Alternate canal negative apical pressure technique

Alternate canal negative apical pressure technique is a process of cleaning teeth canals that have a connection apically or through isthmi. This technique is for specific canals of dental root canals in the field of endodontics.

What is the alternate canal negative apical pressure technique?

This is a technique to remove tissue, debris, and bacteria from any connections from one canal system and another canal system within the same tooth root. The most common canals that this technique works for is lower molar mesial roots, upper molar mesial buccal roots, and some premolars. Micro CBCT studies show that a large number of those roots have isthmi connecting them. The complexity of these isthmus make it very difficult if not impossible to truly clean. This method helps to a large degree clean those areas out.

What equipment do I need for the alternate canal negative apical pressure technique?

The best thing about this technique is that you do not need any extra equipment! Your high speed suction with a surgical suction tip is your suction. You will need to add any of the smaller tips that you use for medicament applications. However, the smaller the tip size the better. Finally you need something to get your solution in the connecting canal, so whatever syringe you currently use.

The image sucks but it’s taken from the very helpful video below. The video will help with understanding what the alternate canal negative apical pressure technique is.

What is the research behind the alternate canal negative apical pressure technique?

There is no direct research on the alternate canal negative apical pressure technique. The closest thing that I can find is research on the modified endovac technique. This is essentially the same thing but using the endovac in the receiving canal instead of using just suction. The modified negative apical pressure study by Thomas 2014 JOE shows it is far superior to both traditional endovac and passive ultrasonic in terms of cleaning out the isthmus. Other studies show that negative apical pressure is superior to other methods when it comes to isthmus cleansing Neelakantan JOE 2016

Finally, if you have an interest in more research on medicaments and irrigation techniques I have many more on my post about root canal irrigation techniques.

Questions the alternate canal negative apical pressure technique research needs to answer

1. Does it work? I only assume it works because it is very similar to the modified endovac technique.
2. Do we need to alternate the canals with one having suction then the other?
3. How long?
4. What chemicals work best? I currently use all four but I would think EDTA and NaOCl would be best.

Alternate canal negative apical pressure technique video

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