Passive or Active Ultrasonic Activation of Irrigation

[@DrShahid-Shafi]

Best endo- educator I've ever come across. I wish someday I could meet you Sir. Respect

[@rolandfrancis7066]

Thank you Dr Nasseh for your interesting vids. I do have some few questions for you : 1- I got the Endoactivator few weeks ago and I am using it extensively ,should I better switch to ultrasonic instead ? 2- I usually try to irrigate my canal w 5% hypochloride for at least 30min before obturation is it sufficient ? , 3- does( ultra) sonic agitation allow saving in the irrigation time ? 4- do you usually perform vital multirooted in one or more sessions ? 5- what is your last irrigation solution before obturation ? Thanks again and regards.

[@AANasseh]

I think as long as you're using something you'll be fine. Endoactivator is definitely better than nothing. The advantage of an ultrasonic is its ability to create continuous ultrasonic irrigation if you have a self contained cart and are able to have a continuous flow of clean water. Furthermore, ultrasonics are multitaskers, they are used not only for irrigation but also for access and other facets of treatment. Cheers!

[@michaellupu2080]

Thank you! Can you please clarify 2 points, please? At 4:58 you said about these Brasseler/NSK tips they they "would fit on any other piezoelectric US unit that take this type of an attachment"; does that include Acteon Satelac piezoelectric units? Said a different way, could one use Satelac-compatible tips like irrisafe, X-start, BUC or TFRK with the Varios/Forza US unit? Also, you showcased the 20 size u file inserts: is there any rational to use larger size u file inserts, perhaps in a wide, straight canal? And lastly, do you have any experience with Satelac irrisafe irrigation tips? How do they compare with the tips you showcased in this video?

[@AANasseh]

Yes those tips would fit. Any tip that has a female positive lock will fit. (*Note: Some tips suck as ENAC tips have male attachment and won't fit). but Satelac compatible BUC tips fit. Only issue is power setting has to be tried for each practice to make sure the correct setting is used. For E12 tips with U-Blade files you only really need the size 20. Larger tips are not necessarily better in larger canals. A universal size 20 is adequate for going deeper while being safer. You can use this tip for about 10-15 times. Best to throw it away after than to avoid it breaking due to fatigue in time. The irrisafe tips work well too. I've tried it before. That tips doesn't cut at all though. So, its agitation his limited as well. But it's good. Cheers!

[@michaellupu2080]

@@AANasseh Thank you so much for taking the time and replying! I'm thrilled by your answer; NSK varios PE US units are amazing, with an incredible amount of tips for perio, hygiene, operative and even surgery, but the array of endo tips is limited (far more limited than for Brasseler), so having the abillity to use tips by different manufaturers is great news! To your knowledge (in your opinion), to what degree should we worry about the "oscillation dampening by wall contact" that clinicians advocating for (selling?) Sonic activating devices talk about? Is PUI safe and efficient in curved (30+ degrees) canals? The fear of uncontrolled dentin cutting by PUI has been brought forward by the sonically activated irrigation crowd; this phenomeanon makes sense to me; that's why I asked about the IRRIsafe tips. But if I understand your reply, you seem to suggest that there's a direct correlation between cutting efficiency of the insert and agitation efficiency (i.e. cleanliness that could be expected). Could you please explain this correlation? Thank you once again, Dr. Nasseh! You're the best!

[@zakkammer9847]

Dr. Nasseh, I am a gp finishing up my AEGD residency and I love endo. I am currently discussing contract terms with a private group practice to come on as their endo and oral surgery dentist. However, I am wondering what helped you decide to specialize and what you think the best route would be to take to enter into endo school. Although I have been through enough schooling to put down a rhino, endo is something I would still consider going back for. I appreciate your time and love your videos. Very well produced and informative.

[@AANasseh]

Zak, a year or so of private practice will help and then apply. I assume you have good enough scores with your National Boards, etc. There's nothing specific you can do if you're already at this level of education. Right now having passion and getting an interview is the main thing if you're interested in endo. It's a good field; but you have to make sure you're ready and excited both economically and emotionally for an additional 2-3 years of schooling. If you like restorative dentistry you can alway do more endo-restorative and gain your experience by practice. You need to look deep and make sure your reasons are right and do a cost:benefit analysis. Otherwise endo is a great field. Good luck!

[@zakkammer9847]

Thank you so much for the reply! I really appreciate it!

[@san5a89]

hello Dr Nasseh. consider a situation where there's no possibility to do an active irrigation. is it possible to create negative pressure with a simple syringe and obtain a better result than passive irrigation? in your opinion can this option be dangerous?

[@FZsound]

The ultra mint pro has a tank, the company is saying you can add your disinfection protocol to this. Is Triton safe to use in a continuous ultra sonic disinfection capacity?

[@AANasseh]

It is. But like normal NaClO it’s very caustic to the tubing and lines. So, you’ll have to make sure your US tubing can take NaClO. That would be the dream protocol.

[@ramreddymatta]

W ell explained Dr.. thank you.

[@ramreddymatta]

Can you explain Dr how to deal with irrigation when there is confluence of the canals.. thank you.

[@AANasseh]

Irrigation will be covered in detail this year. Stay tuned.

[@shahnamamini]

thank you for this video. one of Dr. Nasseh's students on his youtube channel had mentioned using the "Power Flosser" by WaterPik as a sonic activator. What are your thoughts on that?

[@AANasseh]

Sure. Anything you can do to add an element of agitation or activation is more helpful than mere positive pressure with a needle that does not reach the apex. Using 31gauge needle with a very dilute NaClO solution (1%) within 2mm of WL is also very helpful. But you would have to be very careful and skilled about where you on and make sure the needle is not binding. Therefore the canal should be prepared to about a 30/04 in such case.

[@amrezz7119]

Thank you Dr Nasseh if u can write down the most common sizes to be used after shaping a canal for 25/04 or 35/04 and link for the ultrasonic file i got one but it's cheap and i am worried if it might get separated inside the canal & thank you again :)

[@AANasseh]

I use the size 20 U-File as the ultrasonic tip. But the key is to set the power to the lowest power on the ultrasonic so it doesn't;t ledge the canal. You can look a the Forza V3 model with the E11 or E12 Tips and these U-File inserts or get any other ultrasonic unit with their corresponding tips. The key is to work out the power setting that doesn't ledge before putting in the canals. Cheers!

[@angelicafoster670]

what should be my final flush irrigant before drying and obturation ? saline or sodium hypochlorite ?

[@AANasseh]

Depends on your sealer. Whether it’s hydrophilic or hydrophobic. Would be eithe NaClO for hydrophilic sealers or alcohol for hydrophobic sealers. Best wishes! 👍

[@w1ldr1ce88]

any thoughts on the gentlewave?

[@AANasseh]

Asked Dr. Nasseh and he says "GW would have been a useful irrigation adjunct, however, at the present time, the price point and procedure fees are prohibitive compared to the much less expensive alternatives (Ultrasonics, Sonics, Negative Pressure, & Mechanical)."

[@muhammadhamed9739]

nice video thnQ :)

[@MostafaMahmoud-jb9hn]

Use the lowest power of scaler in endo mode?

[@AANasseh]

Depends on your ultrasonic unit. Each head is designed for a given motor. So, you have to test your own ultrasonic unit but for the Forza v30 which I use that’s the setting.

[@НарекГригорян-ы6щ]

What about EDDY (VDW)?

[@veronicasanabria6257]

Excellent video Dr! I have a question. Do you use after the desinfection with hypochorite another substance, like EDTA, to remove inorganic debrys?

[@AANasseh]

You can use it with either. For your final rinse you can use EDTA followed by Bleach to remove the smear layer as well. Cheers!

[@rolandfrancis7066]

I personnally use 10% citric acid. It is an acceptable and very affordable substitute to EDTA.I just don't know why it is less popular than the latter....

[@AANasseh]

Some studies show more dentinal erosion with critic acid compared to EDTA. That's the reason it's not as popular.

[@drshuvo8771]

Sonic activation or ultrasonic activation which one you recommand Sir?

[@AANasseh]

Ultrasonic is generally better but sonic is also good. So, either sonic or ultrasonic is better than nothing.

[@mikegomez6846]

Hi Dr. Why not using a scaler instead of an ultrasonic?

[@AANasseh]

It's magnetorestrictive vs. piezoelectric and therefore not as powerful. However, it's better than nothing. But it will require a tip that can go deep in the canal.

[@mikegomez6846]

Real World Endo thank you so much for you time Dr. One last question. What do you think about the Dentsply Endo Activator?

[@AANasseh]

In general, ultrasonic energy is superior to sonic energy in activating irritants; but Endoactivator's sonic activation is certainly better than nothing. Good luck!

[@gregors.5734]

That was really nice to see that the (my?) idea of using phosphoric acid as a test medium is finding wordwide use :D...Regarding the mentined Endoactivator: in my opinion, you are better of just using a fitting guttapercha cone manually, apperently the Endoactivator is not achieving that much in the root canal. Check one of my videos to see the difference: kzbin.info/www/bejne/epeshaWAgMyXfKs

[@AANasseh]

This is not phosphoric acid. It's EndoSequence Viscous Lubricant (it's blue like Phosphoric acid gel.) However, it's more tenacious than phosophoric acid, which washes out more readily with water.

[@salima7394]

Correction: you can not have sonic activation. Activation is only the case when it is done ultrasonically! We have sonic agitation!

[@AANasseh]

I’d be curious to know who invented that definition?! What’s your source?

[@salima7394]

Laws of physics! Joyce et al 2012 and Macedo et al 2014 and Boutsioukis 2013: Ultrasonic only can cause cavitation (and there is never cavitation in sonic!!!!)--> cavitation will lead to local increase of pressure and temperature--> so it will have effect on chemical reaction--> so that is why it is called activation. just science no commercial BS

[@AANasseh]

Yes, ultrasonic alone are capable of cavitation; but Dr. Nasseh did not say cavitation. He mentioned activation of the solution referring to making the solution more active through agitation. So, the use common use. Also, watch your language in the comments section.

[@miraamshah]

Real World Endo well he is right cause there is only chemical action in us and so he corrected Dr Nasseh ;)

[@AANasseh]

Hi folks! I was asked by my staff to chime in in person. Regarding Sonics and Ultrasonics, they both have physical actions on fluids. The difference between the two is merely the energy frequency and motion . Salim is right that Cavitation is reserved for the higher energy ultrasonics. But I no one claimed cavitation for sonics here. The point here is activating (or making whatever solution you are using more active through increasing its kinetic energy.) Activating the fluid is possible through several mechanical means. Either way, this is a matter of semantics and not worth the discussion here. In pure physics the distinction is between agitation vs activation but I’m using the term colloquially as it's used the same way it's used in this article. www.ncbi.nlm.nih.gov/pmc/articles/PMC4979287/