Evaluation of machine-assisted irrigation on removal of intracanal biofilm and extrusion of sodium hypochlorite using a three-dimensionally printed root canal model

Purpose: This study aimed to compare the biofilm removal and apical extrusion of sodium hypochlorite (NaOCl) following machine-assisted irrigation using a three-dimensionally (3D) printed dentin-insert model. Methods: Multispecies biofilms were formed in a 3D-printed curved root canal model with dentin insert. The model was then placed in a container that was filled with 0.2% agarose gel containing 0.1% m-Cresol purple. Root canals were irrigated with 1% NaOCl using syringe irrigation, sonically agitated (EndoActivator or EDDY) or ultrasonically activated (Endosonic Blue) irrigation. Samples were photographed and the color-changed area was measured. Biofilm removal was assessed using colony-forming unit counting, confocal laser scanning microscopic analysis and scanning electron microscopic observations. The data were analyzed using one-way ANOVA, followed by Tukey test (P < 0.05). Results: EDDY and Endosonic Blue demonstrated significantly greater reduction of biofilms compared to other groups. No significant differences were observed in the remaining biofilm volume in syringe irrigation and EndoActivator groups. Furthermore, EDDY and Endosonic Blue presented with numerous exposed dentinal tubules. EDDY showed significantly greater NaOCl extrusion compared to other groups. Conclusion: Ultrasonic activation with a small-sized nickel-titanium file irrigation system may be beneficial in intracanal biofilm removal avoiding extrusion of NaOCl beyond the root apex.