OBJECTIVES: This study aimed to compare the effectiveness of ultrasound and acoustic and laser cleaning of curved root canals. METHODS: A total of 92 molars with independent root canals with a curvature of 20°-40° were prepared and standardized at 04 25# and stained with gentian violet solution for 72 h. Among them, 52 were randomly divi-ded into four groups for final rinsing (n=13): NI group, PUI group, EDDY group, and PIPS group. Ten samples in each group were cut horizontally along the long axis perpendicular to the root and divided into curved upper, curved, and apical segments. Images were taken with a stereomicroscope and Image J measurements were taken to calculate the depth of rinse penetration. The remaining three samples from each group were split along the long axis of the dentin, photographed by scanning electron microscope to record the dentin tubule exposure and staining layer, and scored for staining layer by double-blind method. SPSS 26.0 software was used to perform statistical analysis and select the best flushing method. An extra 40 samples were randomly divided into four groups for detection of flushing fluid penetration depth (n=10): 10, 20, 30, and 40 s. RESULTS: In the upper part, the mean depth of infiltration was not significantly different between the experimental and control groups (P>0.05). The PIPS group had a significantly lower smear layer score than the control group and the EDDY group (P<0.01). In the curved segment, the mean depth of infiltration was significantly greater in the PUI group than in the control group (P<0.05); the tarnish layer score was lower in each experimental group than in the control group. At the top, the mean depth of infiltration was greater in the PUI and PIPS groups than in the control group (P<0.05), and the smear layer score was lower in the PIPS group than in the other groups (P<0.05). After the time was changed, the depth of infiltration of PUI increased only in the apical segment as the flushing time increased. CONCLUSIONS The PUI and PIPS methods facilitate the penetration of irrigation solution into the dentin canal in curved root canals, especially in the apical segment. The PIPS technique is effective in removing the smear layer in curved root canals.
Humans ; Dental Pulp Cavity ; Microscopy, Electron, Scanning ; Root Canal Irrigants ; Root Canal Preparation/methods* ; Smear Layer ; Sodium Hypochlorite ; Therapeutic Irrigation/methods* ; Double-Blind Method

The aim of this study was to compare the efficiency of four final irrigation protocols in smear layer removal and bacterial inhibition in root canal systems. Thirty roots inoculated with Enterococcus faecalis were prepared with ProTaper Universal files. The teeth were disinfected by conventional needle irrigation, sonic agitation using the EndoActivator device, passive ultrasonic irrigation, or an M3 Max file. Teeth with no root canal preparation served as blank controls for the establishment of the infection baseline. Teeth with preparation but no final irrigation served as a post-instrumentation baseline. After the final irrigation, the teeth were sectioned in half. One half of each tooth was examined by scanning electron microscopy (SEM) to assess smear layer removal using a five-point scale. The other half was examined by confocal laser scanning microscopy (CLSM) using the LIVE/DEAD BackLight bacterial viability kit to evaluate the depth of bacterial survival in dentinal tubules. SEM analysis revealed no significant difference in smear layer removal throughout the whole canal among the EA, PUI, and M3 Max groups (P > 0.05). CLSM revealed that PUI achieved the greatest bacterial inhibition depth in the coronal ((174.27 ± 31.63) μm), middle ((160.94 ± 37.77) μm), and apical ((119.53 ± 28.49) μm) thirds of the canal (all P < 0.05 vs. other groups). According to this comprehensive SEM and CLSM evaluation, PUI appears to have the best infection control ability in root canal systems.
Dental Pulp Cavity ; Edetic Acid ; Humans ; Microscopy, Electron, Scanning ; Root Canal Irrigants ; Root Canal Preparation ; Smear Layer ; Sodium Hypochlorite

OBJECTIVE: This study aimed to evaluate the effectiveness of XP-endo Finisher (XPF) file and passive ultrasonic irrigation (PUI) in the smear layer removal of the root canal. METHODS: A total of 60 human single-rooted premolars were selected and decoronated to standardize their canal length to 16 mm. Tooth samples were prepared using a S3 rotary system to prepare root canal with the file size of 3S and then randomly divided into 6 groups according to the final irrigation protocol, as follows: XPF 3 mL of 3% NaOCl for 1 min (group A); XPF 3 mL of 3% NaOCl for 1 min, followed by 4 mL of 17% ethylene diamine tetraacetic acid (EDTA) for 1 min (group B); PUI of 3 mL of 3% NaOCl for 1 min (group C); PUI of 3 mL of 3% NaOCl for 1 min, followed by 4 mL of 17% EDTA for 1 min (group D); 3 mL of 3% NaOCl for 1 min by using a syringe and a 30 G side-vented needle (group E); and 3 mL of 3% NaOCl for 1 min by using a syringe and a 30 G side-vented needle, followed by 4 mL of 17% EDTA for 1 min (group F). After the completion of the root canal preparation, the teeth were split into two longitudinally. The mean numbers of the visible open dentinal tubules in the apical and middle thirds of the root canals were evaluated via scanning electron microscope. RESULTS: The whole surfaces of the root canals in groups A, C, and E were covered by a smear layer. Groups A and C possessed significantly higher number of visible open dentinal tubules than in group E (P<0.05), with statistically insignificant difference between groups A and C (P>0.05). The apical third of the samples in groups B and D and in the middle thirds of canals in group F exhibited a small amount of smear layer, and the dentinal tubules were open or semi-open. The root canal surfaces in the apical third of the samples in group F were covered by a smear layer, and the dentinal tubules were sealed or semisealed. The smear layers in the middle third of the samples in groups B and D were removed, and the dentinal tubules were more visibly open than those of the four other groups (P<0.05). The difference between groups B and D were statistically insignificant (P>0.05). CONCLUSIONS The difference between XPF and PUI in terms of the smear layer removal of the root canals was insignificant. Hence, XPF, as a new irrigation agitation technique, can aid in improving smear layer removal.
Dental Pulp Cavity ; Edetic Acid ; Humans ; Microscopy, Electron, Scanning ; Root Canal Irrigants ; Root Canal Preparation ; Smear Layer ; Sodium Hypochlorite

OBJECTIVES: The aim of this systematic review was to critically analyze previously published studies of the effects of dentin surface pretreatment with deproteinizing agents on the bonding of self-etch (SE) adhesives to dentin. Additionally, a meta-analysis was conducted to quantify the effects of the above-mentioned surface pretreatment methods on the bonding of SE adhesives to dentin. MATERIALS AND METHODS: An electronic search was performed using the following databases: Scopus, PubMed and ScienceDirect. The online search was performed using the following keywords: ‘dentin’ or ‘hypochlorous acid’ or ‘sodium hypochlorite’ and ‘self-etch adhesive.’ The following categories were excluded during the assessment process: non-English articles, randomized clinical trials, case reports, animal studies, and review articles. The reviewed studies were subjected to meta-analysis to quantify the effect of the application time and concentration of sodium hypochlorite (NaOCl) and hypochlorous acid (HOCl) deproteinizing agents on bonding to dentin. RESULTS: Only 9 laboratory studies fit the inclusion criteria of this systematic review. The results of the meta-analysis revealed that the pooled average microtensile bond strength values to dentin pre-treated with deproteinizing agents (15.71 MPa) was significantly lower than those of the non-treated control group (20.94 MPa). CONCLUSIONS: In light of the currently available scientific evidence, dentin surface pretreatment with deproteinizing agents does not enhance the bonding of SE adhesives to dentin. The HOCl deproteinizing agent exhibited minimal adverse effects on bonding to dentin in comparison with NaOCl solutions.
Adhesives* ; Animals ; Dentin* ; Hypochlorous Acid ; Smear Layer* ; Sodium Hypochlorite

OBJECTIVE: This work aimed to evaluate the influence of smear layer on the bonding effectiveness and durability of the self-adhesive resin cements to dentin. METHODS: A total of 48 fresh caries-free third molars with exposed dentin surface were divided into two groups. The dentin surfaces were treated using a standard grit diamond bur (group A) or further polished using a fine grit diamond bur (group B) and then bonded with either of the two self-adhesive resin cements, namely, Clearfil SA Cement (CSA, Kuraray) and Multilink Speed (MS, Ivoclar Vivadent). After 24 h or 2-year water storage, a microtensile bond strength test was performed. RESULTS: In group A, the dentin surface was rough, the smear layer was thick, and the dentin tubule orifice detritus showed low embolism value. In group B, the dentin surface roughness decreased, the embolism proportion increased, and the smear layer became thin. The initial bonding strengths of CSA and MS in group A were significantly lower than those in group B (P<0.05). The bonding strengths of CSA and MS significantly decreased after two years of water storage (P<0.05). For CSA, the bond strength of group B was significantly lower than that of group A (P<0.05). For MS, the differences in the bonding strength between groups A and B were insignificant (P>0.05). CONCLUSIONS The properties of the smear layer and the types of self-adhesive resin cement used affected the bond strength and durability.
Composite Resins ; Dental Bonding ; Dental Cements ; Dentin ; Dentin-Bonding Agents ; Humans ; Materials Testing ; Resin Cements ; Smear Layer ; Surface Properties ; Tensile Strength

OBJECTIVE: To investigate the effect of smear layer on apical sealing ability in teeth obturated with mineral trioxide aggregate (MTA) Plus as retrofilling materials. METHODS: Fifty freshly extracted maxillary anterior teeth or premolars with single root canal were used in this study. All teeth were instrumented to master apical point 60# by using the stepback technique, obturated with lateral condensation technique, and then apical resected. A rootend cavity was then instrumented with an ultrasonic diamond-coated tip. Then the selected teeth were randomly and equally divided into two groups (n=25). In the experimental group (smear-), the teeth were irrigated with 0.17 g/L ethylenediaminetetraacetic acid (EDTA) to remove smear layer on the root-end cavity wall; in the control group (smear+), the teeth were irrigated with physiological saline. Five teeth were extracted to evaluate the cleanliness of root end cavity walls under a videomicroscope, respectively. The scanning electron microscope (SEM) evaluation was also performed for the presence of smear layer and open tubule. For the additional 40 teeth, the root-end cavities were filled with MTA Plus. The quantitative apical leakage of each teeth was evaluated by measuring the concentration of leaked sucrose in apical reservoir on 1, 7, 14, 21, 28, 35, 42, 49 and 56 days, respectively. The samples were stored at 37 °C and 100% humidity for 56 days. Statistical analysis was done with ANOVA for repeated measurement design data. RESULTS: Removal of the smear layer did not cause significantly less apical leaked sucrose than that when the smear layer was left intact for 56 days (P>0.05). There were statistically significant differences at the concentration of leaked sucrose among different observation time points (P<0.05). CONCLUSION It may be concluded that removing the smear layer may not be necessary in root-end cavities filled with MTA Plus.
Aluminum Compounds ; Calcium Compounds ; Dental Leakage ; Drug Combinations ; Edetic Acid ; Oxides ; Root Canal Filling Materials ; Root Canal Irrigants ; Root Canal Preparation ; Root Canal Therapy ; Silicates ; Smear Layer ; Sucrose/pharmacokinetics*

OBJECTIVES: This study evaluated smear layer removal by different chemical solutions used with or without ultrasonic activation after post preparation. MATERIALS AND METHODS: Forty-five extracted uniradicular human mandibular premolars with single canals were treated endodontically. The cervical and middle thirds of the fillings were then removed, and the specimens were divided into 9 groups: G1, saline solution (NaCl); G2, 2.5% sodium hypochlorite (NaOCl); G3, 2% chlorhexidine (CHX); G4, 11.5% polyacrylic acid (PAA); G5, 17% ethylenediaminetetraacetic acid (EDTA). For the groups 6, 7, 8, and 9, the same solutions used in the groups 2, 3, 4, and 5 were used, respectively, but activated with ultrasonic activation. Afterwards, the roots were analyzed by a score considering the images obtained from a scanning electron microscope. RESULTS: EDTA achieved the best performance compared with the other solutions evaluated regardless of the irrigation method (p < 0.05). CONCLUSIONS: Ultrasonic activation did not significantly influence smear layer removal.
Bicuspid ; Chlorhexidine ; Edetic Acid ; Humans ; Methods ; Microscopy ; Post and Core Technique ; Smear Layer* ; Sodium Chloride ; Sodium Hypochlorite ; Ultrasonics*

OBJECTIVES: This study investigated the cleaning ability of ultrasonically activated irrigation (UAI) and a novel activation system with reciprocating motion (EC, EasyClean, Easy Equipamentos Odontológicos) when used with a relatively new chelating agent (QMix, Dentsply). In addition, the effect of QMix solution when used for a shorter (1 minute) and a longer application time (3 minutes) was investigated. MATERIALS AND METHODS: Fifty permanent human teeth were prepared with K3 rotary system and 6% sodium hypochlorite. Samples were randomly assigned to five groups (n = 10) according to the final irrigation protocol: G1, negative control (distilled water); G2, positive control (QMix 1 minute); G3, QMix 1 minute/UAI; G4, QMix 1 minute/EC; G5, QMix 3 minutes. Subsequently the teeth were prepared and three photomicrographs were obtained in each root third of root walls, by scanning electron microscopy. Two blinded and pre-calibrated examiners evaluated the images using a four-category scoring system. Data were statistically analyzed using Kruskal-Wallis and Dunn tests (p < 0.05). RESULTS: There were differences among groups (p < 0.05). UAI showed better cleaning ability than EC (p < 0.05). There were improvements when QMix was used with auxiliary devices in comparison with conventional irrigation (p < 0.05). Conventional irrigation for 3 minutes presented significantly better results than its use for 1 minute (p < 0.05). CONCLUSIONS: QMix should be used for 1 minute when it is used with UAI, since this final irrigation protocol showed the best performance and also allowed clinical optimization of this procedure.
Endodontics ; Humans ; Microscopy, Electron, Scanning ; Root Canal Irrigants ; Root Canal Therapy ; Smear Layer ; Sodium Hypochlorite ; Tooth ; Ultrasonics

OBJECTIVES: The aim of this study was to compare the push-out bond strength and dentinal tubule penetration of root canal sealers used with coated core materials and conventional gutta-percha. MATERIALS AND METHODS: A total of 72 single-rooted human mandibular incisors were instrumented with NiTi rotary files with irrigation of 2.5% NaOCl. The smear layer was removed with 17% ethylenediaminetetraacetic acid (EDTA). Specimens were assigned into four groups according to the obturation system: Group 1, EndoRez (Ultradent Product Inc.); Group 2, Activ GP (Brasseler); Group 3, SmartSeal (DFRP Ltd. Villa Farm); Group 4, AH 26 (Dentsply de Trey)/gutta-percha (GP). For push-out bond strength measurement, two horizontal slices were obtained from each specimen (n = 20). To compare dentinal tubule penetration, remaining 32 roots assigned to 4 groups as above were obturated with 0.1% Rhodamine B labeled sealers. One horizontal slice was obtained from the middle third of each specimen (n = 8) and scanned under confocal laser scanning electron microscope. Tubule penetration area, depth, and percentage were measured. Kruskall-Wallis test was used for statistical analysis. RESULTS: EndoRez showed significantly lower push-out bond strength than the others (p < 0.05). No significant difference was found amongst the groups in terms of percentage of sealer penetration. SmartSeal showed the least penetration than the others (p < 0.05). CONCLUSIONS: The bond strength and sealer penetration of resin-and glass ionomer-based sealers used with coated core was not superior to resin-based sealer used with conventional GP. Dentinal tubule penetration has limited effect on bond strength. The use of conventional GP with sealer seems to be sufficient in terms of push-out bond strength.
Dental Pulp Cavity* ; Dentin* ; Edetic Acid ; Glass ; Gutta-Percha ; Humans ; Incisor ; Rhodamines ; Smear Layer

OBJECTIVEThis study aimed to evaluate the effects of treatment with different powers of Nd: YAG laser irradiation on root surfaces and Streptococcus mutans (S. mutans) adhesion.

METHODSExtracted teeth because of severe periodontal disease were divided into the following four groups: control group, laser group 1, laser group 2, and laser group 3. After scaling and root planning, laser group 1, laser group 2, and laser group 3 were separately treated with Nd: YAG laser irradiation (4/6/8 W, 60 s); however, the control group did not receive the treatment. Scanning electron microscopy (SEM) was used to determine the morphology. S. mutans were cultured with root slices from each group. Colony forming unit per mL (CFU·mL⁻¹) was used to count and compare the amounts of bacteria adhesion among groups. SEM was used to observe the difference of bacteria adhesion to root surfaces between control group (scaling) and laser group 2 (6 W, 60 s), thereby indicating the different bacteria adhesions because of different treatments.

RESULTSMorphology alterations indicated that root surfaces in control group contain obvious smear layer, debris, and biofilm; whereas the root surfaces in laser group contain more cracks with less smear layer and debris. The bacteria counting indicated that S. mutans adhesion to laser group was weaker than that of control group (P<0.05). No statistical significance among the laser groups (P>0.05) was observed. Morphology alterations also verified that S. mutans adhesion to laser group 2 (6 W, 60 s) was weaker than that of control group (scaling).

CONCLUSIONSThis study demonstrated that Nd: YAG laser irradiation treatment after scaling can reduce smear layer, debris, and biofilm on the root surfaces as compared with conventional scaling. The laser treatment reduces the adhesion of S. mutans as well. However, Nd: YAG laser irradiation can cause cracks on the root surfaces. In this experiment, the optimum laser power of 6 W can thoroughly remove the smear layer and debris, as well as relatively improve the control of thermal damagee.