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Published:
Apr 4, 2022
Section
Artículos Endodoncia
Main Article Content
Abstract
The success of endodontic treatment will depend on the cleanliness and conformation of the root canal system.
In clinical practice, the use of irrigants provides chemical disinfection of root canals and removal of the smear
trapped inside the canal thanks to the efficient action of chelating solutions. The purpose of this study
was to calculate the efficacy of removing the smear layer in the apical third, with the use of 17% EDTA
and 10% citric acid activated with different devices and techniques such as passive ultrasonic irrigation
(PUI) and EDDY tips (ED). Forty-five premolar teeth were randomly divided into five groups: 4 experimental
groups (n=10) and 1 control group (n=5). In each root, two longitudinal grooves were prepared in the buccal
and lingual, which were covered with gold for observation under the scanning electron microscope to thus
quantify the open dentinal tubules. For the statistical analysis, the Shapiro-Wilk, Kruskal-Wallis test and
a multiple comparison with U Mann-Whitney were used, which showed that the activation with EDDY has had
the lowest scores of the experiment with a difference of 8 points with respect to PUI with EDTA at 17% and
a difference with PUI of 13 points with citric acid at 10% in the apical third. However, none of the
experimental groups was able to remove the entire dentin smear layer in the apical third, but they did
present significant differences with respect to the control group, so the use of chelating solutions and an
activation system is recommended to better obtain cleaning index and ensure a successful root canal treatment.
In clinical practice, the use of irrigants provides chemical disinfection of root canals and removal of the smear
trapped inside the canal thanks to the efficient action of chelating solutions. The purpose of this study
was to calculate the efficacy of removing the smear layer in the apical third, with the use of 17% EDTA
and 10% citric acid activated with different devices and techniques such as passive ultrasonic irrigation
(PUI) and EDDY tips (ED). Forty-five premolar teeth were randomly divided into five groups: 4 experimental
groups (n=10) and 1 control group (n=5). In each root, two longitudinal grooves were prepared in the buccal
and lingual, which were covered with gold for observation under the scanning electron microscope to thus
quantify the open dentinal tubules. For the statistical analysis, the Shapiro-Wilk, Kruskal-Wallis test and
a multiple comparison with U Mann-Whitney were used, which showed that the activation with EDDY has had
the lowest scores of the experiment with a difference of 8 points with respect to PUI with EDTA at 17% and
a difference with PUI of 13 points with citric acid at 10% in the apical third. However, none of the
experimental groups was able to remove the entire dentin smear layer in the apical third, but they did
present significant differences with respect to the control group, so the use of chelating solutions and an
activation system is recommended to better obtain cleaning index and ensure a successful root canal treatment.
Article Details
How to Cite
López Espinoza, J. A. (2022). Español. OdontoInvestigación, 8(1). https://doi.org/10.18272/oi.v8i1.2589
References
Andrabi, S. M.-U.-N. (2014). Effect of passive ultrasonic irrigation and manual dynamic irrigation on smear layer removal from root canals in aclosed apex in vitro model. Journal of Investigative and Clinical Dentistry.
Urban, K. (2017 ). Canal cleanliness using different irrigation activation systems: a SEMevaluation. Clinic Oral Investigation .
Kato, A. S. (2016). Investigation of the Efficacy of Passive Ultrasonic Irrigation Versus Irrigation with Reciprocating Activation: An Environmental Scanning Electron Microscopic Study. Journal of Endodontics.
Olivieri, J. G. (2016). Effect of manual dynamic activation with citric acid solutions in smear layer removal: A scanning electron microscopic evaluation. Journal of Dental Sciences.
Prado, M. (2011). Scanning Electron Microscopic Investigation of the Effectiveness of Phosphoric Acid in Smear Layer Removal When Compared with EDTA and Citric Acid . Journal of Endodontics .
Zeng, C. (2018). Antibacterial efficacy of an endodontic sonic-powered irrigation system: An in vitro study. Journal of Dentistry.
Cohen. (2010). Limpieza y conformacion del sistema de conductos radicular. Elsevier.
Mukhtar-Un-NisarAndrabi, S. (2014). Effect of passive ultrasonic irrigation and manual dynamic irrigation on smear layer removal from root canals in aclosed apex in vitro model. Journal of Investigative and Clinical Dentistry.
Swanljung, O. (2018). Root Canal Irrigants and Medicaments in Endodontic Malpractice Cases: A Nationwide Longitudinal Observation. Journal of Endodontics.
Verma, N. (2019). Effect of different concentrations of sodium hypochlorite on outcome of primary root canal treatment: a randomized controlled trial. Journal of Endodontics.
Kuah, H.-G. (2009). The Effect of EDTA with and without Ultrasonics on Removal of the Smear Layer. Journal of Endodontics.
Arias-Moliz, M. T. (2016). Effects of Dentin Debris on the Antimicrobial Properties of Sodium Hypochlorite and Etidronic Acid. Journal of Endodontics .
Agreda, C. (2015). Effectiveness of edta and citric acid on removal smear layer of the root canal system. Odous Científica.
ZEHNDER, M. (2011). Disinfection of the root canal system during root canal re-treatment. ENDODONTIC TOPICS.
Jiménez-Chaves, V. (2013). "EVALUATION OF SEAR LAYER REMOVAL USING 10%CITRIC ACID AND RC-PREP SOLUTIONS AS IRRIGANTS A SCANNING ELECTRON MICROSCOPE STUDY IRRIGANTS A SCANNING ELECTRON MICROSCOPE STUDY IRRIGANTS A SCANNING ELECTRON MICROSCOPE STUDY. Revista Cientifica Odontologica .
Machado, R. (2017). Evaluation of 17% EDTA and 10% citric acid in smear layer removal and tubular dentin sealer penetration. Microscopy Research and Technique.
Prado, M. (2011). Scanning Electron Microscopic Investigation of the Effectiveness of Phosphoric Acid in Smear Layer Removal When Compared with EDTA and Citric Acid. Journal of Endodontics.
Olivieri. (2016). Effect of manual dynamic activation with citric acid solutions in smear layer removal: A scanning electron microscopic evaluation. Journal of Dental Sciences.
Caputi, P. E. (2019). Ultrasonic Irrigant Activation during Root Canal Treatment: A Systematic Review. Journal of Endodontics .
Li-Sha. (2009 ). Review of Contemporary Irrigant Agitation Techniques anad Devices. Journal of Endodontics.
Chang, Z. (2018). Antibacterial efficacy of an endodontic sonic-powered irrigation system: An in vitro study. Journal of Dentistry.
Sluis, L. W. (2007). Passive ultrasonic irrigation of the root canal: a review of the literature. International Endodontic Journa.
Haupt, F. (2019). Effectiveness of different activated irrigation techniques on debris and smear layer removal from curved root canals: a SEM evaluation. Australian Endodontic Journal .
Virdee, S. S. (2017). Efficacy of irrigant activation techniques in removing intracanal smear layer and debris from mature permanent teeth: a systematic review and meta-analysis. International Endodontic Journal.
Hülsmann, M. R. (1997). Root canal cleanliness after preparation with different endodontic handpieces and hand instruments: A comparative SEM investigation . Journal of Endodontics .
Carrasco, V. I., & Caballero, P. A. (2014). Sonic Versus Ultrasonic Activation of 10% EDTA for Smear Layer Removal in the Root Canal Apical Third. International journal of odontostomatology .
Zeng, C. e. (2018). Antibacterial efficacy of an endodontic sonic-powered irrigation system: An in vitro study. Journal of Dentistry.
Donnermeyer, D. (2019). Removal of Calcium Hydroxide from Artificial Grooves in Straight Root Canals: Sonic Activation Using EDDY Versus Passive Ultrasonic Irrigation and XPendo Finisher. Journal of Endodontics.
H. S. Topçuoğlu, S. D. (2014). Efficacy of different irrigation techniques in the removal of calcium hydroxide from a simulated internal root resorption cavity. International Endodontic Journal .
Mancini, M. (2013). Smear Layer Removal and Canal Cleanliness Using Different Irrigation Systems (EndoActivator, EndoVac, and Passive Ultrasonic Irrigation): Field Emission Scanning Electron Microscopic Evaluation in an In Vitro Study. Journal of Endodontics .
Manuele, M. (2013). Smear Layer Removal and Canal Cleanliness Using Different Irrigation Systems (EndoActivator, EndoVac, and Passive Ultrasonic Irrigation): Field Emission Scanning Electron Microscopic Evaluation in an In Vitro Study. American Association of Endodontists.
Mozo, S. (2014). Effectiveness of passive ultrasonic irrigation in improving elimination of smear layer and opening dentinal tubules. Journal of Clinical and Experimental Dentistry .
Retsas, A. (2019). An update on ultrasonic irrigant activation. ENDO EPT.
Plotino G PC, G. N. (2007). Ultrasonics in endodontics . Journal of endodontics .
De - Deus G, P. S. (2006). Real-time atomic force microscopy of root dentine during demineralization when subjected to chelating agents. INTERNATIONAL ENDODONTIC JOURNAL.
Saito, K. (2008). Effect of shortened irrigation times with 17% ethylene diamine tetra-acetic acid on smear layer removal alter rotary canal instrumentation . Journal of endodontic .
Kuah, H.-G. (2009). The effect of EDTA with and without ultrasonics on removal of the smear layer. Journal of endodontics .
Rius, L. (2020). Analysis of the smear layer generated by different activation systems: an in vitro study. Clinical Oral Investigations.
Plotino, G. (2020). Evaluation of smear layer and debris removal by stepwise intraoperative activation (SIA) of sodium hypochlorite . Clinical Oral Investigations.
Kanaan, C. G. (2020). Can Irrigant Agitation Lead to the formation of a Smear Layer? Journal of Endodontics.
Urban, K. (2017 ). Canal cleanliness using different irrigation activation systems: a SEMevaluation. Clinic Oral Investigation .
Kato, A. S. (2016). Investigation of the Efficacy of Passive Ultrasonic Irrigation Versus Irrigation with Reciprocating Activation: An Environmental Scanning Electron Microscopic Study. Journal of Endodontics.
Olivieri, J. G. (2016). Effect of manual dynamic activation with citric acid solutions in smear layer removal: A scanning electron microscopic evaluation. Journal of Dental Sciences.
Prado, M. (2011). Scanning Electron Microscopic Investigation of the Effectiveness of Phosphoric Acid in Smear Layer Removal When Compared with EDTA and Citric Acid . Journal of Endodontics .
Zeng, C. (2018). Antibacterial efficacy of an endodontic sonic-powered irrigation system: An in vitro study. Journal of Dentistry.
Cohen. (2010). Limpieza y conformacion del sistema de conductos radicular. Elsevier.
Mukhtar-Un-NisarAndrabi, S. (2014). Effect of passive ultrasonic irrigation and manual dynamic irrigation on smear layer removal from root canals in aclosed apex in vitro model. Journal of Investigative and Clinical Dentistry.
Swanljung, O. (2018). Root Canal Irrigants and Medicaments in Endodontic Malpractice Cases: A Nationwide Longitudinal Observation. Journal of Endodontics.
Verma, N. (2019). Effect of different concentrations of sodium hypochlorite on outcome of primary root canal treatment: a randomized controlled trial. Journal of Endodontics.
Kuah, H.-G. (2009). The Effect of EDTA with and without Ultrasonics on Removal of the Smear Layer. Journal of Endodontics.
Arias-Moliz, M. T. (2016). Effects of Dentin Debris on the Antimicrobial Properties of Sodium Hypochlorite and Etidronic Acid. Journal of Endodontics .
Agreda, C. (2015). Effectiveness of edta and citric acid on removal smear layer of the root canal system. Odous Científica.
ZEHNDER, M. (2011). Disinfection of the root canal system during root canal re-treatment. ENDODONTIC TOPICS.
Jiménez-Chaves, V. (2013). "EVALUATION OF SEAR LAYER REMOVAL USING 10%CITRIC ACID AND RC-PREP SOLUTIONS AS IRRIGANTS A SCANNING ELECTRON MICROSCOPE STUDY IRRIGANTS A SCANNING ELECTRON MICROSCOPE STUDY IRRIGANTS A SCANNING ELECTRON MICROSCOPE STUDY. Revista Cientifica Odontologica .
Machado, R. (2017). Evaluation of 17% EDTA and 10% citric acid in smear layer removal and tubular dentin sealer penetration. Microscopy Research and Technique.
Prado, M. (2011). Scanning Electron Microscopic Investigation of the Effectiveness of Phosphoric Acid in Smear Layer Removal When Compared with EDTA and Citric Acid. Journal of Endodontics.
Olivieri. (2016). Effect of manual dynamic activation with citric acid solutions in smear layer removal: A scanning electron microscopic evaluation. Journal of Dental Sciences.
Caputi, P. E. (2019). Ultrasonic Irrigant Activation during Root Canal Treatment: A Systematic Review. Journal of Endodontics .
Li-Sha. (2009 ). Review of Contemporary Irrigant Agitation Techniques anad Devices. Journal of Endodontics.
Chang, Z. (2018). Antibacterial efficacy of an endodontic sonic-powered irrigation system: An in vitro study. Journal of Dentistry.
Sluis, L. W. (2007). Passive ultrasonic irrigation of the root canal: a review of the literature. International Endodontic Journa.
Haupt, F. (2019). Effectiveness of different activated irrigation techniques on debris and smear layer removal from curved root canals: a SEM evaluation. Australian Endodontic Journal .
Virdee, S. S. (2017). Efficacy of irrigant activation techniques in removing intracanal smear layer and debris from mature permanent teeth: a systematic review and meta-analysis. International Endodontic Journal.
Hülsmann, M. R. (1997). Root canal cleanliness after preparation with different endodontic handpieces and hand instruments: A comparative SEM investigation . Journal of Endodontics .
Carrasco, V. I., & Caballero, P. A. (2014). Sonic Versus Ultrasonic Activation of 10% EDTA for Smear Layer Removal in the Root Canal Apical Third. International journal of odontostomatology .
Zeng, C. e. (2018). Antibacterial efficacy of an endodontic sonic-powered irrigation system: An in vitro study. Journal of Dentistry.
Donnermeyer, D. (2019). Removal of Calcium Hydroxide from Artificial Grooves in Straight Root Canals: Sonic Activation Using EDDY Versus Passive Ultrasonic Irrigation and XPendo Finisher. Journal of Endodontics.
H. S. Topçuoğlu, S. D. (2014). Efficacy of different irrigation techniques in the removal of calcium hydroxide from a simulated internal root resorption cavity. International Endodontic Journal .
Mancini, M. (2013). Smear Layer Removal and Canal Cleanliness Using Different Irrigation Systems (EndoActivator, EndoVac, and Passive Ultrasonic Irrigation): Field Emission Scanning Electron Microscopic Evaluation in an In Vitro Study. Journal of Endodontics .
Manuele, M. (2013). Smear Layer Removal and Canal Cleanliness Using Different Irrigation Systems (EndoActivator, EndoVac, and Passive Ultrasonic Irrigation): Field Emission Scanning Electron Microscopic Evaluation in an In Vitro Study. American Association of Endodontists.
Mozo, S. (2014). Effectiveness of passive ultrasonic irrigation in improving elimination of smear layer and opening dentinal tubules. Journal of Clinical and Experimental Dentistry .
Retsas, A. (2019). An update on ultrasonic irrigant activation. ENDO EPT.
Plotino G PC, G. N. (2007). Ultrasonics in endodontics . Journal of endodontics .
De - Deus G, P. S. (2006). Real-time atomic force microscopy of root dentine during demineralization when subjected to chelating agents. INTERNATIONAL ENDODONTIC JOURNAL.
Saito, K. (2008). Effect of shortened irrigation times with 17% ethylene diamine tetra-acetic acid on smear layer removal alter rotary canal instrumentation . Journal of endodontic .
Kuah, H.-G. (2009). The effect of EDTA with and without ultrasonics on removal of the smear layer. Journal of endodontics .
Rius, L. (2020). Analysis of the smear layer generated by different activation systems: an in vitro study. Clinical Oral Investigations.
Plotino, G. (2020). Evaluation of smear layer and debris removal by stepwise intraoperative activation (SIA) of sodium hypochlorite . Clinical Oral Investigations.
Kanaan, C. G. (2020). Can Irrigant Agitation Lead to the formation of a Smear Layer? Journal of Endodontics.