Smear layer removal efficacy of combination of herbal extracts in two different ratios either alone or supplemented with sonic agitation: An in vitro scanning electron microscope study

Comparative evaluation of the effect of ultrasonic and rotary agitation of herbal irrigating solutions on smear layer: A SEM study

Context

Instrumentation and irrigation balance helps in effective removal of endodontic microbes housing inside the smear layer.

Aim

This study aimed to (1) evaluate whether activation of the irrigating solutions with two different systems during the final irrigation step can lead to smear layer formation in the middle and apical third of the root canal and (2) evaluate and compare the smear layer removal ability of the aqueous extracts of Emblica officinalis and Morinda citrifolia.

Materials and Methods

A total of 72 single-rooted teeth were prepared up to F4 ProTaper. The specimens were assigned into eight groups of nine teeth each, according to the final irrigant and activation techniques. Further, the teeth were evaluated under SEM for endodontic smear layer at the middle and apical third.

Statistical Analysis

Inferential statistics included Pearson's Chi-square. Level of significance was set at 0.05 at 95% confidence level.

Results

Ultrasonic activation system showed significant (P = 0.000) amount of smear layer compared to XP-Endo Finisher file. A significant difference (P = 0.00) in the smear layer removal was observed when 6% M. citrifolia was activated with XP-Endo Finisher file both in the middle and apical third.

Conclusion

Within the limitations of this in vitro study, it can be concluded that smear layer formation was noted with ultrasonic and XP-Endo Finisher file when saline was used as an irrigant. 6% M. citrifolia when activated with XP-Endo Finisher file showed best results among all other experimental groups.

Comparative Evaluation of Microhardness, Smear Layer Removal Efficacy and Depth of Penetration Using Punica granatum, Emblica officinalis and Sodium Hypochlorite As Endodontic Irrigants: An In Vitro Study

Introduction Root canal morphology tends to be complicated by nature and dealing with this intricacy can be challenging because it makes it difficult to completely disinfect the root canal space. The success of root canal therapy is also determined by the biomechanical preparation of the canal with the application of instruments and irrigating solutions. Due to the fact that the root dentin surface continues to interact with the irrigating solution during preparation, it's critical to evaluate the mechanical characteristics and smear layer removal. Though sodium hypochlorite (NaOCl) is the most commonly used irrigant due to its tissue-dissolving abilities, it has certain drawbacks which include the inability to remove the smear layer and also affects the mechanical properties of root dentin. To overcome these limitations, a variety of herbal substitutes like Punica granatum and Emblica officinalis which possess anti-bacterial and anti-fungal properties can be used as endodontic irrigants. Several studies on the anti-bacterial properties of natural irrigants of pomegranate and amla were reported. However, the mechanical properties and smear layer removal of Punica granatum and Emblica officinalis have not been explored in the field of endodontics. Aim The main aim of this in vitro study is to compare and evaluate microhardness, smear layer removal efficacy and depth of penetration of herbal and conventional irrigants. Materials and methods Thirty-six palatal roots of maxillary molars were decoronated and instrumented up to F3. These roots were sectioned longitudinally and divided into three test groups: Group 1: 12.5% Punica granatum; Group 2: 6.25% Emblica officinalis; control: Group 3: 2.5% NaOCl. All specimens were irrigated with 5ml of each irrigant for 5 minutes. Microhardness of root dentin was measured using a Vickers diamond intender, smear layer removal using a scanning electron microscope (SEM) and depth of penetration using a stereomicroscope. The data was analyzed using one-way ANOVA and the inter-group comparison using Tukey's post hoc test. Results Statistical analysis was done using one-way analysis of variance (ANOVA) and Tukey's post hoc test using SPSS software version 17.0 (SPSS Inc., Chicago ). The highest microhardness was seen in Group 1 (cervical: 53.8375 ± 1.35956, middle: 53.9875 ± 1.01761, apical: 53.6875 ± 1.63133) while Group 2 (cervical: 43.2750 ± 1.73596, middle: 43.3125 ± 1.17648, apical: 43.8000 ± ​​​​​​​1.32665) and Group 3 (cervical: 42.7250 ±​​​​​​​ 2.93391, middle: 41.9625 ±​​​​​​​ 1.66985, apical: 42.0250 ±​​​​​​​ 2.21085) showed significant reduction in root dentin hardness. Regarding smear layer removal Group 1 (1.3750 ±​​​​​​​ 0.51755), and Group 2 (1.2500 ±​​​​​​​ 0.46291) reveals greater smear removal in the middle third of the root dentin compared with Group 3 (2.3750 ±​​​​​​​ 0.51755), which showed the least smear layer removal. A greater depth of penetration was seen in Group 1 (0.5488 ± 0.05222) and Group 2 (0.5263 ±​​​​​​​ 0.05181) than in Group 3 (0.3087 ±​​​​​​​ 0.05743). Conclusion The present study reveals that the least reduction of microhardness was seen in Punica granatum followed by Emblica officinalis and NaOCl. The smear layer removal efficacy and depth of penetration were greater in Punica granatum and Emblica officinalis than in NaOCl. It was concluded that as these herbal irrigants are biocompatible agents, they can be considered for future use in root canal treatment.

Comparative Evaluation of Intracanal Smear Layer Removal by Different Root Canal Irrigants: A Scanning Electron Microscope Study

Aim

The purpose of the study is to compare and evaluate the efficacy of different root canal irrigants-100, 75, 50, and 25% neem extract, 100, 75, 50, and 25% apple cider vinegar (ACV), a combination of 5.25% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA), and saline on smear layer removal using a scanning electron microscope (SEM).

Materials and methods

A total of 80 freshly extracted single-rooted teeth were collected and divided into 10 groups-group I: normal saline (negative control), group II: NaOCl with EDTA (positive control), group III: 100% neem extract, group IV: 75% neem extract, group V: 50% neem extract, group VI: 25% neem extract, group VII: 100% ACV, group VIII: 75% ACV, group IX: 50% ACV, and group X: 25% ACV. The samples were irrigated with a specific group of irrigants, then split in a longitudinal axis and processed for analysis in an SEM. Microphotographs were obtained and scored according to Torabinejad et al.

Results

Microphotographs were assessed and showed that 100% neem extract was similar to NaOCl with EDTA, followed by 75% neem extract and 100% ACV.

Conclusion

This study showed that 100% neem extract removed the smear layer, similar to the NaOCl with EDTA.

How to cite this article

Sudhakar S, Gupta N, Ghambir N, et al. Comparative Evaluation of Intracanal Smear Layer Removal by Different Root Canal Irrigants: A Scanning Electron Microscope Study. Int J Clin Pediatr Dent 2023;16(4):633-638.

Use of final irrigant Potassium Titanyl Phosphate laser; Sapindus Mukorossi and Fotoenticine on the bond values of zirconia post-to-canal dentin

AIMS

Assessment of the efficacy of final root canal irrigants Sapindus mukorossi (SM), Potassium titanyl phosphate laser (KTPL), and Fotoenticine (FTC) on the push-out bond strength (PBS) of zirconia post.

MATERIALS AND METHODS

The root canal procedure was initiated using the 10 K file and the working length was determined on single-rooted human premolar teeth after decoration. The canals were then enlarged using ProTaper universal system and filled using single cone gutta-percha (GP) and AH Plus resin sealer. Post space was prepared by removing 10mm of GP from the canal. All the teeth were then allocated into four groups based on the final irrigating regime used (n=10) Group 1: 5.25% NaOCl+17% EDTA, Group 2: 5.25% NaOCl + KTPL, Group 3: 5.25% NaOCl + FTC and Group 4: 5.25% NaOCl+ SM. Zirconia posts were cemented in the canal space. The specimens were sectioned and implanted in auto-polymerizing acrylic resin. A universal testing machine and stereomicroscope at 40x magnification were used for PBS and failure mode analysis. ANOVA and Tukey post hoc test were used to make group comparisons(p=0.05).

RESULTS

Group 4 (5.25% NaOCl+ SM) coronal section displayed the highest PBS (9.29±0.24 MPa). However, group 3 (5.25% NaOCl+ FTC) apical third (4.08±0.14 MPa) showed the lowest bond values. Group 2 (5.25% NaOCl+ KTP laser) and Group 3 at all three-thirds unveiled no significant difference in PBS(p>0.05). However, Group 1 (5.25% NaOCl+17%EDTA) and Group 4 displayed comparable outcomes of bond strength(p>0.05) CONCLUSION: Sapindus mukorossi has the ability to be used as a final root canal irrigant alternative to EDTA. However, future studies are still required to conclude the outcomes of existing research.

Effect of Malachite green, Ocimum Sanctum, and Er, Cr: YSGG laser on antimicrobial activity against S.mutans and CAD disinfection bonded to resin restoration

AIMS

Evaluation of survival of S.mutans and shear bond strength (SBS) of adhesive restorative material bonded to carious affected dentin (CAD) after using cavity disinfectant i.e., Er, Cr: YSGG (ECYL), (Nd: YAG) (NYL), Malachite green (MG), Ocimum sanctum (OS) in comparison to the conventional control chlorhexidine gluconate (CHX).

MATERIALS AND METHODS

Seventy-five caries-affected mandibular third molars having ICDAS scores 4 and 5 were included. Carious infected dentin was eliminated and CAD surface was obtained. On twenty-five samples, an uncontaminated suspension of S. mutans strain ATCC 35668 in Brain-Heart Infusion broth (BHI) was obtained after 12 hours of incubation at 37°C. Based on the disinfection regime used to sterilize the CAD surface, all the specimens were allocated into five different groups. (n=15) Group 1: CAD disinfected with CHX, Group 2: CAD disinfected with ECYL, Group 3: CAD disinfected with NYL, Group 4: CAD disinfected with MG, and Group 5: CAD disinfected with OS. An assessment of the survival rate of S. mutans was performed. Fifty specimens were smeared with single-step adhesive bond followed by restoring the CAD surface using packable composite. SBS and failure mode were determined using a universal testing machine and stereomicroscope at 40x magnification. ANOVA and post-hoc Tukey-Kramer test was used for data analysis p=0.05 RESULTS: Group 1: CHX-treated specimens displayed the lowest bacterial viability (0.11±0.03 CFU/mL). However, group 4: MG exhibited the highest bacterial survival (0.15 ±0.09 CFU/mL). The highest and lowest SBS of resin adhesive bonded to disinfected CAD surface were exhibited by (group 5: OS) (21.48±1.39 MPa) and (group 3: NYL) (16.41±0.90 MPa) respectively (p>0.05).

CONCLUSION

Ocimum sanctum seems to be promising in terms of its antibacterial efficacy against S.mutans and positive impact on SBS of resin adhesive to CAD surface.

Herbal Agents versus Ethylene Diamine Tetra Acetic Acid on Removal of the Smear Layer-A Systematic Review of In Vitro Studies

This systematic review aimed to compare the efficacy of herbal agents with ethylene diamine tetraacetic acid (EDTA) in removing the smear layer during root canal instrumentation. The research question in the present study was to assess: "Is there a significant difference in reducing smear layer comparing EDTA and herbal agents?" Electronic databases (PubMed, Scopus, and Web of Science) were searched from their start dates to April 2022 using strict inclusion and exclusion criteria, and reviewed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Only in vitro studies comparing herbal agents with EDTA were included in the current systematic review. Two reviewers independently assessed the included articles. A total of 625 articles were obtained from an electronic database. Eighteen papers were included for review of the full text, out of which, ten papers were excluded because they did not meet the inclusion criteria. Finally, eight articles were included in the systematic review. The present systematic review considered only in vitro studies; hence, the result cannot be completely translated to strict clinical conditions. The results of the present systematic review have shown that quixabeira, morindacitrifolia, oregano extract, and neem show better smear layer removal compared to other herbal agents, whereas they showed reduced smear layer removal when compared with EDTA. Although, it was seen that most of the included studies did not report a high quality of evidence. Hence, the present systematic review concludes that herbal agents have reported to show inferior smear layer removal when compared to EDTA. Thus, as far as herbal based alternatives are concerned, there is no highest level of evidence to state its real benefit when used as a chelating root canal irrigant.

Natural Extracts as Biological Smear Layer Removing Agents: A Literature Review

OBJECTIVES

The aim of this article is to identify whether natural irrigants are better than synthetic conventional irrigants for smear layer removal and to analyze their influence on mechanical and chemical radicular dentin properties.

MATERIALS AND METHODS

The last electronic search was performed on June 2020 through five databases, limited to articles either published or accepted for publication in the English language using the following keywords: "Natural extracts" or "Fruit and plant extracts" and "Smear layer removal."

RESULTS

According to the inclusion criteria, 36 articles were included. Most studies revealed that apple or apple cider vinegars, grape seed extract, citrus aurantifolia, 5-10% glycolic acid, and 0.5-1% phytic acid effectively removed the smear layer better or similar to synthetic conventional agents.

CONCLUSION

Natural irrigants are effective smear layer removing agents with the least deteriorated effect on mechanical and chemical radicular dentin properties compared with synthetic agents.

A proposed classification system for herbal endodontic irrigants

Irrigating solutions are an essential adjunct in the root canal therapy for the complete disinfection of the root canal space. The recent trend focuses on the use of herbal extracts in endodontics owing to their advantages and minimal side effects. In view of this, we have proposed a classification system to classify herbal endodontic irrigants as currently, there is no standard classification available. This structured classification will give an overview of the diversity of herbal irrigants and also highlight the potential use of each of them. Thus, it will be easy to segregate the study and use the herbal endodontic irrigants according to the requirements. The proposed classification system shall prove to be highly beneficial to the students, researchers, and clinicians.

Human pulp tissue dissolution ability of different extracts of Sapindus mukorossi: An in vitro study

Objective

Due to the many negative properties of sodium hypochlorite used in current root canal treatment, interest in biocompatible natural agents is increasing day by day. The aim of this study was to evaluate whether various extract solutions of Sapindus mukorossi have dissolution effects on human pulp tissues.

Methods

Primarily powder extracts were obtained by extracting fruit shells of S. mukorossi in different solvents (ethanol, methanol, buthanol and distilled water). The test solutions were prepared and randomly separated into six groups with 10 samples in each group: ethanol extract, methanol extract, butanol extract, distilled water extract of S. mukorossi, sodium hypochlorite (NaOCl) and the control group. Among these, S. mukorossi extracts were separated into two subgroups, depending on their concentration level (50 µg/mL and 100 µg/mL). The pulp tissues of freshly extracted human molars were used for dissolution test. The weights of the pulpal tissues were measured and recorded for two times after the samples were placed in the solutions. Statistical analysis for all descriptive statistics was performed using SPSS 22 (P < 0.05).

Results

Our results showed that maximum percent yield of preparation was obtained in methanol extract of S. mukorossi. Among all of the groups, the best dissolution capacity was seen in the NaOCl group (positive control group). Among S. mukorossi groups, the best tissue solvent solution was found in SMM group at 50 µg/mL and SMB group at 100 µg/mL.

Conclusion

The different extracts of S. mukorossi had a capacity to dissolve pulp tissue but this capacity was less than NaOCl. Therefore, further studies will enable the creation of a commercial solution for clinical use by increasing the effectiveness of S. mukorossi while combining it with other endodontic irrigation solutions.

Effectiveness of Three Different Irrigants - 17% Ethylenediaminetetraacetic Acid, Q-MIX, and Phytic Acid in Smear Layer Removal: A Comparative Scanning Electron Microscope Study

Background:

Removal of smear layer from the root canal walls is important for long-standing endodontic success.

Aim:

The aim of this study is to evaluate and compare smear layer removing ability among 17% ethylenediaminetetraacetic acid (EDTA), Q-MIX, and phytic acid by scanning electron microscopy (SEM).

Materials and Methods:

This in-vitro experimental study assessed smear layer removal using three different irrigants. Thirty single-rooted freshly extracted human permanent premolars were collected, disinfected, and decoronated to a standardized root length of 13 mm. Root canals were cleaned and shaped till F2 universal rotary protaper at working length 1 mm short of the apex. They were randomly divided into three groups, and final irrigation was done accordingly. Group 1 (n = 10): with 1 ml of 17% EDTA, Group 2 (n = 10): with 1 ml of Q-MIX, Group 3 (n = 10): with 1 ml of phytic acid. Samples were then longitudinally sectioned and evaluated under SEM at coronal, middle, and apical levels.

Statistical Analysis:

Two-way analysis of variance and Tukey's post hoc test were performed. The level of significance was set at 0.05.

Results:

Smear layer removing ability among irrigants and sections in descending order: 17 EDTA > Q-MIX > phytic acid; coronal > middle > apical.

Conclusion:

17% EDTA showed better and promising results followed by Q-MIX and then phytic acid.

Comparative analysis of endodontic smear layer removal efficacy of 17% ethylenediaminetetraacetic acid, 7% maleic acid, and 2% chlorhexidine using scanning electron microscope: An in vitro study

Aim:

The aim of the present study was to evaluate the efficiency of different endodontic irrigants in the removal of smear layer through scanning electron microscopic image analysis.

Materials and Methods:

The present in vitro study was carried out on 45 single-rooted extracted human mandibular premolar teeth with single canal and complete root formation. Teeth were randomly assigned to three groups with 15 teeth in each group. Group I samples were irrigated with 17% ethylenediaminetetraacetic (EDTA) irrigation, Group II with 7% maleic acid irrigation, and Group III with 2% chlorhexidine irrigation. Scanning electron microscope evaluation was done for the assessment of smear layer removal in the coronal, middle, and apical thirds. Comparison of the smear layer removal between the three different groups was done by Kruskal–Wallis test, followed by Mann–Whitney U test for comparing individual groups. A P value less than 0.05 was considered to be statistically significant.

Results:

Statistically significant difference was seen between the two test groups (17% EDTA vs. 7% maleic acid and 17% EDTA vs. 2% chlorhexidine) in smear layer removal at coronal, middle, and apical thirds of the root canal. The most efficient smear layer removal was seen in Group I with 17% EDTA irrigation compared with other groups (P < 0.05) and the least by 2% chlorhexidine.

Conclusion:

The present study shows that 17% EDTA efficiently removes the smear layer from root canal walls.