Combining Apical Negative Pressure and Vibration
Inside Dentistry provides the latest in endodontics, implantology, periodontics, and more, with in-depth articles, expert videos, and top industry insights.
March 1, 2023
Volume 19, Issue 3, March 2023
Page(s): p. 54
Carlos A. Spironelli Ramos, DDS, MS, PhD
Carlos A. Spironelli Ramos, DDS, MS, PhD, got his first taste of research and development during a trip to Japan in 1987 as part of his first postgraduate work in endodontics. In his native Brazil, much of his focus was on testing existing products rather than developing new technologies. In Japan, he saw true innovation. "That was my inspiration," he says. For the next two decades, Ramos worked to innovate in Brazil, where he was the head of the Endodontics Department at the Londrina State University School of Dentistry. He patented a model of an apex locator that is still on the market today. However, when the opportunity to work in R&D with a US company arose, he jumped at the chance, first becoming a consultant in 2008 and then moving his family to the United States in 2012.
Over the past decade, Ramos has developed a number of products that are still in use, including heat-treated engine-driven files. He still returns to Brazil occasionally, and each time, he treats endodontic patients at his former university among his ex-students and successors. "I do miss practicing, and I like to keep my fingers a little bit wet," he says.
Nevertheless, Ramos's passion is innovation, and one area that he has turned his attention to in recent years is irrigation. "When I graduated from dental school, the instrumentation of a root canal took at least 20 to 40 minutes, depending on the anatomy, and now, it can be done in 3 to 5 minutes," he says. "That is great, but it also creates a problem regarding disinfection, which is the fundamental basis of endodontic treatment. Fast instrumentation leaves less time for the liquids to irrigate. Chemically speaking, sodium hypochlorite and ethylenediaminetetraacetic acid (ETDA) work very well, but improving the delivery and activation of these chemicals inside the canal is the big challenge." Ramos cites three fundamentals of mechanical irrigation: penetration of the fluids to the apical portion of the canal up to the working length without extrusion, activation of the liquid, and concomitant irrigation, or continuous renewal of the liquid.
According to Ramos, machine-assisted irrigation systems and lasers could be utilized to meet these challenges, but they are expensive and come with steep learning curves. Alternatively, an apical negative pressure system was developed, but it was not designed to activate the liquid. "What I did was create a negative pressure system combined with an activation system via vibration with ultrasonics," he says. Ramos invested years into developing Pac-Dent's iVac™ Apical Negative Pressure Irrigation and Activation System, which operates safely to prevent the risk of liquid extrusion into the periapical tissue and activates the renewed fluid inside the canal. The system comprises an aspiration/activation cannula with two options for the outside diameter: 0.35 mm and 0.5 mm. "The iVac's cannula is positioned inside the canal with its tip at the working length, and while connected to your piezo ultrasonic scaler, it vibrates to create activation of the liquid, which flows into the canal along the external surface of the cannula and is recollected via the tip," Ramos says.
As of early January, the system had been shown at only three events, but the initial feedback was overwhelmingly positive. "People recognize that the concept makes good sense," Ramos says. According to Ramos, other than the low cost per procedure, the flexibility and vibration capacity of the cannula are what have impressed dentists the most. "The systems that many dentists had been using previously utilized metal cannulas that were not flexible," he says. "The iVac has a special polymer cannula that vibrates like metal but is as flexible as plastic. It is more effective because you can use it in curved canals easily, and you have the advantage of both concomitant irrigation and active vibration automatically coming from the device. People always ask how plastic can vibrate like metal. That is precisely why this project has taken so much time. After testing many different types of polymers, we came up with a special one that is a mix of polyether ether ketone (PEEK) and polypropylene. We developed a way to fabricate a very small cannula from this material. You would not believe how many tests it took with the polymer, the injection machine, the molds, and everything else, but the end result was worth the time."
Pac-Dent also offers an iVac™ LED Piezo Ultrasonic Scaler, but the iVac irrigation system can be used with any piezo device. If dentists prefer not to use the specified liquids in their machines, they can use a different method with a syringe and the cannula. "Pac-Dent provides excellent instructions for the various ways in which the iVac system can be utilized in its instructions for use and demonstration videos," Ramos says.
The result is an affordable, easy-to-use system that avoids the risk of extrusion of the irrigating fluid while allowing it to clean and disinfect the entire root canal to the working length. The system's irrigation depth control is particularly helpful in cases involving young teeth, apexification, regeneration, and apical foramen resorptions.
As much sense as the system makes, Ramos notes that its development was anything but simple. "This is not a concept that just came about in 2 months," he says. "I have been working on this for a long, long time." Ramos jokes that he should probably ease his workload after more than 30 years of research and development. "I just enjoy innovation so much!" he says.
• Apical negative pressure with concomitant irrigation avoids the risk of extrusion of the irrigating fluid while allowing it to clean and disinfect the entire root canal to the working length.
• Highly instrumental in cases in which irrigation depth control is essential.
• The design facilitates the continuous exchange of ultrasonically activated irrigants throughout the procedure.
• Effective cleaning and disinfection of irregularities of the root canal system can be accomplished with the action of continuous ultrasonic irrigation.
For more information, contact:
Pac-dent
pac-dent.com • 909-839-0888
