EndoVac: Apical Negative Pressure Irrigation Delivery System
Occasionally a technology or device comes along in endodontics that has the potential to revolutionize treatment efficacy and increase its success safely and predictably. Endodontic treatment is already a predictable and successful procedure. In addition to proper shaping, obturation, and subsequent coronal restoration, it is the irrigation and decontamination of the root canal space to the apices and anatomic irregularities that is the sine qua non to achieving these results.
Desired Irrigant Properties
The desired attributes of a root canal irrigant include the ability to dissolve necrotic and pulpal tissue, bacterial decontamination of a broad microbial spectrum, the ability to enter deep into the dentinal tubules and dissolve organic and inorganic material, removal of the smear layer, and ease of use?all at a moderate cost. Sodium hypochlorite, in conjunction with aqueous EDTA, satisfies these requirements. However, sodium hypochlorite also can result in damage to the adjacent tissues if it is extruded into the periradicular tissues.
Irrigant Delivery Systems
The most important factors during irrigation are delivering the irrigant to the full extent of the root canal system, the ability to debride areas that can?t be reached with mechanical instrumentation, and creating a current that carries debris and other particles away. The system also must be able to exchange the irrigant through the apical vapor lock, the column of gas (ammonia and carbon dioxide) that is produced by the hydrolysis of organic tissue that will not occur with traditional positive pressure needle irrigation. But most importantly, the irrigant must be delivered safely so that solutions are retained within the root canal system and not beyond the apex.
EndoVac: Safety First
Discus Dental?s EndoVac is analogous to a mini vacuum cleaner. The Macro and MicroCannulae are the ?mini vacuum hoses? that are connected via tubing to the high-speed suction of a dental unit.
Apart from being able to avoid air entrapment and overcome the issue of apical vapor lock, the EndoVac system can safely deliver irrigants to working length without causing extrusion into the periapex. This becomes possible through the use of negative pressure, pulling the irrigants passively into the canal to full working length, and removing them along with debris via suction out of the canal system.
In vitro and in vivo studies have demonstrated statistically significant greater removal of debris from the apical walls and cleaner results in anatomic irregularities such as isthmi and cul de sacs. This is particularly significant at 1 mm from working length, with higher volumes of irrigant exchanged using apical negative pressure irrigation in closed root canal systems when compared to traditional positive pressure needle irrigation. The same has been shown with respect to microbial removal, even with the most resistant bacteria, Enteroccocus faecalis trapped in a biofilm.
The EndoVac irrigation system is an inexpensive, revolutionary technology that pays for itself after the first use with the comfort of knowing that irrigants are safely and predictably delivered to the full extent of the root canal terminus, removing organic tissue and microbial contaminants to levels never seen before.