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VOLUME 23 , ISSUE 11 ( November, 2022 ) > List of Articles

ORIGINAL RESEARCH

The Effectiveness of Different Irrigation Techniques on Debris and Smear Layer Removal in Primary Mandibular Second Molars: An In Vitro Study

Claire El Hachem, Walid Nehme, Marc Krikor Kaloustian, Nabil Ghosn, Maha Daou, Carla Zogheib, Mia Karam, Rami Mhanna, Valentina Macaluso, Naji Kharouf, Jean Claude Abou Chedid

Keywords : Endodontic irrigation, Passive ultrasonic irrigation, Primary teeth pulpectomy, Smear layer, Sonic irrigation

Citation Information : Hachem CE, Nehme W, Kaloustian MK, Ghosn N, Daou M, Zogheib C, Karam M, Mhanna R, Macaluso V, Kharouf N, Chedid JC. The Effectiveness of Different Irrigation Techniques on Debris and Smear Layer Removal in Primary Mandibular Second Molars: An In Vitro Study. J Contemp Dent Pract 2022; 23 (11):1173-1179.

DOI: 10.5005/jp-journals-10024-3440

License: CC BY-NC 4.0

Published Online: 17-03-2023

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Aims: The aim of the present in vitro study was to compare the effectiveness of passive ultrasonic irrigation (PUI), sonic irrigation, and mechanic dynamic activation on the removal of debris and smear layer from primary mandibular second molars during pulpectomy. Materials and methods: Mesial roots of 48 primary mandibular second molars were prepared with an R-motion 21 mm file (30/0.04) (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland), irrigated with 1% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA), and divided into four groups (n = 24 canals) according to the final irrigation activation technique: control group without activation, PUI with Ultra-X (Eighteeth, Changzhou, China), mechanical activation with XP-endo Finisher (FKG), and sonic irrigation with EQ-S (Meta Biomed, Chungcheongbuk-do, Korea). The roots were split longitudinally and analyzed using scanning electron microscopy (SEM). The presence of debris and smear layer was assessed using a 5-grade scoring scale with 200× and 1000× magnification, respectively. The Kruskal–Wallis and Friedman tests were used for data analysis. Results: The activation of the irrigant significantly improved debris and smear layer removal (p < 0.001). There was no significant difference between Ultra-X, XP-endo Finisher, and EQ-S (p > 0.05). No activation technique was able to completely eliminate debris and smear layer from the root canals of primary mandibular second molars. Conclusions: During pediatric pulpectomy, the irrigation protocol must include activation of the irrigation solutions using either ultrasonic, sonic, or mechanical activation techniques to enhance the removal of debris and smear layer for a better prognosis. Clinical significance: During root canal treatment on primary teeth, the clinician must incorporate an activation technique in the irrigation protocol to enhance the removal of debris and smear layer and increase the success of the treatment.


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  1. Coll JA, Vargas K, Marghalani AA, et al. A systematic review and meta-analysis of nonvital pulp therapy for primary teeth. Pediatr Dent 2020;42(4):256–461. PMID: 32847665.
  2. Manchanda S, Sardana D, Yiu CKY. A systematic review and meta-analysis of randomized clinical trials comparing rotary canal instrumentation techniques with manual instrumentation techniques in primary teeth. Int Endod J 2020;53(3):333–353. DOI: 10.1111/iej.13233.
  3. El Hachem C, Kaloustian MK, Nehme W, et al. Three-dimensional modeling and measurements of root canal anatomy in second primary mandibular molars: A case series micro CT study. Eur Arch Paediatr Dent 2019;20(5):457–465. DOI: 10.1007/s40368-019-00426-8.
  4. Zancan RF, Di Maio A, Tomson PL, et al. The presence of smear layer affects the antimicrobial action of root canal sealers. Int Endod J 2021;54(8):1369–1382. DOI: 10.1111/iej.13522.
  5. Tannure PN, Azevedo CP, Barcelos R, et al. Long-term outcomes of primary tooth pulpectomy with and without smear layer removal: A randomized split-mouth clinical trial. Pediatr Dent 2011;33(4):316–320. PMID: 21902998.
  6. Bukhari S, Babaeer A. Irrigation in endodontics: A review. Curr Oral Health Rep 2019;6(4):367–376. DOI: 10.1007/s40496-019-00241-6.
  7. Silva EJNL, Carvalho CR, Belladonna FG, et al. Micro-CT evaluation of different final irrigation protocols on the removal of hard-tissue debris from isthmus-containing mesial root of mandibular molars. Clin Oral Investig 2019;23(2):681–687. DOI: 10.1007/s00784-018-2483-1.
  8. Buldur B, Kapdan A. Comparison of the EndoVac system and conventional needle irrigation on removal of the smear layer in primary molar root canals. Niger J Clin Pract 2017;20(9):1168–1174. DOI: 10.4103/1119-3077.181351.
  9. Topçuoğlu G, Topçuoğlu HS, Delikan E, et al. The effect of two different irrigation needles on post-operative pain after pulpectomy in primary molar teeth: A randomized clinical study. Int J Paediatr Dent 2020;30(6):758–763. DOI: 10.1111/ipd.12652.
  10. Anand P, Mathur S, Sachdev V, et al. Inter-comparison of antimicrobial photodynamic therapy, LASER, and an antifungal agent as adjunct intracanal irrigation techniques to standard disinfection protocols in reducing Candida albicans counts in the root canals of primary teeth: A pilot study. J Indian Soc Pedod Prev Dent 2020;38(3):304–310. DOI: 10.4103/JISPPD.JISPPD_286_20.
  11. Ahmad M, Pitt Ford TJ, Crum LA. Ultrasonic debridement of root canals: Acoustic streaming and its possible role. J Endod 1987;13(10):490–499. DOI: 10.1016/s0099-2399(87)80016-x.
  12. Çapar İD, Ari Aydinbelge H. Effectiveness of various irrigation activation protocols and the self-adjusting file system on smear layer and debris removal. Scanning 2014;36(6):640–647. DOI: 10.1002/sca.21171.
  13. Johnson M, Sidow SJ, Looney SW, et al. Canal and isthmus debridement efficacy using a sonic irrigation technique in a closed-canal system. J Endod 2012;38(9):1265–1268. DOI: 10.1016/j.joen.2012.05.009.
  14. Öter B, Topçuog Lu N, Tank MK, et al. Evaluation of antibacterial efficiency of different root canal disinfection techniques in primary teeth. Photomed Laser Surg 2018;36(4):179–184. DOI: 10.1089/pho.2017.4324.
  15. Gümüş H, Delikan E. The effect of sonic activation of irrigant on postoperative pain after root canal treatment in primary molar teeth: A randomized, clinical study. Clin Oral Investig 2021;25(1):363–370. DOI: 10.1007/s00784-020-03687-6.
  16. Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surg Oral Med Oral Pathol 1984;58(5):589–599. DOI: 10.1016/0030-4220(84)90085-9.
  17. Mancino D, Kharouf N, Cabiddu M, et al. Microscopic and chemical evaluation of the filling quality of five obturation techniques in oval-shaped root canals. Clin Oral Investig 2021;25(6):3757–3765. DOI: 10.1007/s00784-020-03703-9.
  18. Ultra X – Ultrasonic device – Changzhou Sifary Medical Technology Co., Ltd. (Accessed on 26 April 2022). Available from: https://www.eighteeth.com/ultrasonic-device/9.html.
  19. Alakshar A, Saleh ARM, Gorduysus MO. Debris and smear layer removal from oval root canals comparing XP-endo finisher, endoactivator, and manual irrigation: A SEM evaluation. Eur J Dent 2020;14(4):626–633. DOI: 10.1055/s-0040-1714762.
  20. Kharouf N, Pedullà E, La Rosa GRM, et al. In vitro evaluation of different irrigation protocols on intracanal smear layer removal in teeth with or without pre-endodontic proximal wall restoration. J Clin Med 2020;9(10):3325. DOI: 10.3390/jcm9103325.
  21. Urban K, Donnermeyer D, Schäfer E, et al. Canal cleanliness using different irrigation activation systems: a SEM evaluation. Clin Oral Investig 2017;21(9):2681–2687. DOI: 10.1007/s00784-017-2070-x.
  22. Hülsmann M, Rümmelin C, Schäfers F. Root canal cleanliness after preparation with different endodontic handpieces and hand instruments: A comparative SEM investigation. J Endod 1997;23(5):301–306. DOI: 10.1016/S0099-2399(97)80410-4.
  23. Rödig T, Döllmann S, Konietschke F, et al. Effectiveness of different irrigant agitation techniques on debris and smear layer removal in curved root canals: A scanning electron microscopy study. J Endod 2010;36(12):1983–1987. DOI: 10.1016/j.joen.2010.08.056.
  24. Esentürk G, Akkas E, Cubukcu E, et al. A micro-computed tomographic assessment of root canal preparation with conventional and different rotary files in primary teeth and young permanent teeth. Int J Paediatr Dent 2020;30(2):202–208. DOI: 10.1111/ipd.12587.
  25. Hachem CE, Chedid JCA, Nehme W, et al. Physicochemical and antibacterial properties of conventional and two premixed root canal filling materials in primary teeth. J Funct Biomater 2022;13(4):177. DOI: 10.3390/jfb13040177.
  26. Chaugule VB, Panse AM, Gawali PN. Adverse reaction of sodium hypochlorite during endodontic treatment of primary teeth. Int J Clin Pediatr Dent 2015;8(2):153–156. DOI: 10.5005/jp-journals-10005-1304.
  27. Elheeny AAH. Allium sativum extract as an irrigant in pulpectomy of primary molars: A 12-month short-term evaluation. Clin Exp Dent Res 2019;5(4):420–426. DOI: 10.1002/cre2.197.
  28. Silva EJNL, Prado MC, Soares DN, et al. The effect of ozone therapy in root canal disinfection: A systematic review. Int Endod J 2020;53(3):317–332. DOI: 10.1111/iej.13229.
  29. Torabinejad M, Khademi AA, Babagoli J, et al. A new solution for the removal of the smear layer. J Endod 2003;29(3):170–175. DOI: 10.1097/00004770-200303000-00002.
  30. Pozos-Guillen A, Garcia-Flores A, Esparza-Villalpando V, et al. Intracanal irrigants for pulpectomy in primary teeth: A systematic review and meta-analysis. Int J Paediatr Dent 2016;26(6):412–425. DOI: 10.1111/ipd.12228.
  31. Yüksel BN, Demirel A, Ziya M, et al. The effects of various irrigation protocols on root canal wall adaptation and apical microleakage in primary teeth. Acta Odontol Scand 2020;78(5):321–326. DOI: 10.1080/00016357.2019.1709890.
  32. Mader CL, Baumgartner JC, Peters DD. Scanning electron microscopic investigation of the smeared layer on root canal walls. J Endod 1984;10(10):477–483. DOI: 10.1016/S0099-2399(84)80204-6.
  33. Plotino G, Grande NM, Mercade M, et al. Efficacy of sonic and ultrasonic irrigation devices in the removal of debris from canal irregularities in artificial root canals. J Appl Oral Sci 2019;27:e20180045. DOI: 10.1590/1678-7757-2018-0045.
  34. Susila A, Minu J. Activated irrigation vs. conventional non-activated irrigation in endodontics – A systematic review. Eur Endod J 2019;4(3):96–110. DOI: 10.14744/eej.2019.80774.
  35. Bao P, Shen Y, Lin J, et al. In vitro efficacy of XP-endo finisher with 2 different protocols on biofilm removal from apical root canals. J Endod 2017;43(2):321–325. DOI: 10.1016/j.joen.2016.09.021.
  36. Zhou J, Liu T, Guo L. Effectiveness of XP-endo finisher and passive ultrasonic irrigation on intracanal medicament removal from root canals: A systematic review and meta-analysis. BMC Oral Health 2021;21(1):294. DOI: 10.1186/s12903-021-01644-7.
  37. Karade P, Sharma D, Hoshing UA, et al. Efficiency of different endodontic irrigation and activation systems, self-adjusting file instrumentation/irrigation system, and XP-endo finisher in removal of the intracanal smear layer: An ex vivo scanning electron microscope study. J Pharm Bioallied Sci 2021;13(Suppl 1):S402–S407. DOI: 10.4103/jpbs.JPBS_775_20.
  38. Martins MP, Duarte MAH, Cavenago BC, et al. Effectiveness of the protaper next and reciproc systems in removing root canal filling material with sonic or ultrasonic irrigation: A micro-computed tomographic study. J Endod 2017;43(3):467–471. DOI: 10.1016/j.joen.2016.10.040.
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