Effect of ultrasonication with EDTA or MTAD on smear layer, debris and erosion scores

A Comparative Evaluation of Phytic Acid as Final Rinse Solution with Other Chelating Agents for Elimination of Intraradicular Smear: A Scanning Electron Microscopy Study

AIM

The aim of this study was to compare radicular smear layer removal ability of different solutions of phytic acid (PA) with other chelating agents when used in specific irrigant protocols.

MATERIALS AND METHODS

Seventy four maxillary central incisors were collected, standardized, and canals were prepared. A total of 5% sodium hypochlorite was used as the initial rinse solution (8mL). Samples were divided into control (Group I-normal saline and II-7% ethylenediaminetetraacetic acid) and experimental groups (Group III, IV, V, VI, VII, and VIII) based on the type of final rinse solution used, that is, 5% PA, 10% PA, 17% PA, 5% citric acid (CA), 10% CA, and 17% CA (5mL). Samples were coded, buccolingually divided into two halves, dehydrated, mounted, splutter coated, and examined under scanning electron microscope.

RESULTS

Group IV had the least smear and debris in coronal, middle, and apical thirds with mean scores of 1.06 and 1.3, respectively. When compared with Group II, no statistically significant difference was found (P > 0.05). Overall, the Group III had the lowest erosion scores at apical, middle, and coronal one-third with a mean of 1.68. Group VII had the highest amount of erosion with loss of peritubular and intertubular dentin at all levels.

CONCLUSION

The role of PA as final rinse solution for the removal of radicular smear is promising and comparable to other chelating agents.

Intraradicular Smear Removal Efficacy of Triphala as a Final Rinse Solution in Curved Canals: A Scanning Electron Microscope Study

Aim:

This study aimed to compare smear layer removal ability of different solutions of Triphala (TA) when used in specific irrigant protocols in curved canals.

Materials and Methods:

Seventy-four mandibular first molars with 25–35 degrees of curvature of mesial roots were selected and standardized, and canals were prepared. As the initial rinse solution (8 mL), 5% sodium hypochlorite was used. Samples were divided into control (Group I—normal saline, Group II—17% ethylenediaminetetraacetic acid) and experimental (Group III, IV, V, VI, VII, VIII, and IX) groups based on the type of final rinse solution (5 mL) used, that is, TA-premixed (P), TA-(P)-sonic, TA-(P)-ultrasonic, 3% TA solution, 5% TA solution, 10% TA solution, and 10% citric acid. Samples were dehydrated, split buccolingually, splutter coated, and examined in field emission scanning electron microscope.

Results:

Among the experimental groups, Group V presented the least amounts of smear and debris in all thirds of the root canal with mean values of 1.6 ± 0.63 and 1.6 ± 0.62, respectively, and on comparison with Group II the results were comparable, and no significant difference was found statistically (P > 0.05). Group V presented with the highest amount of erosion with loss of peritubular and intertubular dentin at all levels with mean values of 1.60 ± 0.51.

Conclusion:

The use of TA as a final rinse solution during biomechanical preparation seems promising.

[Research progress on QMix properties in root canal irrigation]

Mechanical instrumentation preparation alone is insufficient to completely remove root canal infection, and chemical irrigation is essential to eliminate infected remnants. An ideal root canal irrigant should completely remove the smear layer, lubricate the root canal, efficiently kill bacteria, induce mild or no inflammatory response in the tissues, and avoid damaging the dentin structure. However, a commercial irrigant that meets all these requirements is currently lacking. QMix is a root canal irrigation mixture of ethylenediamine tetraacetic acid (EDTA), chlorhexidine (CHX) and surfactant. This mixture can remove the smear layer efficiently, and it possesses strong antibacterial effect and good biocompatibility with minimal cytotoxicity. Furthermore, the influence of QMix on the color and micro-hardness of dentin is low, and it can improve the wettability of root canal sealant without affecting its adhesive properties. This review compares the efficiencies of QMix with other irrigants (sodium hypochlorite, CHX, EDTA, SmearClear, and MTAD) in term of smear layer removal, dentine and root canal sealing, cell cytotoxicity, and bacterial growth inhibition.

A Comparative Evaluation of Intraradicular Smear Removal Efficacy of 2% Chitosan (Low Molecular Weight), 4% Chitosan Citrate, and 10% Citric Acid when Used as Final Rinse in Irrigation Protocols: A Field Emission Scanning Electron Microscopic Study

Aim:

This study aims to compare the smear layer removal efficacy of 2% chitosan (low molecular weight) (C-LMV), 4% chitosan citrate (CC), and 10% citric acid (CA) when used in specific irrigant protocols.

Materials and Methods:

A total of 60 single-rooted maxillary incisors and canines were decoronated, standardized to a root length of 15 mm, and prepared with rotary files up to protaper F3 size. Sodium hypochlorite was used as initial rinse [8 ml]. The samples were divided into experimental (Group III, IV, V, and VI) (n = 10) and control groups (I – 17% EDTA, II – normal saline) (n = 5) based on the type of final rinse solution (5 ml) used, that is, 2% C-LMV, 4% C-citrate, 10% CA, and 1% acetic acid. Samples were dehydrated, split buccolingually, gold sputter coated, and examined in field emission scanning electron microscope.

Results:

Overall, the Group IV, V, and III presented the least amounts of smear, debris, and erosion among the experimental groups at the apical, middle, and coronal one-thirds of the root canal with a mean value of 1.53 ± 0.42, 1.33 ± 0.42, and 1.60 ± 0.46, respectively, and there was no statistically significant difference (P > 0.05).

Conclusion:

The use of CC as final rinse solution during biomechanical preparation seems promising.

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.

The effects of various irrigating solutions on intra-radicular dentinal surface: An SEM analysis

Aim:

The action of irrigant solutions on intra- radicular dentinal surface were evaluated in an in vitro setting using a scanning electron microscope (SEM) and it was observed that sodium hypochlorite and MTAD produced the cleanest surface and that none of the irrigants were able to produce an ideal preparation of the dentinal surface when used individually. The primary objective of endodontic therapy is to achieve a clean, optimal environment in root canals to avoid unsuccessful treatment outcomes. The complexities of the root canal system necessitate the use of irrigating solutions which act on radicular dentin surface, modifying it. The action of irrigants can be beneficial, and yet at the same time, as they modify the surface structure of dentin, they can have an adverse impact on the properties of dentin. The present study was undertaken to assess the effect of various irrigants on the dentinal surface using an SEM.

Materials and Methods:

Forty-five roots were randomly divided into nine groups (n=5) and prepared by sectioning at the level of cemento-enamel junction (CEJ) and 10 mm from the CEJ and split longitudinally. The dentin surface was prepared and the cemental surfaces were coated with double layer of varnish. The irrigants tested were normal saline, de-ionized water, 17% ethylenediaminetetraacetic acid (EDTA), 5% sodium hypochlorite (NaOCl), 5% NaOCl with ultrasonic agitation, 3% hydrogen peroxide, 2% chlorhexidine (CHX), MTAD, and MTAD with ultrasonic agitation. The prepared samples were placed in the irrigant solution for 3 min, subsequently dehydrated, sputter coated, and observed under SEM. The images were subsequently analyzed for dentinal surface changes.

Results:

17% EDTA and MTAD produced the cleanest dentinal surface. Ultrasonic agitation enhanced the effect of irrigants. 5% NaOCl and 3% hydrogen peroxide were efficient at removal of organic debris, but were unable to remove the smear layer. De-ionized water, normal saline, and 2% chlorhexidine were not effective at removing the debris or the smear layer.

Conclusion:

None of the irrigants individually were able to achieve conditions of an ideal dentinal surface preparation.

Characterization of a conjugate between Rose Bengal and chitosan for targeted antibiofilm and tissue stabilization effects as a potential treatment of infected dentin

Bacterial biofilms and dentin structural changes are some of the major challenges in the management of infected dentin tissue. This study characterized a photosensitizer-conjugated chitosan with enhanced photodynamic efficacy against dental biofilms, as well as the ability to reinforce the postinfected dentin matrix in order to improve its mechanical and chemical stability. Rose Bengal-conjugated chitosan (CSRB) was synthesized using a chemical cross-linking method and characterized for photophysical, photobiological, and cytotoxicity properties. Its potential as an antibacterial and matrix-reinforcing agent on dentin collagen was also evaluated. Enterococcus faecalis as planktonic and in vitro biofilms was treated with CSRB and photodynamically activated with 5 to 60 J/cm(2) green light. Dentin collagen was used for the CSRB cross-linking experiments and evaluated for chemical changes, resistance to enzymatic degradation, and mechanical properties. CSRB was a photosensitizer with efficient singlet oxygen yield. In vitro photoactivation gave higher fibroblast cell survival than did RB alone. CSRB showed significant antibiofilm photoinactivation (P < 0.01). The CSRB-cross-linked dentin collagen showed higher resistance to collagenase degradation and superior mechanical properties (P < 0.05). In summary, the photoactivated CSRB particles synthesized in this study may be a synergistic multifunctional treatment approach with lower cytotoxicity and effective antibiofilm activity as well as the ability to reinforce the dentin collagen to enhance resistance to degradation and improve mechanical properties. This may be a targeted treatment strategy to deal with infected dentin hard tissues in a clinical scenario, where both disinfection and structural integrity need to be addressed concomitantly.