Abstract

Aim of the work: The aim of this study was to evaluate the effectiveness of the XP-endo Finisher file on smear layer removal in straight root canals after biomechanical instrumentation in comparison to two different chelating solutions (EDTA and Chitosan) by scanning electron microscope and to quantify the concentration of calcium ions on surface of root dentin by using atomic absorption spectrophotometry with flame (AASF).

Materials and Methods: Twenty freshly extracted, permanent, mandibular and maxillary premolars were included in the study. The sound teeth were decoronated at the cemento-enamel junction using a fine tapered diamond stone with round end mounted on high speed hand-piece under water coolant. The root canal of each specimen was mechanically prepared using a BT-Race rotary system (FKG Dentaire) and then divided randomly into two groups, as follows: EDTA group (n = 10) XP-endo Finisher file; 5-mL 17% EDTA. Chitosan group (n = 10) XP-endo Finisher file; 5-mL 0.2% Chitosan. The roots were longitudinally split and specimens were fixed on metallic subs and examined using an environmental SEM for the presence of smear layer and the containers were forwarded for spectrometric determination of calcium ion concentration within the liquid.

Results: Representative SEM images for EDTA group showed efficient smear layer removal with the dentinal tubules open in apical, middle and coronal thirds. On the other hand, chitosan group showed efficient smear layer removal, with coronal and middle thirds having more open dentinal tubules than the apical third. The mean Ca level was 45.58 ± 12.56 in EDTA group which recorded the highest Ca concentration among samples and chelated more calcium ion than others with 69.9 mg/L while the mean Ca level was 23.36 ± 6.38 in Chitosan group which recorded the lowest Ca concentration among samples with 12.9 mg/L. This difference was statistically significant p < 0.001, being higher in EDTA group.

Conclusion: Irrigation with 0.2% chitosan solution is as effective in root canal cleaning as 17% EDTA, in terms of smear layer removal. Regardless of the irrigation protocol, the apical third retains more smear layer than the coronal and middle thirds. Irrigation with 0.2% chitosan solution chelated less calcium than 17% EDTA.

Keywords: Difficulties; Reintegration; Professional; Psychiatric Patients - Lomé (TOGO)

References

1. Peeters Harry Huiz and Ketut Suardita. “Efficacy of Smear Layer Removal at the Root Tip by Using Ethylenediaminetetraacetic Acid and Erbium, Chromium: Yttrium, Scandium, Gallium Garnet Laser”.Journal of Endodontics11 (2011): 1585-1589.
2. McComb Dorothy and Dennis C. Smith. “A Preliminary Scanning Electron Microscopic Study of Root Canals after Endodontic Procedures”.Journal of Endodontics7 (1975): 238-242.
3. Mader Carson L., et al. “Scanning Electron Microscopic Investigation of the Smeared Layer on Root Canal Walls”.Journal of Endodontics10 (1984): 477-483.
4. Bogra P., et al. “Study of Dimercapto Succinic Acid , Sodium Hypochlorite and Their Combination Used as Irrigant in Root Canals - An in vitro Study”.Endodontology2 (2003): 19-25.
5. Baumgartner J Craig., et al. “A Scanning Electron Microscopic Evaluation of Root Canal Debridement Using Saline, Sodium Hypochlorite, and Citric Acid Una Evaluacion de La Biomecanica Del Conducto Usando Solucion Salina, Hipoclorito de Sodio, y Acido Citrico, Con Microscopio de Ba”.Journal of Endodontics11 (1984): 525-31.
6. Zehnder Matthias. “Root Canal Irrigants”.Journal of Endodontics5 (2006): 389-398.
7. Munoz Hugo Roberto and Karla Camacho-Cuadra. “In Vivo Efficacy of Three Different Endodontic Irrigation Systems for Irrigant Delivery to Working Length of Mesial Canals of Mandibular Molars”.Journal of Endodontics4 (2012): 445-448.
8. Shahravan Arash., et al. “Effect of Smear Layer on Sealing Ability of Canal Obturation: A Systematic Review and Meta-Analysis”.Journal of Endodontics2 (2007): 96-105.
9. Clark-Holke Deborah., et al. “Bacterial Penetration through Canals of Endodontically Treated Teeth in the Presence or Absence of the Smear Layer”.Journal of Dentistry4 (2003): 275-281.
10. Gengoglu Nimet., et al. “Dentinal Wall Adaptation of Thermoplasticized Gutta- Percha in the Absence or Presence of Smear Layer : A Scanning Electron Microscopic Study”.Journal of Endodontics11 (1993): 558-562.
11. Violich DR and NP Chandler. “The Smear Layer in Endodontics - A Review”.International Endodontic Journal1 (2010): 2-15.
12. Scelza MF., et al. “Efficacy of Final Irrigation--a Scanning Electron Microscopic Evaluation”.Journal of Endodontics6 (2000): 355-358.
13. Ballal Nidambur Vasudev., et al. “Evaluation of Decalcifying Effect of Maleic Acid and EDTA on Root Canal Dentin Using Energy Dispersive Spectrometer”.Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology2 (2011): e78-84.
14. Silva EJ NL., et al. “Effectiveness of XP-Endo Finisher and XP-Endo Finisher R in Removing Root Filling Remnants: A Micro-CT Study”.International Endodontic Journal1 (2018): 86-91.
15. Marques Andre Augusto Franco., et al. “Smear Layer Removal and Chelated Calcium Ion Quantification of Three Irrigating Solutions”.Brazilian Dental Journal4 (2006): 306-309.
16. Spanó JCE., et al. “Atomic Absorption Spectrometry and Scanning Electron Microscopy Evaluation of Concentration of Calcium Ions and Smear Layer Removal With Root Canal Chelators”.Journal of Endodontics5 (2009): 727-730.
17. Von der Fehr FR and NygaardØstby B. “Effect of EDTAC and sulfuric acid on root canal dentine”.Oral Surgery2 (1963): 199-205.
18. Gomes-Filho João Eduardo., et al. “Comparison of the Biocompatibility of Different Root Canal Irrigants”.Journal of Applied Oral Science2 (2008): 137-144.
19. Kumar Yogender., et al. “Comparative Evaluation of Demineralization of Radicular Dentin with 17% Ethylenediaminetetraacetic Acid, 10% Citric Acid, and MTAD at Different Time Intervals: An in vitro Study”.Journal of International Society of Preventive and Community Dentistry1 (2016): 44.
20. Akncbay H., et al. “Application of Chitosan Gel in the Treatment of Chronic Periodontitis”.Journal of Biomedical Materials Research Part B: Applied Biomaterials 2 (2007): 290-296.
21. Peter MG. “Pure and Applied Chemistry Applications and Environmental Aspects of Chitin and Chitosan applications and environmental aspects”.Journal of Macromolecular Science, Part A: Pure and Applied Chemistry4 (1995): 629-640.
22. Takeda Frank Hirono., et al. “Efficacy of Er:YAG Laser Irradiation in Removing Debris and Smear Layer on Root Canal Walls”.Journal of Endodontics8 (1998): 548-551.
23. Torabinejad Mahmoud., et al. “Endodontics: Principles and Practice”. Elsevier Health Sciences (2014).
24. Lester KS and A Boyde. “Scanning Electron Microscopy of Instrumented, Irrigated and Filled Root Canals”.British Dentistry Journal143 (1977): 359-367.
25. , et al. “Clinical Implications of the Smear Layer in Endodontics: A Review”.Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology94.6 (2002): 658-666.
26. Poggio Claudio., et al. “Effects of NiTi Rotary and Reciprocating Instruments on Debris and Smear Layer Scores: An SEM Evaluation”.Journal of Applied Biomaterials and Functional Materials3 (2014): 256-62.
27. PaquéFrank., et al. “Preparation of Oval-Shaped Root Canals in Mandibular Molars Using Nickel-Titanium Rotary Instruments: A Micro-Computed Tomography Study”.Journal of Endodontics4 (2010): 703-707.
28. Siqueira Jr., et al. “Ability of Chemomechanical Preparation with Either Rotary Instruments or Self-Adjusting File to Disinfect Oval-Shaped Root Canals”.Journal of Endodontics11 (2010): 1860-1865.
29. Peters Ove A., et al. “Root Canal Preparation with a Novel Nickel-Titanium Instrument Evaluated with Micro-Computed Tomography: Canal Surface Preparation over Time”.Journal of Endodontics6 (2010): 1068-1072.
30. van der Waal, Suzette., et al. “Free Available Chlorine Concentration in Sodium Hypochlorite Solutions Obtained from Dental Practices and Intended for Endodontic Irrigation: Are the Expectations True?” Quintessence International6 (2014): 467-474.
31. Radcliffe CE., et al. “Antimicrobial Activity of Varying Concentrations of Sodium Hypochlorite on the Endodontic Microorganisms Actinomyces israelii, A. naeslundii, Candida albicans and Enterococcus faecalis”.International Endodontic Journal7 (2004): 438-446.
32. Siqueira Jr., et al. “Chemomechanical Reduction of the Bacterial Population in the Root Canal after Instrumentation and Irrigation with 1%, 2.5%, and 5.25% Sodium Hypochlorite”.Journal of Endodontics6 (2000): 331-334.
33. Kaya Sadullah., et al. “Evaluation of Radicular Dentin Erosion and Smear Layer Removal Capacity of Self-Adjusting File Using Different Concentrations of Sodium Hypochlorite as an Initial Irrigant”.Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology4 (2011): 524-530.
34. Retamozo Bonnie., et al. “Minimum Contact Time and Concentration of Sodium Hypochlorite Required to Eliminate Enterococcus faecalis”.Journal of Endodontics3 (2010): 520-523.
35. Berber VB., et al. “Efficacy of Various Concentrations of NaOCl and Instrumentation Techniques in Reducing Enterococcus faecalis within Root Canals and Dentinal Tubules”.International Endodontic Journal1 (2006): 10-17.
36. Silva Polliana Vilaça., et al. “Time-Dependent Effects of Chitosan on Dentin Structures”.Brazilian Dental Journal4 (2012): 357-361.
37. Poudyal Sitashi., et al. “Efficacy of Solution Form of Ethylenediaminetetraacetic Acid on Removing Smear Layer of Root Canal at Different Exposure Time In vitro”.Journal of Huazhong University of Science and Technology3 (2014): 420-424.
38. Živković Slavoljub., et al. “XP-Endo Finisher: A New Solution for Smear Layer Removal”.Serbian Dental Journal3 (2015): 122-129.
39. Bao Pingping., et al. “In vitro Efficacy of XP-Endo Finisher with 2 Different Protocols on Biofilm Removal from Apical Root Canals”.Journal of Endodontics2 (2017): 321-325.
40. Sanabria-liviac Daniel., et al. “Comparison of the XP-Endo Finisher File System and Passive Ultrasonic Irrigation (PUI) on Smear Layer Removal after Root Canal Instrumentation Effectiveness of Two Irrigation Methods on Smear Layer Removal”.Journal of Dentistry and Oral Health4 (2017).
41. Elnaghy Amr M., et al. “Effectiveness of XP-Endo Finisher, EndoActivator, and File Agitation on Debris and Smear Layer Removal in Curved Root Canals: A Comparative Study”.Odontology2 (2017): 178-183.
42. Prabhakaran Pranitha and Annapoorna Ballagere Mariswamy. “A Scanning Electron Microscope Evaluation of Efficacy of Sodium Hypochlorite and Allium Sativum in Smear Layer Removal in Root Canals with the Use of Modified Evacuation System: An Ex Vivo Study”.Journal of Conservative Dentistry: JCD4 (2018): 401.
43. Khademi Abbasali., et al. “Determination of the Minimum Instrumentation Size for Penetration of Irrigants to the Apical Third of Root Canal Systems”.Journal of Endodontics5 (2006): 417-420.
44. Mancini Manuele., et al. “A Comparative Study of Smear Layer Removal and Erosion in Apical Intraradicular Dentine with Three Irrigating Solutions: A Scanning Electron Microscopy Evaluation”.Journal of Endodontics6 (2009): 900-903.
45. Neha et al. “Effect of Different Irrigation Regimens on Smear Layer Removal in Human Root Dentin an In-Vitro Study”.Asian Pacific Journal of Health Sciences2 (2017): 31-37.
46. Kamble AradhanaBabu., et al. “Scanning Electron Microscopic Evaluation of Efficacy of 17% Ethylenediaminetetraacetic Acid and Chitosan for Smear Layer Removal with Ultrasonics: An In vitro Study”.Contemporary Clinical Dentistry4 (2017): 621.
47. Luis Fábio., et al. “Chelating Agents and Agitation Protocols Assessment of the Amount of Calcium Ions Released after the Use of Different Chelating Agents and Agitation Protocols”.Open Dental Journal7 (2017): 133-139.
48. Silva PV., et al. “Chitosan: A New Solution for Removal of Smear Layer after Root Canal Instrumentation”.International Endodontic Journal4 (2013): 332-338.

Citation

Citation: Marwan (Mohammad Shafik) Ashour Seyaj., et al. “Role of Xp-Endo Finisher Agitation File with the Use of EDTA and Chitosan, on Smear Layer Removal by SEM and the Use of Flame Atomic Absorption Spectrometry to Quantify the Concentration of Calcium Ions: An In Vitro Study". Acta Scientific Dental Sciences 4.8 (2020): 11-19.

Copyright

Copyright: © 2020 Marwan (Mohammad Shafik) Ashour Seyaj., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.