Evaluation of Influence of Widening Apical Preparation of Root Canals on Efficiency of Ethylenediaminetetraacetic Acid Agitation Protocols: Study by Scanning Electron Microscopy.

Aim: The purpose of this study was to evaluate the influence of widening the apical root canal preparation (RCP) on the efficiency of different ethylenediaminetetraacetic acid (EDTA) agitation protocols on smear layer removal: EDTA; EDTA + Easy Clean in rotary movement (ECROT); EDTA + Easy Clean in reciprocating movement (ECREC); and EDTA + Passive ultrasonic irrigation (PUI).
Materials and Methods: A total of 80 mandibular premolars had their crowns sectioned and then were divided into two groups according to widening: size 25 or 40, 0.08 taper. Sequentially they were once again allocated to subgroups according to the agitation protocol performing eight experimental groups (n = 10). Ten additional teeth were prepared for controls (C+/C-). The specimens were then submitted to the cleaning protocols and thereafter cleaved and microphotographed by variable pressure scanning electron microscopy (SEM) at previously determined points along their root thirds (750*). Scores were attributed to the images, and data were analyzed by the Kruskal-Wallis, Student-Newman-Keuls and Friedman tests.
Results: A higher widening was observed to have a positive influence on cleaning efficiency offering significant differences in global and apical third evaluations (p < 0.05). Relative to the agitation, significant differences were observed mainly in the apical third, with PUI and ECROT providing the best results (p < 0.05); no difference for C+ was observed when higher widening was employed.
Conclusion: A greater widening of the apical third provided a significant improvement in the action of the agitation/activation protocols. Moreover, the PUI and ECROT activation methods were shown to be superior to the use of EDTA solely, particularly in the apical third.
Clinical Significance: The findings of this study reinforce the need for clinical use of additional methods to complement cleaning. Therefore, it is important for professionals to have knowledge and command of these protocols to obtain more satisfactory results.