{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,12]],"date-time":"2025-04-12T04:07:24Z","timestamp":1744430844835,"version":"3.40.4"},"reference-count":33,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T00:00:00Z","timestamp":1744329600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BIiD"],"abstract":"<jats:p>Introduction: Endodontic infections are biofilm-mediated, demanding effective biofilm eradication from the root canal. Root canal complexities, coupled with bacterial biofilm resistance, pose challenges to thorough disinfection. Irrigation, particularly with sodium hypochlorite, is crucial in endodontics. Activation techniques, like sonic or ultrasonic oscillations, enhance irrigant penetration and biofilm disruption, improving decontamination and treatment outcomes.\nThe aim of the present study was to evaluate the effectiveness of XP Finisher, EndoUltra, Eddy and Irriflex in the reduction of the multispecies endodontic biofilm formed by Enterococcus faecalis, Pseudomonas aeruginosa, Candida albicans and Proteus mirabilis.\nMethods: A total of 44 single-rooted mandibular premolars were selected and divided into groups for investigation: Group A: Irriflex, Group B: XP Finisher, Group C: Eddy system, and Group D: EndoUltra system. Multispecies biofilms, comprising Enterococcus faecalis, Proteus mirabilis, Pseudomonas aeruginosa, and Candida albicans, were cultured and inoculated into the pre-treated dentinal canals, which were then incubated for 16 days. Following this, the canals were subjected to the respective irrigation protocols. Bacterial counts were assessed using sterile paper points and culture techniques post-irrigation. Additionally, four non-inoculated root canals were used as negative controls for comparison.\nResults: EndoUltra achieved the highest reduction in Total Bacterial Count (TBC) with a median decrease of 75% (interquartile range [IQR]: 70\u201380%), significantly better than XP Finisher (p = 0.001) and Irriflex (p = 0.001). Eddy led to a reduction in Pseudomonas aeruginosa (PA) with a median decrease of 85% (IQR: 80\u201390%), significantly outperforming Irriflex (p = 0.001) and XP Finisher (p = 0.001). For Enterococcus faecalis (EF), EndoUltra had a median reduction of 70% (IQR: 65\u201375%), significantly better than Eddy (p = 0.01) and Irriflex (p = 0.001), while XP Finisher resulted in a reduction of 60% (IQR: 55\u201365%). EndoUltra showed the highest reduction in Proteus mirabilis (ProM) with 80% (IQR: 75\u201385%), significantly better than Irriflex (p = 0.001) and XP Finisher (p = 0.001), with Eddy also better than Irriflex (p = 0.009). EndoUltra reduced Candida albicans (CA) by 65% (IQR: 60\u201370%), significantly outperforming XP Finisher (p = 0.001) and Eddy (p = 0.001).\nConclusion: Within its limitations, this study identified EndoUltra as highly effective in reducing bacterial counts, indicating its potential utility in disinfecting root canals. These findings underscore the significance of such methods in enhancing treatment outcomes and addressing root canal infections.<\/jats:p>","DOI":"10.2340\/biid.v12.43065","type":"journal-article","created":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T09:47:05Z","timestamp":1744364825000},"page":"60-67","source":"Crossref","is-referenced-by-count":0,"title":["The action of different irrigant activation methods on engineered endodontic biofilm: an in vitro study"],"prefix":"10.2340","volume":"12","author":[{"given":"Aya","family":"Awaida","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roula","family":"El Hachem","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aline","family":"Issa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mireille","family":"Kallasy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla","family":"Zogheib","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wajih","family":"Hage","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1183","published-online":{"date-parts":[[2025,4,11]]},"reference":[{"key":"107258","unstructured":"Siqueira JF, Jr, R\u00f4\u00e7as IN. Protocols for irrigant activation in microbiology and treatment of acute apical abscesses. Clin Microbiol Rev. 2009;22:16\u201333."},{"key":"107259","doi-asserted-by":"crossref","unstructured":"Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of persistent infections. Science. 1999;284:1318\u201322. https:\/\/doi.org\/10.1126\/science.284.5418.1318","DOI":"10.1126\/science.284.5418.1318"},{"key":"107260","unstructured":"Kishen A, George S, Kumar R, Asa KV. Advanced therapeutic options for endodontic biofilms. Endod Topics. 2006;10:157\u201382."},{"key":"107261","unstructured":"Bhuva B, Patel S, Wilson R, Niazi S. Irrigation techniques used in the endodontic treatment of teeth with apical periodontitis in an adult UK population: a national clinical audit. Int Endod J. 2021;54:861\u201372."},{"key":"107262","unstructured":"Mohammadi Z, Shalavi S. A review of the properties and applications of sodium hypochlorite in endodontics. Iran Endod J. 2018;13:299\u2013305."},{"key":"107263","doi-asserted-by":"crossref","unstructured":"Haapasalo M, Shen Y. Current therapeutic options for endodontic biofilms. Endod Topics. 2010;22:79\u201398. https:\/\/doi.org\/10.1111\/j.1601-1546.2012.00281.x","DOI":"10.1111\/j.1601-1546.2012.00281.x"},{"key":"107264","doi-asserted-by":"crossref","unstructured":"Gu LS, Kim JR, Ling J, Choi KK, Pashley DH. Review of contemporary irrigant agitation techniques and devices. J Endod. 2009;35:791\u2013804. https:\/\/doi.org\/10.1016\/j.joen.2009.03.010","DOI":"10.1016\/j.joen.2009.03.010"},{"key":"107265","doi-asserted-by":"crossref","unstructured":"Ahmad M, Pitt Ford TR, Crum LA. Ultrasonic debridement of root canals: acoustic cavitation and its relevance. J Endod. 1987;13:490\u20139. https:\/\/doi.org\/10.1016\/S0099-2399(87)80016-X","DOI":"10.1016\/S0099-2399(87)80016-X"},{"key":"107266","unstructured":"Alves FR, Almeida BM, Neves MA, R\u00f4\u00e7as IN. A field emission scanning electron microscopic evaluation of smear layer and debris remaining following the use of the FKG race system with R-endo tip compared with a conventional needle irrigation in teeth with vital pulp. J Endod. 2016;42:1062\u20136."},{"key":"107267","unstructured":"Coggan J, Cobb C, Velenik V, Anderson R. Comparison of a novel irrigation device and a sonic activation system on cleaning efficacy of maxillary and mandibular molar root canals. Int J Dent. 2020;2020:8812152."},{"key":"107268","doi-asserted-by":"crossref","unstructured":"Karobari MI, Maqbool M, Ahmad P, Abdul MSM, Marya A, Venugopal A, et al. Endodontic microbiology: a bibliometric analysis of the top 50 classics. Biomed Res Int. 2021;2021:6657167. https:\/\/doi.org\/10.1155\/2021\/6657167","DOI":"10.1155\/2021\/6657167"},{"key":"107269","unstructured":"Fischer G. Zur Anatomie der Wurzelkan\u00e4le; Zahnarztl Rundsch. Anat Root Canals. 1954;63(24):693\u20137."},{"key":"107270","doi-asserted-by":"crossref","unstructured":"Neelakantan P, Romero M, Vera J, Daood U, Khan AU, Yan A, et al. Biofilms in endodontics-current status and future directions. Int J Mol Sci. 2017;18(8):1748. https:\/\/doi.org\/10.3390\/ijms18081748","DOI":"10.3390\/ijms18081748"},{"key":"107271","doi-asserted-by":"crossref","unstructured":"Haapasalo M, Shen Y, Wang Z, Gao Y. Irrigation in endodontics. Br Dent J. 2014;216(6):299\u2013303. https:\/\/doi.org\/10.1038\/sj.bdj.2014.204","DOI":"10.1038\/sj.bdj.2014.204"},{"key":"107272","doi-asserted-by":"crossref","unstructured":"Dioguardi M, Gioia GD, Illuzzi G, Laneve E, Cocco A, Troiano G. Endodontic irrigants: different methods to improve efficacy and related problems. Eur J Dent. 2018;12(3):459\u201366. https:\/\/doi.org\/10.4103\/ejd.ejd_56_18","DOI":"10.4103\/ejd.ejd_56_18"},{"key":"107273","doi-asserted-by":"crossref","unstructured":"Tonini R, Salvadori M, Audino E, Sauro S, Garo ML, Salgarello S. Irrigating solutions and activation methods used in clinical endodontics: a systematic review. Front Oral Health. 2022;3:838043. Erratum in: Front Oral Health. 2022;3:876265. https:\/\/doi.org\/10.3389\/froh.2022.838043","DOI":"10.3389\/froh.2022.838043"},{"key":"107274","doi-asserted-by":"crossref","unstructured":"Stuart CH, Schwartz SA, Beeson TJ, Owatz CB. Enterococcus faecalis: its role in root canal treatment failure and current concepts in retreatment. J Endod. 2006;32(2):93\u20138. https:\/\/doi.org\/10.1016\/j.joen.2005.10.049","DOI":"10.1016\/j.joen.2005.10.049"},{"key":"107275","unstructured":"Ghoddusi J, Moushekhian S, Arian E, Ghiasi J, Forghani M. The effectiveness of sonic-activated irrigation in reducing intratubular enterococcus faecalis. Iran Endod J. 2019;14(1):63\u20137."},{"key":"107276","doi-asserted-by":"crossref","unstructured":"Swimberghe RCD, Coenye T, De Moor RJG, Meire MA. Biofilm model systems for root canal disinfection: a literature review. Int Endod J. 2019;52:604\u201328. https:\/\/doi.org\/10.1111\/iej.13050","DOI":"10.1111\/iej.13050"},{"key":"107277","doi-asserted-by":"crossref","unstructured":"Paix\u00e3o S, Rodrigues C, Grenho L, Fernandes MH. Efficacy of sonic and ultrasonic activation during endodontic treatment: a meta-analysis of in vitro studies. Acta Odontol Scand. 2022;80(8):588\u201395. https:\/\/doi.org\/10.1080\/00016357.2022.2061591","DOI":"10.1080\/00016357.2022.2061591"},{"key":"107278","doi-asserted-by":"crossref","unstructured":"Galler KM, Grubm\u00fcller V, Schlichting R, Widbiller M, Eidt A, Schuller C, et al. Penetration depth of irrigants into root dentine after sonic, ultrasonic and photoacoustic activation. Int Endod J. 2019;52(8):1210\u201317. https:\/\/doi.org\/10.1111\/iej.13108","DOI":"10.1111\/iej.13108"},{"key":"107279","doi-asserted-by":"crossref","unstructured":"Ballal NV, Gandhi P, Shenoy PA, Dummer PMH. Evaluation of various irrigation activation systems to eliminate bacteria from the root canal system: a randomised controlled single blinded trial. J Dent. 2020;99:103412. https:\/\/doi.org\/10.1016\/j.jdent.2020.103412","DOI":"10.1016\/j.jdent.2020.103412"},{"key":"107280","doi-asserted-by":"crossref","unstructured":"Orozco EIF, Toia CC, Cavalli D, Khoury RD, Cardoso F, Bresciani E, et al. Effect of passive ultrasonic activation on microorganisms in primary root canal infection: a randomized clinical trial. 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