Smear Layer Removal Using Passive Ultrasonic Irrigation and Different Concentrations of Sodium Hypochlorite

Orlowski, Nayra Bittencourt; Schimdt, Tamer Ferreira; Teixeira, Cleonice da Silveira; Garcia, Lucas da Fonseca Roberti; Savaris, Julia Menezes; Tay, Franklin R.; Bortoluzzi, Eduardo Antunes

doi:10.1016/j.joen.2020.07.020

Cited by 42 publications

(44 citation statements)

References 32 publications

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“…This has been confirmed by previous research where PUI with both irrigants was very effective, with an average of 88% of the cleaned root canal walls [20]. Newer research underlines activating chelating irrigants (ultrasonically agitated) with PUI as very efficient [27,28]. The combination of these two irrigants produces optimal results with the appropriate duration of irrigation, as well as the amount of irrigants themselves [8,13,18,29].…”

Section: Discussionsupporting

confidence: 69%

Efficiency of calcium hydroxide removal techniques from simulated internal resorptions - in vitro study

et al. 2021

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Introduction/Objective. Calcium hydroxide (CH) is the medicament of choice in endodontic treatment of internal root resorptions. The aim of the study was to compare the effectiveness of three different techniques for CH removal from simulated internal root resorptions. Methods. Twenty-nine extracted single-root teeth were prepared using NiTi rotary files of BioRaCe system (40/.04) following irrigation. A round diamond drill was used in the making of a symmetrical standardized internal resorptions 6mm from the apex. Three techniques for CH removal from internal resorptions were tested: modified conventional syringe irrigation (CSI), passive ultrasonic irrigation (PUI), XP-endo Finisher (XP). Resorptive cavities and apical thirds were observed under a stereomicroscope (X45) and scored (from 1 to 5), while representative samples were analysed by SEM. Obtained results were statistically processed by Kruskal-Wallis and Mann-Whitney U-test, (p <0.05). Results. The most efficient system was PUI, with 66.7% of samples rated 1 and 33.3% rated 2. The next one was XP-endo Finisher, and the least efficient was CSI with 33.3% of samples rated 1 (resorptive defect without medicament). There was a statistically significant difference between the PUI and CSI systems (p <0.05), while there was no difference between the PUI and XP systems. Conclusion. No system completely removed the CH from the simulated internal root resorption cavities. PUI was the most effective system for removing CH. The combination of techniques provides better performance in removing CH paste residues from the canal walls.

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Section: Discussionsupporting

confidence: 69%

Efficiency of calcium hydroxide removal techniques from simulated internal resorptions - in vitro study

et al. 2021

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“…In some instances, conventional syringe needle irrigation fails to reach the third apical intricacy of the root canal system, which warrants the use of irrigation activation to increase the flow and distribution. Activation of the irrigant causes acoustic streaming and cavitation, enabling the irrigant to reach the inaccessible areas of the canal [ 31 , 32 , 33 ]. All the included studies used S.E.M.…”

Section: Discussionmentioning

confidence: 99%

Herbal Agents versus Ethylene Diamine Tetra Acetic Acid on Removal of the Smear Layer—A Systematic Review of In Vitro Studies

Teja¹,

Janani

Alqahtani

et al. 2022

IJERPH

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This systematic review aimed to compare the efficacy of herbal agents with ethylene diamine tetraacetic acid (EDTA) in removing the smear layer during root canal instrumentation. The research question in the present study was to assess: “Is there a significant difference in reducing smear layer comparing EDTA and herbal agents?” Electronic databases (PubMed, Scopus, and Web of Science) were searched from their start dates to April 2022 using strict inclusion and exclusion criteria, and reviewed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Only in vitro studies comparing herbal agents with EDTA were included in the current systematic review. Two reviewers independently assessed the included articles. A total of 625 articles were obtained from an electronic database. Eighteen papers were included for review of the full text, out of which, ten papers were excluded because they did not meet the inclusion criteria. Finally, eight articles were included in the systematic review. The present systematic review considered only in vitro studies; hence, the result cannot be completely translated to strict clinical conditions. The results of the present systematic review have shown that quixabeira, morindacitrifolia, oregano extract, and neem show better smear layer removal compared to other herbal agents, whereas they showed reduced smear layer removal when compared with EDTA. Although, it was seen that most of the included studies did not report a high quality of evidence. Hence, the present systematic review concludes that herbal agents have reported to show inferior smear layer removal when compared to EDTA. Thus, as far as herbal based alternatives are concerned, there is no highest level of evidence to state its real benefit when used as a chelating root canal irrigant.

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“…Although the NaOCl concentrations during final irrigation protocols were different among the studies (ranging from 1 to 2.5%), it is noteworthy to point out that the removal of AHTD does not seem to be a purely chemical phenomenon, but rather one with a strong physical component. 37,38 A previous systematic review that used SEM analysis 13 to evaluate the removal of debris with different activation techniques, demonstrated that PUI improved debris removal in the middle third only when compared with NAI. However, the conventional SEM is a non-trustworthy and non-reproducible method for evaluating AHTD removal.…”

Section: Discussionmentioning

confidence: 99%

Effect of passive ultrasonic irrigation on hard tissue debris removal: a systematic review and meta-analysis

et al. 2021

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Accumulated hard tissue debris (AHTD) in root canal irregularities may negatively impact adequate root canal disinfection. In light of this, the efficacy of passive ultrasonic irrigation (PUI) to reduce AHTD has been largely studied in in vitro studies, which have adopted different analytic methods of varying accuracy to determine the extent of AHTD more correctly. Therefore, the aim of this study was to compare how well PUI and non-activated irrigation (NAI) systems perform in reducing AHTD during final irrigation protocols, based exclusively on studies whose analyses used microCT scanning. A systematic search of the studies published up to April 2020 was performed using MeSH terms and free terms, in the following databases: PubMed, Scopus, Web of Science, BVS (Lilacs and BBO) and Embase. The inclusion criteria consisted of laboratory studies that evaluated the amount of AHTD, and compared PUI with NAI protocols using microCT analysis. The risk of bias in the selected studies was assessed critically by two reviewers. A meta-analysis was performed using the RevMan software program (P<0.05), and included studies providing the standardized mean difference (SMD), using a fixed effect model, and adopting a confidence interval of 95%. In all, 3495 studies were identified, three of which met the inclusion criteria. All three were considered as having a low risk of bias. The meta-analysis comparing the ability of PUI and NAI protocols to remove hard tissue debris showed a higher percentage of AHTD reduction (P<0.01) for PUI, with a confidence interval of 1.41 [0.79, 2.02]. The heterogeneity among the studies was 82% (I 2 ). Considering the limitations of the present study, this systematic review and meta-analysis showed that PUI was more effective than NAI in removing hard tissue debris, based exclusively on studies that used microCT scanning to provide a more precise analysis of the two techniques used. The findings presented in the present study reinforce the concept that PUI can increase residue removal and improve the cleanliness of the root canal in endodontic treatments.

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Smear Layer Removal Using Passive Ultrasonic Irrigation and Different Concentrations of Sodium Hypochlorite

Cited by 42 publications

References 32 publications

Efficiency of calcium hydroxide removal techniques from simulated internal resorptions - in vitro study

Efficiency of calcium hydroxide removal techniques from simulated internal resorptions - in vitro study

Herbal Agents versus Ethylene Diamine Tetra Acetic Acid on Removal of the Smear Layer—A Systematic Review of In Vitro Studies

Effect of passive ultrasonic irrigation on hard tissue debris removal: a systematic review and meta-analysis

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