Efficacy of Different Irrigation Activation Methods on the Amount of Extruded Irrigation Solution in Teeth with Simulated Immature Apex

Objective: The study aimed to quantitatively evaluate the effects of four final irrigation activation methods—standard needle irrigation (SNI), passive ultrasonic irrigation (PUI), EndoActivator (EA), and EDDY—on apical irrigant extrusion in teeth with simulated immature apex. Materials and Methods: Sixty single-rooted teeth with single canals were prepared up to the X3 instrument of the ProTaper Next system. To simulate open apices, Gates Glidden burs (#1–#6) were used, standardizing the apical diameter to 1.5 mm. The canals were irrigated with 2.5% NaOCl, 17% EDTA, and distilled water. Each tooth was mounted in the cap of an Eppendorf tube, allowing drainage through a 27G needle positioned at the root tip. The tubes were filled with NaOCl. Samples were randomly divided into four groups (n=15) based on the irrigation activation method: SNI, PUI, EA, and EDDY. In all groups, 6 ml of 2.5% NaOCl was activated over 3 minutes. The extruded irrigant was collected using an insulin syringe, and the volume was recorded in milliliters. Results: Data normality was assessed with the Kolmogorov-Smirnov test. Statistical analysis was performed using the Kruskal-Wallis and Mann-Whitney U tests (p<.05). The highest mean irrigant extrusion occurred in the SNI and PUI groups, while the EA group exhibited lower extrusion compared to others. However, no statistically significant difference was found among the methods regarding the mean volume of extruded irrigant (p>.05). Conclusion: This study highlights that all tested irrigation activation methods perform similarly in controlling apical extrusion in teeth with immature apex.