Smear layer removal evaluation of different protocol of Bio Race file and XP- endo Finisher file in corporation with EDTA 17% and NaOCl

Effect of irrigation protocols on smear layer removal, bond strength and nanoleakage of fiber posts using a self-adhesive resin cement

Objectives

This study aimed to investigate the effect of the application method of 2% chlorhexidine (CHX) and its influence on the adhesion of fiberglass posts cemented with a self-adhesive resin cement.

Materials and Methods

Sixty human mandibular premolars were endodontically treated and divided into 5 groups (n = 12), according to the canal irrigant and its application method: 2 groups with conventional syringe irrigation (CSI)-2.5% sodium hypochlorite (NaOCl) (control) and 2% CHX- and 3 groups with 2% CHX irrigation/activation-by passive ultrasonic irrigation (PUI), Easy Clean file, and XP-Endo Finisher file. Two roots per group were evaluated for smear layer (SL) removal by scanning electron microscopy. For other roots, fiber posts were luted using a self-adhesive resin cement. The roots were sectioned into 6 slices for push-out bond strength (BS) (7/group) and nanoleakage (NL) (3/group). Data from SL removal were submitted to Kruskal-Wallis and Student-Newman-Keuls tests (α = 0.05). Data from BS and NL were evaluated by 2-way analysis of variance and Tukey's test (α = 0.05).

Results

For SL removal and BS, the CHX irrigation/activation promoted better values than CSI with CHX (p < 0.05), but it was not significantly different from CSI with NaOCl (p > 0.05). For NL, the lowest values were obtained by the chlorhexidine irrigation/activation groups (p < 0.05).

Conclusions

Active 2% CHX irrigation can be used to improve the post space cleaning and adhesion before fiber post cementation with self-adhesive resin cements.

Effectiveness of XP-Endo Finisher and Passive Ultrasonic Irrigation in the Removal of the Smear Layer Using two Different Chelating Agents

STATEMENT OF THE PROBLEM

The smear layer may harbor microorganisms and necrotic pulp tissue, jeopardizing irrigant penetration. Recently, Dual Rinse®, a weak chelating agent, has been introduced to the market. However, its chelating capacity in the final irrigation protocol with different activation systems has not yet been deeply analyzed.

PURPOSE

The aim of this ex vivo study was to evaluate the effectiveness of passive ultrasonic irrigation (PUI) and XP-endo Finisher (XP) on smear layer removal in combination with two chelating agents, ethylenediaminetetraacetic acid (EDTA) and etidronic acid (HEDP).

MATERIALS AND METHOD

This in vitro, experimental study evaluated fifty-two single-rooted human teeth were standardized to 16 mm in length. Root canal instrumentation was performed by the ProTaper Gold system up to the F4 file. The apical end of the samples was sealed with wax to simulate a closed system. Teeth from group 1 (n=24) were irrigated with 3% sodium hypochlorite (NaOCl) and 17% EDTA, while teeth from group 2 (n=24) were irrigated with 3% NaOCl mixed 9% HEDP. Both groups were divided into two subgroups (n=12) depending on the activation system used: XP (group XP-EDTA and XP-HEDP) or PUI (group PUI-EDTA and PUI-HEDP). The specimens were evaluated by scanning electron microscopy at 3, 5 and 8mm from the apex. Statistical analysis was performed using ANOVA and Bonferroni tests considering p> 0.05 as significant.

RESULTS

PUI-EDTA was the most effective at removing the smear layer, with a statistically significant difference from XP-EDTA (p< 0.042) and group XP-HEDP (p< 0.003). There were no statistically significant differences among the other groups.

CONCLUSION

Under the conditions of this ex vivo study, no activation system was able to completely remove the smear layer from the root canal walls. However, the combination of NaOCl with ultrasonically activated EDTA obtained better results than the other treatments.

Cleaning Efficacy of the XP-Endo® Finisher Instrument Compared to Other Irrigation Activation Procedures: A Systematic Review

Background. One of the most important aims of an endodontic treatment is to obtain the complete removal or reduction of root canal remaining filling material: Smear layer, bacteria, intra-canal medicaments. To meet this requirement, several irrigation activation techniques have been proposed. Our systematic review examined studies which analyzed the XP-endo Finisher (XPF) instrument efficacy in removing root canal debris during initial endodontic treatment or retreatment, comparing it with the efficacy of other irrigation activation protocols, such as passive ultrasonic irrigation (PUI), laser activation procedure (Er:YAG), and Self-Adjusting File system (SAF). Methods. A systematic review was conducted using PubMed, Chocrane Library, and Scopus databases, identifying 51 items. Thirty-four articles were excluded based on title, abstract, full text, and language. Seventeen randomized controlled trials were selected and consequently submitted to quality assessment and data collection. Results. Conventional needle irrigation (CNI) is the less effective irrigation technique, but it is still unclear whether XPF is able to guarantee greater debris removal than the PUI technique. Er:YAG laser has been proven to be more effective in apical third than XPF instrument. Conclusions. Further investigations are needed in order to establish which final irrigation activation procedure could reach the maximum root canal debris reduction.

The Effects of Different Agitation Techniques of Canal Irrigant on Tubular Penetration of a Bioceramic Sealer

Introduction

This study aimed to compare the effects of different agitation techniques of sodium hypochlorite (NaOCL) as the final irrigation with XP-Finisher file, passive ultrasonic irrigation (PUI), Er:YAG laser and irrigation with conventional syringes, on penetration of Sure Seal Root bioceramic sealer into dentinal tubules.

Methods and Materials

Forty freshly extracted single-rooted human teeth were included in the present in vitro study. All the teeth were prepared up to #40 (4%) with Bio Race rotary file system, using crown-down technique. After chemomechanical preparation, the teeth were randomly assigned to 4 groups based on the agitation protocol: conventional needle irrigation (CNI) with a 30-G needle in a syringe, PUI, Er:YAG laser and XP-Finisher file, Subsequent to the agitation procedure, the root canals were obturated with tapered bioceramic-covered gutta-percha point and, bioceramic sealer, using the single-cone technique. The maximum penetration of the sealer into the dentinal tubules was determined in the coronal, middle and apical thirds using the scanning electron microscope (SEM) technique. After confirmation of the normal distribution of data with Shapiro-Wilk test, Data were analyzed using the one-way ANOVA and Tukey tests.

Results

The mean penetration depth of the bioceramic sealer into the dentinal tubules in the PUI group was greater than that of other groups; however, the difference between the two PUI and Er:YAG laser groups in the apical third was not significant (P=0.078). Er:YAG laser, PUI and XP-Finisher file agitation techniques resulted in significantly greater penetration of the bioceramic sealer into the dentinal tubules compared to the CNI (P<0.001). The XP-Finisher file technique in the apical (P=0.752) and middle thirds (P=0.339) and the Er:YAG laser technique in the apical thirds (P=0.086) were not significantly different from the conventional irrigation technique.

Conclusion

The PUI technique resulted in significantly deeper penetration of the Bioceramic sealer into the dentinal tubules compared to the three other techniques.

Intracanal heating of sodium hypochlorite: Scanning electron microscope evaluation of root canal walls

Introduction:

The aim of this study is to evaluate the surface of root canals dentine using scanning electron microscope (SEM) after instrumentation with rotary Nickel-Titanium systems and two different protocols of activation of sodium hypochlorite (NaOCl) (extracanal heating at 50°C and intracanal heating at 180°C), to assess the presence/absence of smear layer and also the presence/absence of open dentinal tubules along the walls at the coronal, middle, and apical third of each sample.

Materials and Methods:

Thirty-six single-rooted teeth were selected, divided into three groups and shaped with ProTaper Universal instruments following irrigation protocols with 5.25% NaOCl. At the end of the preparation, three different protocols of activation were used: nonheated NaOCl in Group A, extra-canal heated NaOCl at 50°C for Group B and intracanal heated NaOCl at 180°C for Group C. Specimens were cut longitudinally and analyzed by SEM at standard magnification of ×1000. The presence/absence of the smear layer as well as the presence/absence of open tubules at the coronal, middle, and apical third of each canal were estimated using a five-step scale for scores. Numeric data were analyzed using Kruskal–Wallis and Mann–Whitney U statistical tests and significance was predetermined at P < 0.05.

Results:

Kruskal–Wallis analysis of variance (ANOVA) for debris score showed significant differences among the Ni-Ti systems (P < 0.05). Mann–Whitney test confirmed that Group A presented significantly higher score values than other Ni-Ti systems. The same results were assessed considering the smear layer scores. ANOVA confirmed that the apical third of the canal maintained a higher quantity of debris and smear layer after preparation of all the samples.

Discussion and Conclusions:

Intra-canal heating of NaOCl at 180°C proved to be more effective in obtaining clean canal walls. On the other hand, extra-canal heating at 50°C of NaOCl left a higher quantity of debris and the smear layer was widely represented.