Search

The effects of Easydo Activator (EA), a new sonic irrigation system, on sealer penetration at the root apex were compared to needle irrigation (NI) and passive ultrasonic irrigation (PUI) in this study. Forty-two single-rooted teeth were prepared and randomly divided into three groups (n = 14): group 1: NI; group 2: PUI; and group 3: EA. A solution of 3% sodium hypochlorite (NaOCl) was used for irrigation. Nine teeth in each group were filled with AH Plus sealer mixed with CY5 fluorescent dye and a single gutta-percha cone. The sealer penetration area, maximum penetration depth and percentage of sealer penetration at 5 mm and 1 mm from the apex were analyzed by confocal laser scanning microscopy (CLSM). The remaining 5 teeth in each group were subjected to test smear layer scores by scanning electron microscopy (SEM). The CLSM evaluation showed that increases in the area, depth and percentage of sealer penetration were detected at 1 and 5 mm from the root apex in the PUI group compared with the NI group, and greater increases were observed in the EA group (P < 0.05). The SEM experiment showed that the lowest scores for the smear layer and debris removal were achieved by the EA group when compared with the PUI and NI groups (P < 0.05). In conclusion, EA was superior to PUI and NI regarding sealer penetration at the root apex during endodontic treatment, and it could provide a new technical idea for clinical root canal therapy. [ABSTRACT FROM AUTHOR]

Introduction: Endodontic therapy aims to eradicate pulpal and periapical diseases by removing bacteria from root canals. Despite thorough cleaning, the smear layer obstructs canal disinfection. Root canal preparation and irrigation, particularly with sodium hypochlorite, are essential for debridement. However, conventional techniques may leave areas untreated, necessitating innovative solutions like superoxidised water and Laser-activated Irrigation (LAI) for effective treatment. Need for the Study: The effectiveness of root canal treatment is contingent upon the success of the irrigating solution and the mode used for its activation, which is directly reflected in its ability to penetrate dentinal tubules. Thus, the focus of this experimental in-vitro study is to identify the most suitable irrigating solution and an effective activation technique for better penetration into dentinal tubules. Aim: The study will evaluate and compare the penetration of Sodium Hypochlorite (NaOCl) and oxidised water irrigants into dentinal tubules using diode laser and ultrasonic activation. Materials and Methods: An experimental in-vitro study will be conducted in the Department of Conservative Dentistry and Endodontics at Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India, from August 2024 to May 2025. The approach involves categorising 60 recently extracted single-rooted teeth with fully formed apical foramina and intact occlusal morphology into six primary groups according to distinct irrigation techniques and the application of two different irrigants, resulting in 10 teeth per group. Decoronated specimens will be injected with a specific irrigant and activated using different techniques. The penetration of oxidised water into dentinal tubules by low-level laser therapy and ultrasonic activation will be evaluated and compared using confocal laser microscopy. The normality of the data will be analysed using the Kolmogorov-Smirnov test. If the data are normal, then the T-Analysis of Variance (ANOVA) test will be applied; if not, the Kruskal-Wallis test will be used at a 5% level of significance (p≤0.05).

Aim: This study aims to evaluate and compare the efficiency of grapeseed and pineapple extract in removing smear layer from the apical third of root canal, with and without ultrasonic activation. Methods: Eighty single-rooted permanent teeth were divided into two main groups: Group I: conventional syringe irrigation and Group II: ultrasonic activation. Each group was subdivided into two experimental groups, i.e. grapeseed and pineapple extract and one control group, i.e., 17% ethylenediaminetetraacetic acid (EDTA). For each subgroup, instrumentation was done using ProTaper Gold up to size F3 and irrigated with 5 mL of the respective irrigant, followed by a final rinse of 2.5 mL of 5.25% NaOCl. For Group II, the respective irrigant was ultrasonically activated for 1 min, followed by a final rinse of 2.5 mL of 5.25% NaOCl. Smear layer evaluation was done with scanning electron microscope, and data were statistically analyzed. Results: In Group I, both pineapple and grapeseed extracts were more effective than 17% EDTA in removing smear layer from the apical root canal. However, in Group II, 17% EDTA showed highest efficacy in smear layer removal, followed by pineapple and grapeseed extracts (P < 0.05). Conclusion: Natural extracts such as pineapple and grapeseed seeds extracts exhibit potential for smear layer removal in the apical third, without the disadvantage of dentinal erosion from synthetic smear layer removing agents.

Introduction: Endodontic therapy aims to eradicate pulpal and periapical diseases by removing bacteria from root canals. Despite thorough cleaning, the smear layer obstructs canal disinfection. Root canal preparation and irrigation, particularly with sodium hypochlorite, are essential for debridement. However, conventional techniques may leave areas untreated, necessitating innovative solutions like superoxidised water and Laser-activated Irrigation (LAI) for effective treatment. Need for the Study: The effectiveness of root canal treatment is contingent upon the success of the irrigating solution and the mode used for its activation, which is directly reflected in its ability to penetrate dentinal tubules. Thus, the focus of this experimental in-vitro study is to identify the most suitable irrigating solution and an effective activation technique for better penetration into dentinal tubules. Aim: The study will evaluate and compare the penetration of Sodium Hypochlorite (NaOCl) and oxidised water irrigants into dentinal tubules using diode laser and ultrasonic activation. Materials and Methods: An experimental in-vitro study will be conducted in the Department of Conservative Dentistry and Endodontics at Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India, from August 2024 to May 2025. The approach involves categorising 60 recently extracted single-rooted teeth with fully formed apical foramina and intact occlusal morphology into six primary groups according to distinct irrigation techniques and the application of two different irrigants, resulting in 10 teeth per group. Decoronated specimens will be injected with a specific irrigant and activated using different techniques. The penetration of oxidised water into dentinal tubules by low-level laser therapy and ultrasonic activation will be evaluated and compared using confocal laser microscopy. The normality of the data will be analysed using the Kolmogorov-Smirnov test. If the data are normal, then the T-Analysis of Variance (ANOVA) test will be applied; if not, the Kruskal-Wallis test will be used at a 5% level of significance (p=0.05). [ABSTRACT FROM AUTHOR]

Aim: To evaluate and compare the smear layer removal capabilities of Smear Clear and Q-Mix using scanning electron microscopy. Materials and Methods: Forty-two human premolars were standardized to a 10 mm root length, cleaned, and shaped with X2 universal rotary ProTaper. The samples were divided into two groups for final irrigation: Group 1 with 17% Ethylene diamine tetra acetic acid (EDTA) (n = 20) and Group 2 with Q-Mix (n = 20). The canals were sectioned and analyzed under an SEM at various root levels. Statistical analysis was performed at a significant level of 0.05. Result: QMix performed better at removing the smear layer than Smear Clear. Conclusion: QMix, a newly introduced irrigant, effectively removed the smear layer from the apical region of the root canal, which is typically inaccessible to conventional irrigants.

Background: The removal of the smear layer and antimicrobial efficacy are critical factors in endodontic treatment. Conventional chemical irrigants like sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) have proven effective but can have adverse effects. Materials and Methods: A total of 60 extracted single-rooted human teeth were randomly assigned to four groups of 15 each. Group 1 was irrigated with 5.25% NaOCl, group 2 with 17% EDTA, group 3 with 10% neem extract, and group 4 with 5% turmeric extract. Smear layer removal was assessed using scanning electron microscopy (SEM) at the coronal, middle, and apical thirds of the root canals. Antimicrobial efficacy was tested against Enterococcus faecalis using the agar diffusion method, and the zones of inhibition were measured in millimeters. Results: Neem extract showed an average smear layer removal score of 2.5 (±0.3) compared to 1.8 (±0.2) for NaOCl, 1.9 (±0.3) for EDTA, and 3.2 (±0.4) for turmeric extract. Neem and turmeric extracts demonstrated significant antimicrobial activity with mean inhibition zones of 16 mm (±1.2) and 14 mm (±1.1), respectively, compared to 18 mm (±1.5) for NaOCl and 15 mm (±1.3) for EDTA. Conclusion: Herbal irrigants, particularly neem extract, show promise as effective alternatives to conventional irrigants for smear layer removal and antimicrobial activity. Their biocompatibility and comparable efficacy suggest potential for use in endodontic practice.

ABSTRACT: Aim: To evaluate and compare the smear layer removal capabilities of Smear Clear and Q-Mix using scanning electron microscopy. Materials and Methods: Forty-two human premolars were standardized to a 10 mm root length, cleaned, and shaped with X2 universal rotary ProTaper. The samples were divided into two groups for final irrigation: Group 1 with 17% Ethylene diamine tetra acetic acid (EDTA) (n = 20) and Group 2 with Q-Mix (n = 20). The canals were sectioned and analyzed under an SEM at various root levels. Statistical analysis was performed at a significant level of 0.05. Result: QMix performed better at removing the smear layer than Smear Clear. Conclusion: QMix, a newly introduced irrigant, effectively removed the smear layer from the apical region of the root canal, which is typically inaccessible to conventional irrigants. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: The removal of the smear layer and antimicrobial efficacy are critical factors in endodontic treatment. Conventional chemical irrigants like sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) have proven effective but can have adverse effects. Materials and Methods: A total of 60 extracted single-rooted human teeth were randomly assigned to four groups of 15 each. Group 1 was irrigated with 5.25% NaOCl, group 2 with 17% EDTA, group 3 with 10% neem extract, and group 4 with 5% turmeric extract. Smear layer removal was assessed using scanning electron microscopy (SEM) at the coronal, middle, and apical thirds of the root canals. Antimicrobial efficacy was tested against Enterococcus faecalis using the agar diffusion method, and the zones of inhibition were measured in millimeters. Results: Neem extract showed an average smear layer removal score of 2.5 (±0.3) compared to 1.8 (±0.2) for NaOCl, 1.9 (±0.3) for EDTA, and 3.2 (±0.4) for turmeric extract. Neem and turmeric extracts demonstrated significant antimicrobial activity with mean inhibition zones of 16 mm (±1.2) and 14 mm (±1.1), respectively, compared to 18 mm (±1.5) for NaOCl and 15 mm (±1.3) for EDTA. Conclusion: Herbal irrigants, particularly neem extract, show promise as effective alternatives to conventional irrigants for smear layer removal and antimicrobial activity. Their biocompatibility and comparable efficacy suggest potential for use in endodontic practice. [ABSTRACT FROM AUTHOR]

Aim: This study aims to evaluate and compare the efficiency of grapeseed and pineapple extract in removing smear layer from the apical third of root canal, with and without ultrasonic activation. Methods: Eighty single-rooted permanent teeth were divided into two main groups: Group I: conventional syringe irrigation and Group II: ultrasonic activation. Each group was subdivided into two experimental groups, i.e. grapeseed and pineapple extract and one control group, i.e., 17% ethylenediaminetetraacetic acid (EDTA). For each subgroup, instrumentation was done using ProTaper Gold up to size F3 and irrigated with 5 mL of the respective irrigant, followed by a final rinse of 2.5 mL of 5.25% NaOCl. For Group II, the respective irrigant was ultrasonically activated for 1 min, followed by a final rinse of 2.5 mL of 5.25% NaOCl. Smear layer evaluation was done with scanning electron microscope, and data were statistically analyzed. Results: In Group I, both pineapple and grapeseed extracts were more effective than 17% EDTA in removing smear layer from the apical root canal. However, in Group II, 17% EDTA showed highest efficacy in smear layer removal, followed by pineapple and grapeseed extracts (P < 0.05). Conclusion: Natural extracts such as pineapple and grapeseed seeds extracts exhibit potential for smear layer removal in the apical third, without the disadvantage of dentinal erosion from synthetic smear layer removing agents. [ABSTRACT FROM AUTHOR]

Objective: This in vitro study aimed to compare and evaluate the effectiveness of different irrigation solutions, including Triton, 0.5% Chitosan nanoparticles (CNP), and 17% ethylenediaminetetraacetic acid (EDTA), on the smear layer removal of the root canal walls. Methods: Forty extracted sound mandibular premolars were examined; the samples were decoronated to obtain a root length of 14 mm. Each sample was instrumented using ProTaper Next rotary file X4 (40/0.06). The samples were longitudinally sectioned and examined under a scanning electron microscope at 3000x magnification in the coronal, middle, and apical thirds using a four-level scoring system. Results: Triton demonstrated the lowest mean smear layer removal (p>0.05) compared to the other irrigation solutions at all the levels of the root canal. No significant differences were observed (p>0.05) at the coronal and middle levels of the root canal between the CNP and EDTA groups. CNP demonstrated significantly more smear layer removal at the apical level compared to EDTA. Conclusion: Smear layer removal was least effective with Triton at all the levels of the root canal compared to the other irrigation solutions tested in this study. CNP demonstrated superior smear layer removal at the apical level compared to the other irrigation solutions. [ABSTRACT FROM AUTHOR]

Background: Smear layer is formed after root canal preparation. Removing the smear layer is an important aspect because it can affect the adaptation of sealer so it can increase the leakage of the root canal filling. Chitosan is a natural biopolymer produced by the deacetylation of chitin which has a chelation effect. Purpose: To explain the potential of chitosan as an irrigant on smear layer removal in root canal. Method: Based on sources obtained from journals, textbooks, and websites accessed through the Google Scholar database. The types of references taken are in the form of research reports, literature studies, published from 2014–2021. Conclusion: Chitosan has the potential as root canal irrigant for smear layer removal even in low concentrations with minimal side effects. However, there are differences of opinion regarding the region of smear layer removal.

AbstractThe present study aimed to assess the effectiveness of different final irrigation regimens (Cold Atmospheric Pressure Plasma Jet, MTAD, and EDTA) in removing the smear layer from intra-radicular dentin using a Scanning Electron Microscope (SEM). Eighty-four mandibular premolars were prepared with ProTaper Universal hand files and were equally divided into four groups i.e. Normal saline (control), EDTA, MTAD and CAP Plasma Jet. Prepared samples in the control, EDTA and MTAD groups were irrigated with 5 milliliters of the irrigant, and it was retained for 2 min. In the CAP Plasma Jet group, the plasma plume was directed towards the canal lumen for 2 min. The smear layer removal of all the groups was evaluated at the coronal, middle and apical thirds. Statistical analysis was performed using Kruskal–Wallis test followed by Dunn’s test. Evaluation by SEM showed that the smear layer removal ability of MTAD and EDTA were significantly better than CAP Plasma Jet (p 0.05). MTAD and EDTA aided in better smear layer removal than the CAP Plasma Jet in the coronal, middle, and apical third of the test samples. CAP Plasma jet performed better in the coronal third.

This study aimed to evaluate the antibacterial effect of three final irrigation protocols and to compare their ability to remove the smear layer and debris from the root canal. Methods: Sixty-three single-rooted human teeth were inoculated with Enterococcus faecalis for 14 days. The teeth were divided into a positive control group (N = 3) and three treatment groups (N = 20) as follows: final irrigation with saline solution (control group), irrigation with 5.25% NaOCl ultrasonically activated with EndoUltra (EU), standard needle irrigation with Qmix 2in1 (Qx) and irrigation with 5.25% NaOCl activated using SiroLaser Blue (SB). The bacterial load was evaluated by analyzing the colony-forming units (CFU/mL). Selected specimens were split longitudinally and examined using scanning electron microscopy in order to determine the presence of a smear layer and debris. Statistical analyses were performed using one-way ANOVA and the Kruskal–Wallis rank-sum test. Results: Activation of NaOCl with EndoUltra or SiroLaser Blue was superior at reducing intracanal bacteria relative to standard needle irrigation with Qmix 2in1 solution (p < 0.05). Even though SiroLaser Blue showed the best results for removing the smear layer and debris, no significant differences were detected between the groups (p > 0.05). Conclusions: Final irrigation with 5.25% NaOCl ultrasonically activated using EndoUltra or SiroLaser Blue demonstrated a higher efficacy in bacterial reduction than standard needle irrigation with Qmix 2in1. [ABSTRACT FROM AUTHOR]

Reactive oxygen species (ROS) and free radicals, which have been implicated in inflammation, pain, carcinogenesis, and aging, are actually used in dental treatments such as tooth bleaching and composite resin polymerization. Recently, numerous studies have investigated the application of ROS in the medical and dental fields. In previous studies, ROS were generated intentionally through pathways such as photolysis, photocatalytic methods, and photodynamic therapy, which are used in the medical field to target cancer. In the field of dentistry, generated ROS are applied mainly for periodontal treatment and sterilization of the root canal, and its effectiveness as an antibacterial photodynamic therapy has been widely reported.. Given this background, the present article aimed to review the basic effects of ROS in dental medicine, especially endodontic therapy, and to discuss future applications of ROS. [ABSTRACT FROM AUTHOR]

Abstract Background Irrigation of the pulp space is a mandatory step to get rid of all its organic and inorganic content. Activation of the irrigants play a key role in the era of minimally invasive endodontics. The aim of this study was to assess the effectiveness of different irrigants activation methods in removing the smear layer at 1, 3, 5 and 8 mm from the apex from conservatively shaped canals. Methods Eighty-five human mandibular premolars were selected. Specimens were shaped to TruShape 25/.06 and divided into 5 groups (1 control and 4 test groups) according to the final activation technique (EndoActivator, EA), Ultrasonic (EndoUltra, PUI) and Laser (PIPS and SWEEPS). EDTA (Ethylenediaminetetraacetic acid) followed by NaOCl (Sodium Hypochlorite) and again EDTA were activated for each test group. Specimens were then split longitudinally and observed by Field Emission Scanning Electron Microscopy (FESEM). Blinded evaluation of the presence of smear layer was performed at 1000X magnification, according to a 5-score index system. Comparison between groups were analysed statistically using the Kruskal–Wallis non-parametric analysis of variance. Bonferroni multiple comparison tests were used. Results At 1 mm only PIPS and SWEEPS performed better than the control group. At 3, 5 and 8 mm from the apex, every activation technique showed statistically significant reduction of smear layer when compared to the control group. PIPS and SWEEPS obtained better cleanliness result compared to EA, while only PIPS was superior to PUI in terms of cleanliness. Conclusions PIPS and SWEEPS showed the best results in conservative canal preparations. Nowadays, contemporary rotary instruments allow fast and minimally invasive shaping of the endodontic space. In this scenario irrigants’ activation may be regarded as a mandatory step to a favourable clinical outcome.

Objective: This study aimed to compare the two nickel–titanium (NiTi) instruments on root dentin thickness using cone-beam computed tomography (CBCT) and ability to remove the smear layer using scanning electron microscope (SEM). Materials and Methods: The effect of two NiTi rotary instruments such as XP Endo shaper and ProTaper Gold (PTG) in retaining adequate dentin thickness and debridement (i.e., removal of smear layer) was evaluated in vitro using CBCT and SEM. After cleaning and shaping of the root canal with adequate irrigation, the effect of two NiTi instrument systems at 3 mm (apical), 6 mm (middle), and 9 mm (coronal) levels on buccal, lingual, mesial, and distal aspects in terms of amount of dentin removal and smear layer removal was evaluated. The data were analyzed using student's unpaired t-test with a significance of P ≤ 0.05. Results: Both NiTi instrument systems had no statistically significant difference in amount of dentin removal at all three levels and on all four aspects. In smear layer removal, PTG had significantly better efficacy compared to XP Endo shaper at the coronal third of root canal. Conclusion: Instrumentation with XP Endo Shaper and PTG showed a similar amount of dentin removal. PTG has a significant effect on smear layer removal compared to XP Endo Shaper only at the coronal third of root canal.

Abstract Objective This study was done to evaluate the effect of the prepared Moringa oleifera-based root canal irrigant compared to conventionally used irrigants on the microhardness of root dentin and smear layer removal. Materials and methods One hundred freshly extracted teeth with single root were divided into 5 groups according to the irrigant used: group 1, saline; group 2, Moringa oleifera; group 3, Moringa oleifera + chlorhexidine; group 4, chlorhexidine; and group 5, sodium hypochlorite. Root canal preparation was done using Protaper universal system till size F5 using one of the irrigants after each file. Fifty teeth were prepared to measure dentin microhardness, while the remaining fifty were prepared for evaluation of the remaining debris and smear layer using stereomicroscope and scanning electron microscope (SEM) in each third of the canal. Results Chlorhexidine alone and combined with Moringa oleifera showed higher microhardness values in apical and coronal parts. In the middle parts, chlorhexidine followed by Moringa oleifera showed the highest results. SEM examination showed that none of the used irrigants has the ability to completely remove smear layer. However, Moringa oleifera group showed the least amount of smear layer on canal wall. Conclusions Moringa oleifera is a promising final irrigant solution alone or combined with chlorhexidine throughout the instrumentation. Moringa oleifera was proved to have a high effect as a chelating agent.

Although high-intensity focused ultrasound (HIFU) has been applied widely in medicine, utilising its non-invasive dual ablation and thermal coagulation properties, its application in dentistry has primarily remained in the research phase, predominantly in in vitro studies. Nonetheless, there has been a consistent increase in the number of publications on this subject in recent decades, focusing on areas such as remineralisation of dentine surfaces, removal of smear layers, drug delivery, and microbial elimination. The number of advantages HIFU can offer, such as its non-surgical nature, absence of ionising radiation, lack of residue, and absence of aerosols, is driving this upward trend, indicating the potential for HIFU in clinical dentistry and ongoing efforts towards developing HIFU-based devices for routine dental use. This succinct review aims to outline the historical context, operational mechanisms of HIFU, summarise recent dental research, and provide a forward-looking perspective on the role of HIFU in modern clinical dentistry., Competing Interests: Conflict of interest None disclosed., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: The present study aimed to test the efficiency of photoinduced photoacoustic streaming using 2940 nm Er: YAG laser and 980 nm diode laser agitation on smear layer removal, sealer penetration and push-out bond strength. Methods: Sixty single canaled human permanent teeth were collected for this study. Specimens were grouped into three experimental groups (20 teeth in each group), depending on the activation protocol used for final irrigation: Group I (needle agitation), group II (980nm diode laser agitation) and group III (photon induced photoacoustic streaming (PIPS) using 2940 nm Er: YAG laser. The quantity of irrigant was standardized in all groups to 4 ml. The irrigant was activated for 40 seconds in different groups under continuous flow. Two teeth from each group were used to check the smear layer removal, and then the remaining teeth in each group were randomly divided into three equal experimental subgroups according to methods of evaluation used: subgroup A: Sealing ability evaluated by dye penetration method; subgroup B: SEM for sealer penetration; and subgroup C: Push-out bond strength assessed by the universal test machine. Results: As regards smear layer removal, results showed that the PIPS group had opened dentinal tubules, followed by the diode laser group, while the least cleaning effect was found in the Sidevented needle group. As for Sealing ability and dye penetration, a statistically significant difference was found between all of the three groups, with the Er:YAG laser (PIPS) having the best sealing ability and sealer penetration. Push-out bond strength results showed no statistically significant difference between diode and Er:YAG groups, with a significant difference between each of them and the Side-vented needle group. Conclusion: Using the diode or Er:YAG laser (PIPS) for irrigant activation led to better irrigant penetration and smear layer removal which subsequently led to obvious sealer penetration, better sealing, and strength properties of endodontic treated teeth. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the two nickel–titanium (NiTi) instruments on root dentin thickness using cone-beam computed tomography (CBCT) and ability to remove the smear layer using scanning electron microscope (SEM). Materials and Methods: The effect of two NiTi rotary instruments such as XP Endo shaper and ProTaper Gold (PTG) in retaining adequate dentin thickness and debridement (i.e., removal of smear layer) was evaluated in vitro using CBCT and SEM. After cleaning and shaping of the root canal with adequate irrigation, the effect of two NiTi instrument systems at 3 mm (apical), 6 mm (middle), and 9 mm (coronal) levels on buccal, lingual, mesial, and distal aspects in terms of amount of dentin removal and smear layer removal was evaluated. The data were analyzed using student's unpaired t-test with a significance of P ≤ 0.05. Results: Both NiTi instrument systems had no statistically significant difference in amount of dentin removal at all three levels and on all four aspects. In smear layer removal, PTG had significantly better efficacy compared to XP Endo shaper at the coronal third of root canal. Conclusion: Instrumentation with XP Endo Shaper and PTG showed a similar amount of dentin removal. PTG has a significant effect on smear layer removal compared to XP Endo Shaper only at the coronal third of root canal. [ABSTRACT FROM AUTHOR]

Introductio: Healing potential of plants is an age-old idea that has recently attained renewed interest. Considering the ineffectiveness, potentially harmful effects, and safety concerns of commonly used synthetic irrigants, the herbal alternatives for endodontic usage might prove to be advantageous. Aim: The aim of this study was to evaluate the adequacy of smear layer removal and cytotoxicity potential of triphala in comparison to sodium hypochlorite. Materials and Methods: The study was conducted in two parts: the first part of the study was cytotoxicity assessment studied using Alamar blue assay. L929 mouse fibroblasts were seeded in 96-well plates at a density of 5000 cells/well and treated with different concentrations of triphala and NaOCl for a period of 24 and 48 h. The percentage of cell viability was then quantified using an Alamar blue assay. The optical density was measured at 570 nm and compared with 620 nm, which was considered as a reference wavelength. The second part of the study was smear layer assessment at the coronal, middle, and apical third of twenty human premolar teeth using scanning electron microscope. Results: The Alamar blue reagent cytotoxicity study suggested that triphala showed no cytotoxic properties against the normal mouse fibroblast cells whereas sodium hypochlorite showed a significant cytotoxic effect against the L929 cell lines with the IC50 concentration at 1.8%, respectively, after the treatment of 24 h of incubation at 37°C temperature. Triphala was as effective as sodium hypochlorite in smear layer removal in the coronal and middle third of the root, but sodium hypochlorite showed better smear layer removal in the apical third. Conclusion: Triphala can be considered as a superior irrigant with good antibacterial efficacy and least cytotoxicity potential compared to conventional hypochlorite irrigating agent and provide adequate clearing of smear layer in the coronal and middle third, and further studies are warranted to alter the properties of liquid to make it more cleansable in the apical third of the root.

Introduction/Objective. Irrigation has an important role in root canal cleaning and its efficiency depends on the type of irrigants, the amount, the technique and the irrigation protocol. The aim of this work was to estimate the efficiency of cleaning of the canal walls by using scanning electron microscope analysis after the instrumentation by rotary NiTi instruments with the use of three different irrigation solutions and two final irrigation protocols. Methods. Sixty extracted human incisors were divided into two groups after the rotary instrumentation with the iRace instruments. In both groups, the same amount (1.5 ml) of three solutions (2% sodium hypochlorite solution, 2% chlorhexidine solution, and 10% citric acid solution) and total final irrigation time (90 seconds) was the same. The final irrigation in the first group was accomplished using the technique of continuous irrigation and in the second group it was done using the intermittent protocol. The roots were cut longitudinally and analyzed by thirds (coronal, middle, and apical) on a scanning electron microscope (JSM 6460LV, JEOL Ltd., Tokyo, Japan) with 1,000× magnification. Results. The most efficient cleaning of the root canal walls in both groups was seen after the use of citric acid with the intermittent protocol of the final irrigation (90.7% clean walls), while the least efficient was the final irrigation by chlorhexidine with continuous irrigation (80.3%). The most efficient cleaning of the canal walls in both groups was observed in the coronal third and the largest amount of the smear layer in the apical third. Conclusion. The most efficient cleaning of the canal was achieved by the use of citric acid and the intermittent protocol of the final irrigation. In all tested solutions, the intermittent protocol of irrigation was more efficient than continuous irrigation.

Context: The presence of smear layer and debris can prevent the irrigant and sealer from penetrating the dentinal tubules thereby compromising the seal of the root canal filling. Aim: This study aims to evaluate the efficacy of XP-endo Finisher with ProTaper Next and HyFlex in smear layer and debris removal. Materials and Methods: Thirty-two extracted mandibular premolar teeth were selected and sectioned at the cementoenamel junction. The roots were then randomly divided into 4 groups. In group 1 and 2, canals were instrumented with X2 ProTaper Next (25 0.06 taper). In group 3 and 4, canals were instrumented with HyFlex system (25 0.06 taper). The canals in group 2 and 4 were further finished with XP-endo Finisher. Irrigation was carried out using 3% sodium hypochlorite during instrumentation, and 17% ethylenediaminetetraacetic acid was used as the final rinse. The roots were then split longitudinally. The canal wall was observed under the scanning electron microscope in coronal, middle, and apical thirds at a magnification of ×400 and ×1000 for evaluation of debris and smear layer, respectively. Photomicrographs were taken, and qualitative assessment for debris and smear layer removal was done. Statistical Analysis Used: The results were analyzed using Kruskal–Wallis test and Mann–Whitney U-test. Results: Lower debris and smear layer scores were seen in canal thirds instrumented with ProTaper Next and XP-endo Finisher (P < 0.01). Conclusion: The use of XP-endo Finisher as an adjuvant during shaping and cleaning produced cleaner root canal walls.

Background: Irrigation of the pulp space is a mandatory step to get rid of all its organic and inorganic content. Activation of the irrigants play a key role in the era of minimally invasive endodontics. The aim of this study was to assess the effectiveness of different irrigants activation methods in removing the smear layer at 1, 3, 5 and 8 mm from the apex from conservatively shaped canals. Methods: Eighty-five human mandibular premolars were selected. Specimens were shaped to TruShape 25/.06 and divided into 5 groups (1 control and 4 test groups) according to the final activation technique (EndoActivator, EA), Ultrasonic (EndoUltra, PUI) and Laser (PIPS and SWEEPS). EDTA (Ethylenediaminetetraacetic acid) followed by NaOCl (Sodium Hypochlorite) and again EDTA were activated for each test group. Specimens were then split longitudinally and observed by Field Emission Scanning Electron Microscopy (FESEM). Blinded evaluation of the presence of smear layer was performed at 1000X magnification, according to a 5-score index system. Comparison between groups were analysed statistically using the Kruskal–Wallis non-parametric analysis of variance. Bonferroni multiple comparison tests were used. Results: At 1 mm only PIPS and SWEEPS performed better than the control group. At 3, 5 and 8 mm from the apex, every activation technique showed statistically significant reduction of smear layer when compared to the control group. PIPS and SWEEPS obtained better cleanliness result compared to EA, while only PIPS was superior to PUI in terms of cleanliness. Conclusions: PIPS and SWEEPS showed the best results in conservative canal preparations. Nowadays, contemporary rotary instruments allow fast and minimally invasive shaping of the endodontic space. In this scenario irrigants' activation may be regarded as a mandatory step to a favourable clinical outcome. [ABSTRACT FROM AUTHOR]

The aim of this comparative study is to analyze the efficacy of EndoVac and Endoactivator endodontic irrigation systems for removing the endodontic smear layer present in the coronal, middle, and apical root third of the root canal system (RCS) and the isthmus from mesial roots from the first lower molar teeth using micro-computed tomography (micro-CT) analysis. The study was performed on 40 mesial roots that were randomly assigned to the following groups: Group A, EndoVac endodontic irrigation system (EV) (n = 10); Group B, Endoactivator endodontic irrigation system (EA) (n = 10); Group C, Root canal systems performed with F2 ProTaper Gold endodontic rotary system but not irrigated (Positive control) (n = 10); Group D, Root canal systems not performed or irrigated (Negative control) (n = 10). The samples were exposed to micro-CT analysis and the mesial roots were segmented using an advanced image segmentation technique based on partial differential equations (ROI: 10 × 10 × 10 mm) and the root canal systems and isthmus were reconstructed at a resolution of 25 microns per voxel. The EA study group showed statistically significant different residual endodontic smear layer volume (0.48 ± 0.24 mm3) compared to the EV study group (0.18 ± 0.15 mm3) (p = 0.016). The EV endodontic irrigation system performed a higher smear layer removal at coronal and middle root thirds, compared to the EA endodontic irrigation system; however, the EA endodontic irrigation system performed a higher smear layer removal at the apical root third, compared to the EV endodontic irrigation system. [ABSTRACT FROM AUTHOR]

Introductio: Healing potential of plants is an age-old idea that has recently attained renewed interest. Considering the ineffectiveness, potentially harmful effects, and safety concerns of commonly used synthetic irrigants, the herbal alternatives for endodontic usage might prove to be advantageous.Aim: The aim of this study was to evaluate the adequacy of smear layer removal and cytotoxicity potential of triphala in comparison to sodium hypochlorite.Materials and Methods: The study was conducted in two parts: the first part of the study was cytotoxicity assessment studied using Alamar blue assay. L929 mouse fibroblasts were seeded in 96-well plates at a density of 5000 cells/well and treated with different concentrations of triphala and NaOCl for a period of 24 and 48 h. The percentage of cell viability was then quantified using an Alamar blue assay. The optical density was measured at 570 nm and compared with 620 nm, which was considered as a reference wavelength. The second part of the study was smear layer assessment at the coronal, middle, and apical third of twenty human premolar teeth using scanning electron microscope.Results: The Alamar blue reagent cytotoxicity study suggested that triphala showed no cytotoxic properties against the normal mouse fibroblast cells whereas sodium hypochlorite showed a significant cytotoxic effect against the L929 cell lines with the IC50 concentration at 1.8%, respectively, after the treatment of 24 h of incubation at 37°C temperature. Triphala was as effective as sodium hypochlorite in smear layer removal in the coronal and middle third of the root, but sodium hypochlorite showed better smear layer removal in the apical third.Conclusion: Triphala can be considered as a superior irrigant with good antibacterial efficacy and least cytotoxicity potential compared to conventional hypochlorite irrigating agent and provide adequate clearing of smear layer in the coronal and middle third, and further studies are warranted to alter the properties of liquid to make it more cleansable in the apical third of the root. [ABSTRACT FROM AUTHOR]

Objective: This study was done to evaluate the effect of the prepared Moringa oleifera-based root canal irrigant compared to conventionally used irrigants on the microhardness of root dentin and smear layer removal. Materials and methods: One hundred freshly extracted teeth with single root were divided into 5 groups according to the irrigant used: group 1, saline; group 2, Moringa oleifera; group 3, Moringa oleifera + chlorhexidine; group 4, chlorhexidine; and group 5, sodium hypochlorite. Root canal preparation was done using Protaper universal system till size F5 using one of the irrigants after each file. Fifty teeth were prepared to measure dentin microhardness, while the remaining fifty were prepared for evaluation of the remaining debris and smear layer using stereomicroscope and scanning electron microscope (SEM) in each third of the canal. Results: Chlorhexidine alone and combined with Moringa oleifera showed higher microhardness values in apical and coronal parts. In the middle parts, chlorhexidine followed by Moringa oleifera showed the highest results. SEM examination showed that none of the used irrigants has the ability to completely remove smear layer. However, Moringa oleifera group showed the least amount of smear layer on canal wall. Conclusions: Moringa oleifera is a promising final irrigant solution alone or combined with chlorhexidine throughout the instrumentation. Moringa oleifera was proved to have a high effect as a chelating agent. [ABSTRACT FROM AUTHOR]

Aim: The aim is to evaluate the smear layer removal efficacy of Oxytetracycline and compare it with different endodontic irrigating solutions (QMix, mixture of tetracycline, citric acid, and detergent [MTAD] and ethylenediaminetetraacetic acid [EDTA]) under scanning electron microscope (SEM). Materials and Methods: Fifty single-rooted teeth were decoronated. All the root canals were shaped with K3XF rotary Ni-Ti instruments (#30.,06) and irrigation was done with 2 ml of 5.25% sodium hypochlorite (NaOCl) solution between each file change. The samples were divided randomly into the 5 groups (n = 10) depending on the final irrigant used as follows: 5.25% NaOCl as control (Group 1), 17% EDTA (Group 2), QMix (Group 3), BioPure MTAD (Group 4), and Oxytetracycline (Group 5). The final irrigation was done using 5 ml of the respective irrigating solutions, each for 60 s. Specimens were fractured longitudinally. For each root, the half containing most visible part of apex was selected for the SEM analysis. The presence/absence of smear layer was evaluated at the coronal, middle, and apical third of the root canal using three score criteria. Data were analyzed using Mann–Whitney U-test and Kruskal–Wallis test. Results: QMix showed the least smear layer scores followed by MTAD, EDTA, NaOCl, and Oxytetracycline. Conclusion: Within the limitation of this study, it can be concluded that the test irrigant Oxytetracycline failed to remove the smear layer throughout the entire length of the root canal.

Context: The presence of smear layer and debris can prevent the irrigant and sealer from penetrating the dentinal tubules thereby compromising the seal of the root canal filling.Aim: This study aims to evaluate the efficacy of XP-endo Finisher with ProTaper Next and HyFlex in smear layer and debris removal.Materials and Methods: : Thirty-two extracted mandibular premolar teeth were selected and sectioned at the cementoenamel junction. The roots were then randomly divided into 4 groups. In group 1 and 2, canals were instrumented with X2 ProTaper Next (25 0.06 taper). In group 3 and 4, canals were instrumented with HyFlex system (25 0.06 taper). The canals in group 2 and 4 were further finished with XP-endo Finisher. Irrigation was carried out using 3% sodium hypochlorite during instrumentation, and 17% ethylenediaminetetraacetic acid was used as the final rinse. The roots were then split longitudinally. The canal wall was observed under the scanning electron microscope in coronal, middle, and apical thirds at a magnification of ×400 and ×1000 for evaluation of debris and smear layer, respectively. Photomicrographs were taken, and qualitative assessment for debris and smear layer removal was done.Statistical Analysis Used: The results were analyzed using Kruskal-Wallis test and Mann-Whitney U-test.Results: Lower debris and smear layer scores were seen in canal thirds instrumented with ProTaper Next and XP-endo Finisher (P < 0.01).Conclusion: The use of XP-endo Finisher as an adjuvant during shaping and cleaning produced cleaner root canal walls. [ABSTRACT FROM AUTHOR]

Plaque, calculus and altered cementum removal by scaling and root planing is a fundamental procedure in periodontal treatment. However, the residual smear layer contains cytotoxic and inflammatory mediators which adversely affect healing. Chemical smear layer removal is also problematic. In previous investigations effective smear layer removal was achieved using long pulsed irradiation at 1.06 μ. However, laser irradiation was not adequate as an alternative to scaling and root planing procedures and concurrent temperature rises exceeded thermal thresholds for pulpal and periodontal safety. It was the aim of this study to determine whether nanosecond pulsed irradiation at 1.06 μ could be used as an alternative or an adjunct to scaling and root planing. Sixty freshly extracted teeth were divided as follows: 5 control, 5 root planed only, 25 irradiated only, 25 root planed and irradiated. Irradiation was performed at fluences of 0.5 - 2.7 J/cm2, total energy densities of 12 - 300 J/cm2, frequencies of 2 - 10 Hz using the Medlite (Continuum) laser. Irradiation-induced thermal events were recorded using a thermocouple within the root canal and a thermal camera to monitor surface temperatures. SEM demonstrated effective smear layer removal with minimal microstructural effects. Surface temperatures increased minimally (< 3 C) at all parameters, intrapulpal temperature rises remained below 4 C at 2 and 5 Hz, F < 0.5 J/cm2. Without prior scaling and root planing, laser effects did not provide an adequately clean root surface.

The aim of this comparative study is to analyze the efficacy of EndoVac and Endoactivator endodontic irrigation systems for removing the endodontic smear layer present in the coronal, middle, and apical root third of the root canal system (RCS) and the isthmus from mesial roots from the first lower molar teeth using micro-computed tomography (micro-CT) analysis. The study was performed on 40 mesial roots that were randomly assigned to the following groups: Group A, EndoVac endodontic irrigation system (EV) (n = 10); Group B, Endoactivator endodontic irrigation system (EA) (n = 10); Group C, Root canal systems performed with F2 ProTaper Gold endodontic rotary system but not irrigated (Positive control) (n = 10); Group D, Root canal systems not performed or irrigated (Negative control) (n = 10). The samples were exposed to micro-CT analysis and the mesial roots were segmented using an advanced image segmentation technique based on partial differential equations (ROI: 10 × 10 × 10 mm) and the root canal systems and isthmus were reconstructed at a resolution of 25 microns per voxel. The EA study group showed statistically significant different residual endodontic smear layer volume (0.48 ± 0.24 mm3) compared to the EV study group (0.18 ± 0.15 mm3) (p = 0.016). The EV endodontic irrigation system performed a higher smear layer removal at coronal and middle root thirds, compared to the EA endodontic irrigation system; however, the EA endodontic irrigation system performed a higher smear layer removal at the apical root third, compared to the EV endodontic irrigation system.

Aims: The purpose of this study was to compare the efficacy of smear layer removal by 5% chlorine dioxide and 15% Ethylenediamine Tetra-Acetic Acid plus Cetavlon (EDTAC) from the human root canal dentin. Materials >and Methods : Fifty single rooted human mandibular anterior teeth were divided into two groups of 20 teeth each and control group of 10 teeth. The root canals were prepared till F3 protaper and initially irrigated with 2% Sodium hypochlorite followed by 1 min irrigation with 15% EDTAC or 5% Chlorine dioxide respectively. The control group was irrigated with saline. The teeth were longitudinally split and observed under Scanning electron microscope SEM (×2000). Statistical Analysis Used: The statistical analysis was done using General Linear Mixed Model. Results : At the coronal thirds, no statistically significant difference was found between 15% EDTAC and 5% Chlorine dioxide in removing smear layer. In the middle and apical third region 15% EDTAC showed better smear layer removal ability than 5% Chlorine dioxide. Conclusion : Final irrigation with 15% EDTAC is superior to 5% chlorine dioxide in removing smear layer in the middle and apical third of radicular dentin.

Background: The aim of the present study was to evaluate and compare the ability of a mixture of tetracycline isomer, citric acid and detergent (MTAD) and ethylene diamine tetra-acetic acid (EDTA) in removing the smear layer along with their effects on peritubular and intertubular dentinal structures by scanning electron microscopic (SEM) examination. Materials and Methods: Thirty recently extracted maxillary and mandibular single-rooted human teeth were divided into 3 groups and prepared to an apical size of 30. In Group 1, 2, and 3, MTAD, EDTA, and distilled water were used, respectively, as a final rinse solution to remove the smear layer. The specimens were subjected to SEM evaluation for the presence or absence of the smear layer and degree of erosion using a scoring system. Results: The result showed that MTAD shows better smear layer removing ability and does not significantly change the structure of dentinal tubules. Conclusion: MTAD is an efficient solution for the removal of the smear layer, especially in the apical third of root canals, and does not significantly change the structure of the dentinal tubules.

The purpose of this study was to investigate ultrastructurally the effect of smear layer removal by applying different root canal irrigances: 3% HO2, 4% NaOCl and 15% Na-EDTA (in combination with 3% HO2, 4% NaOCl) and establish the appearance of root canal dentine surface after treatment with 15% Na-EDTA for different time periods(1 min and 5 min) using additional irrigant 3% HOor 4% NaOCl. 22 22 Teeth with single and double canals extracted for orthodontic reasons, were used in this study. After instrumentation, coronal and apical parts were removed. Middle parts were cut longitudinally into two equal segments. The specimens were grouped and treated: with HO2, NaOCl, and with combination of Na-EDTA+ HO2 and Na-EDTA+NaOCl where the irrigation with 2 Na-EDTA lasted 1 or 5 minutes. Control segments were enlarged and irrigated with distillate water to obtain the smear layer. The results obtained showed that irrigation with HOand NaOCl did 22 not remove the smear layer, one-minute application of 15% Na-EDTA followed by 4% NaOCl showed that the smear layer was completely removed. Using of 3% HOafter Na-EDTA over the same period of time obtained 22 less "clear" surfaces. Five-minute application of Na-EDTA caused excessive peritubular and intertubular dentinal erosion. It is concluded that for effective removal of smear layer with Na- EDTA, this procedure should not last longer than 1 minute and should be followed by NaOCl.

This study aimed to conduct a systematic review and critical analysis of the evidence pertaining to the efficacy of laser-activated irrigation (LAI) versus ultrasonic-activated irrigation (UAI) in mature permanent teeth. A comprehensive literature search was performed using PubMed and Google Scholar. Additionally, a hand search was performed to identify relevant studies related to UAI and LAI. The search covered all articles published from January 1997 to December 2021. The identified studies were screened for eligibility using the inclusion and exclusion criteria. The included articles were then subjected to data extraction and analysis. The search yielded 1,637 results. Of these, 23 articles were included in this systematic review. All included articles were assessed for the outcomes of antimicrobial efficacy, smear layer, and dentin debris removal. The majority of the articles reported the superiority of LAI over UAI. Within the confines of this systematic review, the current evidence mandates that LAI has superior efficacy over UAI in the elimination of microorganisms, dentin debris, and smear layer from the root canal system., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Badami et al.)

Aims: The purpose of this study was to compare the efficacy of smear layer removal by 5% chlorine dioxide and 15% Ethylenediamine Tetra‑Acetic Acid plus Cetavlon (EDTAC) from the human root canal dentin. Materials and Methods: Fifty single rooted human mandibular anterior teeth were divided into two groups of 20 teeth each and control group of 10 teeth. The root canals were prepared till F3 protaper and initially irrigated with 2% Sodium hypochlorite followed by 1 min irrigation with 15% EDTAC or 5% Chlorine dioxide respectively. The control group was irrigated with saline. The teeth were longitudinally split and observed under Scanning electron microscope SEM (×2000). Statistical Analysis Used: The statistical analysis was done using General Linear Mixed Model. Results: At the coronal thirds, no statistically significant difference was found between 15% EDTAC and 5% Chlorine dioxide in removing smear layer. In the middle and apical third region 15% EDTAC showed better smear layer removal ability than 5% Chlorine dioxide. Conclusion: Final irrigation with 15% EDTAC is superior to 5% chlorine dioxide in removing smear layer in the middle and apical third of radicular dentin. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to evaluate and compare the ability of a mixture of tetracycline isomer, citric acid and detergent (MTAD) and ethylene diamine tetra-acetic acid (EDTA) in removing the smear layer along with their effects on peritubular and intertubular dentinal structures by scanning electron microscopic (SEM) examination. Materials and Methods: Thirty recently extracted maxillary and mandibular single-rooted human teeth were divided into 3 groups and prepared to an apical size of 30. In Group 1, 2, and 3, MTAD, EDTA, and distilled water were used, respectively, as a final rinse solution to remove the smear layer. The specimens were subjected to SEM evaluation for the presence or absence of the smear layer and degree of erosion using a scoring system. Results: The result showed that MTAD shows better smear layer removing ability and does not significantly change the structure of dentinal tubules. Conclusion: MTAD is an efficient solution for the removal of the smear layer, especially in the apical third of root canals, and does not signi? cantly change the structure of the dentinal tubules. [ABSTRACT FROM AUTHOR]