Evaluation of Smear Layer Removal Using Different Irrigation Methods In Root Canals. (original) (raw)
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Smear Layer Removing Ability of Root Canal Irrigation Solutions: A Review
The journal of contemporary dental practice, 2019
Aim: The purpose of this review is to address the smear layer removing the ability of root different canal irrigants including ethylenediaminetetraacetic acid (EDTA), a mixture of tetracycline, acid and detergent (MTAD), tetraclean, citric acid, Q-Mix, maleic acid, and smear clear. Background: Smear layer is a layer which is produced during instrumentation. It contains both organic and inorganic materials. It may also contain bacteria and their byproduct considering the root canal situation. This layer may prevent the penetration of the healing material introduced to the canal to the interior of the dentinal tubules. In addition, it can affect the adaptation of sealing materials to the root canal walls. Review results: The smear layer removal ability of MTAD is superior and faster than EDTA. Tetraclean is similarly composed of an acid, an antibiotic, and a detergent. The presence of doxycycline is believed to help the smear layer removal ability of these irrigants. Antibiotics such as tetracycline had similar smear layer removal ability as even citric acid. EDTA is an amino acid with a chelating ability that sequestrates metal ions. Some believed EDTA smear layer removing ability is better than MTAD, tetraclean, SmearClear, and 20% citric acid which is controversial in case of comparison between MTAD and EDTA. Phosphoric acid is efficient enough to be comparable to EDTA in removing the smear layer. Maleic acid is an organic compound with acid etching smear layer removal. Its ability seems to be similar or even better than EDTA. Citric acid as another organic acid is believed to be used as smear removing agent. HEBP is another chelating agent that can be used in combination with NaOCl; however, HEBP is a weak decalcifying agent compared to EDTA and hence cannot be applied as a mere final rinse. QMiX is a combination of CHX, EDTA, and detergent and should be used at final rinse. It is believed that QMiX is as efficient as EDTA. Smear clear is a 17% EDTA solution including an anionic and cationic (cetrimide) surfactant. The ability of QMiX is similar to EDTA. Conclusion: There are different canal irrigation solutions with various smear layer removal ability that some should be used as a mere final rinse and some should not. Clinical significance: The usage of canal irrigation solutions depends on the clinical situation and preference of the dentists. This study provides a good guide for clinician of the field.
Journal of Endodontics, 2009
Introduction: The aim of this study was to assess, by scanning electron microscopic (SEM) analysis, the ability of 17% EDTA and 7% maleic acid in the removal of the smear layer from the human root canal system. Methods: Eighty single-rooted human anterior teeth were subjected to standardized root canal instrumentation (step-back technique) and were irrigated with 2.5% NaOCl after each instrument. Based on the final irrigating solution used, samples were divided randomly into three groups: (1) the EDTA group: 17% EDTA+ 2.5% NaOCl (n = 30), (2) the maleic acid group: 7% maleic acid + 2.5% NaOCl (n = 30), and (3) the control group: 0.9% saline (n = 20). After final irrigation, teeth were prepared for SEM analysis to evaluate the cleaning of the coronal, middle, and apical thirds of radicular dentin by determining the presence or absence of smear layer. The data was statistically analyzed using the Kruskall-Wallis test. Results: At the coronal and middle thirds, there was no significant difference between EDTA and maleic acid. Both were equally efficient in the removal of smear layer. In the apical third, maleic acid showed significantly better smear layer removing ability than EDTA. Conclusion: Final irrigation with 7% maleic acid is more efficient than 17%EDTA in the removal of smear layer from the apical third of the root canal system, which is a crucial area for disinfection. (J Endod 2009;35:1573-1576
One of the main objectives of endodontic treatment is the decontamination of root canal systems. The removal of the smear layer is important, as it acts as a barrier, interfering in the diffusion of antimicrobial agents and in the adequacy between the filling materials and the canal walls. In this way, different irrigation techniques and devices have emerged to increase chemical disinfection and improve cleaning after mechanical instrumentation. The main objective of the present study was to analyze the effectiveness of different endodontic irrigation techniques in removing smear layer. As an inclusion criterion, articles from the PubMed and Google Scholar database were used. In PubMed, 397 articles were found, 10 were selected and in Google Scholar, 857 articles were found, 11 of which were selected for the research. . Thus, a final sample of 21 articles inserted in the work was obtained. It is concluded that all endodontic irrigation techniques removed more smear layer compared to conventional irrigation, but none was able to remove it entirely. Further laboratory and clinical studies are needed to prove the effectiveness of removing this layer with the standardization of clinical protocol.
Objectives: The purpose of this study was to evaluate the effectiveness of two different final irrigant activation methods in removing the smear layer at 3 and 7 mm from the apex. Methods: Thirty-six extracted single-rooted human mandibular premolars were instrumented by a reciprocating Wave-One 40.08 (Dentsply Maillefer, Switzerland) and irrigated with 2.5ml. 2.5% NaOCl at 37 C°. Teeth were divided into four groups according to the final irrigant activation technique (Group 1: XP-Endo Finisher File NaOCl 2.5% /EDTA 17%; Group 2: XP-Endo Finisher File NaOCl 2.5%; Group 3: passive ultrasonic irrigation [PUI] NaOCl 2.5% /EDTA 17% and Group 4: PUI-NaOCl 2.5%). Root canals were then split longitudinally and observed by field emission scanning electron microscopy. The percentage of area of open dentinal tubules was evaluated. Data were analyzed using the Kolmogorov-Smirnov and two factor ANOVA. Results: In all groups, the middle third of the roots demonstrated a significant higher percentage of dentinal tubules free of smear layer compared to the apical third (p<0.05). The XP Endo-finisher NaOCl/EDTA group showed a higher percentage of open dentinal tubules for the middle and apical thirds (P < 0.001). Group 3 (PUI NaOCl/EDTA) removed more smear layer at both root thirds than groups 2 (XP Endo-finisher NaOCl) and 4 (PUI NaOCl) respectively (p<0.001). Conclusions: None of the systems eliminated the smear layer; nevertheless, the XP-Endo-finisher NaOCl/EDTA group was more effective than PUI with and without EDTA for smear layer removal at both middle and apical canal thirds. Clinical significance: The use of the XP-Endo-finisher file system is an effective method for smear layer removal after root canal instrumentation.
International Journal of Dentistry Research, 2020
Introduction: Sodium Hypochlorite (NaOCl) remains gold standard as a result of its antimicrobial effect and tissue dissolution properties, but it has no effect on inorganic portion of smear layer. Thus the combination of NaOCl and EDTA has been proven to have the perfect ability in removal of both organic and inorganic debris. These irrigants when used with conventional syringe irrigation were unable to penetrate the apical portion of the root canal, so new activation devices have come in the market which claims to be effective in delivering the irrigant to the working length. Objective/Aim: This study evaluated and compared the efficacy of recently introduced irrigation activation devices EndoActivator, Passive ultrasonic irrigation and Laser on removal of smear layer from the apical third of instrumented root canal using Scanning electron microscope. Methods: Forty three single rooted teeth were prepared with the help of protaper files and divided into four groups. Group I: EDTA o...
An In Vitro SEM Study on the Effectiveness of Smear Layer Removal of Four Different Irrigations
Iranian Endodontic Journal, 2012
Introduction The aim of this study was to compare the smear layer removal efficacies of 3% sodium hypochlorite (NaOCl), 17% Ethylenediaminetetraacetic acid (EDTA), SmearClear and BioPure MTAD using a common irrigation protocol. Materials and Methods: Fifty freshly extracted human single rooted maxillary and mandibular teeth were prepared by a ProTaper rotary system up to an apical preparation file size F3. Prepared teeth were randomly divided into five groups (n=10); distilled water (Group A; negative control), EDTA (Group B), SmearClear (Group C), BioPure MTAD (Group D) and NaOCl (Group E). After final irrigation with tested irrigants the teeth were decoronated, split into two halves longitudinally and observed under a scanning electron microscope (SEM) for removal of the smear layer. The SEM images were then analyzed for the amount of smear layer present using a three score system. Data were analyzed using the Kruskal-Wallis test and Mann-Whitney U test. Results: Intergroup comparison of groups B, C, and D showed no statistical significant differences in the coronal and middle thirds, however, in the apical third the canal surfaces were cleaner in samples from group D (P<0.05). Conclusion: BioPure MTAD was the most effective agent for the purpose of smear layer removal in the apical third of the root canals.
Iranian endodontic journal, 2017
This in vitro study was designed to evaluate and compare different endodontic irrigation and activation systems for removal of the intracanal smear layer. Forty recently extracted, non-carious human intact single rooted premolars were selected and divided into five groups (n=10) according to the root canal irrigation systems; syringe and needle irrigation (CTR), sonic irrigation, passive ultrasonic irrigation (PUI) and EndoVac irrigation system. All groups were prepared to #40 apical size with K-files. Each sample was subjected to final irrigation by using four different irrigation/activation systems. After splitting the samples, one half of each root was selected for examination under scanning electron microscope (SEM). The irrigation systems were compared using the Fisher's exact test with the level of significance set at 0.05. The four groups did not differ from each other in the coronal and mid-root parts of the canal. In the apical part of the canal none of the methods coul...
Journal of Endodontics, 2010
Introduction: A final flush with chelating agents and antiseptic irrigating solutions is needed to remove the smear layer. The improvement of these protocols is possible by using specific delivery and agitation techniques. This study examined the effect of different final irrigation regimens and methods of activation on smear layer removal in curved canals after root canal instrumentation. Methodology: Mesial root canals of 50 extracted mandibular molars were prepared using ProTaper rotary files (Dentsply Maillefer, Ballaigues, Switzerland) and 3% NaOCl. Teeth were then allocated to two control groups and four experimental groups (n = 10) for final irrigation as follows: no-activation group (final rinse with a 27-gauge needle and 17% EDTA/3% NaOCl), manual-dynamic activation group (final rinse 17% EDTA/3% NaOCl + gutta-percha agitation), automated-dynamic activation group (final rinse 17% EDTA/3% NaOCl + RinsEndo [Dü rr Dental GmbH & Co KG, Bietigheim-Bissingen, Germany]), and sonicactivation group (final rinse 17% EDTA/3% NaOCl + Endoactivator [Advanced Endodontics, Santa Barbara, CA]). All mesial roots were split with a new approach to allow visualization of every third of the canal, particularly the apical third. The samples were prepared for scanning electron microscopic observation to assess the smear layer removal. Blind scoring was performed by two calibrated observers using a five-score scale. The differences in smear layer scores between the experimental groups were analyzed with the Kruskal-Wallis test and the Mann-Whitney U test. The level of significance was set at p = 0.05. Results: Very high levels of root canal cleanliness (#score 3) were found for each test group with activation. For the middle and apical third, the no-activation group was significantly less effective than the three other activation groups (p < 0.05). The manual-dynamic activation group (final rinse 17%EDTA/3%NaOCl + gutta-percha agitation) and the sonic-activation group (final rinse 17%EDTA/ 3%NaOCl + Endoactivator) showed significantly better smear layer removal (p < 0.05) in comparison with the other test groups in the apical third. Conclusion: Root canal cleanliness benefits from solutions activation (especially sonic activation and manual-dynamic activation) in comparison with no activation during the final irrigation regimen. (J Endod 2010;36:1361-1366
Journal of Advances in Medicine and Medical Research
Aim: The aim of this study was to compare and evaluate the effectiveness of three different irrigation solutions, namely Chloroquick, maleic acid, and a multi-step irrigation solution when used in combination with ultrasonics for the removal of smear layers in endodontic procedures. Materials and Methods: Sixty single-rooted teeth that had been freshly extracted were gathered, disinfected, and stored in distilled water. To ensure uniform root length, each tooth was coronally removed below the Cementoenamel Junction (CEJ). The working length was meticulously determined, and F3 Protaper rotary files were employed for the biomechanical preparation of the root canals. Subsequently, the teeth were randomly assigned to one of three groups for the irrigation process: Group A (Chloroquick), Group B (Maleic Acid 7%), and Group C (Multistep Irrigation approach). Following the preparation, longitudinal sections of the specimens were obtained and examined under a scanning electron microscope. T...
Advances in Clinical and Experimental Medicine
Background. After the mechanical preparation of a root canal, the canal walls are covered with a smear layer. In order to deeply clean the dentinal tubules, removal of the smear layer is recommended. There is no consensus on the length of time of rinsing with chelating agents or irrigation with alternating chelating agents and sodium hypochlorite (NaOCl). Objectives. The aim of the study was to evaluate the effectiveness of smear layer removal using 4 irrigation protocols. Material and methods. We prepared 42 straight root canals to size ISO40/04 and assigned them into 4 study groups (n = 10) and a control group (n = 2). The root canals were irrigated as follows: in the control group, 180 s with 5.25% NaOCl; in group 1, 60 s with 40% citric acid (CA) and 120 s with NaOCl; in group 2, 120 s with CA and 120 s with NaOCl; in group 3, 30 s CA, 30 s with NaOCl, 30 s CA and 120 s with NaOCl; and in group 4, 60 s with CA, 30 s with NaOCl, 60 s with CA, and 120 s with NaOCl. The roots were split longitudinally and the root canals were observed under ×200-500 magnification. The root canal walls were analyzed in areas 2 mm, 6 mm and 10 mm from the apex. Results. In the apical and medial sections, the best effects were achieved in groups 3 and 4. In coronal sections, no significant differences between experimental groups were found. Conclusions. Within the limitations of this study, it can be concluded that irrigation with alternating NaOCl and CA was the most effective at smear layer removal, regardless of the irrigation time.