Efficiency of Canal Brush and Ultrasonic Activated Irrigation in Smear Layer Removal Using Two Different Chelating Agents (In Vitro Study)

Volume 11 , Issue 1 , April 2024 , Pages 48-60

Authors

Zainab E. Fakhruldeen ; Bestoon M. Faraj

DOI logo 10.17656/sdj.10186

Keywords

Abstract

Objective: This study aims to evaluate the efficiency of two different activation methods after using two different chelating agents in the removal of the smear layer.

Methods: In this study, seventy single-rooted mandibular premolar teeth were included, and divided into six study groups and one control group according to the chelating agents and activation methods used. In groups 1,3, and 5, EDTA was used as the chelating agent, where it was activated by Canal Brush in G3 and by Ultra Smart in G5. In groups 2,4, and 6, 7% Maleic acid was used instead and activated by Canal Brush in G4 and Ultra Smart in G6. While in G1 and G2, no activation systems were used. The 7th group was a negative control and purposed to verify the internal microstructure, so only distal water was irrigated (no activation and no chelating agent was used). Samples were sectioned longitudinally and prepared for Scanning Electron Microscope (SEM) analysis in the coronal, middle, and apical parts. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U tests. The level of significance was set to 0.05 (P < 0.05).

Results: Although the G5 (Ultra Smart +EDTA) median score showed the best smear layer removal score, it was not statistically significant in comparison with the other 5 study groups. In all groups (whether Maleic acid or EDTA were used), smear layer removal was effective in the coronal and middle thirds while less effective in the apical third, with no statistically significant difference between the chelating agents.

Conclusions: Under the limitations of this in vitro study, no activation system was able to remove the smear layer from the root canal wall completely. However, NaOCl and EDTA's irrigation sequence combined with Ultra Smart (ultrasonic activation) obtained better results than the other techniques.

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