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Conventional to EndoVac: A
Comparative Evaluation of Two

Irrigation Systems in Microbial
Reduction of Primary Root
Canals Using Chemical Irrigants: An
In Vivo Study Int J Clin Pediatr Dent
2023;16(S-2):S113–S117
Madina Ahmadi
Authors
Somya Govil
Keywords
 Antibacterial efficacy
 Chlorhexidine
 EndoVac
 Microbial reduction
 Sodium hypochlorite.
Microorganisms cause the Pulpal and periapical
infections. Endodontic therapy has been advocated as
an effective way to eliminate microorganisms from the
root canal. This is achieved by optimally cleaning,
shaping, and obturating the root canals hermetically,
which is the principal purpose of endodontic therapy.
Introduction
But due complexity of the root canal system, microbial
penetration into the dentinal tubules and the
production of a smear layer during mechanical
instrumentation of the root canals make full cleaning
and shaping of the canals practically difficult.
The use of an irrigant becomes necessary to clean the

root canal system thoroughly.
The randomly chosen
in vivo study investigated
patients were from the
80 deciduous posterior
outpatient section of the
teeth. The study
Department of
population included
Materials and
Pedodontics &
systemically healthy
Preventive Dentistry,
children between the
Babu Banarasi Das
ages of 3 and 9 requiring
College of Dental
endodontic treatment.
Sciences.
Methods
Before the inclusion of

It was approved by the each child in the study,
institutional ethics and the purpose of the study
research committee. was explained to their
parents.
Healthy children with no systemic conditions
Inclusion Criteria were considered.
The primary teeth should be asymptomatic

with necrotic.
The roots should be intact, or less than two-

thirds of
physiological root resorption should be

considered.
Resorbing and mobile teeth with excessive root
resorption.
Exclusion Criteria Any patient with developmental anomalies, periodontal
Problems or traumatic injuries require pulp therapy.
Children with special healthcare needs.
Children who have received antibiotics within the last 3

months before treatment.
Teeth with periodontal pockets.
Teeth that need the operative intervention of the root

canals.
Endodontic of Access Complete oral prophylaxis
Polishing with pumice was done
The tooth was isolated using a rubber dam after being injected with lignocaine
containing 1:80000 adrenaline.
A high-speed air turbine with a round diamond point was used to initiate the root
Preparation
canal access opening, followed using a low-speed engine to gain the final access.
An inverted cone diamond point was used to modify the cavity walls.
Cavity
The root canal was accessed with a size 10 K-file and the working length was
determined.
The contents were debrided from the canal walls using circumferential filing
Preoperative sterile paper point samples
(S1) were placed in the canal for at least 60
seconds at the same level to soak up the
fluid in the canal. The saturated paper
points were deposited into 10 mL of
thioglycolate broth and immediately
transferred to the microbiology lab for
microbial culture. The working length was
estimated.
Collection
In all the cases, chemomechanical

Sample
preparation was completed at the same

appointment. Hand nickel-titanium K-files
(Mani, Inc.,Tochigi, Japan) were used for
canal preparation to the working length in a
back-and-forth alternating rotation motion
using a circumferential technique up to
International Organization for
Standardization #25 size file. The 20 teeth
designated for each group were irrigated
with one of the following irrigant and
irrigation systems.
1 2 3 4
GROUP I: AROUND GROUP II: AROUND GROUP III: AROUND GROUP IV: AROUND
2.5% NAOCL 2.5% NAOCL 2% CHX IRRIGANT 2% CHX IRRIGANT
IRRIGANT USING A IRRIGANT USING USING A USING ENDOVAC
CONVENTIONAL ENDOVAC SYSTEM. CONVENTIONAL SYSTEM.
NEEDLE. NEEDLE.
After irrigation, the postoperative paper point
samples (S2) were placed for 60 seconds and
immediately transferred to the microbiology lab
for microbial culture.
Statistical analysis was
conducted using means and
Statistics were tabulated in a standard deviations for each
Microsoft Excel sheet under the group (Statistical Package for the
guidance of a statistician. Social Sciences (SPSS) 22.00 for
Windows; SPSS Inc, Chicago,
United States of America).
Statistical
Analysis
The data were analyzed

statistically using a one-way
analysis of variance for each
A p-value of <0.05 was
assessment point. Student t-
considered significant.
tests were used to determine the
difference between the two
groups.
RESULT
Preoperative and postoperative mean Colony
Forming Units (CFU)
 The study found that EndoVac irrigation yielded
superior results in 2.5% NaOCl and 2% CHX compared
to traditional irrigation methods using a needle
technique.
 The study revealed that EndoVac reduced irrigant
Discussion
spills, thereby reducing suction needs, thereby

enhancing visibility and ease of use in the working
field.
 The study compared 2.5% NaOCl with EndoVac and
2% CHX with EndoVac, finding 2% CHX had superior
antimicrobial efficacy, but no significant difference
was observed.
Sodium hypochlorite Chlorhexidine (CHX)
(NaOCl)
• Broad-spectrum antimicrobial action
 Gold standard
• Substantivity: attaches to human
 Most preferred tissues, sustained antimicrobial
 Wide clinical range from 0.5% to action
5.25% • Chemical plaque control- aqueous
 Primary root canal treatment, 2.5% solution of 0.1–0.2%
NaOCl -- total removal of viable
bacteria in the root canal system. • Root canal irrigation- 2% CHX
CHX showed superior antibacterial activity compared to NaOCl in this in vivo investigation, with
a mean CFU count of 1.16 for traditional systems and 0.93 for EndoVac systems.
The present study demonstrates that the EndoVac system performs
significantly better than the conventional needle when it comes to eliminating
bacteria.
Although there was a statistically significant benefit of the EndoVac system

Conclusions
over the conventional system, they both have greatly reduced the number of
bacteria in the root canal system of primary teeth with hopeful results.
The study is one of a kind, where we have conducted the first in vivo study
examining the antimicrobial efficacy of both the EndoVac system and
conventional needle irrigation system in primary teeth.
Using the EndoVac system to treat root canals in primary teeth requires more
research, both in vitro and in vivo.
 Visual Representation:
 Figures 1, 2, 3, and 4 visually enhance the
comprehension of the results, offering clear insights
into the bacterial load comparisons among systems and
irrigants.
 Significant Reduction in Bacterial Load with
EndoVac .
 Improved Postoperative Efficacy with Various
Merits
Irrigants.
 Comparable Efficacy between CHX and NaOCI in
Both Systems
 Demerit 1: Limited Sample Size:
 One notable limitation is the relatively small sample
size, potentially affecting the generalizability of the
results. A larger and more diverse sample could offer a
more robust understanding of the comparative efficacy
between the two systems.
 Demerit 2: Short-Term Observations:

Demerits
 The study primarily focuses on short-term

observations, providing insights into immediate
postoperative outcomes. However, a more
comprehensive understanding of the long-term effects
and success rates of both systems would require
extended follow-up periods.
 Demerit 3: Single-Center Study:
 The research is conducted within a specific setting, potentially
limiting the external validity of the findings. Multicenter studies
across different geographical locations and patient demographics
would contribute to a more comprehensive assessment of the
systems' efficacy.
 Demerit 4: Lack of Clinical Outcome Measures:
Demerits
 While the study assesses bacterial load reduction, it does not

delve into broader clinical outcomes such as patient-reported
pain, postoperative complications, or the overall success of
pulpectomy procedures. Incorporating these measures would
provide a more holistic understanding of the systems' impact.
 Demerit 5: Potential Bias in Irrigant Selection:
The study does not explicitly address the criteria for
selecting specific irrigants. The potential bias in irrigant
selection could impact the generalizability of the
findings, and a more standardized approach to irrigant
selection would strengthen the study's reliability.
Demerits
 Demerit 6: Lack of Blinding:

The absence of blinding in the study design may
introduce bias, as both the practitioners and patients are
aware of the system used. Blinding could minimize
potential sources of bias and enhance the study's
internal validity.
 Demerit 7
Demerits
 No mention of consent taken by the parents .

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Conventional to EndoVac: A

Comparative Evaluation of Two

The use of an irrigant becomes necessary to clean the

Before the inclusion of

The primary teeth should be asymptomatic

The roots should be intact, or less than two-

physiological root resorption should be

Problems or traumatic injuries require pulp therapy.

Children with special healthcare needs.

Children who have received antibiotics within the last 3

Teeth that need the operative intervention of the root

Polishing with pumice was done

In all the cases, chemomechanical

preparation was completed at the same

The data were analyzed

spills, thereby reducing suction needs, thereby

Although there was a statistically significant benefit of the EndoVac system

 Demerit 2: Short-Term Observations:

 The study primarily focuses on short-term

 While the study assesses bacterial load reduction, it does not

 Demerit 6: Lack of Blinding:

 No mention of consent taken by the parents .

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