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Abstract
BackgroundEfforts to improve the efficacy of smear layer removal by applying irrigant activation at the final irrigation or by elevating the temperature of the irrigant have been reported. However, the combination of such activation protocols with 60°C 3% sodium hypochlorite (NaOCl) has seldom been mentioned. The aim of this study was to compare the efficacy in smear layer removal of four different irrigation techniques combined with 60°C 3% NaOCl and 17% EDTA.MethodsFifty single-rooted teeth were randomly divided into five groups (n = 10) according to the irrigant agitation protocols used during chemomechanical preparation(Dentsply Maillefer, Ballaigues, Switzerland): a side-vented needle group, a ultrasonic irrigation (UI) group, a NaviTip FX group, an EndoActivator group, and a control group (no agitation). After each instrumentation, the root canals were irrigated with 1 mL of 3% NaOCl at 60°C for 1 minute, and after the whole instrumentation, the root canals were rinsed with 1 mL of 17% EDTA for 1 minute. Both NaOCl and EDTA were activated with one of the five irrigation protocols. The efficacy of smear layer removal was scored at the apical, middle and coronal thirds. The Data were statistically analyzed using SAS version 9.2 for Windows (rank sum test for a randomised block design and ANOVA).ResultsNo significant differences among the NaviTip FX group, EndoActivator group and control groups, and each of these groups showed a lower score than that of UI group (P < 0.05). Within each group, all three thirds were ranked in the following order: coronal > middle > apical (P < 0.05). In the coronal third, the NaviTip FX group was better than UI group. In the middle and apical third, the differences were not significant among any of the groups.ConclusionsEven without any activation, the combination of 60°C 3% NaOCl and 17% EDTA could remove the smear layer effectively, similar to NaviTip FX or EndoActivator, and these three protocols were more effective than UI. However, regardless of different types of irrigation technique applied, complete removal of the smear layer was not achieved, particularly in the apical third.
Highlights
Efforts to improve the efficacy of smear layer removal by applying irrigant activation at the final irrigation or by elevating the temperature of the irrigant have been reported
Even the combination of 60°C 3% NaOCl and 17% ethylenediaminetetraacetic acid (EDTA) was shown to be inadequate for complete clearance of the smear layer in one study [5]
Findings from the comparison of the efficacy of the five different irrigation protocols for smear layer removal are summarized in Figure 1 and Table 1
Summary
Efforts to improve the efficacy of smear layer removal by applying irrigant activation at the final irrigation or by elevating the temperature of the irrigant have been reported. The aim of this study was to compare the efficacy in smear layer removal of four different irrigation techniques combined with 60°C 3% NaOCl and 17% EDTA. The combined application of sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) has been recommended to remove both the organic and inorganic components of the smear layer effectively [2,4,5,6]. NaOCl is widely used in endodontic irrigation because of its antimicrobial activity and tissue-dissolving capability [7,8,9], which removes the organic component of the smear layer. EDTA, a decalcifying agent, removes the inorganic component of the smear layer [4,10,11,12]. Even the combination of 60°C 3% NaOCl and 17% EDTA was shown to be inadequate for complete clearance of the smear layer in one study [5]
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