Influence of Root Canal Tapering on Smear Layer Removal.

The purpose of the study presented here was to compare the influence of root canal taper on the efficacy of irrigants and chelating agents in smear layer removal. Eighty mesial roots of molar teeth were selected and prepared with rotary instruments. In group A, file 30/0.02 and in group B, file 30/0.4 were placed at working length and the smear layer was removed. In groups C and D, root canal preparation was the same as in groups A and B, respectively, except that the smear layer was not removed. The amount of the smear layer was quantified using a scanning electron microscope. Greater smear layer was detected in the apical portion of each group, whereas no significant difference was detected between groups in other portions. No statistical difference was found between canals with different tapers.

Effectiveness of final irrigant protocols for debris removal from simulated canal irregularities.

INTRODUCTION: The aim of this in vitro study was to compare the effectiveness of saline, 2.5% sodium hypochlorite, and 2% chlorhexidine, with or without passive ultrasonic irrigation (PUI), in debris removal from simulated canal irregularities within prepared root canals. METHODS: Ninety bovine lateral incisors were randomly divided into 3 main groups (n = 30) based on the irrigant and prepared with hand files attached to an oscillating handpiece (NSK, Tokyo, Japan) up to a size #80 K-file. Next, the teeth were split longitudinally, and a standardized groove was prepared into the apical third and filled with dentin debris. After the halves were reassembled, they were placed in a muffle. Each main group was randomly subdivided into 2 groups (n = 14) and was treated with different final irrigation protocols. In the sodium hypochlorite/PUI, chlorhexidine/PUI, and saline/PUI groups, the solution was ultrasonically activated 3 times for 20 seconds. In the remaining groups, PUI was not performed. Specimens were scored for debris removal and analyzed under a scanning electron microscope. RESULTS: An association was observed between the score of debris removal and protocols using PUI (P < .05). No association was observed between the scores of debris removal and the irrigants (P = .87). CONCLUSIONS: Final irrigation protocols that used PUI were more effective in removing debris from simulated canal irregularities into the apical third than those that did not use it.

Activation of ethylenediaminetetraacetic acid by a 940 nm diode laser for enhanced removal of smear layer.

Laser enhancement of ethylenediaminetetraacetic acid with cetrimide (EDTAC) has previously been shown to increase removal of smear layer, for middle-infrared erbium lasers. This study evaluated the efficiency of EDTAC activation using a near-infrared-pulsed 940 nm laser delivered by plain fibre tips into 15% EDTAC or 3% hydrogen peroxide. Root canals in 4 groups of 10 single roots were prepared using rotary files, with controls for the presence and absence of smear layer. After laser treatment (80 mJ pulse(-1) , 50 Hz, 6 cycles of 10 s), roots were split and the apical, middle and coronal thirds of the canal were examined using scanning electron microscopy, with the area of dentine tubules determined by a validated quantitative image analysis method. Lasing EDTAC considerably improved smear layer removal, while lasing into peroxide gave minimal smear layer removal. The laser protocol used was more effective for smear layer removal than the 'gold standard' protocol using EDTAC with sodium hypochlorite (NaOCl). In addition, lasers may also provide a benefit through photothermal disinfection. Further research is needed to optimise irrigant activation protocols using near-infrared diode lasers of other wavelengths.

Efficacy of four different irrigation techniques combined with 60 °C 3% sodium hypochlorite and 17% EDTA in smear layer removal.

BACKGROUND: 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. 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. METHODS: Fifty 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). RESULTS: No 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. CONCLUSIONS: Even 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.

Effects of different sonic activation protocols on debridement efficacy in teeth with single-rooted canals.

OBJECTIVES: The effects of different EndoActivator® (EA) sonic activation protocols on root canal debridement efficacy were examined. METHODS: Root canals in 48 single-rooted teeth were instrumented, irrigated initially with NaOCl and divided into 6 groups (N=8) based on the application time of QMix (antimicrobial calcium-chelating irrigant), and the time and sequence of EA irrigant activation - Positive Control: 90s QMix; Negative Control: 90s saline; Group 1A: 15s QMix+15s QMix with EA-activation; Group 1B: 30s QMix+30s of QMix with EA-activation; Group 2A: 15s QMix with EA-activation+15s QMix; Group 2B: 30s QMix with EA-activation+30s QMix. Split roots were examined with scanning electron microscopy for assignment of smear and debris scores in locations along the coronal, middle and apical thirds of the canals. The overall cleanliness of pooled canal locations in the Positive Control and the 4 experimental groups were compared with chi-square tests. RESULTS: Significant differences were detected among the 5 groups (P<0.001). Post hoc pairwise comparisons indicated that the overall canal cleanliness was in the order (from best to worst): 1B=2B>2A>1A>Positive Control. Completely clean canals could not be achieved due to the absence of continuous irrigant flow for EA to clear intraradicular debris. CONCLUSIONS: Irrespective of the sonic activation sequence, irrigant activation for 30s during a 60-s period of QMix application appears to maximise the smear layer and debris removal potential of the EndoActivator® system. CLINICAL SIGNIFICANCE: Sonic activation of root canal irrigants produces cleaner root canals and reduces the time required for final delivery of a canal wall smear later-removing irrigant when compared to the use of needle irrigation alone.

Comparison of the efficacy of Smear Clear with and without a canal brush in smear layer and debris removal from instrumented root canal using WaveOne versus ProTaper: a scanning electron microscopic study.

INTRODUCTION: The aim of this study was to compare by scanning electron microscopy the presence of smear layer and debris on root canal walls after preparation with the single-file system WaveOne (Dentsply Maillefer, Ballaigues, Switzerland) versus the rotary ProTaper system (Dentsply Maillefer, Ballaigues, Switzerland) under 2 final irrigant regimens. METHODS: Forty freshly extracted single-rooted human teeth were randomly divided into 4 groups (n = 10). The ProTaper and ProTaper and rotary CanalBrush (Coltène Whaledent GmbH+ Co KG, Langenau, Germany) groups were instrumented with the ProTaper system. Groups WaveOne and WaveOne and rotary CanalBrush were instrumented with the WaveOne system. The irrigant in all groups was 2 mL 5.25% sodium hypochlorite (NaOCl) solution, whereas the final irrigation after preparation in the ProTaper and WaveOne groups was 1 mL Smear Clear solution (Sybron Endo, Orange, CA) and then 5.25% NaOCl applied with a plastic syringe, and in the ProTaper and rotary CanalBrush and WaveOne and rotary CanalBrush groups, it was 1 mL Smear Clear solution and then 5.25% NaOCl (rotary CanalBrush agitation). Roots were processed for scanning electron microscopic examination for debris and smear layer scoring. Data were statistically analyzed. RESULTS: All groups showed more efficient smear layer and debris removal coronally than in the middle and apical regions, whereas the mean total debris score and the mean smear layer score in all groups were less in the WaveOne and rotary CanalBrush groups than the ProTaper and rotary CanalBrush and the WaveOne and ProTaper groups. CONCLUSIONS: Using the rotary CanalBrush in canals prepared with WaveOne produced the cleanest canal walls, and the WaveOne system gave superior results compared with the ProTaper system.

The effects of ageing on the biomechanical properties of root dentine and fracture.

OBJECTIVES: Knowledge of the mechanical behaviour of root dentine can facilitate better understanding of spontaneous vertical root fracture (VRF), an age-related disease initiated mainly at the root apex. We tested the hypothesis that the biomechanical properties of root dentine change with ageing. METHODS: Sixteen human premolars were divided into "old" (17-30 years) and "young" (50-80 years) groups. The elastic modulus, nano-hardness, micro-hardness, elemental contents, tubular density/area of root dentine in cervical, middle and apical root regions were evaluated using atomic force microscopy-based nano-indentation, Knoop indentation, scanning electron microscopy and energy dispersive X-ray spectroscopy, respectively. RESULTS: The apical dentine showed a lower nano-hardness, a lower elastic modulus, a lower calcium content, a lower calcium-to-phosphorus ratio and a smaller tubular density/area than the cervical dentine in both age groups, whereas spatial differences in micro-hardness were observed only in old roots. Compared with young dentine, old dentine showed a greater hardness, a higher elastic modulus, a greater mineral content and a smaller tubular size in the cervical portion, whereas the age-induced changes in tubular density were insignificant. Finite element analysis revealed that due to its higher elastic modulus, old apical dentine has a higher stress level than young dentine. CONCLUSIONS: The intrinsic material properties of root dentine have spatial variations, and they are altered by ageing. The higher stress level in old apical dentine may be one reason, if not the most important one, why spontaneous VRFs are more likely to occur in the elderly population.

Scanning electron microscopic analysis to compare the cleaning efficiency of three different irrigation systems at different root canal levels: an in vitro study.

AIM: This study compared the efficacy of conventional, endovac and ultrasonic irrigation system for the removal of debris from root canal walls, using scanning electron microscopy (SEM) at cervical, middle and apical 3rd. MATERIALS AND METHODS: A total of 30 freshly extracted human mandibular premolars with complete root formation were selected and divided into group 1 endovac, group 2 conventional and group 3 ultrasonic. After instrumentation and irrigation, the teeth were sectioned in buccolingual direction and analyzed by SEM and the results were analyzed statistically by students unpaired 't' test. RESULTS: There was significant difference between mean values of cervical (CV), middle (M), and apical (A) when endovac compared with conventional and conventional compared with ultrasonic group (i.e. < 0.05) and no significant difference between mean values at CV, M and A when endovac compared with ultrasonic group. CONCLUSION: Among all groups ultrasonic and endovac group showed cleaner canal walls and less amount of debris than conventional group. CLINICAL SIGNIFICANCE: Application of ultrasonic and endovac can be used effectively for irrigation of canals leading to least debris and better prognosis.

Effect of agitation of EDTA with 808-nanometer diode laser on removal of smear layer.

INTRODUCTION: Near-infrared diode lasers can be used for several applications, which range from disinfection to smear layer removal in endodontics. This study evaluated the efficacy of agitation of 15% EDTA with an 808-nm diode laser on removal of the smear layer. METHODS: Sixty extracted human maxillary central incisor teeth were instrumented up to ProTaper F4 (Dentsply Maillefer, Ballagues, Switzerland) and then randomly divided into 6 groups (n = 10 for each group) according to the different final irrigating protocols as follows: 5% sodium hypochlorite for 120 seconds performed with the NaviTip (Dentsply Maillefer, Ballaigues, Switzerland) (control group); 15% EDTA for 120 seconds performed with the NaviTip; and agitation of 15% EDTA with an 808-nm diode laser for 10, 20, 30, and 40 seconds. Specimens were observed under a scanning electron microscope, and open dentinal tubules were counted using Adobe Photoshop software (Adobe Systems, San Jose, CA). The data were analyzed with 1-way analysis of variance and Tukey post hoc tests (P = .05). RESULTS: The number of open dentinal tubules was higher in the middle thirds than in the apical thirds. The differences between the apical and middle thirds were statistically significant (P < .05). Statistically significant differences were also found between the control group and the other groups in both the middle and apical thirds of the root canals (P < .05). CONCLUSIONS: The results indicated that agitation of 15% EDTA with an 808-nm diode laser for 20 seconds was effective in removing the smear layer in the apical thirds of root canals.

Effect of manual dynamic activation on smear layer removal efficacy of ethylenediaminetetraacetic acid and SmearClear: an in vitro scanning electron microscopic study.

The purpose of the present study was to evaluate the effect of manual dynamic activation (MDA) with a master gutta-percha point on the smear layer removal efficacy of 17% ethylenediaminetetraacetic acid (EDTA) and SmearClear. Fifty freshly extracted human single-rooted teeth were prepared using ProTaper rotary system up to F3 size. The prepared teeth were divided into five groups on the basis of final irrigation received. Group A: 3% NaOCl solution (negative control group). Group B: 5 mL of 17% EDTA. Group C: 1 mL of 17% EDTA + MDA for 2 min + 4 mL of 17% EDTA rinse. Group D: 5 mL of SmearClear. Group E: 1 mL of SmearClear + MDA for 2 min + 4 mL of SmearClear rinse. Prepared samples were decoronated and then longitudinally split into two halves and evaluated under scanning electron microscope. Representative images at coronal, middle and apical third level were taken and scored for the amount of smear layer present, using a three-score system. The data were analysed through Kruskal-Wallis and Mann-Whitney U-test. The root canal surfaces of samples of group C and group E (where MDA was done) were significantly cleaner in apical third regions than those of group B and group D (P < 0.05).

Percentage exposure of root dentin collagen after application of two irrigation protocols with manual or rotary instrumentation and two methacrylate resin-based sealers.

PURPOSE: To compare the percentage of collagen exposed in dentin root thirds after two irrigation protocols with manual or rotary instrumentation using two methacrylate resin-based sealers. MATERIALS AND METHODS: Forty-eight single-root human teeth were prepared with manual (n = 24) or nickeltitanium ProFile rotary (n = 24) instrumentation, using 5% NaOCl between instruments and 5 ml 17% EDTA as final irrigant or 20% citric acid + 2% chlorhexidine (CHX) between instruments and as the final irrigant. RealSeal or EndoREZ were used as filling materials. One 1-mm slice per third was abraded and stained with Masson's trichrome method. Mean exposed collagen values were obtained in four areas from each section (at 60X magnification) and a complete factorial ANOVA was used to analyze the influence of the study variables. Non-parametric Mann-Whitney's test was used to compare groups. Differences with p < 0.05 were considered significant. RESULTS: A significantly higher percentage of collagen was exposed in all thirds with the use of the 20% citric acid + 2% CHX protocol with rotary vs manual instrumentation, but percent collagen exposed did not differ as a function of the filling material. After the 5% NaOCl + 17% EDTA protocol, the percentage of collagen exposed did not differ between rotary and manual instrumentation but was higher with the use of RealSeal. CONCLUSION: The highest percentage exposure of collagen was with 20% citric acid + 2% CHX using rotary instrumentation, regardless of the filling material.

Self-adjusting file cleaning-shaping-irrigation system improves root-filling bond strength.

INTRODUCTION: The aim of the present study was to assess the bond strength of root fillings in oval-shaped canals prepared with the self-adjusting file (SAF) system. METHODS: A careful specimen selection resulted in 2 equal groups, each consisting of 12 extracted mandibular canines with oval canals that had vital pulps before extraction. One group was subjected to the SAF protocol, and the other group underwent conventional protocol, which was the ProTaper system with syringe-needle irrigation. Full-strength sodium hypochlorite was used as an irrigant for both groups. The teeth were obturated in a standardized way, filled with a lentulo spiral as the root filling, and then prepared for micropush-out assessment by using root slices of 1-mm thickness. Loading was performed on a universal testing machine at a speed of 0.5 mm/min(-1). The Student's t test for pairwise comparisons was applied to assess the effect of each preparation technique on the push-out bond strength. RESULTS: All specimens showed measurable adhesive properties to root dentin. In addition, no premature failure occurred. The group-by-location interaction was significant (P = .0071); thus, the group comparisons were dependent on the canal third. Overall, the push-out bond strength was the highest in the coronal third and the lowest in the apical third. SAF-prepared specimens displayed significantly higher bond strengths (P = .0012, 0.51-5.9 MPa). CONCLUSIONS: The present study showed that SAF preparation markedly influenced root-filling push-out bond strength in oval-shaped canals. Further investigations are needed to provide a better understanding of the physicochemical modifications of the root dentin prepared with the SAF cleaning-shaping-irrigation system.

Cleaning the apical third of curved canals after different irrigation protocols.

This study evaluated the protocols of sonic and vacuum irrigation regarding the capacity of debris removal from root canal systems. Canal preparations were carried out on 30 mandibular first molars using the ProTaper Universal System. Teeth were divided into two experimental groups (n=15): Group 1: sonic irrigation and Group 2: vacuum irrigation protocol. Subsequently, the mesial roots were sectioned and observed by stereomicroscopy and scanning electron microscopy. Three independent examiners evaluated images of the apical thirds according to the following scores: 1= small presence of debris, 2= moderate presence of debris, and 3= dense presence of debris. Data were analyzed with ANOVA and Kruskal-Wallis tests (α=0.05). Comparison among the groups revealed that at the apical third, the root halves of Group 1 had significantly less surface debris (p=0.002) than those of Group 2. However, at 2 mm from the working length, Group 2's specimens showed less remaining debris in approximately 75% of the analyzed root canals. At the whole apical third, the sonic irrigation protocol removed significantly more debris than the vacuum protocol. However, in the region at 2 mm from the working length, the second irrigation method demonstrated a better performance.

The effect of peracetic acid on removing calcium hydroxide from the root canals.

INTRODUCTION: The goal of this study was to evaluate the efficiencies of different irrigation solutions in the removal of calcium hydroxide (CH). METHODS: Forty-eight maxillary central incisor teeth were used. Root canals were prepared with the ProTaper system (Dentsply Maillefer, Baillagues, Switzerland). Five milliliters 2% NaOCl, 5 mL 17% EDTA, and 10 mL saline were used for final irrigation. The canals were filled with CH paste. Specimens were randomly divided into 4 experimental groups (n = 10) according to irrigation protocols. Positive and negative control groups (n = 4) were used. Group 1 used 2.5 mL 17% EDTA, group 2 used 2.5 mL 2.5% NaOCl + 2.5 mL 17% EDTA, group 3 used 2.5 mL 1% peracetic acid (PAA), and group 4 used 2.5 mL 0.5% PAA. The specimens were evaluated with scanning electron microscope analysis and scored. Kruskal-Wallis and Student Newman-Keuls post hoc tests were used for statistical analysis. RESULTS: In the apical thirds, 1% PAA was superior to the other groups (P < .05); however, there were no significant differences among the other groups (P > .05). In the middle thirds, no significant differences were found among the groups (P > .05). In the coronal thirds, 1% PAA was superior to the other groups. There were significant differences among all the other groups (P < .05). CONCLUSIONS: According to the findings of the present study, 1% PAA could be recommended for the removal of CH from the root canals.

Carisolv as an endodontic irrigant in deciduous teeth: an SEM study.

AIM: Root canal irrigation plays an important role in the debridement and disinfection of the root canal system. "The purpose of this study was to evaluate the efficacy of Carisolv , 1% sodium hypochlorite (NaOCl) gel, and 1% NaOCl solution as root canal irrigants in deciduous anterior teeth." MATERIALS AND METHODS: THIRTY-six extracted deciduous anterior teeth were used. Root canals were flooded with NaOCl solution in Group A, NaOCl gel in Group B and Carisolv in Group C and incubated for 30 min. Scanning electron microscope photomicrographs of canal wall debris in the apical, middle and coronal thirds were scored. RESULTS: The results showed that regardless of irrigation regime, canals were consistently cleaner in the coronal and middle thirds than in the apical thirds. NaOCl solution, NaOCl gel, and Carisolv had comparable activity at coronal third and middle third of root canals. At the apical third, NaOCl solution cleaned canals better than NaOCl gel and Carisolv. Carisolv cleaned debris better than NaOCl gel at the apical third. CONCLUSION: Carisolv can be used as an adjunct to root canal preparation.

Dentinal tubule infection as the cause of recurrent disease and late endodontic treatment failure: a case report.

INTRODUCTION: This article describes a case of recurrent post-treatment apical periodontitis and late failure after endodontic retreatment performed in a single visit. METHODS: The patient presented with a tooth exhibiting inadequate endodontic treatment and a large periradicular lesion that extended laterally to the root. Retreatment was performed in a single visit and involved chemomechanical preparation using 5.25% NaOCl as the irrigant and root canal obturation by Schilder's vertical compaction technique. A large lateral canal was radiographically revealed after obturation. After 2 years, the lesion was no longer radiographically discernible, a condition that was confirmed 9 years after retreatment procedures. Nonetheless, after 12 years, radiographs revealed recurrent disease. Apical surgery was performed, and the root apex, including the area of the large lateral canal, was resected with care to maintain the lesion attached to it. The biopsy specimen was subjected to histopathologic and histobacteriologic analyses. RESULTS: Longitudinal sections of the apical root specimen revealed a heavy dentinal tubule infection surrounding the area of the lateral canal. Bacteria were not found in any other area of the specimen. No other possible reason for the inflammatory periradicular lesion, such as root fracture, coronal leakage, or foreign-body reaction, was evident. CONCLUSIONS: A persistent intraradicular infection caused by bacteria located within dentinal tubules is the most reasonable explanation for resurgence of the apical periodontitis lesion. This case report stresses the importance of attaining proper disinfection of the root canal system for a predictable long-term outcome of the treatment.

Evaluation of push-out bond strength of surface treatments of two esthetic posts.

OBJECTIVES: To evaluate the push-out bond strength of two surface treatments of a glass fiber and zirconia ceramic post. MATERIALS AND METHODS: Sixty samples were fabricated and divided into two main groups according to the type of esthetic post indicated for maxillary central incisor: glass fiber post and zirconia ceramic post. Each group was subdivided to two subgroups according to the type of bond strength test either between post and root or between post and core. Each subgroup was further subdivided into three classes according to surface treatment: no treatment (control), sandblasting in conjunction with silica particles then silane coating (SB+SIC+SC), etching using hydrofluoric acid then silane coating (E+SC). For the subgroups of the bond strength between post and root, each class was subdivided into two subclasses according to the location of the sample (cervical or apical). RESULTS: Bond strength to root canal or resin core were affected by the type of post, glass fiber post recorded significant higher bond strength than zirconia ceramic. Surface treatment recorded higher values for bond strength, SB+SIC+SC gave higher bond strength than E+SC. Cervical section recorded significant higher bond strength than apical section. CONCLUSIONS: Glass fiber posts recorded higher bond strength than glass ceramic post to both root canal and resin core. Surface treatments increase bond strength for glass fiber and zirconia ceramic posts to both root canal and resin core. SB+SIC+SC gave higher bond strength than E+SC. Bond strength at the cervical section is higher than at the apical section.

Effects of three different irrigating solutions and KTP laser irradiation on apical leakage: an electrochemical study.

OBJECTIVE: The purpose of this study was to evaluate the effect of three different irrigating solutions (17% EDTA, 10% citric acid and 2.5% NaOCl) and KTP laser irradiation on apical leakage using an electrochemical method. MATERIALS AND METHODS: Sixty extracted single-rooted human teeth with mature apices were instrumented up to a size 35 K-file. After using each file and before proceeding to the next, canals were irrigated with 2 ml of 2.5% NaOCl. All teeth were then randomly divided into four groups. In group 1, the root canals were irrigated with a final flush of 17% EDTA. In group 2, the root canals were irrigated with a final flush of 10% citric acid. In group 3, the root canals were irradiated with KTP laser at 1 W, 4.45 J/cm(2). In group 4, the root canals were irrigated with a final flush of 2.5% NaOCl. The root canals were then filled using the cold lateral condensation method. Apical leakage was evaluated using an electrochemical method over a period of 10 days. Data were analysed using Tukey HSD and Friedmann tests with p = 0.05 as the level for statistical significance. RESULTS: The 17% EDTA and 10% citric acid groups had statistically less apical leakage than the 2.5% NaOCl group at days 7, 8, 9 and 10 (p < 0.05); however, no significant differences were found between the tested groups at the other time intervals (p > 0.05). No significant difference was found between the KTP laser group and other groups tested at all time intervals (p > 0.05). CONCLUSION: All groups were unable to eliminate apical leakage. However, final irrigation with 17% EDTA and 10% citric acid following root canal preparation reduced postobturation apical leakage compared with 2.5% NaOCl irrigation. When KTP laser and the other three irrigants were compared, no significant difference was found.

Cleaning the apical third of curved canals after different irrigation protocols

This study evaluated the protocols of sonic and vacuum irrigation regarding the capacity of debris removal from root canal systems. Canal preparations were carried out on 30 mandibular first molars using the ProTaper Universal System. Teeth were divided into two experimental groups (n=15): Group 1: sonic irrigation and Group 2: vacuum irrigation protocol. Subsequently, the mesial roots were sectioned and observed by stereomicroscopy and scanning electron microscopy. Three independent examiners evaluated images of the apical thirds according to the following scores: 1= small presence of debris, 2= moderate presence of debris, and 3= dense presence of debris. Data were analyzed with ANOVA and Kruskal-Wallis tests (α=0.05). Comparison among the groups revealed that at the apical third, the root halves of Group 1 had significantly less surface debris (p=0.002) than those of Group 2. However, at 2 mm from the working length, Group 2's specimens showed less remaining debris in approximately 75% of the analyzed root canals. At the whole apical third, the sonic irrigation protocol removed significantly more debris than the vacuum protocol. However, in the region at 2 mm from the working length, the second irrigation method demonstrated a better performance.

Este estudo avaliou protocolos de irrigação sônica e a vácuo em relação à capacidade de remoção de debris do sistema de canais radiculares. Trinta primeiros molares mandibulares tiveram seus canais radiculares preparados pela utilização do Sistema ProTaper Universal. Os dentes foram divididos em dois grupos experimentais (n=15): Grupo 1: protocolo de irrigação sônica, e Grupo 2: protocolo de irrigação a vácuo. Posteriormente, as raízes mesiais foram seccionadas e observadas em lupa estereoscópica e microscopia eletrônica de varredura. Três examinadores independentes avaliaram as imagens do terço apical de acordo com as seguintes pontuações: 1. pequena presença de debris; 2: moderada presença de debris; e 3. densa presença de debris. Os dados foram analisados pelos testes estatísticos ANOVA e Kruskal-Wallis (α=0,05). A comparação entre os grupos revelou que, no terço apical, as hemissecções radiculares do Grupo 1 apresentaram debris remanescentes de forma significativamente menor (p=0,002) do que as do Grupo 2. No entanto, a 2 mm do comprimento de trabalho, as amostras do Grupo 2 mostraram menos debris remanescentes em aproximadamente 75% dos canais radiculares analisados. Considerando todo o terço apical, o protocolo de irrigação sônica removeu significativamente mais debris do que o protocolo de irrigação a vácuo. No entanto, na região a 2 mm do comprimento de trabalho, o segundo método de irrigação demonstrou um melhor desempenho.

Efficacy of sodium hypochlorite, ethylenediaminetetraacetic acid, citric acid and phosphoric acid in calcium hydroxide removal from the root canal: a microscopic cleanliness evaluation.

Rooted molars were subjected to standardized canal instrumentation to a master apical file (MAF). The samples were dressed with Ca(OH)(2), and after 7 days, teeth were reopened and Ca(OH)(2) medication was removed by 1 of 4 different experimental procedures: 2.5% sodium hypochlorite (NaOCl) (n = 10); 17% EDTA-T (n = 10); 10% citric acid (n = 10); or 37% phosphoric acid (n = 10). This was followed by reinstrumentation with MAF plus 15 mL saline solution. The roots were prepared for scanning electron microscopic analysis of the cervical, middle, and apical thirds. Statistical analysis was performed with the Kruskal-Wallis test. EDTA-T and phosphoric acid gave the best results in the apical third, with significant statistical differences compared with other groups. NaOCl gave the worst results. Irrigation with 17% EDTA-T and 37% phosphoric acid is more effective than sodium hypochlorite and citric acid in the removal of calcium hydroxide from the apical third.