (p<0.05). The AP of flat needle was the highest, followed by notched, side-vented needle for the same needle tip position and irrigant flow rate. The APs at needle tip position of 1 mm or with more than 0.1 ml/s flow rate were higher than central venous pressure (5.88 mmHg) for all conditions. Flat needle was not recommended for clinical use due to sharp increase of AP with changing needle tip position and irrigant flow rate. For safe and effective root canal irrigation, irrigant should be applied with the needle tip position of 3 mm and flow rate of less than 0.05 ml/s.

본 연구에서는 근관 내의 주사침 말단의 위치, 근관 세척액의 주입 속도, 주사침 말단의 형상이 근관 세척 시 발생하는 치근단 압력에 미치는 영향을 평가하고자 하였다. 5개의 사람 하악 소구치에 근관 와동 형성 후 #35(0.06 taper) 니켈-티타늄 회전식 기구로 근관을 형성하였다. 주사침 말단의 형상에 따라 구분되는 notched, side-vented, flat 3가지 종류의 주사침을 근단 협착부로부터 치관 방향으로 1, 3, 5 mm 거리가 되는 지점(주사침 말단의 위치)에 위치시켰다. 각 군에 대하여 세척액 주입 속도는 0.05, 0.1, 0.2, 0.3 ml/s로 변화시키면서 치근단 압력을 측정하였다. 나머지 조건이 동일한 경우 주사침 말단의 위치가 감소할수록, 세척액 주입 속도가 증가할수록 치근단 압력은 유의하게 증가하였다(p<0.05). 주사침 말단의 위치와 세척액 주입 속도가 동일한 조건 하에서 side-vented 주사침이 가장 낮은 치근단 압력을 보였고, notched, flat 주사침 순서로 치근단 압력이 유의하게 증가하였다(p<0.05). 주사침 말단의 위치가 1 mm인 군 또는 세척액 주입 속도가 0.1 ml/s 이상인 군에서는 나머지 조건에 관계없이 모든 경우에서 중심정맥압(5.88mmHg)보다 높은 치근단 압력을 나타냈다. Flat 주사침은 세척액 주입 속도와 주사침 말단의 위치에 따른 치근단 압력의 급격한 증가로 인해 임상에서 사용이 추천되지 않으며, 안전하고 효율적인 근관 세척을 수행하기 위해서는 근단 협착부로부터 치관 방향으로 3 mm 떨어진 지점에 주사침 말단을 위치시키고 0.05 ml/s 이하의 세척액 주입 속도로 근관 세척액을 적용해야 할 것이다.

Keywords

Acknowledgement

Supported by : 한국연구재단

References

  1. Peters OA, Schonenberger K, Laib A. Effects of four Ni-Ti preparation techniques on root canal geometry assessed by micro computed tomography. Int Endod J. 2001;34(3):221-230. https://doi.org/10.1046/j.1365-2591.2001.00373.x
  2. Paque F, Balmer M, Attin T, Peters OA. Preparation of oval-shaped root canals in mandibular molars using nickel-titanium rotary instruments: a micro-computed tomography study. J Endod. 2010;36(4):703-707. https://doi.org/10.1016/j.joen.2009.12.020
  3. Haapasalo M, Shen Y, Qian W, Gao Y. Irrigation in endodontics. Dent Clin North Am. 2010;54(2):291-312. https://doi.org/10.1016/j.cden.2009.12.001
  4. Boutsioukis C, Psimma Z, van der Sluis LW. Factors affecting irrigant extrusion during root canal irrigation: a systematic review. Int Endod J. 2013;46(7):599-618. https://doi.org/10.1111/iej.12038
  5. Sathorn C, Parashos P, Messer H. The prevalence of postoperative pain and flare-up in single- and multiple-visit endodontic treatment: a systematic review. Int Endod J. 2008;41(2):91-99. https://doi.org/10.1111/j.1365-2591.2007.01316.x
  6. Gondim E Jr, Setzer FC, Dos Carmo CB, Kim S. Postoperative pain after the application of two different irrigation devices in a prospective randomized clinical trial. J Endod. 2010;36(8):1295-1301. https://doi.org/10.1016/j.joen.2010.04.012
  7. Baumann UA, Marquis C, Stoupis C, Willenberg TA, Takala J, Jakob SM. Estimation of central venous pressure by ultrasound. Resuscitation. 2005;64(2):193-199. https://doi.org/10.1016/j.resuscitation.2004.08.015
  8. Zhu WC, Gyamfi J, Niu LN, Schoeffel GJ, Liu SY, Santarcangelo F, Khan S, Tay KC, Pashley DH, Tay FR. Anatomy of sodium hypochlorite accidents involving facial ecchymosis - a review. J Dent. 2013;41(11):935-948. https://doi.org/10.1016/j.jdent.2013.08.012
  9. Haapasalo M, Shen Y, Wang Z, Park E, Curtis A, Patel P, Vandrangi P. Apical pressure created during irrigation with the GentleWaveTM system compared to conventional syringe irrigation. Clin Oral Investig. 2016;20(7):1525-1534. https://doi.org/10.1007/s00784-015-1632-z
  10. Topcuoglu HS, Topcuoglu G, Arslan H. The Effect of Apical Positive and Negative Pressure Irrigation Methods on Postoperative Pain in Mandibular Molar Teeth with Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial. J Endod. 2018;44(8):1210-1215. https://doi.org/10.1016/j.joen.2018.04.019
  11. Boutsioukis C, Lambrianidis T, Kastrinakis E. Irrigant flow within a prepared root canal using various flow rates: a Computational Fluid Dynamics study. Int Endod J. 2009;42(2):144-155. https://doi.org/10.1111/j.1365-2591.2008.01503.x
  12. Gao Y, Haapasalo M, Shen Y, Wu H, Li B, Ruse ND, Zhou X. Development and validation of a threedimensional computational fluid dynamics model of root canal irrigation. J Endod. 2009;35(9): 1282-1287. https://doi.org/10.1016/j.joen.2009.06.018
  13. Boutsioukis C, Verhaagen B, Versluis M, Kastrinakis E, van der Sluis LW. Irrigant flow in the root canal: experimental validation of an unsteady Computational Fluid Dynamics model using high-speed imaging. Int Endod J. 2010;43(5):393-403. https://doi.org/10.1111/j.1365-2591.2010.01692.x
  14. Boutsioukis C, Verhaagen B, Versluis M, Kastrinakis E, Wesselink PR, van der Sluis LW. Evaluation of irrigant flow in the root canal using different needle types by an unsteady computational fluid dynamics model. J Endod. 2010;36(5):875-879. https://doi.org/10.1016/j.joen.2009.12.026
  15. Boutsioukis C, Gogos C, Verhaagen B, Versluis M, Kastrinakis E, van der Sluis LW. The effect of apical preparation size on irrigant flow in root canals evaluated using an unsteady Computational Fluid Dynamics model. Int Endod J. 2010;43(10):874-881. https://doi.org/10.1111/j.1365-2591.2010.01761.x
  16. Boutsioukis C, Gogos C, Verhaagen B, Versluis M, Kastrinakis E, van der Sluis LW. The effect of root canal taper on the irrigant flow: evaluation using an unsteady Computational Fluid Dynamics model. Int Endod J. 2010;43(10):909-916. https://doi.org/10.1111/j.1365-2591.2010.01767.x
  17. Khan S, Niu LN, Eid AA, Looney SW, Didato A, Roberts S, Pashley DH, Tay FR. Periapical pressures developed by nonbinding irrigation needles at various irrigation delivery rates. J Endod. 2013;39(4):529-533. https://doi.org/10.1016/j.joen.2013.01.001
  18. Park E, Shen Y, Khakpour M, Haapasalo M. Apical pressure and extent of irrigant flow beyond the needle tip during positive-pressure irrigation in an in vitro root canal model. J Endod. 2013;39(4):511-515. https://doi.org/10.1016/j.joen.2012.12.004
  19. Psimma Z, Boutsioukis C, Kastrinakis E, Vasiliadis L. Effect of needle insertion depth and root canal curvature on irrigant extrusion ex vivo. J Endod. 2013;39(4):521-524. https://doi.org/10.1016/j.joen.2012.12.018
  20. Chang JW, Cheung AW, Cheung GS. Effect of root canal dimensions, injection rate, and needle design on the apical extrusion of an irrigant: an in vitro study. J Investig Clin Dent. 2015;6(3):221-227. https://doi.org/10.1111/jicd.12092
  21. Gulabivala K, Ng YL, Gilbertson M, Eames I. The fluid mechanics of root canal irrigation. Physiol Meas. 2010;31(12):R49-84. https://doi.org/10.1088/0967-3334/31/12/R01
  22. Shen Y, Gao Y, Qian W, Ruse ND, Zhou X, Wu H, Haapasalo M. Three-dimensional numeric simulation of root canal irrigant flow with different irrigation needles. J Endod. 2010;36(5):884-849. https://doi.org/10.1016/j.joen.2009.12.010