Comparative Efficacy of Sonic, Ultrasonic, and Diode Laser-Activated Irrigation with Combination of NaOCl/EDTA/CHX Solutions Against Fusobacterium nucleatum in Dentinal Tubules: A Confocal Microscopy Study

Eddie Nagadi,1 Dudi Aripin,1 Diani Prisinda,1 Indra Primathena,1 Fitria Dwi Ayuningtyas,2 Alfina Gracia Feronytha2 1Conservative Dentistry Department, Faculty of Dentistry, Universitas Padjadjaran, Bandung, West Java, Indonesia; 2Scientific Imaging Center, Institut Teknologi Bandung, Bandung, West Java, IndonesiaCorrespondence: Diani Prisinda, Conservative Dentistry Department, Faculty of Dentistry Universitas Padjadjaran, Jl. Sekeloa Selatan No. 1, Bandung, 40132, West Java, Indonesia, Email [email protected]: This research evaluated the effectiveness of sonic, ultrasonic, and diode laser irrigation techniques with a final irrigation protocol of 3% NaOCl, 17% EDTA, and 2% CHX in eliminating Fusobacterium nucleatum (F. nucleatum) from dentinal tubules.Materials and Methods: The research method utilized 38 human lower premolar teeth inoculated with F. nucleatum, which were divided into four groups: conventional needle irrigation (positive control), sonic irrigation (EDDY® tips), ultrasonic irrigation (IrriSafe™), and diode laser (SOLASE, 976 nm). Bacterial viability was assessed using confocal laser scanning microscopy with the LIVE/DEAD™ BacLight™ Bacterial Viability Kits. Data were analyzed using the Kruskal–Wallis and post-hoc Mann–Whitney tests.Results: The results demonstrated that the diode laser irrigation technique achieved the highest effectiveness, with an average penetration depth of 1045.55 (740.00– 1420.00) μm, significantly outperforming sonic (751.11 [480.00– 1170.00] μm; p-value = 0.024) and ultrasonic (617.77 [450.00– 1090.00] μm; p-value = 0.002) irrigation techniques. The control group exhibited the lowest effectiveness (243.33 [150.00– 330.00] μm).Conclusion: Diode laser irrigation with the final irrigation protocol provided the highest efficacy against F. nucleatum in dentinal tubules, highlighting its superiority over other irrigation techniques for disinfection in endodontic treatment.Keywords: Fusobacterium nucleatum, endodontic irrigation, diode laser, bacterial viability, confocal laser scanning microscopy