Uncontrolled Removal of Dentin during In Vitro Ultrasonic Irrigant Activation

• We investigated if ultrasonic activation results in uncontrolled removal of dentin.
• Ultrasonic K-files and Irrisafe files were used in straight root canals in vitro.
• Both types of files removed small amounts of dentin.
• K-files were more aggressive than Irrisafe files in the apical third.
• Ultrasonic activation protocols may need to be revised.

IntroductionThe aim of this study was to evaluate uncontrolled removal of dentin during in vitro ultrasonic irrigant activation in prepared root canals using 2 different files.MethodsFifty-four human single-rooted teeth with straight root canals were prepared to size 35/.06 taper. The specimens were randomly allocated to 3 groups (n = 18). Two milliliters of 2% sodium hypochlorite was delivered 3 times to each root canal by a syringe and an open-ended needle. After each delivery, the irrigant was ultrasonically activated for 10 seconds at 35% power either by a size 15 ultrasonic K-file (group A) or a size 20 Irrisafe file (Acteon Satelec, Merignac, France) (group B) placed at 2 mm short of the working length. The irrigant in the control specimens (group C) was not activated. Specimens were scanned by micro–computed tomographic imaging at 10-μm voxel size before preparation, after preparation, and after the final irrigation/activation sequence. Scans were coregistered and segmented, and the amount of dentin removed during the final step was quantified by morphologic operations. Results were analyzed by nonparametric statistical tests. The level of significance was set to P < .05.ResultsDefects with a maximum depth of 0.09 mm and 0.07 mm were identified in groups A and B, respectively. Both ultrasonic files removed significantly more dentin than irrigant delivery in the control group (P ≤ .005). K-files removed significantly more dentin than Irrisafe files in the apical third (P = .001).ConclusionsUltrasonic irrigant activation may result in uncontrolled removal of dentin in straight root canals and at manufacturer-recommended power settings.