A scanning electron microscopy study of diseased root surfaces conditioned with EDTA gel plus Cetavlon after scaling and root planing

Background: Residual calculus, following scaling and root planing (SRP), is associated with persistent inflammation and the progression of periodontitis. This study examined the effects of a 24% neutral ethylenediaminetetraacetic acid (EDTA) gel on subgingival calculus and biofilms. Methods: Eleven single-rooted teeth extracted because of severe periodontal disease were randomly assigned to the following treatment groups: (1) three teeth served as untreated controls; (2) three teeth were treated by scaling and root planing (SRP) only; and (3) three teeth were treated by SRP + EDTA. The remaining two teeth, one SRP only and the other SRP + EDTA were designated for energy-dispersive X-ray spectroscopy (EDS) analysis. EDTA gel was placed on the SRP surface for 2 min and then burnished with a sterile cotton pellet. Results: SRP + EDTA treated specimens exhibited severely damaged biofilm and the disruption of the extracellular polymeric matrix. EDS scans of the smear layer and calculus featured reductions in the Weight % and Atomic % for N, F, Na, and S and increases in Mg, P, and Ca. Conclusions: A 25% neutral EDTA gel was applied after SRP severely disrupted the residual biofilm and altered the character of dental calculus and the smear layer as shown by reductions in the Weight % and Atomic % for N, F, Na, and S and increases in Mg, P, and Ca.

Objectives:Scaling and root planing (SRP) is one of the most commonly used procedures during periodontal treatment. The aim of this study was to evaluate the root surface roughness after SRP with erbium: yttrium aluminum garnet (Er:YAG) laser compared to ultrasonic and hand instruments.Materials and Methods:In this experimental study, 56 extracted sound single-rooted teeth with moderate level of calculus were selected and randomly divided into four groups: SRP was performed with Er:YAG laser (100 mJ pulse, 1W, 10Hz, VSP and contact mode, with 50% water and air) in group one, hand instrument in group two and ultrasonic tool in group three. Group four was considered as the control group. After SRP, all samples were cut by Servocut cutting machine into pieces with 3×3×2mm dimensions. The samples were mounted in acrylic resin. The surface roughness of the samples was evaluated with profilometry, and the data were analyzed using one-way ANOVA and Tukey’s test in SPSS software.Results:Surface roughness was higher in laser and lower in ultrasonic group compared to other groups. There was a significant difference in surface roughness between laser and ultrasonic groups (P=0.043), but there was no significant difference in surface roughness among other groups (P>0.05).Conclusion:The results of this study showed that surface roughness after SRP with Er:YAG laser was not higher than that after manual SRP, but the former value was higher than that after SRP with ultrasonic instrument.

Introduction:Irrigants remove or dissolve smear layer formed during instrumentation. Thus it is important to study the effect of different irrigant solutions on smear layer removal.Objectives:The aim of this study is to determine which irrigant effectively removes the smear layer from the coronal, middle, and apical third of the root canal.Materials and Methodology:One hundred and twenty single-rooted mandibular premolars were decoronated and biomechanical preparation was done through hand instrumentation up to size 40 k file with 2.5% NaOCl irrigation between each successive filing, followed by irrigation with 5 ml of saline. The teeth were divided into Groups I, II, III, and IV containing 30 samples each and irrigated with 5 ml of 17% ethylenediamine tetraacetic acid (EDTA), 10% Citric acid, 7% Maleic acid and normal saline respectively for 1 min and final irrigation was done with 5 ml of distilled water of each sample. The canals were dried with 2% absorbent paper points. The roots were then split with a chisel and mallet. One-half of each tooth was selected and then was analyzed using a scanning electron microscope. The dentinal surfaces were observed at the cervical, middle, and apical third with ×2000 for the smear layer. The scores were attributed, according to Torabinejad et al. rating system.Results:7% maleic acid and 10% citric acid both are equally effective in smear layer removal from coronal and middle third, but in apical third 7% maleic acid is more effective than 10% citric acid. Between citric acid and EDTA, both are equally effective in smear layer removal from coronal and middle third, but in apical third, 10% citric acid is more efficacious than 17% EDTA.Conclusion:Within the limitations of the study, it can be concluded that all three tested irrigants removed the smear layer from coronal, middle, and apical third. However, in apical third 7% maleic acid is the most efficacious irrigant in smear layer removal.

The aim of this study is to evaluate the incidence of crack formation while using Reciproc, WaveOne and Twisted File Adaptive with and without ethylenediaminetetraacetic acid (EDTA) gel. Seventy extracted mandibular premolars were included. The teeth were decoronated until roots of 16 mm were obtained. Samples were distributed into seven groups: group 1, no canal preparation (control); other groups were instrumented so; group 2, Reciproc; group 3, Reciproc + EDTA; group 4, WaveOne; group 5, WaveOne + EDTA; group 6, Twisted File Adaptive; group 7, Twisted File Adaptive + EDTA. Roots were horizontally sectioned from 3, 6 and 9 mm from apex and observed under stereomicroscope. The number and the incidence of cracks were recorded and statistically analysed with chi-squared and Kruskal-Wallis tests. Control group did not reveal any cracks. Crack formation with three novel Ni-Ti instruments was similar. Using EDTA gel did not reduce crack occurrence.

This in vitro study is an attempt to compare the effectiveness in cleaning oval shaped root canals using Anatomic Endodontic Technology (AET®), ProFile system® and Manual Instrumentation with K-files. Sixty oval shaped single rooted maxillary and mandibular premolars with straight canals were divided in to three groups. The root canals were, confirmed as being oval shape by means of radiographs made in a buccolingual and mesiodistal direction. Automated canal preparation was performed using Anatomic Endodontic Technology (group 1) and the ProFile system® (group 2). Manual instrumentation (group 3) was performed with k-files. Irrigation was performed using alternatively 3% NaOCl and 17% EDTA, followed by rinsing with normal saline. The roots were split longitudinally into two halves and examined under a scanning electron microscope. The presence of debris and smear layer was recorded at distances 1, 5 and 10 mm from the working length using a three step scoring scale. Mean scores for debris and smear layer was calculated and statistically analyzed for between and within groups significance, using the Kruskal-Wallis nonparametric ANOVA test and Bonferroni's multiple comparison test. At 1, 5 and 10 mm levels the root canals prepared with AET had significantly less surface debris and smear layer on the canal walls as compared to canals prepared with ProFile system® or manual instrumentation. For all three groups significantly lower mean smear layer scores (p < 0.05) were recorded at 5 and 10 mm levels compared with the 1 mm level. Significantly lower mean debris scores (p < 0.05) were also recorded at 5 and 10 mm levels for the AET group whereas no significant differences were found between the three levels for the ProFile system® and manual instrumentation groups. Although better instrumentation scores were obtained in canals prepared with AET, complete cleanliness was not achieved with any of the techniques and instruments investigated.

The role of root surface conditioning treatment on smear layer removal of human teeth is affected by periodontitis in periodontal regeneration. The objective of this study is to analyze the smear layer on root surface conditioned with 2.1% minocycline HCl ointment (Periocline), and 24% EDTA gel (Prefgel). A total of 10 human teeth indicated for extraction due to chronic periodontitis were collected and root planed. The teeth were sectioned in thirds of the cervical area, providing 30 samples that were divided into three groups – minocycline ointment treatment, 24% EDTA gel treatment, and saline as a control. The samples were examined by scanning electron microscope. No significant differences in levels of smear layer were observed between the minocycline group and the EDTA group (p=0.759). However, there were significant differences in the level of smear layer after root surface treatment in the minocycline and EDTA groups, compared with the control group (p=0.00). There was a relationship between root surface conditioning treatment and smear layer levels following root planing.

Evaluation of the impact of the latest root canal disinfectant, that is carbon quantum dots (CQDs), synchronized microbubble-photodynamic activation (SYMPA), and Nd: YAG laser along with ethylenediaminetetraacetic acid (EDTA) as a final irrigant on the Marten hardness (MH), smear layer (SL) removal, and extrusion bond strength (EBS) of zirconia post to the canal dentin. Eighty intact single-rooted premolars were obtained and disinfected using 0.5% chloramine-T solution. Root canal preparation was performed using ProTaper files followed by obturation. The post space was prepared for prefabricated zirconia post and all the teeth were randomly divided into four groups based on the disinfection used (n = 20 each) Group 1: 5.25% NaOCl + 17% EDTA (Control), Group 2: Nd: YAG laser + 17% EDTA, Group 3: SYMPA + 17% EDTA, and Group 4: CQDs + 17% EDTA. MH, SL removal, and EBS of zirconia post-bonded to root dentin were performed using a microhardness tester, scanning electron microscope (SEM), and universal testing machine, respectively. Both intragroup and intergroup comparisons were performed using one-way analysis of variance (ANOVA) and posthoc-Tukey test for significant difference (p < .05). Group 2 samples (Nd: YAG laser + 17% EDTA) (0.24 ± 0.06 GPa) exhibited highest values of MH. Samples in group 3 (SYMPA + 17% EDTA) treated teeth unveiled the lowest MH scores (0.13 ± 0.02 GPa). Moreover, the coronal third of Group 3 specimens (SYMPA and 17% EDTA) (1.54 ± 0.31) eliminated SL from the canal with the greatest efficacy as well as presented the highest EBS (10.13 ± 0.69 MPa). However, the apical third of Group 1 samples (5.25% NaOCl + 17% EDTA) (2.95 ± 0.33) exhibited the least efficient elimination of SL from the radicular dentin as well as the lowest bond strength (5.11 ± 0.19 MPa) of zirconia post to the dentin. The SYMPA technique with 17% EDTA proved highly effective in removing the SL from canal dentin and enhancing the EBS of zirconia posts. The least preferable method for SL removal and MH improvement was found to be 5.25% NaOCl + 17% EDTA. CQDs and Nd: YAG laser demonstrated satisfactory smear layer removal properties from the canal, along with achieving appropriate bond strength of zirconia posts. RESEARCH HIGHLIGHTS: Nd: YAG laser and 17% EDTA as canal disinfectant exhibited the highest values of MH. Specimens irrigated with SYMPA and 17% EDTA eliminated SL from the canal with the greatest efficacy. The coronal third of Group 3 (SYMPA + 17% EDTA) samples unveiled the highest zirconia post-bond integrity score to the canal dentin. Cohesive failure was a dominant failure type among different experimental groups.

Background and objectives: .The purpose of this study was to evaluate the effect of smear layer removal on apical seal and the quantity of microleakage associated with lateral cold condensation and thermafil obturation. Methods: Forty extracted single–rooted human teeth were randomly divided into two experimental groups; in group A, 20 roots with smear layer free, 5.25 % sodium hypochlorite (NaOCl) and 17% Ethylenediamine tetraacetic acid (EDTA) were used as irrigants to remove the smear layer, while in group B, 20 roots with smear layer, normal saline was used as irrigant. All root canals were instrumented with the Pro-taper rotary system using a crown-down technique. Each group of instrumented roots were subdivided randomly into two obturation groups; in group 1, 10 roots were obturated by thermafil with plastic carrier, while in group 2, 10 roots were obturated by cold lateral compaction technique. Zinc oxide euginol was used as the sealer. The root surfaces were then coated with nail polish except for the apex, then dye penetration study conducted and samples were examined under the stereomicroscope. Data had been collected from two independent examiners and statistically analyzed using student t-test. Results: There was non significant difference between all the groups radiographically while stereomicroscopic analysis showed significant difference of smear layer free group when obturated by thermafil with other groups. Conclusion: Smear layer free group gave the best results when used with lateral condensation technique (LCT) and smear layer group gave the best results when used with thermafil.

Effects of ND:YAG laser irradiation on untreated and root planed tooth roots were investigated to determine whether a cleaning effect and/or removal of smear layer could be achieved without concomitant microstructural or thermal damage. Sixty (60) healthy extracted teeth were either untreated, irradiated only, root planed only, or irradiated and root planed. Intra-pulpal and surface temperatures were monitored during irradiation, then SEM was performed. Smear layer elimination was achieved without inducing hard tissue microstructural damage at 5W, using pulse durations and intervals of 0.1 s, a fluence of 0.77 J/cm2, and a total energy density of approximately 700 J/cm2. However, these results were not consistent in all samples. At these parameters, intra-pulpal temperature increases of 9 to 22 degrees C and surface temperature increases of 18 to 36 degrees C were recorded. Thus, despite their effectiveness for smear layer removal, these parameters may not be appropriate for clinical use as an adjunct to conventional periodontal therapy.

The erbium-doped yttrium, aluminum, and garnet (Er:YAG) laser is thought to be the most promising laser for periodontal treatment; however, its application is still under consideration. The aim of this study was to compare Er:YAG laser monotherapy with conventional scaling and root planing (SRP) for chronic periodontitis using clinical parameters, the detection rate of periodontal pathogens, and the calprotectin level in gingival crevicular fluid. Twenty-seven participants with moderate-to-advanced chronic periodontitis were included. In a split-mouth design, the 2 half-mouths of each participant were randomly assigned to Er:YAG laser or SRP (combination of ultrasonic and manual instruments) treatment. Clinical parameters were recorded at baseline, 6 weeks, and 3 and 6 months after treatment. At the same time points, gingival crevicular fluid was collected to analyze the detection rate of 6 periodontal pathogens by polymerase chain reaction and the levels of calprotectin by enzyme-linked immunosorbent assay. Both treatment groups showed significant reductions in probing depth (PD), bleeding index (BI), and clinical attachment level (CAL) from baseline to 6 months. For sites with 4 mm ≤ PD ≤ 6 mm at baseline, SRP resulted in a greater reduction in PD and CAL than Er:YAG laser treatment, and the difference remained at 6 months post-treatment (P = .01 and P < .01, respectively). For sites with PD ≥7 mm at baseline, the clinical parameters showed similar results between the 2 groups. SRP resulted in a lower detection rate of Porphyromonas gingivalis at 6 months post-treatment. The levels of calprotectin were significantly decreased from baseline to 6 months in both groups, without a significant difference between the groups. For mild pockets, conventional SRP may still be the preferred choice. For deep pockets, Er:YAG laser treatment could be an effective alternative. Studies are needed to explore more advanced instruments and new application methods for the Er:YAG laser for periodontal treatment in deep pockets.

Background: The smear layer is attached to dentine and occludes the orifice and, consequently, must be removed in order to improve the success of inroot canal treatment. The ideal irrigation material removes both the organic and inorganic smear layers. Ethylene diamine tetra-acetic acid (EDTA) is one of the most commonly used root canal irrigation materials, but removes only inorganic smear layer. To overcome this problem, Pineapple (Ananas comosus L. Merr.) peel extract, which contains saponins, bromelain, polyphenol and flavonoid, is used during root canal irrigation. Purpose: The study aimed to analyze the difference in smear layer removal between the use of 6.25% pineapple peel extract and 17% EDTA. Methods: 27 samples of mandibular premolar teeth with straight root canals were divided randomly into three groups (n = 9) and subsequently prepared using protaper. Irrigation was performed on the control group (aquadest), group I (17% EDTA) and group II (6.25% pineapple peel extract). The samples were dried, temporarily compressed and cut horizontally from the apical to the coronal. Samples were fixed with holder before the smear layer was observed through a scanning electron microscope (SEM). The resulting data was analyzed by means of an ANOVA test. Results: The highest score of root canal hygiene was recorded by group II, followed by group I and, finally, the control group. There were significant differences between the groups (p&lt; 0.000). Conclusion: 6.25% pineapple peel extract produces a higher smear layer removal effect than 17%EDTA on the apical 1/3 of the root canal.

Cleaning of oval canals using ultrasonic or sonic instrumentation

The effect of endosonic instrumentation in simulated curved root canals

Objectives: To evaluate SmearOFF, 7% maleic acid (MA) and two different preparations of ethylenediaminetetraacetic acid (EDTA) in smear layer removal.Materials and methods: Fifty single-rooted teeth were separated into five groups, instrumented and irrigated as follows: (1) SmearOFF, (2) 7% MA, (3) 18% EDTA (pH 11.4), (4) 17% EDTA (pH 8.5) and (5) 0.9% saline. Teeth samples were blinded and examined by scanning electron microscopy with Image J software.Results: Eighteen percent EDTA was less efficient when compared to SmearOFF and MA at all thirds of the root canal system. There was no difference between SmearOFF and MA in the coronal and middle thirds. In the apical third, MA removed more smear layer. Seventeen percent EDTA was as efficient as SmearOFF and MA in coronal and middle third but not in the apical third. Eighteen percent EDTA removed smear layer less efficiently in the coronal and middle thirds than 17% EDTA; in the apical third, there was no difference observed. In the saline group, all specimens were heavily smeared. There was no significant difference between 18% EDTA and saline at all canal thirds.Conclusions: SmearOFF and 17% EDTA (pH 8.5) had better smear layer removal capability in the coronal and middle thirds of the root canal system. In the apical third, 7% MA was superior. 18% EDTA (pH 11.4) and saline had poor smear layer removal ability.

Background:Smear layer removal and collagen fiber exposure may improve regeneration which can be accomplished by use of root biomodifiers. These enhance the degree of connective tissue attachment to denuded roots. The objective of this in vitro study was to evaluate and compare novel root canal irrigant and other root biomodifiers for smear layer removal on periodontally involved human teeth.Materials and Methods:Forty human teeth were collected and stored in saline. After scaling and root planing, two samples were obtained from each tooth. Thus, a total of 80 dentin blocks were randomly divided into four groups: Mixture of tetracycline, acid and detergent (MTAD), tetracycline hydrochloride (TTC HCl), citric acid (CA), and ethylenediaminetetraacetic acid (EDTA). The agents were applied for 3 min by active burnishing. Immediately following treatment, the specimens were rinsed, dehydrated, fixed and prepared for scanning electron microscope and were examined at × 3500 magnification. Sampaio's index was evaluated by the previously trained blind examiner using photomicrographs. Groups were compared using analysis of variance followed by Tukey's post-hoc test.Results:Mixture of tetracycline, acid, and detergent is most efficacious in removing the smear layer and showed statistically significant dentinal tubules opening, followed by EDTA, TTC HCl, and CA.Conclusion:Mixture of tetracycline, acid and detergent and conventional root biomodifiers used in the study alters the dentin surface by smear layer removal and exposure of dentinal tubules. Hence, MTAD as a root biomodifier may have a significant role in periodontal regeneration.