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- DOI 10.18231/j.ijce.12524.1758946730
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CrossMark
Comparative Assessment of the Effect of a Modified Irrigation Protocol on the Cleanliness of Moderately Curved Root Canals: An In-vitro Study
- Author Details:
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Gaurav Jain *
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Preeti Shukla
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Pradyumna Misra
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Shronika Shronika
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Swadhinta Raj
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Anupama Keerikkadu
Gaurav Jain *
Shronika Shronika
Background: Adequate disinfection of root canal system is essential for the success of endodontic therapy and chemo-mechanical preparation of the root canal system during root canal treatment ensures the same. The varying anatomical complexities of root canal is one of the limiting factors for mechanical instrumentation of the canal alone, so judicious use of chemical irrigation assumes more responsibility in such cases. The present study assesses and compares the efficacy of modified irrigation protocols on the debridement and smear layer removal in moderately curved canals, and also its subsequent effect on chemical composition of root canal dentin.
Materials and Methods: 60 human single rooted teeth with moderately curved canals (10-30° curvature) were randomly divided into 3 groups (n=20). Irrigation protocol employed in Group I was 5ml of 3% NaOCl between each instrument, followed by 5ml of 17% EDTA for 30 seconds. Group II employed Reverse Irrigation (RI) protocol wherein 5ml of 17% EDTA was used between each instrument followed by 5ml of 3% NaOCl for 30 seconds. In Group III, Reverse Irrigation plus (RI+) was used which is similar to RI except that NaOCl used was agitated manually in the canals. Debridement of root canal dentin was assessed using Scanning Electron Microscope and the chemical composition of dentin was assessed by energy dispersive X-ray (EDX).
Results: The mean Hulsmann score at the middle third in all groups were comparable, wherein Group I at 1.8, in Group II at 2.9 while in Group III it was 1.5. At the apical third, the score in Group I was 2.5, Group II was 3.6 and Group II was at 1.5. The difference was significant (p<0.05). The atomic percentage of phosphorus, carbon, oxygen, sodium and magnesium in all groups was comparable.
Conclusion: Results showed that 17% EDTA during cleaning and shaping followed by 3% NaOCl rinse for 3 minutes and manual agitation for 30 seconds improved apical debridement in moderately curved canals without inducing dentin erosion.
References
- Bystrom A, Sundqvist G. Bacteriologic evaluation of the efficacy of mechanical root canal instrumentation in endodontic therapy. Scand J Dent Res.1981;89(4):321–8.
- Virdee SS, Seymour DW, Farnell D, Bhamra G, Bhakta S. Efficacy of irrigant activation techniques in removing intracanal smear layer and debris from mature permanent teeth: a systematic review and meta-analysis. Int Endod J. 2018;51(6):605–21.
- Voegeli G, Di Bella E, Mekki M, Machtou P, Bouillaguet S. Effect of a modified irrigation protocol on the cleanliness of moderately curved canals. Eur J Dent. 2021;15(1):90–5.
- Caron G, Nham K, Bronnec F, Machtou P. Effectiveness of different final irrigant activation protocols on smear layer removal in curved canals. J Endod. 2010;36(8):1361–6.
- Bronnec F, Bouillaguet S, Machtou P. Ex vivo assessment of irrigant penetration and renewal during the cleaning and shaping of root canals: a digital subtraction radiographic study. Int Endod J. 2010;43(4):275–82.
- Verma N, Sangwan P, Tewari S, Duhan J. Effect of different concentrations of sodium hypochlorite on outcome of primary root canal treatment: a randomized controlled trial. J Endod. 2019;45(4):357–63.
- Senia ES, Marshall FJ, Rosen S. The solvent action of sodium hypochlorite on pulp tissue of extracted teeth. Oral Surg Oral Med Oral Pathol. 1971;31(1):96–103.
- Saito K, Webb TD, Imamura GM, Goodell GG. Effect of shortened irrigation times with 17% ethylene diamine tetra-acetic acid on 207 Jain et al. / IP Indian Journal of Conservative and Endodontics 2025;10(3):202-207 smear layer removal after rotary canal instrumentation. J Endod. 2008;34(08):1011–4.
- Nagmode PS, Chavan KM, Rathi RS, Tambe VH, Lokhande N, Kapse BS. Radiographic evaluation of root canal curvature in mesiobuccal canals of mandibular molars by different methods and its correlation with canal access angle in curved canals: An in vitro study. J Conserv Dent. 2019;22(5):425–9.
- Kakehashi S, Stanley HR, Fitzgerald RJ. The effects of surgical exposure of dental pulps in germ-free and conventional laboratory rats. OralSurg Oral Med Oral Pathol. 1965;20(3):340–8.
- Möller ÅJ, Fabricius L, Dahlen G, Öhman AE, Heyden GU. Influence on periapical tissues of indigenous oral bacteria and necrotic pulp tissue in monkeys. Scand J Dent Res.1981;89(6):475–
- Shreya, Jain G, Srinkhala, Singh P, Agarwal K. Comparative Evaluation of Antimicrobial Efficacy of Calcium Hydroxide, Triple Antibiotic Paste, and 2% Chlorhexidine Combined with 0.5% Cetrimide against Enterococcus faecalis Biofilm-Infected Dentin Model: An In vitro Study. J Pharm Bioallied Sci. 2021;13(Suppl 2):S1538–43.
- Khademi A, Yazdizadeh M, Feizianfard M. Determination of the minimum instrumentation size for penetration of irrigants to the apical third of root canal systems. J Endod. 2006;32(05):417–20.
- Crane AB. A Practicable root-canal technic. Philadelphia: Lea & Febiger, 1920.
- Clark-Holke D, Drake D, Walton R, Rivera E, Guthmiller JM. Bacterial penetration through canals of endodontically treated teeth in the presence or absence of the smear layer. J Dent. 2003;31(4):275–81.
- De-Deus G, Reis C, Paciornik S. Critical appraisal of published smear layer-removal studies: methodological issues. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112(4):531–43.
- Morago A, Ordinola-Zapata R, Ferrer-Luque CM, Baca P, Ruiz- Linares M, Arias-Moliz MT. Influence of smear layer on the antimicrobial activity of a sodium hypochlorite/etidronic acid irrigating solution in infected dentin. J Endod. 2016;42(11):1647–
- Sedgley CM, Nagel AC, Hall D, Applegate B. Influence of irrigant needle depth in removing bioluminescent bacteria inoculated into instrumented root canals using real-time imaging in vitro. Int Endod J. 2005;38(2):97–104.
- Ciucchi B, Khettabi M, Holz J. The effectiveness of different endodontic irrigation procedures on the removal of the smear layer: a scanning electron microscopic study. Int Endod J. 1989;22(1):21–
- Vanni JR, Santos R, Limongi O, Guerisoli DMZ, Capelli A, Pe´cora JD. Influence of cervical preflaring on determination of apical file size in maxillary molars: SE analysis. Braz Dent J. 2005;16(3):181–
- Barroso JM, Guerisoli DMZ, Capelli A, Saquy PC, Pe´cora JD. Influence of cervical preflaring on determination of apical file size in maxillary premolars: SEM analysis. Braz Dent J.2005;16:30–34.
- Ibelli GS, Barroso JM, Capelli A, Spano´ JCE, Pe´cora JD. Influence of cervical preflaring on apical file size determination in maxillary lateral incisors. Braz Dent J. 2007;18(2):102–6.
- Sanfelice CM, da Costa FB, Só MV, Vier-Pelisser F, Bier CA, Grecca FS. Effects of four instruments on coronal pre-enlargement by using cone beam computed tomography. J Endod. 2010;36(5):858–61.
- Boutsioukis C, Gogos C, Verhaagen B, Versluis M, Kastrinakis E, Van der Sluis LW. The effect of root canal taper on the irrigant flow: Evaluation using an unsteady Computational Fluid Dynamics model. Int Endod J. 2010;43(10):909–16.
- Qian W, Shen Y, Haapasalo M. Quantitative analysis of the effect of irrigant solution sequences on dentin erosion. J Endod. 2011;37(10):1437–41.
- Wang Z, Maezono H, Shen Y, Haapasalo M. Evaluation of root canal dentin erosion after different irrigation methods using energy dispersive X-ray spectroscopy. J Endod. 2016;42(12):1834–9
- Zaparolli D, Saquy PC, Cruz-Filho AM. Effect of sodium hypochlorite and EDTA irrigation, individually and in alternation, on dentin microhardness at the furcation area of mandibular molars. Braz Dent J. 2012;23(6):654–8.
- Garcia AJ, Kuga MC, Palma‐Dibb RG, Só MV, Matsumoto MA, Faria G et al. Effect of sodium hypochlorite under several formulations on root canal dentin microhardness. J Investig Clin Dent. 2013;4(4):229–32.
- Cobankara FK, Erdogan H, Hamurcu M. Effects of chelating agents on the mineral content of root canal dentin. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112(6):e149–54.
- Niu W, Yoshioka T, Kobayashi C, Suda H. A scanning electron microscopic study of dentinal erosion by final irrigation with EDTA and NaOCl solutions. Int Endod J. 2002;35(11):934–9.
- Rossi-Fedele G, Doğramaci E J, Guastalli A R, Steier L, de Figueiredo J A. Antagonistic interactions between sodium hypochlorite, chlorhexidine, EDTA, and citric acid. J Endod. 2012;38(04):426–31.