An Evaluation of the Effect of Pulsed Ultrasound on the Cleaning Efficacy of Passive Ultrasonic Irrigation

Introduction Multiple activations of the irrigant by using pulsed ultrasound may enhance the removal of dentin debris because of repeated acceleration of the irrigant. The aim of this study was to evaluate the effect of pulsed ultrasound on passive ultrasonic irrigation (PUI) in its ability to remove artificially placed dentin debris from a simulated apical oval extension within standardized root canals. Methods Each of 20 in vitro root canal models with a standard groove in the apical portion of one canal wall filled with dentin debris received PUI repeatedly, either without pulsation (group1) or with pulsation (730 milliseconds on/100 milliseconds off in group 2, 400 milliseconds on/400 milliseconds off in group 3, and 100 milliseconds on/670 milliseconds off in group 4), corresponding to duty cycles of 100%, 88%, 50%, and 13%, respectively. After each irrigation procedure, the amount of dentin debris in the groove was evaluated by taking photographs of the groove and scoring. The irrigation procedures were also visualized in vitro using high-speed imaging performed in glass root canal models. Results The debris score was significantly lower only in group 3 (p = 0.023). The in vitro visualization showed increased streaming and cavitation during the start-up phase of each pulse. Conclusions PUI with a pulsation pattern of 400 milliseconds on/400 milliseconds off and a duty cycle of 50% is more effective in removing dentin debris from a simulated apical oval extension in standardized root canals than continuous ultrasonic activation. Duty cycles of 13% and 88% showed no difference compared with continuous oscillation.