Cleaning capacity of octenidine as root canal irrigant: A scanning electron microscopy study

The aim of this study was to assess the cleaning capacity of the octenidine hydrochloride (OCT) used as root canal irrigant by scanning electron microscopy (SEM) analysis. Sixty human unirradicular extracted teeth were randomly distributed in 6 groups (n = 10) according to irrigant solutions which were used during root canal preparation: G1, 0.1% OCT; G2, 2% chlorhexidine (CHX); G3, 2.5% sodium hypochlorite (NaOCl); G4, OCT + 17% ethylenediaminetetraacetic acid (EDTA); G5, 2.5% NaOCl + 17% EDTA and G6, distilled water. All specimens were instrumented with ProTaper system up to F4. Teeth were sectioned and prepared for SEM. The smear layer was evaluated using a 5‐score system and the data were analyzed by Kruskal–Wallis and Dunn (α = 0.05). In all root canal thirds there was no significant difference between OCT, CHX, NaOCl, and water groups (p > .05), and these groups showed higher smear layer values than NaOCl + EDTA and OCT + EDTA groups (p < .05). There was no significant difference between NaOCl + EDTA and OCT + EDTA groups (p > .05). It was concluded that OCT used as a single root canal irrigant presented poor cleaning capacity and could be used in association with a final irrigation with EDTA to obtain smear layer removal.     

Effects of QMix and ethylenediaminetetraacetic acid on decalcification and erosion of root canal dentin

The aim of this study was to evaluate the effect of initial NaOCl on the decalcification and erosion ability of EDTA and QMix. Sixty‐maxillary‐incisors were bisected longitudinally and the tooth‐halves were used. The experiment was conducted in two‐sets. In set‐I, 80‐tooth halves were treated in the presence or absence of initial NaOCl and EDTA. In set‐II, 40‐tooth halves were immersed in NaOCl and QMix. After each treatment, calcium‐ion release was determined with flame photometry. The erosion was imaged using SEM. Initial NaOCl led to concentration‐ and time‐dependent increase in calcium removal effect of 17% EDTA (p < .05). The rate of calcium removal and root canal wall erosion was considerably more severe with the use of 5% NaOCl for 3 min (p < .05). QMix as a final solution showed less decalcification and erosion than 17% EDTA when used 5% NaOCl as an initial irrigant (p < .05). Optimizing the concentration and application time of NaOCl can decrease the decalcification effect of chelating agents.     

Effects of chemical agents on physical properties and structure of primary pulp chamber dentin

This study evaluated the effects of chemical agents on the physical properties and structure of primary pulp chamber dentin using surface roughness, microhardness tests, and scanning electron microscopy (SEM). Twenty‐five primary teeth were sectioned exposing the pulp chamber and were divided into five groups (n = 5): NT, no treatment; SH1, 1% sodium hypochlorite (NaOCl); SH1U, 1% NaOCl + Endo‐PTC^®; SH1E, 1% NaOCl + 17% EDTA; and E, 17% EDTA. After dentin treatment, the specimens were submitted to roughness, microhardness testing, and SEM analysis. Roughness and microhardness data were submitted to one‐way ANOVA and Tukey's test (P < 0.05). The SH1E group showed the highest roughness, followed by the E group (P < 0.05) when compared with the NT, SH1, and SH1U groups. Microhardness values of SH1 and SH1U showed no significant difference as compared to the NT (control) group (P > 0.05). Microhardness values could not be obtained in the EDTA groups (SH1E and E). The presence of intertubular dentin with opened dentin tubules was observed in the NT, SH1, and SH1U groups. SH1E showed eroded and disorganized dentin with few opened tubules and the intertubular/peritubular dentin was partially removed. Considering the physical and structural approaches and the chemical agents studied, it can be concluded that NaOCl and NaOCl associated with Endo‐PTC^® were the agents that promoted the smallest changes in surface roughness, microhardness, and structure of the pulp chamber dentin of primary teeth. Microsc. Res. Tech. 77:52–56, 2014. © 2013 Wiley Periodicals, Inc.     

The effect of final irrigation with MTAD,QMix, and EDTA on smear layer removal and mineral content of root canal dentin

To compare the smear layer removal ability and mineral content of root canal dentine after initial irrigation with NaOCl and final irrigation with MTAD, QMix, and 17% EDTA. Forty extracted human maxillary incisors before root canal preparation and irrigation with NaOCl were randomly divided into four groups (n = 10) according to the type of final irrigants used: MTAD, QMix, 17% EDTA, and control (sterile distilled water). Scanning electron microscopy (SEM) was used to assess the presence of smear layer. SEM energy‐dispersive X‐ray spectroscopy was used to quantify dentin mineral composition in MTAD, QMix, 17% EDTA group, and in no‐treatment samples (no‐treatment group; n = 10). Among the various chelating agents, there were no significant differences in the smear layer removal in the middle and coronal thirds (p > .05). In the apical third, QMix removed significantly more smear layer than 17% EDTA (p < .05), but similarly to MTAD (p > .05). Final irrigation with MTAD resulted in a significant increase in the carbon (C) value compared to EDTA (p < .001). There was no significant difference in the mineral composition between the MTAD and the QMix group, although the values of the mineral elements were significantly altered in the MTAD group. QMix had smear layer removal capability similar to MTAD but better than EDTA in the apical third. MTAD yielded the most pronounced effect on mineral component of root dentin; however, differences were significant only for C level compared to 17% EDTA.     

Effect of EDTA,sodium, and calcium hypochlorite on the inorganic component of root canal dentin: A SEM analysis

This study evaluated the influence of canal irrigation protocols with 5.25% calcium hypochlorite [Ca(OCl)₂], 5.25% sodium hypochlorite (NaOCl) and 17% EDTA solution on the inorganic component of root canal dentin. Sixty roots were randomly divided into six groups (n = 10): Saline solution (SS) (control); Saline solution (SSE) +17% EDTA; CH ? 5.25% Ca(OCl)₂; CHE ? 5.25% Ca(OCl)₂ + 17% EDTA; SH ? 5.25% NaOCl; SHE ? 5.25% NaOCl +17% EDTA. After canal irrigation, the specimens were longitudinally split and analyzed by scanning electron microscopy (SEM). Dentinal tubules were observed in transverse (middle and apical thirds) direction. The images were classified in scores, according to smear layer removal and peritubular dentin alteration, and data were analyzed by Kruskal–Wallis's test, followed by Dunn's test (α = 0.05). In the middle third, all groups with EDTA presented better removal of the smear layer with higher peritubular dentin alteration (p < .05). In the apical third, this happened only in SHE (p < .05). Ca(OCl)₂ and NaOCl exhibit similar performance to remove smear layer and alteration of the inorganic component in the middle third. In the apical third, NaOCl associated with EDTA showed better performance in smear layer removal.     

Effect of final irrigation protocols on microhardness and erosion of root canal dentin

The aim of this study was to evaluate the effect of final irrigation protocols (17% EDTA, BioPure MTAD, SmearClear, and QMiX) on microhardness and erosion of root canal dentin. Fifty roots were sectioned transversely at the cement–enamel junction and each root was sectioned horizontally into 4‐mm‐thick slices. The samples were divided into five groups (n = 10) according to the final irrigation protocol: G1: distilled water (control group); G2: 17% EDTA; G3: BioPure MTAD; G4: SmearClear; and G5: QMiX. The dentin microhardness was then measured with a load of 25 g for 10 s. Initially, the reference microhardness values were obtained for the samples without any etching. The same samples were then submitted to the final irrigation protocols. A new measure was realized and the difference between before and after the procedures was the dentin microhardness reduction. In sequence, the specimens were submitted to SEM analysis to verify the dentinal erosion. The Kruskal Wallis and Dunn tests (α = 5%) were used to compare the results. The dentin microhardness decreased for all final irrigation protocols. There was no significant difference between groups 2, 3, 4, and 5 (P > 0.05), but this groups presented significant dentin microhardness reduction than G1 (P < 0.05). In G2, occurred the highest incidence of dentinal erosion (P < 0.05). 17% EDTA, BioPure MTAD, SmearClear, and QMiX promoted significant dentin microhardness reduction. Dentinal tubules erosion was promoted by 17% EDTA. Microsc. Res. Tech., 76:1079–1083, 2013. © 2013 Wiley Periodicals, Inc.     

Persistence of Epoxy‐Based Sealer Residues in Dentin Treated With Different Chemical Removal Protocols

The presence of residual endodontic sealer in the pulp chamber may cause discoloration of the dental crown and interfere with the adhesion of restorative materials. The aim of this study was to compare the efficacy of different solvents in removing residues of an epoxy resin‐based sealer (AH Plus) from the dentin walls of the pulp chamber, by scanning electron microscopy (SEM). Forty‐four bovine incisor dental crown fragments were treated with 17% EDTA and 2.5% NaOCl. Specimens received a coating of AH Plus and were left undisturbed for 5 min. Then, specimens were divided in four groups (n = 10) and cleaned with one of the following solutions: isopropyl alcohol, 95% ethanol, acetone solution, or amyl acetate solution. Negative controls (n = 2) did not receive AH Plus, while in positive controls (n = 2) the sealer was not removed. AH Plus removal was evaluated by SEM, and a score system was applied. Data were analyzed by Kruskal–Wallis and Dunn tests. None of the solutions tested was able to completely remove AH Plus from the dentin of the pulp chamber. Amyl acetate performed better than 95% ethanol and isopropyl alcohol (p < 0.05), but not better than acetone (p > 0.05) in removing the sealer from dentin. No significant differences were observed between acetone, 95% ethanol, and isopropyl alcohol (p > 0.05). It was concluded that amyl acetate and acetone may be good options for cleaning the pulp chamber after obturation with AH Plus. SCANNING 35:17‐21, 2013. © 2012 Wiley Periodicals, Inc.     

Effect of passive ultrassonic instrumentation as a final irrigation protocol on debris and smear layer removal—a sem analysis

This study sought to evaluate the efficacy of passive ultrasonic irrigation (PUI) on removing the smear layer and debris from root dentin using scanning electron microscopy (SEM). Twenty‐five bovine incisors were manually prepared and divided into three groups according to the final irrigation protocol: EDTA, final irrigation with 12 mL of 17% EDTA for 3 minutes followed by 5 mL of 2.5% NaOCl; EDTA/PUI, final flush with 4 mL of 17% EDTA and PUI for 30 seconds. These procedures were repeated three times to standardize the volume of the irrigant. Control group, after preparation, the specimens were irrigated only with 17 mL of 2.5% NaOCl. The roots were fractured and analyzed using SEM. The intragroup analysis revealed that the EDTA/PUI protocol removed a higher amount of debris at the cervical third (P = 0.03). The intergroup analysis revealed that EDTA/PUI presented the lowest amount of debris at the cervical third (P = 0.007). Smear layer scores were higher in the control group compared with the EDTA and EDTA/PUI groups, but only at the cervical third (P = 0.02). None of the final irrigant protocols completely removed the smear layer and debris. EDTA/PUI only improved the removal of debris at the cervical third. Microsc. Res. Tech. 76:496–502, 2013. © 2013 Wiley Periodicals, Inc.     

Effect of medicaments used in endodontic regeneration on the morphological characteristics of bovine radicular dentin: Experimental immature tooth model

The purpose of this study was to evaluate the effect of different combinations of irrigating solutions and intracanal dressings in the pretreatment of bovine radicular dentin, using an experimental immature tooth model. Eighty healthy bovine teeth, simulated with incomplete rhizogenesis, were randomly distributed according to the protocols of root canal dentin pretreatment for a regenerative endodontic procedure (n = 10): Control (irrigation with distilled water); SH (irrigation with 1.5% Sodium Hypochlorite); EDTA (irrigation with 17% EDTA); SH/EDTA (irrigation with 1.5% SH + 17% EDTA); SH/CH/EDTA (irrigation with 1.5% SH + calcium hydroxide paste +17% EDTA); SH/MTAP/EDTA (irrigation with 1.5% SH + modified triple antibiotic paste + EDTA 17%); SH/TAP/EDTA (irrigation with 1.5% SH + triple antibiotic paste +17% EDTA) and SH/DAP/EDTA (irrigation with 1.5% SH + double antibiotic paste + EDTA 17%). After the completion of the protocol, the demineralization, the exposure of collagen fibers, and the dentin erosion was evaluated under scanning electron microscopy (SEM), by applying a score system (1–3) to classify the observed features. Statistical analysis was performed (Kruskal‐Wallis and Dunn Multiple Comparison tests—p < .05). SH/TAP/EDTA and SH/DAP/EDTA groups presented the highest rates of demineralization in both the coronal and middle thirds of the root (p < .05). In the SH/MTAP/EDTA group, the samples presented moderate demineralization. The samples from the SH/CH/EDTA group presented similar findings to the control group (p < .05). Conventional triple antibiotic (TAP) and double antibiotic (DAP) pastes promoted more pronounced morphological changes on the dentin surface.     

Effects of sodium hypochlorite as dentin deproteinizing agent and aging media on bond strength of two conventional adhesives

This study evaluated the effect of 10% sodium hypochlorite (NaOCl) as deproteinizing agent and storage media on bond strength (BS) of two etch‐and‐rinse adhesive systems to dentin. Twenty‐eight sound extracted human third molars were divided in four groups (n = 7), according to dentin treatment (conventional etching or etching followed by 10% NaOCl application) and adhesive systems (GB—Gluma 2Bond and OS—One‐Step). After dentin treatments and adhesive application, a composite block was built‐up on dentin surface and teeth were serially sectioned to obtain bonded sticks specimens. The sticks were submitted to three aging conditions: (24H) 24 hr in water (immediate), (SH) 3 hr of NaOCl accelerated‐aging or (1Y) 1 year of water storage. Afterward, submitted to microtensile bond strength test (μTBS), failure modes and adhesive interfaces analyzes. Data were analyzed by two‐way analysis of variance (ANOVA) and Tukey's test (α = .05). Dentin deproteinization before bonding significantly reduced μTBS for GB‐treated group (p < .05), regardless the aging conditions. Water storage for 1 year (1Y) and NaOCl accelerated‐aging (SH) decreased μTBS for both adhesives. Yet, the groups stored in NaOCl (SH) exhibited the lowest BS results (p < .05). Bond strength of deproteinized dentin was dependent on the adhesive system composition and NaOCl accelerated‐aging promoted decreased bond strength and further degradation than water storage for 1 year.     

Response of E. faecalis biofilms to different associations of auxiliary substances during root canal preparation: A confocal laser microscopy analysis

Objective: This in vitro study evaluated the effect of different endodontic auxiliary chemical substances over Enterococcus faecalis (Ef) biofilm through confocal laser scanning microscopy (CLSM). Methods: Forty‐five bovine incisors were infected with Ef for 21 days. Teeth were divided into five groups: group 1: 2.5% NaOCl + EDTA, group 2: 2% CHX gel + EDTA, group 3: 2% CHX liquid + EDTA, group 4: 2.5% NaOCl + 2% CHX gel + EDTA, group 5: 2.5% NaOCl + 2% CHX liquid + EDTA and a negative and a positive control group (NCG; PCG). The samples were stained with SYTO9 and propidium iodide and analyzed by CLSM. Bacterial viability was quantitatively analyzed by the proportions of dead and live bacteria in the biofilm remnants. Scores were standardized according to the total bacterial load (TBL)—1: ≤25%, 2: >25 ≤50%, 3: >50 ≤75%, 4: >75% and debris—1: absence of debris; 2: presence of debris. Statistical analysis was carried out through the Kruskal–Wallis and the Fischer exact tests (P = 0.05). Results: No statistical differences were observed to CFU, debris and bacterial viability. Conclusion: None of the tested substances could completely eliminate Ef from the root canal space. Microsc. Res. Tech. 76:658–662, 2013. © 2013 Wiley Periodicals, Inc.     

The effect of a root‐dentin pretreatment technique combining PIPS with MTAD aiming to improve the bond strength of glass fiber post

The aim of this study was to evaluate the combined effect of MTAD and photon‐induced photoacoustic streaming (PIPS) technique on the smear layer removal and the bond strength of glass fiber post. Fifty‐five human mandibular premolars were chosen. After root canal therapy and post space preparation, the teeth were equally divided to five groups according to the methods of root‐dentin pretreatment: G1: distilled water (control); G2: 2.5% NaOCl+17% EDTA; G3: MTAD; G4: PIPS; G5: MTAD+PIPS. One sample was randomly selected from each group, and scanning electron microscope (SEM) was used to observe the microscopic morphology of the coronal, middle and apical level of the root‐dentin. The remaining ten samples from each group were glued to glass fiber posts, and the bond strength was assessed by push‐out test. SEM evaluation showed that the most complete smear layer removal was found in MTAD + PIPS group, especially in coronal third. Push‐out test results exhibited that there was a statistically significant interaction between the experimental groups and root canal third (p < .0005). Significant differences could be found among five groups (p < .05): G5 > G4 > G3 > G2 > G1. G5 had the highest bond strength. In conclusion, post space pretreatments with MTAD or PIPS technique can significantly remove smear layer and improve the bond strength of glass fiber post, and combination of them works best.     

Analysis of adhesive interface in root canals irradiated by Er,Cr:YSGG laser after luting a fiber post

This study evaluated the effect of Er,Cr:YSGG laser on the root canal dentin after luting a fiber post. Twenty‐four bovine teeth roots were prepared using NiTi instruments and filled with Sealer 26 and gutta‐percha. Post spaces were prepared and roots were distributed according to dentin treatment (n = 8): 2.5%NaOCl (group control), Er,Cr:YSGG laser (1.5 W, 20 Hz, 20 s) (group test 1) or 2.5%NaOCl + Er,Cr:YSGG laser (group test 2). Fiber posts were luted using adhesive cement (Rely X U200, 3M) and roots were prepared to confocal laser scanning microscopy (CLSM) and scanning electron microscope (SEM). The morphology of interface, thickness of cement, and the gaps and tags were analyzed. Non‐parametrical data for thickness of cement were submitted to Friedman and Kruskall–Wallis tests (α = 0.05) and parametrical data for gaps to ANOVA (α = 0.05). CLSM of the cement thickness and gaps revealed no significant difference in surface treatment (NaOCl, Er,Cr:YSGG laser and NaOCl + Er,Cr:YSGG laser) (p > .05) and canal thirds (cervical, middle, and apical) (p > 0.05). SEM showed tags and a residual layer of cement adhered to dentin, mainly in laser‐irradiated specimens. The pretreatment of root canal with Er,Cr:YSGG laser previously to luting the fiber post with a self‐adhesive cement did not influence the cement thickness and gaps but affected the dentin interaction.     

Effect of different irrigation protocols on the radicular dentin interface and bond strength with a metacrylate‐based endodontic sealer

This study assessed the influence of different endodontic chemical substances on the adhesion of the Epiphany SE/Resilon system (with and without resinous solvent) to radicular dentin walls, using the push‐out test and scanning electron microscopy (SEM). Forty‐eight root canals of human canines were prepared biomechanically with ProTaper rotary files (crown‐down technique) and the radicular dentin was treated with either 17% EDTA, 2% chlorhexidine gel (CHX) or 2.5% NaOCl (control). The root canals were filled with Resilon cones and Epiphany SE sealer with and without resinous solvent. Six groups of eight canals each had their roots sectioned transversally to obtain 1‐mm thick slices. Data were subjected to statistical analysis by ANOVA and Tukey's tests. The specimens treated with 17% EDTA (1.59 ± 0.91) presented higher bond strength (P < 0.05) than those treated with 2.5% NaOCl (0.93 ± 0.27) and 2% CHX (0.92 ± 0.22). Significantly higher bond strength (P < 0.05) was observed when the Epiphany SE was prepared with (1.37 ± 0.78) than without (0.92 ± 0.33) solvent. Adhesive failures were predominant in all groups. SEM analysis showed greater homogeneity of the filling mass when the solvent was added to the sealer. Treatment of root canal walls with 17% EDTA, and addition of a resinous solvent to Epiphany SE produced the highest adhesion to radicular dentin. Microsc. Res. Tech. 77:446–452, 2014. © 2014 Wiley Periodicals, Inc.     

Investigation of mineral content of root canal dentin after the application of various antibiotic paste using energy‐dispersive X‐ray detector

The purpose of this study was to evaluate mineral content of root canal dentin after treatment with different antibiotic pastes including the mixture of metronidazole, ciprofloxacin, doxycycline, cefaclor, amoxicillin, or minocycline. Fifty extracted maxillary canine teeth were randomly divided into five groups (n = 10 teeth for each group). Root canals were prepared Reciproc rotary files. Canals were irrigated using 5 ml 5% NaOCl and 1 ml 15% EDTA. Each tooth in all groups were longitudinally splitted into two pieces as a control and experimental samples. Each experimental group received following antibiotic paste; double antibiotic paste (DAP) and triple antibiotic paste with doxycycline (TAPd), TAP with cefaclor (TAPc), TAP with amoxicillin (TAPa), and TAP with minocycline (TAPm) for 21 days. The Ca, P, Mg, Ca, and K levels, and the Ca/P ratio was analyzed by a scanning electron microscope (SEM) equipped using a Bruker energy‐dispersive X‐Ray (EDX) detector. Data were analyzed with independent samples t‐test, one‐way anova, and Duncan tests. Ca and Ca/P ratio showed a statistically significant increase TAP with amoxicillin and cefaclor (p < .05). DAP, TAPd, and TAPm did not change the mineral levels (p > .05). TAPa and TAPc with increased the Ca level and Ca/P ratio of the root canal dentin which consequently positively influences the revascularization process.     

Effect of dentin and fiber post surface treatments with fumaric acid on the bonding ability of fiber posts

This study investigated the effects of fumaric acid on push‐out bond strength when applied to dentin surfaces and fiber posts. The root canals of 60 mandibular premolar teeth were instrumented and obturated. After removing two thirds of filling material, teeth were prepared according to six randomized groups (n = 10/group) defined by two fiber post surface treatments (0.7% fumaric acid or 9% hydrofluoric acid) and three dentin conditioning treatments [control (no conditioning); 17% ethylenediamine tetraacetic acid (EDTA); or 0.7% fumaric acid]. After fiber post‐cementation, three 1‐mm thick discs were obtained from each tooth by transverse sectioning, and each disc underwent push‐out bond strength testing. Data were analyzed with a one‐way analyses of variance (anova ) and t tests; p < .05 was considered statistically significant. Failure modes were determined by stereomicroscopy, and the surface characteristics of dentin and fiber posts were observed by scanning electron microscopy. Push‐out bond strength was greater for the group in which the post surface treated with hydrofluoric acid and the dentin surface treated with fumaric acid than the nontreated dentin and hydrofluoric acid‐treated post group (p < .05). There were no significant differences between other comparison pairs (p > .05). A combination of fumaric acid dentin conditioning and hydrofluoric acid fiber post treatment strengthened the bonding ability of fiber posts.     

Adverse effects of respiratory disease medicaments and tooth brushing on teeth: A scanning electron microscopy,X‐ray fluorescence and infrared spectroscopy study

The present study aims to evaluate the effect of brushing with fluoride dentifrice on teeth severely affected by erosion due to respiratory medicaments. Enamel (n = 50) and dentin (n = 50) bovine specimens were prepared and treated with artificial saliva (S‐control), acebrofilin hydrochloride (AC), ambroxol hydrochloride (AM), bromhexine hydrochloride (BR), and salbutamol sulfate (SS) and subjected to cycles of demineralization (immersing in 3 mL, 1 min, three times a day at intervals of 1 hr, for 5 days) followed by remineralization (saliva, 37°C, 1 hr). Simulated brushing with fluoridated toothpaste was performed using 810 strokes in a reciprocal‐action brushing simulator. Scanning electron microscopy, micro energy dispersive X‐ray fluorescence (μ‐EDXRF) spectroscopy and attenuated total reflection Fourier transform infrared (ATR FTIR) spectroscopy were then performed. μ‐EDXRF images showed extensive erosion after treatment with all medicaments. SEM images showed enamel erosion in order SS > BR > AC = AM > S after brushing and fluoridation. FTIR results were in agreement. In case of dentin, μ‐EDXRF measurements showed significant difference in mineral content (percent weight of calcium and phosphate) in SS + brushing + fluoridation treated enamel compared to control, while μ‐EDXRF images showed erosive effects in the order SS > AM>BR > AC = S post brushing + fluoridation. SEM images showed erosion in the order SS > AM = BR > AC > S post brushing + fluoridation. Again, FTIR multivariate results were in agreement. Overall, our study shows that proper oral care is critical when taking certain medication. The study also demonstrates the possible use of FTIR for rapid clinical monitoring of tooth erosion in clinics.     

Qualitative analysis of smear layer treated with different etidronate concentrations: A scanning electron microscopy study

The aim of this study was to examine the smear layer removal capacity of various etidronate treatments. Seventy‐eight roots were instrumented up to apical size X4 and randomly divided into five treatment groups and a positive control group (n = 13). Groups were as follows: irrigation with 5 ml of sterile saline (control) for 3 min, 5 ml of 17% ethylenediaminetetraacetic acid (EDTA) for 3 min, 5 ml of 9% A1‐hydroxyethylidene‐1,1‐bisphosphonate (HEBP) for 3 min, 5 ml of 18% HEBP for 3 min, irrigation with 5 ml of 1% sodium hypochlorite (NaOCl) + 9% HEBP for 3 min, and 5 ml of 2% NaOCl + 18% HEBP for 3 min. The roots were examined using a scanning electron microscope. The smear layer scores in the 2% NaOCl + 18% HEBP group were lower than those in the other treatment groups and the control group (p < .05). There were no significant differences among the treatment groups in the smear layer scores of the coronal and middle thirds. However, the smear layer scores in the 2% NaOCl + 18% HEBP treatment group were lower those in the 9% HEBP and 18% HEBP treatment groups in the apical third (p < .05). In the clinical setting, the recommended concentration of HEBP is 18%, and it should be used with an oxidizing agent to ensure optimum smear layer removal.     

Tubular dentin sealer penetration after different final irrigation protocols: A confocal laser scanning microscopy study

The aim of this study was to evaluate tubular dentin sealer penetration, comparing different final irrigation protocols using a conventional needle (CONV), EndoActivator system (EAS), EndoVac system (EVS), and ultrasound (PUI). Initially, fifty‐two first maxillary molars with a single canal in the palatal root, without abrupt curvatures, resorptive processes, or previous endodontic treatment were selected for this study. Then, the crowns were sectioned to obtain palatal roots 15 mm in length. The root canals were prepared with the ProTaper Universal System and irrigated with 5% NaOCl. Afterwards, the specimens were divided into four groups (n. 13), according to the final irrigation protocol: CONV, EAS, EVS, and PUI. After filling, slices at 3 mm and 5 mm from the apex were obtained for analysis by confocal laser scanning microscopy. Two‐way comparisons between the groups and the levels were performed with Games Howell's test (p < .05). Tubular dentin sealer penetration was higher at 5 mm compared with 3 mm from the apex (p < .05). The EAS group showed a higher percentage of tubular dentin sealer penetration, compared with the CONV group, at both levels. At 3 mm, there was no statistically significant difference among EAS, EVS, and PUI; however, these groups showed better performance, compared with the CONV group. At 5 mm, there was no statistically significant difference between the EAS and EVS groups, but both showed higher sealer penetration than the PUI group (p < .05). The EAS and EVS groups achieved better degrees of tubular dentin sealer penetration, compared with the other groups.