Effectiveness of Six Irrigation Techniques With Sodium Hypochlorite in Tissue Dissolution

Introduction: Complete removal of pulp tissue by mechanical instrumentation remains a challenge. The study aimed to assess the efficacy of six irrigation techniques using 3% sodium hypochlorite (NaOCl) in dissolving tissue. Materials and methods: Seventy standardized fragments of bovine muscle tissue were divided into seven groups and exposed to different irrigation devices, with a maximum of 10 minutes of irrigation at room temperature. The devices included erbium-doped yttrium-aluminum-garnet (Er:YAG) laser (LightWalker® ST-E; Fotona d.o.o., Ljubljana, Slovenia), erbium, chromium-doped yttrium, scandium, gallium and garnet (Er,Cr:YSGG) laser A (EdgePRO™; Biolase Technology Inc., San Clemente, California, United States), Er,Cr:YSGG laser B (WaterLase iPlus®; Biolase, California, United States), multisonic ultracleaning system (MUS) GentleWave® system with CleanFlow™ handpiece (Sonendo, Inc., Laguna Hills, California, United States), passive ultrasonic irrigation (PUI), EndoUltra ultrasonic activator (Vista Apex Dental Products, Racine, Wisconsin, United States), and conventional needle irrigation (CNI), a 29G NaviTip irrigation needle at a flow rate of 5 mL/min (Ultradent Products, Inc., Utah, United States), with 3% NaOCl without agitation as the control. For samples that dissolved completely within 10 minutes, the dissolution time was recorded, and for other samples, the tissue weight was measured after the 10-minute irrigation experiment. The tissue dissolution rate (%/s) was calculated for all experiments. Results: MUS had the fastest tissue dissolution rate (P < 0.01), at 2.986% ± 0.395% per second. The laser systems had dissolution rates of 0.388% ± 0.062% per second for Er:YAG laser, 0.316% ± 0.042% for Er,Cr:YSGG laser A, and 0.258% ± 0.018% for Er,Cr:YSGG laser B. CNI and PUI showed the slowest tissue dissolution rates. Conclusions: MUS with CleanFlow, followed by Er:YAG and Er,Cr:YSGG lasers, achieved a significantly faster tissue dissolution rate than conventional irrigation methods of PUI and CNI tested. MUS with CleanFlow can greatly improve the effectiveness of NaOCl in tissue dissolution.