Differential aggressiveness of ethylenediamine tetraacetic acid in causing canal wall erosion in the presence of sodium hypochlorite

Objective

This study tested the hypothesis that the use of ethylenediamine tetraacetic acid (EDTA) as a final irrigant causes canal wall erosion only after prolonged use of 5.25% sodium hypochlorite (NaOCl) as the initial irrigant.

Methods

Two irrigation protocols were employed: (1) 5.25% NaOCl as the initial irrigant for 10 min and 17% EDTA as the final irrigant for 2 min; and (2) 5.25% NaOCl for 60 min and 17% EDTA for 2 min. Flexural strengths of dentine beams prepared from human mid-coronal dentine were evaluated using a miniature three-point bending device after they were irrigated with either protocol. Transmission electron microscopy was used to examine the conditions of instrumented canal walls irrigated with either protocol after they were bonded with methacrylate resin-based sealers.

Results

Immersion of dentine beams in NaOCl for 60 min instead of 10 min prior to the use of EDTA resulted in a significant (p < 0.001) decline in flexural strength. For both NaOCl initial rinsing times, a 2-min final irrigation with EDTA created similar 0.5 μm thick demineralisation fronts. However, extensive surface and subsurface erosion of radicular dentine was seen only when the dentine was immersed in NaOCl for 60 min.

Conclusion

The apparent aggressiveness of EDTA in causing canal wall erosion is attributed to the prolonged use of NaOCl. The associated decline in dentine flexural strength has potential clinical relevance when thin pulp chamber dentine is immersed in NaOCl for lengthy periods during canal instrumentation. This may render root-treated teeth more prone to vertical fracture.     

Effects of reducing agents on birefringence dentin collagen after use of different endodontic auxiliary chemical substances

Introduction

The aim of this study was to evaluate the effect of 10% ascorbic acid or 10% sodium ascorbate on organic matrix collagen of bovine dentin root canal walls after irrigation with 5.25% sodium hypochlorite (NaOCl), 17% ethylenediaminetetraacetic acid (EDTA), or 0.9% sodium chloride.

Methods

Eighty bovine incisors were randomly divided into 8 groups (n = 10): group 1, 0.9% sodium chloride (control); group 2, 5.25% NaOCl + 17% EDTA (NaOCl + EDTA); group 3, 5.25% NaOCl + 17% EDTA + 10% ascorbic acid (NaOCl + EDTA + AA); group 4, 5.25% NaOCl + 17% EDTA + 10% sodium ascorbate (NaOCl + EDTA + SA); group 5, 5.25% NaOCl (NaOCl); group 6, 17% EDTA; group 7, 10% ascorbic acid (AA); and group 8, 10% sodium ascorbate (SA). Teeth were chemomechanically prepared, submitted to histologic processing, and stained with Sirius Red dye to be analyzed under polarized light microscopy. Absorbance assay was also performed to confirm the loss of collagen.

Results

NaOCl + EDTA and NaOCl groups presented a significantly different birefringence pattern compared with the control group (P < .05). The measurement of the optical retardations of NaOCl + EDTA + SA indicated that this group was not statistically different from the control group. Although the measurement of the optical retardations of NaOCl + EDTA + AA was statistically different from the control group, the results were significantly higher than for NaOCl + EDTA. The birefringence of EDTA, AA, and SA groups was not statistically different from that of control group. The absorbance assay of NaOCl + EDTA and NaOCl groups confirmed the loss of collagen (P < .05).

Conclusions

It is possible to conclude that 5.25% NaOCl, whether associated or not with 17% EDTA, causes birefringence alterations and loss of dentin collagen. These alterations reduced the ability of Sirius Red to bind with collagen fiber molecules. The reductions in the optical retardation values could be reversed by the application of either 10% ascorbic acid or 10% sodium ascorbate after 5.25% sodium hypochlorite and 17% EDTA irrigation.     

Influence of the Dentinal Wall on the pH of Sodium Hypochlorite during Root Canal Irrigation

Introduction

The purpose of this study was to evaluate the influence of dentin on the pH levels of different concentrations of sodium hypochlorite (NaOCl) solutions over time and to evaluate if preconditioning of dentin with 17% EDTA or agitation of the NaOCl solution influences these pH levels.

Methods

A novel clinically representative model that scales with the ratio of the irrigant volume to the dentin surface area of a human root canal was used. Three standardized bovine dentin bars (2 × 2 × 10 mm) were placed in a plastic test tube. A total of 150 tubes were distributed in 29 groups. In the first experiment, the pH of various NaOCl solutions, with different concentrations (3%, 6%, and 9%) and starting pH levels (5 and 12), was monitored during exposure to dentin between 10 and 300 seconds. In a second experiment, the effect of agitation (45 Hz) and pretreatment of dentin with 17% EDTA on the pH levels of various NaOCl solutions was studied after 30 seconds of exposure to dentin. The short-term chemical stability of the tested solutions was assessed for both the concentration and the pH.

Results

The exposure time (P < .001) and concentration of the NaOCl solution (P < .011) significantly influence the pH level after exposure to dentin. However, the change in pH is too small to induce a change in the irrigant antimicrobial/tissue dissolution capacity.

Conclusions

Agitation of the irrigant and preconditioning of the dentin did not alter the pH (P > .05). Both the pH 5 and pH 12 solutions were chemically stable for 1 hour.     

Effect of MTAD on Enterococcus faecalis-contaminated root canals of extracted human teeth

The purpose of this investigation was to compare the antimicrobial effect of MTAD (a mixture of a tetracycline isomer, an acid, and a detergent) with that of NaOCl with and without EDTA. Eighty-five extracted human teeth were contaminated with Enterococcus faecalis for 4 weeks. After biomechanical instrumentation using 1.3% or 5.25% NaOCl as root canal irrigant, the root canal and the external surface of each tooth were exposed to a 5-min application of MTAD, 1.3% NaOCl, 5.25% NaOCl or a 1-min application of EDTA followed by irrigation with 5 ml of 1.3% NaOCl or 5.25% NaOCl. Teeth or dentin shavings were cultured to determine presence or absence of the test bacteria. Fisher's exact test showed that the combination of 1.3% NaOCl as a root canal irrigant and MTAD as a final rinse was significantly more effective against E. faecalis than the other regimens. The chi2 test showed no difference between the other regimens.     

The effect of QMix, an experimental antibacterial root canal irrigant, on removal of canal wall smear layer and debris

Introduction

This study examined the ability of two versions of QMix, an experimental antimicrobial irrigant, on removal of canal wall smear layers and debris using an open canal design.

Methods

Cleaned and shaped single-rooted human root canals were irrigated with NaOCl as the initial irrigant and one of the following as the final irrigant: (1) QMix I (pH = 8), (2) QMix II (pH = 7.5), (3) distilled water, (4) 17% EDTA, and (5) BioPure MTAD (Dentsply Tulsa Dental Specialties, Tulsa, OK). Smear and debris scores were evaluated in the coronal, middle, and apical thirds of longitudinally fractured canal spaces using scanning electron microscopy and analyzed using Cochran-Mantel-Haenszel statistic.

Results

Smear scores, when the overall canal was considered, differences were observed among groups except groups 1 versus 4 and groups 2 versus 4. After adjusting for canal levels, all groups differed significantly from each other (p < 0.005) with the exception of groups 2 versus 5. For the debris scores, no significant difference was observed among the treatment groups when the overall canal was considered and after adjusting for the effect of canal level.

Conclusion

Within the limitations of an open-canal design, the two experimental QMix versions are as effective as 17% EDTA in removing canal wall smear layers after the use of 5.25% NaOCl as the initial rinse.     

A new noninvasive model to study the effectiveness of dentin disinfection by using confocal laser scanning microscopy

Introduction

The present study was designed to develop a standardized model for quantification of the effectiveness of dentin disinfection by different antibacterial solutions including a new root canal irrigant, Qmix.

Methods

Dentinal tubules from the root canal side in semicylindrical dentin specimens were infected with Enterococcus faecalis by centrifugation of the bacterial suspension into the tubules. Scanning electron microscopy (SEM) was used to verify the presence of bacteria in dentin. The outer side of dentin pieces was closed, and the specimens were subjected to 1-minute and 3-minute exposure to sterile water, 1%, 2%, 6% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), and Qmix. Confocal laser scanning microscopy (CLSM) and viability staining were used to quantitatively analyze the proportions of dead and live bacteria inside dentin.

Results

A heavy invasion by E. faecalis was detected by both SEM and CLSM throughout the dentinal tubules. The amount of dead cells in dentin increased with increasing NaOCl concentration and time of exposure (P < .05). Qmix was equally effective in killing bacteria in dentin as 6% NaOCl; more than 40% and 60% of the bacteria were killed by both at 1 minute and 3 minutes, respectively. One percent and 2% NaOCl and 2% CHX killed 20%–30% and 30%–40% bacteria after 1 and 3 minutes of exposure, respectively, with no statistically significant differences among the 3 agents (P > .05). In the control group, which was treated with sterile water, only 4%–6% of the bacteria were dead.

Conclusions

Centrifugation helped to create a heavy, evenly distributed infection deep into the dentinal tubules. The new model made it possible to compare the effectiveness of several disinfecting solutions in killing bacteria inside dentin by a noninvasive CLSM method.     

Effect of Root Dentin Conditioning on the Pushout Bond Strength of Biodentine

Introduction

Sodium hypochlorite (NaOCl) is the main irrigant to clean root canals. Decalcifying agents are advocated as additional means to condition the root dentin. The aim of this study was to evaluate the effect of alternating (EDTA) or continuous 1-hydroxyethane 1,1-diphosphonic (HEDP) chelation in conjunction with NaOCl irrigation on the pushout bond strength of Biodentine (Septodont, Saint Maur des Fosses, France).

Effect of EDTA,Sodium Hypochlorite,and Chlorhexidine Gluconate with or without Surface Modifiers on Dentin Microhardness

Introduction

This study aimed to evaluate the effects of root canal irrigants on the microhardness of root canal dentin in the presence and absence of surface-modifying agents.

Methods

Forty-eight root halves were prepared by longitudinal splitting of the distal roots of 24 freshly extracted mandibular human third molars and embedded in autopolymerizing acrylic resin, leaving the dentin surface exposed. After polishing, the microhardness values of the untreated dentin surfaces were recorded by using Vickers tester at the mid-root level. The root halves were randomly assigned to 6 groups composed of 8 samples each and treated for 5 minutes with one of the following irrigants: 17% EDTA, REDTA, 2% chlorhexidine gluconate (CHX), 2% CHX with surface modifiers (CHX-Plus), 6% NaOCl, or 6% NaOCl with surface modifiers (Chlor-XTRA). After surface treatment, dentin microhardness values were recorded at close proximity to the initial indentation areas. Experimental data were statistically analyzed by using the t test and one-way analysis of variance, followed by Tukey honestly significant difference test at α = 0.05.

Results

EDTA, REDTA, NaOCl, and Chlor-XTRA significantly decreased the microhardness of root dentin compared with intact controls (P < .05).

Conclusions

The addition of surface modifiers to the irrigants did not affect the microhardness of the samples.     

Dentin conditioning codetermines cell fate in regenerative endodontics

Introduction

Recent successes in dental pulp engineering indicate that regenerative treatment strategies in endodontics are feasible. Clinically, revascularization procedures render completion of root formation in immature teeth. The generation of a pulp-like tissue after seeding of dental pulp stem cells into dentin discs or cylinders and transplantation in vivo is possible. In this experimental setup, which mimics the situation in the root canal, the pretreatment of dentin might influence cellular behavior at the cell-dentin interface. Thus, the objective of this study was to investigate whether dentin conditioning can determine cell fate.

Methods

Dental pulp stem cells (DPSCs) were seeded into a growth factor–laden peptide hydrogel, transferred into dentin cylinders, and transplanted subcutaneously into immunocompromised mice. Before cell seeding, dentin cylinders were either pretreated with sodium hypochloride (NaOCl) or conditioned with EDTA. The constructs were explanted after 6 weeks and subjected to histological and immunohistochemical analysis.

Results

In dentin treated with NaOCl, resorption lacunae were found at the cell-dentin interface created by multinucleated cells with clastic activity. After conditioning with EDTA, DPSCs adjacent to the dentin formed an intimate association with the surface, differentiated into odontoblasts-like cells that expressed dentin sialoprotein, and extended cellular processes into the dentinal tubules. A vascularized soft connective tissue similar to dental pulp was observed inside the dentin cylinder.

Conclusions

Dentin conditioning considerably influences DPSC fate when seeded in close proximity to dentin. This information might be critical for optimized strategic planning for future regenerative endodontic treatment.     

Residual Effectiveness of Final Irrigation Regimens on Enteroccus faecalis-infected Root Canals

Introduction

The application of a final irrigating solution that remains active over a fairly long period of time stands as one strategy for preventing bacterial recolonization or eliminating the bacteria that persist after root canal treatment. The aim of this study was to evaluate the residual antimicrobial activity of four final irrigation regimens in root canals contaminated with Enterococcus faecalis.

Methods

Biofilms of E. faecalis were grown in uniradicular roots for 4 weeks. After preparing the roots chemomechanically, four final irrigation regimens were applied: (1) group EDTA-NaOCl, 17% EDTA followed by 5.25% sodium hypochlorite (NaOCl); (2) group MA-NaOCl, 7% maleic acid (MA) followed by 5.25% NaOCl; (3) group EDTA-CHX + CTR, 17% EDTA followed by 2% chlorhexidine (CHX) + 0.2% cetrimide (CTR); and (4) group MA-CHX + CTR, 7% MA followed by 2% CHX + 0.2% CTR. Samples were collected for 60 days to denote the presence of bacterial growth. The Fisher exact test was used to compare the percentages of specimens without E. faecalis regrowth.

Results

All root canals in which the final irrigant was 5.25% NaOCl yielded positive cultures on the fifth day. Groups EDTA-CHX + CTR and MA-CHX + CTR with a final irrigation of 2% CHX + 0.2% CTR showed respective percentages of samples without regrowth of 72.1% and 66.8% at 60 days. There were no statistically significant differences between these groups.

Conclusions

The combination of 2% CHX + 0.2% CTR would be an effective alternative final irrigation regimen given its antimicrobial action over time.     

Concentration-dependent Effect of Sodium Hypochlorite on Stem Cells of Apical Papilla Survival and Differentiation

Introduction

Intracanal disinfection is a crucial step in regenerative endodontic procedures. Most published cases suggest the use of sodium hypochlorite (NaOCl) as the primary irrigant. However, the effect of clinically used concentrations of NaOCl on the survival and differentiation of stem cells is largely unknown. In this study, we tested the effect of various concentrations of NaOCl on the stem cells of the apical papilla (SCAPs) survival and dentin sialophosphoprotein (DSPP) expression.

Methods

Standardized root canals were created in extracted human teeth and irrigated with NaOCl (0.5%, 1.5%, 3%, or 6%) followed by 17% EDTA or sterile saline. SCAPs in a hyaluronic acid–based scaffold were seeded into the canals and cultured for 7 days. Next, viable cells were quantified using a luminescence assay, and DSPP expression was evaluated using quantitative real-time polymerase chain reaction.

Results

There was a significant reduction in survival and DSPP expression in the group treated with 6% NaOCl compared with the untreated control group. Comparable survival was observed in the groups treated with the lower concentrations of NaOCl, but greater DSPP expression was observed in the 1.5% NaOCl group. In addition, 17% EDTA resulted in increased survival and DSPP expression partially reversing the deleterious effects of NaOCl.

Conclusions

Collectively, the results suggest that dentin conditioning with high concentrations of NaOCl has a profound negative effect on the survival and differentiation of SCAPs. However, this effect can be prevented with the use of 1.5% NaOCl followed by 17% EDTA. The inclusion of this irrigation regimen might be beneficial in regenerative endodontic procedures.     

Biofilm Dissolution and Cleaning Ability of Different Irrigant Solutions on Intraorally Infected Dentin

Introduction

The aim of this study was to evaluate the biofilm dissolution and cleaning ability of different irrigant solutions on intraorally infected dentin.

Methods

One hundred twenty bovine dentin specimens were infected intraorally by using a removable orthodontic device. Thirty samples were used for each irrigant solution: 2% chlorhexidine and 1%, 2.5%, and 5.25% sodium hypochlorite (NaOCl). The solutions were used for 5, 15, and 30 minutes and at 2 experimental volumes, 500 μL and 1 mL. The samples were stained by using acridine orange dye before and after the experiments and evaluated by using a confocal microscope. The percentage of biofilm, isolated cells, and noncolonized dentin was measured by using a grid system. Differences in the reduction or increase of the studied parameters were assessed by using nonparametric methods (P < .05).

Results

The higher values of biofilm dissolution and noncolonized dentin were found in the 30-minute NaOCl group and in the 5-minute and 15-minute groups of 5.25% NaOCL. The use of 2% chlorhexidine solution did not improve the biofilm dissolution or increase the cleaning of the dentin in comparison with the NaOCl solutions (P < .05).

Conclusions

Two percent chlorhexidine does not dissolve the biofilms. Thirty minutes of NaOCl are necessary to have higher values of biofilm dissolution and to increase the cleaning of the dentin independently of the concentration in comparison with the 5-minute and 15-minute contact times.     

Efficacy of smear layer removal at the root tip by using ethylenediaminetetraacetic acid and erbium, chromium: yttrium, scandium, gallium garnet laser

Introduction

The purpose of this study was to compare the efficacy of laser-driven irrigation in removing the smear layer and debriding the apical region of the root canal (the root tip) with that of ultrasonic irrigation.

Methods

Forty extracted human teeth with straight single roots were randomized into 4 groups (n = 10). The specimens were shaped by using hand instruments up to a size 30/.02 file (Control, Laser 1, and Laser 2 groups) or a size 20/.02 file (Laser 3 group). During instrumentation, each canal was irrigated with 3% NaOCl and 17% ethylenediaminetetraacetic acid alternately between the use of successive files. The 4 groups of 10 teeth were processed as follows. In the Control group, teeth were irrigated with 17% ethylenediaminetetraacetic acid, and the irrigant was activated with an ultrasonic device for 60 seconds. In the Laser 1 and Laser 3 groups, the irrigant was activated with the laser for 60 seconds. In the Laser 2 group, the irrigant was activated with the laser for 30 seconds.

Results

There were significant differences between the smear layer and debris scores for the Laser 1 group and those for the Control (P < .001), Laser 2 (P = .002), and Laser 3 groups (P = .012 and P = .013, respectively). Completely clean root canals were found in the Laser 1 group.

Conclusions

Use of a laser with a plain fiber tip, which produces cavitation in the irrigant, has potential as an improved alternative method for removing of the smear layer from the apical region of a straight root canal.     

Effect of final irrigation protocols on push‐out bond strength of an epoxy resin root canal sealer to dentin

The purpose of the present study was to evaluate the effect of different final irrigation protocols on push‐out bond strength of an epoxy resin root canal sealer to dentin. Eighty single‐rooted anterior teeth were used. The root canals were partially prepared using a rotary system and the final diameter was standardised using a #5 Gates‐Glidden drill prior to the push‐out bond test. During chemomechanical preparation, 5.25% NaOCl or 2% CHX gel was used. For smear layer removal, 17% ethylenediaminetetraacetic acid (EDTA) or QMix 2 in 1 was applied for 3 min. As final irrigant, 1 mL of NaOCl, CHX solution or distilled water was used. On conclusion of preparation, canals were filled with gutta‐percha/AH Plus sealer. Bond strength was measured by the push‐out test. Data were statistically analysed by Kruskal–Wallis and Mann–Whitney U‐tests. The group NaOCl/EDTA/NaOCl showed significantly higher bond strength values than other groups. In all groups, there were mainly mixed failure patterns. It can be concluded that 5.25% NaOCl proved to be the best solution for the final irrigation when combined with EDTA. The final irrigation protocols affect the push‐out bond strength of AH Plus to dentin.     

Evaluation of the interaction between endodontic sealers and dentin treated with different irrigant solutions

Introduction

Dentin surface treatment with different substances might cause alterations in chemical and structural compositions of the human dentin. The aim of this study was to investigate the wettability of endodontic sealers in contact with dentin treated with 5.25% sodium hypochlorite (NaOCl) and 2% chlorhexidine (CHX) in the presence or absence of smear layer.

Methods

Thirty-six dentin slices were used. They were irrigated with NaOCl and washed with distilled water (DW) to simulate irrigation during chemomechanical preparation. After this procedure, the samples were divided into 6 groups: group 1, DW (control); group 2, NaOCl + DW; group 3, CHX + DW; group 4, ethylenediaminetetraacetic acid (EDTA) + DW; group 5, EDTA + DW + NaOCl + DW; group 6, EDTA + DW + CHX + DW. The Ramé-Hart goniometer was used to measure the contact angle between the dentin surfaces and the AH Plus and Real Seal SE sealers. Data were statistically analyzed.

Results

With regard to the contact angle between AH Plus and treated surfaces, the values of contact angle were lower when CHX was used, regardless of the presence or absence of smear layer. When Real Seal SE was evaluated, in the absence of smear layer, CHX presented lower values of contact angle. In the presence of smear layer, the use of NaOCl and CHX did not favor the spread of the sealer.

Conclusions

The present study has revealed that smear layer removal and final flush with CHX favor the wettability of AH Plus and Real Seal SE sealers.     

Quantitative analysis of the solubilizing action of MTAD,sodium hypochlorite,and EDTA on bovine pulp and dentin

Necrotic bovine pulp and dentin were used in this study as model tissues to represent the organic and inorganic components of the smear layer present in instrumented root canals. The capabilities of endodontic irrigants to dissolve pulverized forms of these tissues were compared. Lyophilized tissue samples were mixed for 2 h at 37 degrees C with MTAD, three concentrations of sodium hypochlorite (NaOCl), 17% EDTA, or isotonic saline. Undissolved tissues were rinsed with water and lyophilized. The change in tissue weight after exposure to an irrigant was measured to quantify solubilization. The results showed that various concentrations of NaOCl removed organic components of pulp and dentin effectively. As pulp solubilizers 5.25% and 2.60% NaOCl were equal (>90%), and 5.25% NaOCl was capable of dissolving virtually the entire organic component of dentin. EDTA was capable of solubilizing inorganic material in dentin and organic material in pulp and likely also in dentin. It dissolved >70% of the dentin and >51% of the pulp. The solubilizing effects of MTAD on pulp and dentin were somewhat similar to those of EDTA. The major difference between the actions of these solutions was a high binding affinity of doxycycline present in MTAD for the dentin.     

Anatomy of sodium hypochlorite accidents involving facial ecchymosis—A review

Objectives

Root canal treatment forms an essential part of general dental practice. Sodium hypochlorite (NaOCl) is the most commonly used irrigant in endodontics due to its ability to dissolve organic soft tissues in the root canal system and its action as a potent antimicrobial agent. Although NaOCl accidents created by extrusion of the irrigant through root apices are relatively rare and are seldom life-threatening, they do create substantial morbidity when they occur.

Methods

To date, NaOCl accidents have only been published as isolated case reports. Although previous studies have attempted to summarise the symptoms involved in these case reports, there was no endeavour to analyse the distribution of soft tissue distribution in those reports. In this review, the anatomy of a classical NaOCl accident that involves facial swelling and ecchymosis is discussed.

Results

By summarising the facial manifestations presented in previous case reports, a novel hypothesis that involves intravenous infusion of extruded NaOCl into the facial vein via non-collapsible venous sinusoids within the cancellous bone is presented.

Conclusions

Understanding the mechanism involved in precipitating a classic NaOCl accident will enable the profession to make the best decision regarding the choice of irrigant delivery techniques in root canal débridement, and for manufacturers to design and improve their irrigation systems to achieve maximum safety and efficient cleanliness of the root canal system.     

Cleaning efficacy and dentin micro-hardness after root canal irrigation with a strong acid electrolytic water

The purpose of this study was to evaluate the cleaning effect of root canal walls using strong acid electrolytic water (SAEW) as a root canal irrigant, and to investigate the influence of SAEW on the root canal dentin by micro-hardness test. Forty-three single-rooted, single-canaled teeth were instrumented using standard step-back technique with K-files. Irrigation was performed using distilled water, 5.25% NaOCl and 3% H(2)O(2), SAEW, or 15% EDTA solution in five groups. Samples were prepared to be examined under a scanning electron microscope (SEM) and micro Vickers hardness (H(V)) test machine. Our results showed that the root cleaning effects of the combined use of SAEW and NaOCl solution as root canal irrigants were equivalent to those in the group with NaOCl and 15% EDTA. When SAEW was used for 1 min under ultrasonic vibration, no decreases in the hardness of dentin inside the root canal were detected.     

Cyclic Fatigue Resistance of Nickel-Titanium Instruments after Immersion in Irrigant Solutions with or without Surfactants

Introduction

The aim of the study was to assess cyclic fatigue resistance of reciprocating (Reciproc and WaveOne) and continuous rotating (ProTaper) nickel-titanium files after immersion in different irrigation solutions with or without surfactants during several short time periods.

Methods

A total of 270 new Reciproc R25, WaveOne Primary, and ProTaper F2 files were tested. Instruments of each brand were divided into 1 control group (n = 10) formed by new files and 4 test groups (n = 20) formed by instruments dynamically immersed at 37°C for 16 mm in 5.25% sodium hypochlorite (NaOCl), Hypoclean (5.25% NaOCl with surfactant), 17% EDTA, or EDTA Plus (17% EDTA with surfactant). Each test group was subdivided into 2 subgroups (n = 10) on the basis of the time of dynamic immersion in the endodontic irrigant solution (45 seconds or 3 minutes). Resistance to cyclic fatigue was determined by recording time to fracture in a stainless steel artificial canal with a 60° angle of curvature and 5-mm radius of curvature. The fracture surface was examined by using scanning electron microscopy.

Results

Immersion in NaOCl did not reduce the cyclic fatigue of reciprocating or continuous nickel-titanium files. The 17% EDTA reduced the fatigue resistance of all instruments after 3 minutes. The immersion in irrigants with surfactants did not influence the cyclic fatigue of instruments except for Reciproc immersed in Hypoclean solution.

Conclusions

EDTA immersion reduced the cyclic fatigue resistance of all instruments after 3 minutes. Addition of surfactants did not influence the cyclic fatigue of files except when added to NaOCl when it contacts Reciproc instruments.     

Comparison of the Efficacy of Smear Clear with and without a Canal Brush in Smear Layer and Debris Removal from Instrumented Root Canal Using WaveOne versus ProTaper: A Scanning Electron Microscopic Study

Introduction

The aim of this study was to compare by scanning electron microscopy the presence of smear layer and debris on root canal walls after preparation with the single-file system WaveOne (Dentsply Maillefer, Ballaigues, Switzerland) versus the rotary ProTaper system (Dentsply Maillefer, Ballaigues, Switzerland) under 2 final irrigant regimens.

Methods

Forty freshly extracted single-rooted human teeth were randomly divided into 4 groups (n = 10). The ProTaper and ProTaper and rotary CanalBrush (Coltène Whaledent GmbH+ Co KG, Langenau, Germany) groups were instrumented with the ProTaper system. Groups WaveOne and WaveOne and rotary CanalBrush were instrumented with the WaveOne system. The irrigant in all groups was 2 mL 5.25% sodium hypochlorite (NaOCl) solution, whereas the final irrigation after preparation in the ProTaper and WaveOne groups was 1 mL Smear Clear solution (Sybron Endo, Orange, CA) and then 5.25% NaOCl applied with a plastic syringe, and in the ProTaper and rotary CanalBrush and WaveOne and rotary CanalBrush groups, it was 1 mL Smear Clear solution and then 5.25% NaOCl (rotary CanalBrush agitation). Roots were processed for scanning electron microscopic examination for debris and smear layer scoring. Data were statistically analyzed.

Results

All groups showed more efficient smear layer and debris removal coronally than in the middle and apical regions, whereas the mean total debris score and the mean smear layer score in all groups were less in the WaveOne and rotary CanalBrush groups than the ProTaper and rotary CanalBrush and the WaveOne and ProTaper groups.

Conclusions

Using the rotary CanalBrush in canals prepared with WaveOne produced the cleanest canal walls, and the WaveOne system gave superior results compared with the ProTaper system.