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

J Endod. 2013 Nov;39(11):1456-60. doi: 10.1016/j.joen.2013.07.028. Epub 2013 Sep 6.

Abstract

Introduction: The purpose of this study was to evaluate the effectiveness of different irrigating methods in removing the smear layer at 1, 3, 5, and 8 mm from the apex of endodontic canals.

Methods: Sixty-five extracted single-rooted human mandibular premolars were decoronated to a standardized length of 16 mm. Specimens were shaped to ProTaper F4 (Dentsply Maillefer, Ballaigues, Switzerland) and irrigated with 5.25% NaOCl at 37°C. Teeth were divided into 5 groups (2 control groups [n = 10] and 3 test groups [n = 15]) according to the final irrigant activation/delivering technique (ie, sonic irrigation, passive ultrasonic irrigation [PUI], or apical negative pressure). Root canals were then split longitudinally and observed by field emission scanning electron microscopy. The presence of debris and a smear layer at 1, 3, 5, and 8 mm from the apex was evaluated. Scores were analyzed by Kruskal-Wallis and Mann-Whitney U tests.

Results: The EndoActivator System (Dentsply Tulsa Dental Specialties, Tulsa, OK) was significantly more efficient than PUI and the control groups in removing the smear layer at 3, 5, and 8 mm from the apex. The EndoVac System (Discus Dental, Culver City, CA) removed statistically significantly more smear layer than all groups at 1, 3, 5, and 8 mm from the apex. At 5 and 8 mm from the apex, PUI and the EndoVac did not differ statistically significantly, but both performed statistically better than the control groups.

Conclusions: In our study, none of the activation/delivery systems completely removed the smear layer from the endodontic dentine walls; nevertheless, the EndoActivator and EndoVac showed the best results at 3, 5, and 8 mm (EndoActivator) and 1, 3, 5, and 8 mm (EndoVac) from the apex.

Keywords: EndoActivator System; EndoVac System; field emission scanning electron microscopy; irrigant activation; passive ultrasonic irrigation; smear layer.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Dental Pulp Cavity / ultrastructure*
  • Dentin / ultrastructure
  • Edetic Acid / administration & dosage
  • Humans
  • Materials Testing
  • Microscopy, Electron, Scanning
  • Root Canal Irrigants / administration & dosage*
  • Root Canal Preparation / instrumentation
  • Smear Layer / pathology
  • Smear Layer / therapy*
  • Sodium Hypochlorite / administration & dosage
  • Sonication / instrumentation
  • Temperature
  • Therapeutic Irrigation / instrumentation*
  • Tooth Apex / ultrastructure
  • Ultrasonics / instrumentation
  • Vacuum
  • Young Adult

Substances

  • Root Canal Irrigants
  • Edetic Acid
  • Sodium Hypochlorite