Smear layer removal and antimicrobial efficacy of chitosan as a root canal irrigant: a systematic review of in-vitro studies.

This systematic review was designed to answer the following question: Does chitosan provide better smear layer removal and antimicrobial efficacy than other root canal irrigants? A literature search was done using electronic databases PubMed, Scopus, Web of Science, Cochrane Library, EBSCO host, Grey Literature Report, and Open Grey from inception to June 18, 2024. The reference lists of included articles were also hand-searched. Two reviewers independently assessed the studies' eligibility based on the inclusion and exclusion criteria and performed data extraction. Two reviewers independently evaluated the risk of bias in the selected studies. The search retrieved 2330 studies. After analysis, 36 studies fulfilled the eligibility criteria and were included, with 19 involving smear layer removal, 16 involving antibacterial efficacy, and 1 involving both. The overall risk of bias of the included studies was medium. Chitosan removed the smear layer more effectively than citric acid and acetic acid, similar to MTAD and Qmix, with conflicting results against EDTA. In addition, chitosan demonstrated comparable antibacterial efficacy to chlorhexidine, propolis, and photodynamic therapy but was less effective than sodium hypochlorite. Based on available evidence, it was found that chitosan provided better smear layer removal and antimicrobial efficacy than most root canal irrigants compared in this systematic review. There was substantial heterogeneity in the methodology of included studies. As a result, this review highly recommends further research using standardized methods to assess the effectiveness of chitosan as a root canal irrigant in in-vitro studies to validate its clinical use.

Comparative Evaluation of Different Methods of Activation of Chelating Solution for Smear Layer Removal in the Apical Portion of the Root Canal Using a Scanning Electron Microscopy: An In Vitro Study.

Background The smear layer has an adverse effect on the sealing of root canals during obturation, and it is the main reason for the failure of root canal treatment. Root canal irrigation using a conventional irrigation system is ineffective for smear layer removal, especially from the apical third region, where most lateral canals are present. For successful endodontic treatment, the smear layer should be removed from the apical third region using an effective irrigation activation system. Aim This study aimed to compare smear layer removal by conventional irrigation, XP Endo Finisher (XPF), endoactivator (EA), passive ultrasonic activation, and root canal brush using 17% ethylenediaminetetraacetic acid (EDTA) as a chelating solution and 5.25% sodium hypochlorite after chemomechanical preparation, using scanning electron microscopy (SEM). Method A total of 50 extracted human mandibular single canal premolars with mature roots were selected for this study. Samples were decoronated to obtain a standard working length (WL) of 15 mm. Canal patency was achieved using a 10 k file. Samples were sealed with sticky wax to obtain the vapor lock effect. Biomechanical preparation is done till F3. The samples were divided into five groups according to the final irrigation activation protocol: Group 1, control group; group 2, XPF; group 3, EA; group 4, passive ultrasonic irrigation (PUI); and group 5,, root canal brush. Samples were divided into two equal halves longitudinally. Each sample was analyzed for a smear layer under SEM at 2000x magnification. Statistical analysis was done using the one-way Anova "F" test and Tukey's post-hoc test. Results Group 3 showed the least presence of a smear layer, followed by groups 4, 2, 5, and 1. All the groups exhibited highly significant differences between each other (p < 0.001). Group B shows no significant difference with groups C, D, and E. Group C shows no significant difference with groups D and E. Group D shows no significant difference with group E. Conclusion The EA removes the smear layer effectively as compared with other groups. All the irrigation activation system shows the presence of smear layer. No activation systems were able to remove the smear layer completely.

Breakthrough in the Development of Endodontic Irrigants.

The three main components of endodontic success are three-dimensional obturation, pulp space sterilization, and biomechanical preparation. Instrumentation techniques are insufficient to accomplish complete disinfection of the pulp space. It is essential to use additional tools, such as endodontic irrigants. This review article aims to provide a general overview of the different root canal irrigants and their clinical uses. Endodontic treatment focuses more on removing infectious material from the root canal system to facilitate the healing of an existing periapical lesion or to prevent the periradicular tissues from being infected. It is important to note that instrumentation alone can reach every part of the root canal wall. Therefore, the irrigation procedure is a crucial aspect of endodontic therapy. Irrigation requires the application of various irrigants, like sodium and chlorhexidine, to get rid of debris, bacteria, and tissue leftovers. The accomplishment of root canal treatments counts heavily on the thoroughness of irrigation, contributing to optimal canal shaping and disinfection. Modern root canal irrigation systems incorporate syringes, needles, and advanced delivery mechanisms, including sonic and ultrasonic devices. These inventions aim to enhance the mechanical action of irrigants, reaching intricate canal anatomy more efficiently. Understanding the dynamics of root canal irrigation and staying abreast of technological advancements are essential for clinicians to achieve improved treatment outcomes in endodontic procedures.

Titanium Oxide and Chitosan Nanoparticles Loaded in Methylene Blue Activated by Photodynamic Therapy on Caries Affected Dentin Disinfection, Bond Strength, and Smear Layer Removal Efficacy.

AIM: Effect of nanoparticles (NPs) loaded methylene blue (MB) mediated photodynamic therapy (PDT) on caries-affected dentin (CAD) against S.mutans, smear layer (SL) elimination, and shear bond strength (SBS) of single bottle 7th generation adhesive. METHODOLOGY: Sixty human molars with carious lesions were selected. Samples were randomly allocated into four groups, based on the disinfection regime (n=11) Group 1-(CHX), Group 2-(MB-PDT), Group 3-(MB-CNPs-PDT), and Group 4-(MB-TiO2NPs-PDT). Following disinfection S.Mutans' survival rate was assessed using the pour plate method. Five specimens from each disinfection group were subjected to SL removal assessment using a scanning electron microscope (SEM). Bonding of 7th generation adhesive and composite restoration was performed on ten samples from each group. Artificial aging of the bonded samples was performed followed by SBS and failure mode analysis using a universal testing machine and stereomicroscope respectively. One-way analysis of variance (ANOVA) and Tukey post hoc test were used to analyze the data. RESULTS: Group 3 (MB-CNPs-PDT) treated CAD surface unveiled the lowest survival rate (0.12 ± 0.02 CFU/mL) of tested bacteria, maximum SL removal (1.21±0.35), and highest bond strength (13.42 ± 1.05). However, Group 1 (CHX) treated specimens displayed the highest survival rate (0.53 ± 0.11 CFU/mL) with the lowest SL removal (2.24±0.30) and SBS (8.88± 0.73 MPa). CONCLUSION: MB-CNPs-PDT appears to be a suitable alternative to CHX for CAD disinfection as it displayed better antibacterial efficacy, SL removal, and SBS with 7th generation single bottle adhesive.

Assessment of Smear Layer Removal and Push-Out Bond Strength Efficacy of Traditional and Herbal Root Canal Irrigants Across Different Root Levels: An In Vitro Study.

INTRODUCTION: Endodontic therapy requires meticulous root canal debridement, pathogen elimination, and effective obturation to prevent microbial intrusion. The presence of the smear layer hinders sealer penetration, compromising sealing effectiveness. Sodium hypochlorite and chlorhexidine are esteemed endodontic irrigants. Herbal extracts like neem and tulsi, with antimicrobial and anti-inflammatory properties, show promise for root canal irrigation. The study aimed to evaluate the efficacy of various irrigants in removing the smear layer and enhancing push-out bond strength at different root canal levels. MATERIALS AND METHODS: One hundred mandibular premolars with single canals were collected, and 50 samples each were used for the smear layer and push-out bond strength analysis. Neem and tulsi extracts were prepared for irrigation. Teeth were decoronated, and up to 30 (6%) canals were prepared and were randomly divided into five groups based on irrigants used. A smear layer examination was conducted after longitudinally sectioning the tooth and sections were observed in a scanning electron microscope (SEM). Obturation was done in the remaining samples, and the push-out bond strength was assessed using a universal test machine. RESULTS: Sodium hypochlorite showed the highest smear layer removal efficacy followed by chlorhexidine, neem, tulsi leaves with rose water extract, and normal saline. Chlorhexidine exhibited the highest push-out bond strength, with the coronal third presenting the strongest values, followed by neem, tulsi with rose water, normal saline, and sodium hypochlorite. CONCLUSION: The study underscores the potential of herbal irrigants in endodontic therapy, indicating promising results while emphasizing the necessity for further clinical trials to validate their efficacy and other properties.

Effectiveness of chitosan nanoparticles, and novel chemical irrigants with surfactant on smear layer removal and microhardness alteration.

Objective: This current study was designed to compare and correlate between smear layer eradication and reduction in microhardness by natural 0.2%chitosan nanoparticles and novel chemical irrigants with surfactant at the apical root third. Materials and method: One hundred and twenty straight single-rooted extracted lower premolars were decoronated and working length obtained with #10 K-file. Pro-taper rotary files were used till apical size F3. The canals were simultaneously flushed with assigned irrigant containing surfactant [(ChX-Ultra, NaOCl-Extra, Pro-EDTA, 0.2%chitosan nanoparticles, Biopure MTAD]. The samples were randomly divided into two equal groups (n = 60). InGroup S (n = 60), the residual smear layer was examined by scanning electron microscope and in Group M(n = 60) microhardness was determined by Vickers Microhardness Tester. Further both groups were divided into six equal groups (n = 10 each) according to assigned irrigating solutions.For smear layer removal; Kruskal-Wallis tests followed by pair wise comparison using Mann Whitney U test was done. For change in microhardness ANOVA and post hoc Tukey tests was done. Results: Maximum smear layer removal was recorded in Biopure MTAD (1.8 ± 0.63), followed by pro-EDTA (2.2 0 ± 0.63) then 0.2%chitosan (2.6 ± 0.51), then NaOCL Extra (3.5 ± 0.53)and least in CHX-Ultra (4.4 ± 0.52) and saline (5.0 ± 0.00). Pro-EDTA group (12.8 ± 2.47) revealed significant highest reduction in microhardness followed by Biopure MTAD (8.01 ± 3.06), 0.2%chitosan nanoparticles (5.48 ± 2.87), NaOCl-Extra (5.44 ± 1.62) and least recorded in CHX-Ultra (4.94 ± 1.43) and saline (3.04 ± 0.63). Conclusion: The elimination of the smear layer is always accompanied by a reduction in microhardness. Moreover, irrigant with surfactant and chelators enhanced smear layer removal, with best perceived in Biopure MTAD.

Effect of Laser Treatment of Root Dentine on Retention of Dental Fiber Post in Endodontically Treated Teeth: An In Vitro Study.

Introduction: The most common causes of fiber post-failure are inadequate restorations and dislodgement. This study aimed to evaluate fiber post-bond strength to dentin following Er,Cr:YSGG laser irradiation. Methods: A total of 65 human mandibular premolars with single roots were included. The 14 mm root length was instrumented with the rotary system using the crown-down technique. Gutta-percha was used for obturation, followed by conventional post space preparation. The samples were divided into two major groups: control (A) and Er,Cr:YSGG (2780 nm) laser group (B). The laser group was subdivided into (B1) 1.25 W, (B2) 1.5 W, and (B3) 1.75 W. All laser groups were set at 20 Hz, 10% and 30% water/air ratio. Fiber posts were cemented with selfadhesive cement. Each sample was divided horizontally into two slices, coronal and apical. The universal testing equipment was used to conduct a push-out test. All groups were examined by SEM and temperature changes. The statistical analysis was performed by using one-way ANOVA and Tukey HSD tests. Results: SEM images of all laser groups revealed the elimination of the smear layer and opened dentinal tubules, which was particularly noticeable in the apical region with no thermal risk to the periodontal tissue. In the push-out test, all laser groups had highly significant (P<0.001) increases in the bond strength of fiber post to dentin. The failure mode of the control group was a predominantly adhesive failure, whereas the laser groups were a predominantly mixed type. Conclusion: The three laser protocols can be used safely in the surface treatment of the fiber post space of endodontically treated teeth. Laser help to increase the bond strength of fiber post to dentin, especially in the apical area.

Root surface biomodification in periodontal therapy: Biological rationale and clinical applications.

Regenerative periodontal therapy aims to form new cementum, periodontal ligament, and alveolar bone, all sealed by gingival tissue. The root surface acts as the wound margin during this regeneration process. Root surface biomodification (root conditioning/root decontamination), therefore, seems instrumental in promoting surface decontamination and enhancing tissue attachment by removing the smear layer, exposing collagen fibrils, and facilitating blood clot formation and stabilization. This review attempted to provide an all-encompassing, evidence-based assessment of the role of root surface biomodification in regenerative periodontal therapy, particularly in intrabony defects, furcation defects, and root coverage procedures. The reviewed evidence suggested that root conditioning agents, whether used independently or in conjunction with bone graft materials, biological agents, membranes, or connective tissue grafts, do not offer any clinical advantage regarding clinical attachment gain. Thus, integrating chemical methods with the mechanical root instrumentation process does not necessarily contribute to superior clinical outcomes.

Assessment of Smear Layer Removal and Penetration Depth of Root Canal Irrigant Using Different Irrigation Activation Systems: A Comparative Study.

AIM: The aim of the current study was to evaluate the penetration depth and smear layer removal of root canal irrigant using various irrigation activation techniques. MATERIALS AND METHODS: In this investigation, sixty single-rooted premolars extracted for orthodontic purposes were chosen. Diamond burs were used to create an access cavity, and #10 K-file was used to determine the patency. About sixty samples were divided into the following three groups (20 samples in each group), group I: Irrigation with conventional needle, group II: Activation of EndoVac system, group III: Passive ultrasonic irrigation (PUI). The efficacy of the smear layer was assessed using a scanning electron microscopy at a ×2000 magnification. One-way ANOVA was used to record and analyze the data. All statistical analyses were performed with a significance level of p < 0.05. RESULTS: At coronal third, the maximum smear layer was removed in group II (1.26 ± 0.02) followed by group III (1.84 ± 0.16) and group I (2.89 ± 0.21). At middle third, smear layer removal was maximum in group I (1.18 ± 0.10) followed by group III (1.72 ± 0.09) and group I (2.66 ± 0.18). At apical third, the more smear layer was removed in group II (1.02 ± 0.01) followed by group III (1.58 ± 0.08) and group I (2.38 ± 0.06). There was a highly significant difference found between the three different irrigation systems at all three levels (p < 0.001). CONCLUSION: In conclusion, every irrigation device that was evaluated was successful in removing the smear layer from the root canal. However, the EndoVac system group removed a greater amount of smear layer compared with PUI and conventional needle group. CLINICAL SIGNIFICANCE: With the goal of promoting cleaning that is beyond the ability of mechanical devices, irrigation is a crucial part of root canal therapy. If an efficient irrigation delivery system is used, the irrigants can reach the working length (WL). This type of distribution system needs to provide a suitable amount of irrigants up to the WL, as well as have enough flow and be effective at debriding the entire canal system. How to cite this article: Pujari MD, Das M, Das A, et al. Assessment of Smear Layer Removal and Penetration Depth of Root Canal Irrigant Using Different Irrigation Activation Systems: A Comparative Study. J Contemp Dent Pract 2024;25(4):331-334.

Evaluation of the Smear Layer Removal Ability of Various Rotary Files with/without Chemical Agents on Primary Teeth: An In Vitro Study.

AIM: The aim of the current study was to assess the cleaning and smear layer removal efficacy of two different rotary files with or without chemical agents on primary teeth. MATERIALS AND METHODS: For the study, 90 extracted primary maxillary incisors without internal or external resorption and with at least two-thirds of complete roots were chosen. Then, based on the kind of instruments used to clean and shape the canals, they were randomly assigned to three experimental groups, each consisting of 30 teeth. Group-I: The canal was instrumented manually with K-files, Group-II: The canal was instrumented with Kedo-S files, Group-III: The canal was instrumented with Kedo-SG Blue files. After the canals were finally instrumented, 2 mL of QMixTM solution was used to irrigate 15 samples from each group. The samples were subsequently allowed to remain in the canals for 90 seconds in order to eliminate the smear layer. After that a stereomicroscope was used to assess the cleaning effectiveness. RESULTS: With irrigant solution, the highest mean value was found in manual K-files (2.86 ± 0.34), followed by Kedo-S files group (1.34 ± 0.26) and Kedo-SG Blue files (1.28 ± 0.18). Without irrigant solution, the highest mean value was found in manual K-files (2.92 ± 0.22) followed by Kedo-S files group (1.44 ± 0.18) and Kedo-SG Blue files (1.36 ± 0.14). There was a statistically significant difference found at all the three levels. CONCLUSION: On conclusion, the current study's findings demonstrated that irrigation solution was significantly more effective in cleaning and removing smear layers from pediatric rotary files than manual K-files. CLINICAL SIGNIFICANCE: The effectiveness of endodontic therapy depends on a successful chemomechanical preparation. The canals are instrumented using either hand files or rotary instruments; there are several irrigation and instrumentation techniques. In order to completely sterilize the canals, chemical agents are utilized for irrigation during instrumentation. Due to their numerous biological, antibacterial, anti-inflammatory, and antioxidant qualities, many natural compounds are also utilized as irrigants. How to cite this article: Abushanan A. Evaluation of the Smear Layer Removal Ability of Various Rotary Files with/without Chemical Agents on Primary Teeth: An In Vitro Study. J Contemp Dent Pract 2024;25(4):354-357.

Scanning electron microscopic analysis of 5% glycolic acid as a novel alternative to 17% ethylenediaminetetraacetic acid in root biomodification: An in vitro study.

Background: Nonsurgical periodontal therapy results in the formation of a smear layer which inhibits tissue regeneration. Root biomodification (RB) using various agents has been tried for the enhancement of new attachment formation. However, no substantial therapeutic advantages of currently available root conditioning agents have been reported emphasizing the need for additional biologically acceptable agents. Glycolic acid (GA) due to its antimicrobial nature and ability of initiation and proliferation of fibroblasts may potentially modify root surface enabling regeneration. Materials and Methods: Eighty specimens from 40 single-rooted teeth were treated with 17% ethylenediaminetetraacetic acid (EDTA) and 5% GA and scanning electron microscopy analysis was done. The micrographs were examined for the evaluation of smear layer removal, total number of dentinal tubules, total number of patent dentinal tubules, mean diameter and surface area of dentinal tubules, and dentin erosion. Statistical analysis was done using unpaired t-test for intergroup comparison. Results: The efficacy of smear layer removal (P = 0.01) and dentin erosion (P = 0.042) was significantly better in the GA group. Both the groups showed no difference in dentinal tubule-related parameters. Conclusion: GA showed improved RB with greater smear layer removal and lesser dentin erosion, indicating its use as a potent alternative to the conventional EDTA root conditioning.

Cerium- and samarium-nitrate interaction and accumulation on human dentin.

OBJECTIVE: To investigate the accumulation of cerium-nitrate and samarium-nitrate on dentin without or with smear-layer and to test their antibacterial activity. DESIGN: 24 dentin-enamel slices were cut from 24 extracted molars. 12 slices underwent smear-layer creation (320 grit, 200 g, 5 s), the other 12 smear-layer removal (20 % EDTA, 300 s). Slices were halved to 48 semilunar-shaped specimens. One specimen per tooth was treated with either Ce(NO3)3 (50 wt% aqueous solution; pH = 1.29; n = 6) or Sm(NO3)3 (50 wt% aqueous solution; pH = 1.88; n = 6). The other specimen served as control (A. demin). After water rinsing, elemental composition (Ce, Sm, Ca, P, O, N, Na, Mg, C) was measured (EDX; EDAX Octane-Elect, APEX v2.5, low-vacuum) in dentin. Atomic percent (At%), Ca/P- and Ca/N-ratios were calculated and analyzed non-parametrically (α = 0.05, error rates method). Additionally, antibacterial activity (2 min exposure) of Ce(NO3)3 and Sm(NO3)3 against Streptococcus mutans, Actinomyces naeslundii, Schaalia odontolytica, and Enterococcus faecalis was determined (colony forming units) after anaerobic incubation at 37 °C for 24 h (control: 0.2 % CHX). RESULTS: At% (median) of Ce and Sm were as follows: Ce(NO3)3 3.4 and 0.9 At%Ce with and without smear-layer, respectively; Sm(NO3)3 2.4 and 1.3 At%Sm with and without smear-layer, respectively. Ce(NO3)3 and Sm(NO3)3-application significantly decreased Ca/P-ratios (1.22 - 1.45; p ≤ 0.02) compared to controls (1.47 - 1.63). With smear-layer, significantly higher Ca/N-ratios (5.1 - 29.3) could be detected across all groups (p ≤ 0.004) compared to specimens without smear-layer (0.37 - 0.48). Ce(NO3)3 and Sm(NO3)3 showed reduction rates of up to ≥ 5 log10 steps for S. mutans, A. naeslundii, and S. odontolytica. CONCLUSIONS: Cerium and samarium nitrate showed accumulation on dentin and certain antibacterial activity and could therefore be identified as potential compounds to treat and prevent dentin and root caries and dentin hypersensitivity.

Effect of Chitosan Irrigant and Lubricating Gel on Bond Strength of Resin Sealer to Radicular Dentin: An In Vitro Study.

BACKGROUND: The adhesive strength of sealers to dentin is influenced by various factors, and the presence of a smear layer is among the critical variables. Chitosan, known for its dentin compatibility, has previously demonstrated a reduction in dentin change and resin sealer bond strength comparable to ethylenediaminetetraacetic acid (EDTA) when used as an irrigant and final rinse. The study investigates the impact of chitosan, used as both a lubricating gel and final rinse, on the push-out bond strength of resin sealer. MATERIALS AND METHOD: Forty single-rooted premolar teeth, each with a fully formed root and a single root canal, were collected post-extraction. During canal preparation, 1 ml sodium hypochlorite (3%) was used for irrigation at every change of instrument, followed by applying specific chelating gel and final rinse for each experimental group. The groups included: Group 1 (17% EDTA chelating gel, final rinse with saline), Group 2 (17% EDTA chelating gel, final rinse with 17% EDTA solution), Group 3 (chitosan chelating gel, final rinse with saline solution), and Group 4 (chitosan chelating gel, final rinse with 0.2% chitosan solution), 10 specimens in each group. After obturation, specimens were sealed and incubated for a week at 37°C with 100% humidity. The universal testing machine was used for push-out tests, and specimens were examined using a scanning electron microscope (SEM) to identify various types of bond failure. RESULTS: Among the four groups, Group 2 exhibited the highest mean push-out bond strength (7.33 ± 0.26 MPa), followed by Group 4 (5.33 ± 0.25 MPa), Group 1 (4.61 ± 0.30 MPa), and Group 3 (2.94 ± 0.32 MPa). The variations in bond strength suggest a notable impact of the chelating agents and final rinse solutions on the resin sealer's interaction with dentin. CONCLUSION: The study concludes that the use of EDTA as both a lubricating gel and a final rinse significantly enhances push-out bond strength, outperforming chitosan in this study. Groups with saline as the final rinse (Group 1 and Group 3) exhibited the least bond strength, highlighting the importance of the final rinse in root canal therapy.

Impact of different agitation methods on smear layer cleaning of mesial canals with accentuated curvature.

Objectives: This study evaluated the impact of different methods of irrigant agitation on smear layer removal in the apical third of curved mesial canals of 3 dimensionally (D) printed mandibular molars. Materials and Methods: Sixty 3D-printed mandibular second molars were used, presenting a 70° curvature and a Vertucci type II configuration in the mesial root. A round cavity was cut 2 mm from the apex using a trephine of 2 mm in diameter, 60 bovine dentin disks were made, and a smear layer was formed. The dentin disks had the adaptation checked in the apical third of the teeth with wax. The dentin disks were evaluated in environmental scanning electron microscope before and after the following irrigant agitation methods: G1(PIK Ultrasonic Tip), G2 (Passive Ultrasonic Irrigation with Irrisonic- PUI), G3 (Easy Clean), G4 (HBW Ultrasonic Tip), G5 (Ultramint X Ultrasonic tip), and G6 (conventional irrigation-CI) (n = 10). All groups were irrigated with 2.5% sodium hypochlorite and 17% ethylenediaminetetraacetic acid. Results: All dentin disks were 100% covered by the smear layer before treatment, and all groups significantly reduced the percentage of the smear layer after treatment. After the irrigation protocols, the Ultra-X group showed the lowest coverage percentage, statistically differing from the conventional, PIK, and HBW groups (p < 0.05). There was no significant difference among Ultramint X, PUI-Irrisonic, and Easy Clean (p > 0.05). None of the agitation methods could remove the smear layer altogether. Conclusions: Ultramint X resulted in the most significant number of completely clean specimens.

Canal disinfection using Nd: YAG Laser, synchronized microbubble-photodynamic activation, and carbon quantum dots on microhardness, smear layer removal, and extrusion bond strength of zirconia post to canal dentin. An invitro scanning electron microscopic analysis.

Evaluation of the impact of the latest root canal disinfectant, that is carbon quantum dots (CQDs), synchronized microbubble-photodynamic activation (SYMPA), and Nd: YAG laser along with ethylenediaminetetraacetic acid (EDTA) as a final irrigant on the Marten hardness (MH), smear layer (SL) removal, and extrusion bond strength (EBS) of zirconia post to the canal dentin. Eighty intact single-rooted premolars were obtained and disinfected using 0.5% chloramine-T solution. Root canal preparation was performed using ProTaper files followed by obturation. The post space was prepared for prefabricated zirconia post and all the teeth were randomly divided into four groups based on the disinfection used (n = 20 each) Group 1: 5.25% NaOCl + 17% EDTA (Control), Group 2: Nd: YAG laser + 17% EDTA, Group 3: SYMPA + 17% EDTA, and Group 4: CQDs + 17% EDTA. MH, SL removal, and EBS of zirconia post-bonded to root dentin were performed using a microhardness tester, scanning electron microscope (SEM), and universal testing machine, respectively. Both intragroup and intergroup comparisons were performed using one-way analysis of variance (ANOVA) and posthoc-Tukey test for significant difference (p < .05). Group 2 samples (Nd: YAG laser + 17% EDTA) (0.24 ± 0.06 GPa) exhibited highest values of MH. Samples in group 3 (SYMPA + 17% EDTA) treated teeth unveiled the lowest MH scores (0.13 ± 0.02 GPa). Moreover, the coronal third of Group 3 specimens (SYMPA and 17% EDTA) (1.54 ± 0.31) eliminated SL from the canal with the greatest efficacy as well as presented the highest EBS (10.13 ± 0.69 MPa). However, the apical third of Group 1 samples (5.25% NaOCl + 17% EDTA) (2.95 ± 0.33) exhibited the least efficient elimination of SL from the radicular dentin as well as the lowest bond strength (5.11 ± 0.19 MPa) of zirconia post to the dentin. The SYMPA technique with 17% EDTA proved highly effective in removing the SL from canal dentin and enhancing the EBS of zirconia posts. The least preferable method for SL removal and MH improvement was found to be 5.25% NaOCl + 17% EDTA. CQDs and Nd: YAG laser demonstrated satisfactory smear layer removal properties from the canal, along with achieving appropriate bond strength of zirconia posts. RESEARCH HIGHLIGHTS: Nd: YAG laser and 17% EDTA as canal disinfectant exhibited the highest values of MH. Specimens irrigated with SYMPA and 17% EDTA eliminated SL from the canal with the greatest efficacy. The coronal third of Group 3 (SYMPA + 17% EDTA) samples unveiled the highest zirconia post-bond integrity score to the canal dentin. Cohesive failure was a dominant failure type among different experimental groups.

High-Intensity Focused Ultrasound in Dentistry: A Literature Review.

Although high-intensity focused ultrasound (HIFU) has been applied widely in medicine, utilising its non-invasive dual ablation and thermal coagulation properties, its application in dentistry has primarily remained in the research phase, predominantly in in vitro studies. Nonetheless, there has been a consistent increase in the number of publications on this subject in recent decades, focusing on areas such as remineralisation of dentine surfaces, removal of smear layers, drug delivery, and microbial elimination. The number of advantages HIFU can offer, such as its non-surgical nature, absence of ionising radiation, lack of residue, and absence of aerosols, is driving this upward trend, indicating the potential for HIFU in clinical dentistry and ongoing efforts towards developing HIFU-based devices for routine dental use. This succinct review aims to outline the historical context, operational mechanisms of HIFU, summarise recent dental research, and provide a forward-looking perspective on the role of HIFU in modern clinical dentistry.

A Comparative Evaluation of Efficacy of Root Surface Biomodification using MTAD, MTAD+I-PRF on Adhesion of Fibrin Clot to Dentin Sem Study.

Root biomodifiers help in removing the smear layer following mechanical debridement. In this context, we evaluated and compared the in vitro efficacy of MTAD, MTAD+I-PRF, and phosphate-buffered saline-conditioned dentin surfaces by examining the distribution of the fibrin network using scanning electron microscopy. It was concluded that MTAD can serve as a potentially useful root conditioner/biomodifier. Further, the adjunct of MTAD+I-P resulted in more fibrin network linkage on the dentinal surface when compared to MTAD alone which can be of great utility in Advanced Regenerative Therapy.

Comparative evaluation of smear layer removal by using different irrigant activation techniques: An in vitro scanning electron microscopic study.

Aim: This in vitro study aims to assess and compare the effectiveness of different irrigation activation techniques in removing the smear layer from the root canal dentin using Scanning electron microscope (SEM) analysis. Materials and Methods: A total of 60 extracted single-rooted premolar with straight canal and mature apex were used for this study. After the selection of teeth, all the samples were decoronated followed by biomechanical preparation. The sample after preparation was irrigated with sodium hypochlorite and randomly divided into three groups with 20 sample in each group (n = 20), (Group 1) control, (Group 2) ultrasonic, and (Group 3) laser. The irrigant activation was done in all the groups and then sample was prepared for the scanning electron microscope analysis. Statistical Analysis: The statistical analysis was performed using the Mann-Whitney-U-test. Results: The findings suggested that the diode laser irrigant activation technique was superior to the ultrasonic and conventional techniques to eradicate smear layers. Conclusion: With the limitation of this study, diode laser activation showed better cleaning of root dentinal walls compared to ultrasonic activator and traditional method.

Glycolic acid on push-out bond strength of fiber post and smear removal: an in vitro study.

This study aims to investigate glycolic acid (GA) as a final irrigant on push-out bond strength of fiber post and smear removal. Ninety mandibular premolars were stabilized with a silicone key and photographed, and canal cross-section was calculated by image processing software. Round canal morphology was selected. The specimens were divided into five groups (n = 18); 10%GA, 17%EDTA, NaOCl + 10%GA, NaOCl + 17%EDTA, and the control. Fifteen specimens were used for the push-out. Three specimens were evaluated using a scanning electron microscope after post space preparation. Two-way ANOVA and Chi-square were used for statistics. GA presented higher strength than EDTA (p < 0.05). The NaOCl + GA showed higher strength than the NaOCl + EDTA (p < 0.05). The highest values were observed in cervical and lowest in apical thirds (p < 0.05). The most failure type was between dentin and resin (p < 0.05). GA removed the smear in the post space including the apical third. The NaOCl + GA has superiority to NaOCl + EDTA on push-out strength. Glycolic acid improved the bond strength of fiber post when used as a final post space irrigant. The combination of NaOCl and glycolic acid did not negatively affect the bond strength and was more effective compared to the combination with EDTA. Glycolic acid improved the bond strength of fiber post when used as a final post space irrigant. The combination of NaOCl and glycolic acid did not negatively affect the bond strength and was more effective compared to the combination with EDTA.

Assessment of the Smear Layer Removal Efficacy of Three Different Agents on Periodontally Compromised Tooth: An In Vitro Study.

AIM: The purpose of the present study was to evaluate the smear layer removal efficacy of three various agents on periodontally compromised tooth. MATERIALS AND METHODS: The current study included 75 molar teeth that were extracted due to periodontal disease. After that, 25 samples were randomly assigned using a simple random technique to the three different agent groups, group A: Scaling and root planing (SRP) and application of SofScale agent, group B: SRP and application of QMix agent, group C: SRP and application of MTAD agent. Using a diamond circular saw, the treated portions were divided into horizontal and vertical halves. All samples were viewed under Scanning Electron Microscope. Every tooth was focused at the coronal third, middle third, and apical third portion with a magnification of 1000×. Data were recorded and statistically analyzed. RESULTS: The smear layer removal efficacy was more in the QMix agent (3.06 ± 0.04) group followed by MTAD agent (3.28 ± 0.09) and SofScale agent (4.14 ± 0.10) group on the root surface. On intra group comparison, there was a statistically significant difference found in all the intra group agents with all the three levels. On inter group evaluation, at coronal third, there was no significant difference found between the different agents. There was a significant difference found between the different agents at middle and coronal third. CONCLUSION: On conclusion, the current investigation found that, the root surfaces treated with QMix shown a greater ability to remove smear layers compared to tooth surfaces treated with MTAD and SofScale agent. CLINICAL SIGNIFICANCE: Conventional therapies such as SRP effectively eliminate calculus, plaque, and necrosed cementum; nevertheless, they leave behind a smear layer that could impede normal healing. In an effort to overcome this, root conditioning agents were applied on the root surface to remove the smear layer. The traditional root conditioning agents such as citric acid have certain disadvantages, though, such as an acidic pH that could harm the root surface. As a result, researchers have been looking for biocompatible root conditioning treatments that are more effective. How to cite this article: Singh DK, BS Raj H, Soans CR, et al. Assessment of the Smear Layer Removal Efficacy of Three Different Agents on Periodontally Compromised Tooth: An In Vitro Study. J Contemp Dent Pract 2024;25(2):156-159.