Smear Layer Removal and Canal Cleanliness Using Different Irrigation Systems (EndoActivator, EndoVac, and Passive Ultrasonic Irrigation): Field Emission Scanning Electron Microscopic Evaluation in an In Vitro Study

Abstract

Introduction: The purpose of this study was to evaluate the effectiveness of different irrigating methods in removing the smear layer at 1, 3, 5, and 8 mm from the apex of endodontic canals. Methods: Sixty-five extracted single-rooted human mandibular premolars were decoronated to a standardized length of 16 mm. Specimens were shaped to ProTaper F4 (Dentsply Maillefer, Ballaigues, Switzerland) and irrigated with 5.25% NaOCl at 37 C. Teeth were divided into 5 groups (2 control groups [n = 10] and 3 test groups [n = 15]) according to the final irrigant activation/delivering technique (ie, sonic irrigation, passive ultrasonic irrigation [PUI], or apical negative pressure). Root canals were then split longitudinally and observed by field emission scanning electron microscopy. The presence of debris and a smear layer at 1, 3, 5, and 8 mm from the apex was evaluated. Scores were analyzed by KruskalWallis and Mann-Whitney U tests. Results: The EndoActivator System (Dentsply Tulsa Dental Specialties, Tulsa, OK) was significantly more efficient than PUI and the control groups in removing the smear layer at 3, 5, and 8 mm from the apex. The EndoVac System (Discus Dental, Culver City, CA) removed statistically significantly more smear layer than all groups at 1, 3, 5, and 8 mm from the apex. At 5 and 8 mm from the apex, PUI and the EndoVac did not differ statistically significantly, but both performed statistically better than the control groups. Conclusions: In our study, none of the activation/delivery systems completely removed the smear layer from the endodontic dentine walls; nevertheless, the EndoActivator and EndoVac showed the best results at 3, 5, and 8 mm (EndoActivator) and 1, 3, 5, and 8 mm (EndoVac) from the apex.

Influence of Root Canal Curvature on Wall Cleanliness in the Apical Third during Canal Preparation

“…Generally, Reciproc resulted in better cleaning of canal walls than PT-shaped canals (15). Mancini et al (21) obtained similar PT results regarding cleanliness that showed the ability to compare instrumental motion in straight versus curved canals similar to our study.…”

“…The amount of debris is generally measured by SEM observations, and even though this method has been widely described and optimised, some drawbacks persist (6,(20)(21)(22)(23). Indeed, debris/smear layer quantification is generally based on a small number of photomicrographs and offers only a selective appreciation of the root canal wall cleanliness.…”

Endoactivator And Diode Laser Assisted Disinfection for Treating C-Shaped Canal in Mandibular Second Molar: Report of 3 Cases.

“…Therefore, in all three cases endoactivator irrigation system was used to increase the efficacy of irrigant. Mancini et al reported that endoactivator also aid in effectively removes the smear layer from root canals [9]. Its design allows for the safe activation of various intracanal reagents and could produce vigorous intracanal fluid agitation.…”

Effectiveness of NaviTip FX on Intracanal Calcium Hydroxide Removal

“…The complexity of the root canal irrigation becomes even more important since it allows cleaning beyond which can be achieved with mechanical instrumentation alone (Peters, 2004;Moradi et al, 2009), since the irrigant washing action, debris, microorganisms, tissues and medications are removed from the canal (Mancini et al, 2013;AbouRass & Piccinino, 1982;Abi-Rached et al, 2014;Rödig et al, 2010). Therefore, many studies have been conducted to evaluate the effectiveness of techniques and chemicals used in irrigation stage (Gu et al, 2009;Foschi et al, 2004).…”