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

Authors

  • Zainab E. Fakhruldeen Conservative Department, College of Dentistry, University of Sulaimani, Kurdistan Region, Iraq. Author
  • Bestoon M. Faraj Conservative Department, College of Dentistry, University of Sulaimani, Kurdistan Region, Iraq. Author

DOI:

https://doi.org/10.17656/sdj.10186

Keywords:

Canal Brush, EDTA, Maleic acid, Smear layer, Ultra Smart

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.

References

Chubb DW. A review of the prognostic value of

irrigation on root canal treatment success. Aust

Endod J. 2019;45(1):5-11.

Prada I, Micó-Muñoz P, Giner-Lluesma T, MicóMartínez P, Muwaquet-Rodríguez S, AlberoMonteagudo A. Update of the therapeutic planning

of irrigation and intracanal medication in root

canal treatment. A literature review. J Clin Exp

Dent. 2019;11(2):185-93.

Haapasalo M, Shen Y, Wang Z, Gao Y. Irrigation

in endodontics. Br Dent J. 2014;216(6):299-303.

Alamoudi RA. The smear layer in endodontic: To

keep or remove - an updated overview. Saudi

Endod J. 2019;9(2):71-81.

Basrani B. Update of endodontic irrigation

solutions. In: Basrani B. Endodontic irrigation

system. chemical disinfection of the root canal

system. 1st ed. Cham, Switezerland. Springer

International Publishing. 2015.

Kuruvilla A, Jaganath BM, Krishnegowda SC,

Ramachandra PKM, Johns DA, Abraham A. A

comparative evaluation of smear layer removal by

using edta, etidronic acid, and maleic acid as root

canal irrigants: An in vitro scanning electron

microscopic study. J Conserv Dent.

;18(3):247-51.

Ballal NV, Kandian S, Mala K, Bhat KS, Acharya

S. Comparison of the efficacy of maleic acid and

ethylenediaminetetraacetic acid in smear layer

removal from instrumented human root canal: a

scanning electron microscopic study. J Endod.

;35(11):1573-6.

Hora BS, Jain H, Jain V, Maurya N, Sardar P,

Chakinala VP. Comparative evaluation of smear

layer removal using different irrigation techniques

in mandibular premolar: a scanning electron

Microscopic study. Ann Romanian Soc Cell Biol.

;25(6):11531-41.

Castelo-Baz P, Martín-Biedma B, Cantatore G,

Ruíz-Piñón M, Bahillo J, Rivas-Mundiña B, et al.

In vitro comparison of passive and continuous

ultrasonic irrigation in simulated lateral canals of

extracted teeth. J Endod. 2012;38(5):688-91.

Mozo S, Llena C, Forner L. Review of ultrasonic

irrigation in endodontics: increasing action of

irrigating solutions. Med Oral Patol Oral Cirugia

Bucal. 2012;17(3):512-6.

Ultra Smart Endo Ultrasonic Activator - COXO

DENTAL Available from:

https://www.coxotec.com/coxo/ultra-smart

wireless-ultrasonic-activator/.

Espinoza I, Villar AJC, Loroño G, Estevez R,

Plotino G, Cisneros R. Effectiveness of XP-Endo

Finisher and Passive Ultrasonic Irrigation in the

Removal of the Smear Layer Using two Different

Chelating Agents. J Dent. 2021;22(4):243-51.

Schneider SW. A comparison of canal preparations

in straight and curved root canals. Oral Surg Oral

Med Oral Pathol. 1971; 32(2):271-5.

McHugh ML. Interrater reliability: the kappa

statistic. Biochemia medica. 2012;22(3):276-82.

Berman LH, Hargreaves KM. Cleaning and

shaping of the root canal system. In: Louis H.

Berman, Kenneth M. Hargreave. Cohen’s

Pathways of the Pulp. 12th ed. Elsevier Health

Sciences; 2020.

Eick JD, Wilko RA, Anderson CH, Sorensen SE.

Scanning electron microscopy of cut tooth surfaces

and identification of debris by use of the electron

microprobe. J Dent Res. 1970;49(6):1359-68.

Nagendrababu V, Jayaraman J, Suresh A,

Kalyanasundaram S, Neelakantan P. Effectiveness

of ultrasonically activated irrigation on root canal

disinfection: a systematic review of in vitro

studies. Clin Oral Investig. 2018; 22:665-70.

Susila A, Minu J. Activated irrigation vs.

conventional non-activated irrigation in

endodontics-A systematic review. Eur Endod J.

;4(3):96-110.

Ballal NV, Jain H, Rao S, Johnson AD, Baeten J,

Wolcott JF. Evaluation of SmearOFF, maleic acid

and two EDTA preparations in smear layer

removal from root canal dentin. Acta Odontol

Scand. 2019;77(1):28-32.

Attur K, Joy M, Karim R, Kumar VA, Deepika C,

Ahmed H. 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. J Int Soc Prev

Community Dent. 2016; 6(2):160-5.

Lo Giudice G, Cutroneo G, Centofanti A,

Artemisia A, Bramanti E, Militi A, et al. Dentin

Morphology of Root Canal Surface: A

Quantitative Evaluation Based on a Scanning

Electronic Microscopy Study. BioMed Res Int.

; 2015:164065.

Wang Z, Shen Y, Haapasalo M. Root canal wall

dentin structure in uninstrumented but cleaned

human premolars: a scanning electron microscopic

study. J Endod. 2018;44(5):842-8.

Hülsmann M, Heckendorff M, Lennon A.

Chelating agents in root canal treatment: mode of

action and indications for their use. Int Endod J.

;36(12):810-30.

Wang L, Zhao Y, Mei L, Yu H, Muhammad I, Pan

Y, et al. Effect of application time of maleic acid

on smear layer removal and mechanical properties

of root canal dentin. Acta Odontol Scand.

;75(1):59-66.

Ballal NV, Mala K, Bhat KS. Evaluation of the

effect of maleic acid and

ethylenediaminetetraacetic acid on the

microhardness and surface roughness of human

root canal dentin. J Endod. 2010;36(8):1385-8.

Crumpton BJ, Goodell GG, McClanahan SB.

Effects on smear layer and debris removal with

varying volumes of 17% REDTA after rotary

instrumentation. J Endod. 2005;31(7):536-8.

Uroz-Torres D, González-Rodríguez MP, FerrerLuque CM. Effectiveness of the EndoActivator

System in removing the smear layer after root

canal instrumentation. J Endod. 2010;36(2):308-

Lottanti S, Gautschi H, Sener B, Zehnder M.

Effects of ethylenediaminetetraacetic, etidronic

and peracetic acid irrigation on human root dentine

and the smear layer. Int Endod J. 2009;42(4):335-

O’Connell MS, Morgan LA, Beeler WJ,

Baumgartner JC. A comparative study of smear

layer removal using different salts of EDTA. J

Endod. 2000;26(12):739-43.

Sanjai K, Kumarswamy J, Patil A, Papaiah L,

Jayaram S, Krishnan L. Evaluation and

comparison of decalcification agents on the human

teeth. J Oral Maxillofac Pathol. 2012;16(2):222-7.

Yoshioka M, Yoshida Y, Inoue S, Lambrechts P,

Vanherle G, Nomura Y, et al.

Adhesion/decalcification mechanisms of acid

interactions with human hard tissues. J Biomed

Mater Res Off J Soc Biomater Jpn Soc Biomater.

;59(1):56-62.

Schmidt TF, Teixeira CS, Felippe MCS, Felippe

WT, Pashley DH, Bortoluzzi EA. Effect of

Ultrasonic Activation of Irrigants on Smear Layer

Removal. J Endod. 2015;41(8):1359-63.

Bueno CR, Cury MT, Vasques AM, Sarmiento JL,

Trizzi JQ, Jacinto RC, Sivieri-Araujo G, DEZAN

E. Cleaning effectiveness of a nickel-titanium

ultrasonic tip in ultrasonically activated irrigation:

a SEM study. Braz Oral Res. 2019;33(17):1-9.

Virdee SS, Seymour DW, Farnell D, Bhamra G,

Bhakta S. Efficacy of irrigant activation techniques

in removing intracanal smear layer and debris from

mature permanent teeth: a systematic review and

meta-analysis. Int Endod J. 2018;51(6):605-21.

Iandolo A, Pisano M, Abdellatif D, Sangiovanni G,

Pantaleo G, Martina S, et al. Smear Layer and

Debris Removal from Root Canals Comparing

Traditional Syringe Irrigation and 3D Cleaning:

An Ex Vivo Study. J Clin Med. 2023;12(2):492.

Di Spirito F, Pisano M, Caggiano M, Bhasin P, Lo

Giudice R, Abdellatif D. Root canal cleaning after

different irrigation techniques: an ex vivo analysis.

Medicina. 2022;58(2):193.

Ramachandran N, Podar R, Singh S, Kulkarni G,

Dadu S. Effect of ultrasonic activation on calcium

ion quantification, smear layer removal, and canal

cleaning efficacy of demineralizing irrigants. J

Conserv Dent JCD. 2018;21(5):551-6.

Ballal N, Rao S. Evaluation of smear layer removal

using maleic acid with different irrigation

techniques. International Journal of Clinical

Dentistry. 2017;10(1):45-54.

BlueFlex - An Endodontics Rotary Files [Internet].

BlueFlex. [cited 2023 Feb 25]. Available from:

https://www.blueflex.in/.

Kamel WH, Kataia EM. 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.

J Endod. 2014;40(3):446-50.

Published

2024-04-01

How to Cite

Efficiency of Canal Brush and Ultrasonic Activated Irrigation in Smear Layer Removal Using Two Different Chelating Agents (In Vitro Study). (2024). Sulaimani Dental Journal, 11(1), 13. https://doi.org/10.17656/sdj.10186

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