Evaluation of 17% EDTA and 10% citric acid in smear layer removal and tubular dentin sealer penetration

The purpose of this study was to compare the efficacy of different chelating solutions (17% EDTA and 10% citric acid) on the smear layer removal, and their effect on tubular dentin sealer penetration. Sixty root canals were prepared and distributed into four groups (n = 15) according to the final irrigation protocol: G1, final irrigation with 2.5 mL of distilled water; G2, final irrigation with 2.5 mL of 2.5% sodium hypochlorite solution; G3, final irrigation with 2.5 mL of 17% EDTA; and G4, final irrigation with 2.5 mL of 10% citric acid. Five specimens from each group were not filled to assess smear layer removal by scanning electron microscopy. Ten specimens from each group were filled for analysis of sealer penetration into dentinal tubules by confocal laser scanning microscopy. Smear layer removal (Kruskal–Wallis and Dunn's tests) and sealer penetration (F and Tukey's tests) were statistically analyzed with 95% of significance level. G3 and G4 had greater smear layer removal rates in the cervical and middle thirds, in comparison with G1 and G2 (p < .05). G3 and G4 had the highest percentages of sealer penetration in all thirds, in comparison with G1 and G2 (p < .05). Smear layer removal was effective only at the cervical and middle thirds when the chelating solutions were used. Sealer penetration into the dentinal tubules significantly increased in all root thirds when the specimens were treated with both chelating solutions.     

Evaluation of different irrigation protocols concerning the formation of chemical smear layer

The aim of this work was to evaluate, by means of scanning electron microscopy (SEM) and electron dispersive spectroscopy (EDS), the different irrigation protocols concerning the formation of chemical smear layer (CSL). Fifty‐five teeth were instrumented by using distilled water (DW) as irrigant. Next, the teeth were submitted to a protocol for removal of the mechanical smear layer produced. The teeth were divided into 11 groups, according to irrigation regimen. Then, the teeth were prepared and analyzed with SEM and EDS. Only in Group 1 [1 mL sodium hypochlorite (NaOCl) + 10 mL DW + 1 mL chlorhexidine (CHX) solution], Group 2 [1 mL NaOCl + 10 mL DW + 1 mL ethylenediaminetetraacetic acid (EDTA) + 10 mL DW + 1 mL CHX solution], and Group 3 [1 mL NaOCl + 10 mL DW + 1 mL citric acid (CA) + 10 mL DW + 1 mL CHX solution], the formation of CSL was observed. In the groups where CHX gel was used alone or in association with EDTA, CA, phosphoric acid (PA), and CHX solution, no formation of CSL was observed. According to the results found in the cases in which one wants to associate NaOCl with CHX, the protocol using PA (1 mL NaOCl + 10 mL DW + 1 mL PA + 10 mL DW + 1 mL CHX solution) did not induce formation of CSL. Microsc. Res. Tech., 2013. © 2012 Wiley Periodicals, Inc.     

Effect of time and ultrasonic activation on ethylenediaminetetraacetic acid on smear layer removal of the root canal

The aim of this study was to assess the effect of time and the ultrasonic activation of ethylenediaminetetraacetic acid (EDTA) in removing the smear layer of at root canal. A total of 60 bovine inferior incisors were transversely sectioned and instrumented; A smear layer was added in the root dentin surface. The specimen were then divided into six groups according to the following final irrigation protocols: Group (G) 1: conventional irrigation with sodium hypochlorite (NaOCl); G2: conventional irrigation with NaOCl + EDTA for 20 s; G3: conventional irrigation with NaOCl + EDTA for 60 s; G4: passive ultrasonic irrigation (PUI) with NaOCl; G5: PUI with NaOCl + PUI with EDTA for 20 s; G6: PUI + NaOCl and PUI with EDTA for 60 s. Samples were analyzed by scanning electron microscope (SEM) at ×500 increase. The images were measured by three blinded evaluators and classified in scores ranging from 1 to 5. The results were analyzed by the Pearson correlation test and the ANOVA nonparametric Kruskal–Wallis and Dunn's tests were used for the comparisons. Irrigated samples only with NaOCl (G1 and G4) had higher scores when compared with other groups. G5 and G6, irrigated with 17% EDTA and ultrasonic irrigation had lower scores. However, there was no statistically significant difference in G2 and G3, where there was no irrigation. It was concluded that irrigation with 17% EDTA for 20 s promoted the effective removal of smear layer, regardless of ultrasonic irrigation.     

Debris and smear removal in flattened root canals after use of different irrigant agitation protocols

Scanning electron microscopy (SEM) can be used to analyze the presence of debris and smear layer on the internal walls of root canal. This study evaluated the debris and smear removal in flattened root canals using SEM after use of different irrigant agitation protocols. Fifty mandibular incisors were distributed into five groups (n = 10) according to the irrigant agitation protocol used during chemomechanical preparation: conventional syringe irrigation with NaviTip needle (no activation), active scrubbing of irrigant with brush-covered NaviTip FX needle, manual dynamic irrigation, continuous passive ultrasonic irrigation, and apical negative pressure irrigation (EndoVac system). Canals were irrigated with 5 mL of 2.5% NaOCl at each change of instrument and received a final flush with 17% EDTA for 1 min. After instrumentation, the roots were split longitudinally and SEM micrographs at ×100 and ×1,000 were taken to evaluate the amount of debris and smear layer, respectively, in each third. Data were analyzed by Kruskal-Wallis and Dunn's post-hoc tests (α = 5%). Manual dynamic activation left significantly (p < 0.05) more debris inside the canals than the other protocols, while ultrasonic irrigation and EndoVac were the most effective (p < 0.05) for debris removal. Regarding the removal of smear layer, there was no statistically significant difference (p > 0.05) either among the irrigant agitation protocols or between the protocol-canal third interactions. Although none of the irrigant agitation protocols completely removed debris and smear layer from flattened root canals, the machine-assisted agitation systems (ultrasound and EndoVac) removed more debris than the manual techniques.     

Evaluation of smear layer removal and marginal adaptation of root canal sealer after final irrigation using ethylenediaminetetraacetic,peracetic, and etidronic acids with different concentrations

The purpose of this study was to investigate the effects of different irrigation solutions on the smear layer removal and marginal adaptation of a resin‐based sealer to root canal dentine. A total of 152 instrumented roots were irrigated with the following irrigants: 9,18% etidronic acid (HEBP), 0.5, 1,2% peracetic acid (PAA), 17% ethylenediaminetetraacetic acid (EDTA), saline. The amount of smear layer was evaluated using scanning electron microscope (SEM) in seventy root samples. Eighty‐two roots were filled with AH Plus and gutta‐percha. Slices obtained from apical third of each specimen were viewed with SEM to assess marginal adaptation. Use of 9% and 18% HEBP resulted in more efficient smear layer removal in the apical third than the other chelators (p < 0.05). Higher smear layer scores in the coronal and middle thirds were obtained from 0.5%, 1% PAA groups. Regarding marginal adaptation, 18% HEBP group showed the lowest gap size values (p < 0.05), and better marginal adaptation. Etidronic acid is a promising candidate for final irrigation of root canals.     

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 the root canal final rinse protocols on the debris and smear layer removal and on the push‐out strength of an epoxy‐based sealer

The aim of the present study was to evaluate the efficacy of QMiX, SmearClear, and 17% EDTA for the debris and smear layer removal from the root canal and its effects on the push‐out bond strength of an epoxy‐based sealer by scanning electron microscopy (SEM). Forty extracted human canines (n = 10) were assigned to the following final rinse protocols: G1‐distilled water (control), G2–17% EDTA, G3‐SmearClear, and G4‐QMiX. The specimens were submitted to a SEM analysis to evaluate the presence of debris and smear layer, respectively, in the apical or cervical segments. In sequence, forty extracted human maxillary canines with the root canals instrumented were divided into four groups (n = 10) similar to the SEM analysis study. After the filling with AH Plus, the roots were transversally sectioned to obtain dentinal slices. The specimens were submitted to a push‐out bond strength test using an electromechanical testing machine. The statistical analysis for the SEM and push‐out bond strength studies were performed using the Kruskal–Wallis and Dunn tests (α = 5%). There was no difference among the G2, G3, and G4 efficacy in removing the debris and smear layer (P > 0.05). The efficacy of these groups was superior to the control group. The push‐out bond strength values of G2, G3, and G4 were superior to the control group. The ability to remove the debris and smear layer by SmearClear and QMiX was as effective as the 17% EDTA. The final rinse with these solutions promoted similar push‐out bond strength values. Microsc. Res. Tech. 76:533–537, 2013. © 2013 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.     

Persistence of resinous cement residues in dentin treated with different chemical removal protocols

The aim of this study was to evaluate the persistence of resin cement residues after dentin surface cleaning with different alcohol-based solutions or an essential oil (eucalyptol). Forty bovine teeth were sectioned in order to expose pulp chamber dentin to be washed with 1.0 mL of 2.5% sodium hypochlorite (NaOCl), followed by 0.1 mL of 17% EDTA application for 3 min, and final irrigation with 2.5% NaOCl. The specimens were air dried and resin-based cement was rubbed onto the dentine surface with a microbrush applicator. After 15 min, the surface was scrubbed with a cotton pellet and moistened with different dentin cleaning solutions, compounding the following groups: G1--95% ethanol, G2--70% ethanol, G3--70% isopropyl alcohol, or G4--eucalyptol. The dentin was scrubbed until the cement residues could not be visually detected. Sections were then processed for SEM and evaluated at × 500 magnification. Scores were attributed to each image according to the area covered by residual sealer, and data were subjected to Kruskal-Wallis at 5% significance. Eucalyptol promoted the most adequate dentin cleaning, although no statistical difference was detected amongst the groups (P > 0.05), except between the eucalyptol and 70% ethanol groups (P < 0.05). All the evaluated dentin cleaning solutions were unable to completely remove the cement residues from the dentin surface.     

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.     

Comparison of different irrigation activation techniques on smear layer removal: An in vitro study

The purpose of this study was to evaluate the efficiency of different irrigation activation techniques on smear layer removal. About 80 single‐rooted human maxillary central teeth were decoronated to a standardized length.The samples were prepared by using ProTaper system to size F4 and divided into eight equal groups (n = 10) according to the final irrigation activation technique; distilled water was used as an irrigant in Group 1. The other groups were treated with 2.5% NaOCl and 17% EDTA, respectively. Conventional syringe irrigation (CSI) was used in Group 2. Irrigation solutions were activated using passive ultrasonic irrigation (PUI, Group 3), EndoVac apical negative pressure (ANP, Group 4), diode laser (Group 5), Nd:YAG laser (Group 6), Er:YAG laser (Group 7), and Er:YAG laser using with photon‐induced photoacoustic streaming (PIPS?, Group 8). Teeth were split longitudinally and subjected to scanning electron microscope (SEM). PIPS showed the best removal of smear layer when compared with PUI, ANP, Nd:YAG, and Er:YAG, but the difference was not statistically significant (P > 0.05). Smear layer scores obtained with PIPS technique were statistically significant different from those of obtained with control, CSI and diode laser groups (P < 0.05). All experimental irrigation techniques except ANP and diode laser removed smear layer more effectively at the coronal and middle levels compared to the apical level (P < 0.05). Irrigation activated/delivered techniques except diode laser have a positive effect on removing of smear layer. Microsc. Res. Tech. 78:230–239, 2015. © 2015 Wiley Periodicals, Inc.     

Efficacy of different irrigant protocols and application systems on sealer penetration using a stepwise CLSM analysis

This study compared several irrigation protocols and application systems for sealer penetration into dentinal tubules. Single‐rooted‐human teeth were divided into 5 experimental groups (n = 15) and a control group (n = 5), according to final irrigation protocols: standard needle irrigation (SNI); Vibringe; Vibringe + NaviTip FX (Vibringe NFX); Endo Spray (ES); and passive‐ultrasonic‐irrigation (PUI). Following obturation of the root canals, the percentage of the sealer penetration was measured at different depths using stepwise CLSM analysis. The sealer penetration in the experimental groups was significantly higher than the control group at all levels (p < .05). No significant differences were observed between Vibringe and SNI or Vibringe NFX, ES, and PUI at all depths (p > .05). The Vibringe NFX, ES, and PUI groups allowed deeper sealer penetration than SNI at 100, 250, and 500 μm levels (p < .05). The irrigant activation, the needle design, and the application form (syringe or spray) may impact the quality of the seal that is achieved with root canal filling.     

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.     

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.     

Influence of passive ultrasonic irrigation on the efficiency of various irrigation solutions in removing smear layer: a scanning electron microscope study

To evaluate the influence of passive ultrasonic irrigation (PUI) to remove the smear layer with different irrigation solutions. Seventy‐eight single rooted mandibular premolars were used. The working lengths were measured and the root canals were prepared by using nickel titanium rotary files. The specimens were subjected to six different irrigation regimens: sodium hypochloride (NaOCl) with classic irrigation (CI); NaOCl with PUI; EDTA with CI; EDTA with PUI; QMix with CI; and QMix with PUI. The specimens were split longitudinally. Scanning electron microscopy images were taken to evaluate the amount of residual smear layer and scored. Statistical analysis was performed with the Kruskal–Wallis test. The Dunn's test was used for post hoc testing after the Kruskal–Wallis test. The smear layer scores of apical thirds were significantly higher than coronal and middle thirds except for NaOCl + CI group (p < 0.001). The irrigation with PUI improved the efficacy of all irrigation solutions on removal of smear layer in both coronal and middle thirds (p < 0.001). The PUI activation increased the activity of NaOCl, EDTA, and QMix, respectively without any significance. All irrigation regimens were significantly more effective in coronal and middle thirds compared to apical third. PUI significantly increased the efficacy of smear layer removal regardless of irrigation solution.     

Comparison of influence of different manufacturing methods on the cleaning efficiency of rotary nickel–titanium files

The purpose of this study was to evaluate and compare cleaning effectiveness of TwistedFile, GT series X, Revo‐S, RaCe, Mtwo, and ProTaper Universal rotary files in curved canals. Seventy mesiobuccal canals of extracted human first maxillary molars were divided into seven groups of 10 samples each. Canals were prepared with six nickel–titanium (NiTi) rotary systems and manual K‐Flexofile. Irrigation was performed with 2 mL 2.5% NaOCl solution after each file, and 5 mL 2.5% NaOCl was used for the final flush. After the roots were split longitudinally, the presence of debris and smear layer was visualized using scanning electron microscopic photomicrographs taken at coronal, middle, and apical third. Mean scores for debris and the smear layer were calculated and statistically analyzed for significance between groups using the Kruskal–Wallis nonparametric analysis of variance (P < 0.05) and Mann–Whitney U test (P < 0.001). There was no significant difference among the groups in terms of debris and smear layer scores (P > 0.05). Without considering the preparation method used, while no statistically significant difference was found between the coronal third and the middle third (P > 0.05), higher amount of debris and smear layer were found in apical third (P = 0.001). The new generation of NiTi rotary files including the Twisted File and GT Series X presented similar cleaning effectiveness compared with traditionally ground NiTi rotary files. Microsc. Res. Tech. 76:231–236, 2013. © 2012 Wiley Periodicals, Inc.