Effectiveness of XP-Endo Finisher and Passive Ultrasonic Irrigation in the Removal of the Smear Layer Using two Different Chelating Agents

  1. Ismael Espinoza 1
  2. Rafael Cisneros 1
  3. Roberto Estevez 1
  4. Antonio Jesus Conde Villar 1
  5. Gaizka Loroño 1
  6. Gianluca Plotino 2
  1. 1 Universidad Europea de Madrid
    info

    Universidad Europea de Madrid

    Madrid, España

    ROR https://ror.org/04dp46240

  2. 2 Private Practice, Grande Plotino & Torsello-Studio di Odontoiatria
Revista:
Journal of Dentistry, Shiraz University of Medical Sciences

Año de publicación: 2021

Volumen: 22

Páginas: 243- 251

Tipo: Artículo

Resumen

Statement of the Problem:The smear layer may harbor microorganisms and necrotic pulp tissue, jeopardizing irrigant penetration. Recently, Dual Rinse®, a weak chelating agent, has been introduced to the market. However, its chelating capacity in the final irrigation protocol with different activation systems has not yet been deeply analyzed.Purpose:The aim of this ex vivo study was to evaluate the effectiveness of passive ultrasonic irrigation (PUI) and XP-endo Finisher (XP) on smear layer removal in combination with two chelating agents, ethylenediaminetetraacetic acid (EDTA) and etidronic acid (HEDP).Materials and Method:This in vitro, experimental study evaluated fifty-two single-rooted human teeth were standardized to 16 mm in length. Root canal instrumentation was performed by the ProTaper Gold system up to the F4 file. The apical end of the samples was sealed with wax to simulate a closed system. Teeth from group 1 (n=24) were irrigated with 3% sodium hypochlorite (NaOCl) and 17% EDTA, while teeth from group 2 (n=24) were irrigated with 3% NaOCl mixed 9% HEDP. Both groups were divided into two subgroups (n=12) depending on the activation system used: XP (group XP-EDTA and XP-HEDP) or PUI (group PUI-EDTA and PUI-HEDP). The specimens were evaluated by scanning electron microscopy at 3, 5 and 8mm from the apex. Statistical analysis was performed using ANOVA and Bonferroni tests considering p> 0.05 as significant.Results:PUI-EDTA was the most effective at removing the smear layer, with a statistically significant difference from XP-EDTA (p< 0.042) and group XP-HEDP (p< 0.003). There were no statistically significant differences among the other groups.Conclusion:Under the conditions of this ex vivo study, no activation system was able to completely remove the smear layer from the root canal walls. However, the combination of NaOCl with ultrasonically activated EDTA obtained better results than the other treatments.

Referencias bibliográficas

  • 1. McComb D, Smith DC. A preliminary scanning electron microscopic study of root canals after endodontic procedures. J Endod. 1975; 1: 238–242. [PubMed] [Google Scholar]
  • 2. Outhwaite WC, Livingston MJ, Pashley DH. Effects of changes in surface area, thickness, temperature and post- extraction time on human dentine permeability. Archives of Oral Biology. 1976; 21: 599–603. [PubMed] [Google Scholar]
  • 3. Kokkas AB, Boutsioukis A, Vassiliadis LP, Stavrianos CK. The influence of the smear layer on dentinal tubule penetration depth by three different root canal sealers: an in vitro study. J Endod. 2004; 30: 100–102. [PubMed] [Google Scholar]
  • 4. Siqueira JF Jr, de Uzeda M, Fonseca MEF. A scanning electron microscopic evaluation of in vitro dentinal tubules penetration by selected anaerobic bacteria. J Endod. 1996; 22: 308–310. [PubMed] [Google Scholar]
  • 5. Zehnder M. Root canal irrigants. J Endod. 2006; 32: 389–399. [PubMed] [Google Scholar]
  • 6. Calt S, Serper A. Smear layer removal by EGTA. J Endod. 2000; 26: 459–461. [PubMed] [Google Scholar]
  • 7. Zehnder M, Schicht O, Sener B, Schmidlin P. Reducing surface tension in endodontic chelator solutions has no effect on their ability to remove calcium from instrumented root canals. J Endod. 2005; 31: 590–592. [PubMed] [Google Scholar]
  • 8. Morago A, Ordionola-Zapata R, Ferrer-Luque CM, Baca P, Ruiz-Linares M, Arias-Moliz MT. Influence of smear layer on the antimicrobial activity of a sodium hypochlorite/ etidronic acid irrigating solution in infected dentin. J Endod. 2016; 11: 1647–1650. [PubMed] [Google Scholar]
  • 9. Zehnder M, Schmidlin P, Sener B, Waltimo T. Chelation in root canal therapy reconsidered. J Endod. 2005; 31: 817–822. [PubMed] [Google Scholar]
  • 10. Baumgartner JC, Ibay AC. The chemical reactions of irrigants used for root canal debridement. J Endod. 1987; 13: 47–51. [PubMed] [Google Scholar]
  • 11. De-Deus G, Zehnder M, Reis C, Fidel S, Sergio Fidel RA, Galán J, et al. Longitudinal co-site optical microscopy study on the chelating ability of etidronate and EDTA using a comparative single-tooth model. J Endod. 2008; 34: 71–75. [PubMed] [Google Scholar]
  • 12. Arias-Moliz T, Ordinola-Zapata R, Baca P, Ruiz-Linares M, Ferrer-Luque CM. Antimicrobial activity of a sodium hypochlorite/etidronic acid irrigant solution. J Endod. 2014; 40: 1999–2002. [PubMed] [Google Scholar]
  • 13. Tartari T, Guimaraes BM, Amoras LS, Duarte MA, Silva e Souza PA, Bramante CM. Etidronate causes minimal changes in the ability of sodium hypochlorite to dissolve organic matter. Int Endod J. 2015; 48: 399–404. [PubMed] [Google Scholar]
  • 14. Van der Sluis LW, Gambarini G, Wu MK, Wesselink PR. The influence of volume, type of irrigant and flushing method on removing artificially placed dentine debris from the apical root canal during passive ultrasonic irrigation. Int Endod J. 2006; 39: 472–476. [PubMed] [Google Scholar]
  • 15. Ram Z. Effectiveness of root canal irrigation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1977; 44: 6–12. [Google Scholar]
  • 16. Wu M, Wesselink P. A primary observation on the preparation and obturation of oval canals. Int Endod J. 2001; 34: 137–141. [PubMed] [Google Scholar]
  • 17. Nair P, Henry S, Cano V, Vera J. Microbial status of apical root canal system of human mandibular first molars with primary apical periodontitis after “one-visit” endodontic treatment. Oral Surg Oral Med Oral Pathol Oral Radiol and Endod. 2005; 23: 1–2. [PubMed] [Google Scholar]
  • 18. Loroño G, Zaldivar JR, Arias A, Cisneros R, Dorado S, Jimenez-Octavio JR. Positive and negative pressure irrigation in oval root canals with apical ramifications: a computational fluid dynamics evaluation in micro-CT scanned real teeth. Int Endod J. 2020; 53: 671–679. [PubMed] [Google Scholar]
  • 19. Conde AJ, Estevez R, Loroño G, Valencia de Pablo O, Rossi-Fedele G, Cisneros R. Effect of sonic and ultrasonic activation on organic tissue dissolution from simulated grooves in root canals using sodium hypochlorite and EDTA. Int Endod J. 2016; 50: 976–972. [PubMed] [Google Scholar]
  • 20. Plotino G, Cortese T, Grande NM, Leonardi DP, Di Gio-rgio G, Testarelli L, et al. New technologies to improve root canal disinfection. Braz Denta J. 2016; 27: 3–8. [PubMed] [Google Scholar]
  • 21. Guerisoli DMZ, Marchesan MA, Walmsley AD, Lumley PJ, Pecora JD. Evaluation of smear layer removal by EDTAC and sodium hypochloride with ultrasonic agitation. Int Endod J. 2002; 35: 418–421. [PubMed] [Google Scholar]
  • 22. Lui JN, Kuah HG, Chen NN. Effect of EDTA with and without surfactants or ultrasonics on removal of smear layer. J Endod. 2007; 33: 472–475. [PubMed] [Google Scholar]
  • 23. Kuah HG1, Lui JN, Tseng PS, Chen NN. The Effect of EDTA with and without Ultrasonics on Removal of the Smear Layer. J Endod. 2009; 35: 393–396. [PubMed] [Google Scholar]
  • 24. Alves FR, Marceliano-Alves MF, Sousa JC, Silveira SB, Provenzano JC, Siqueira JF. Removal of root fillings in curved canals using either reciprocanting single-or rotary multi-instrument systems and a supplementary step with the XP-endo finisher. J Endod. 2016; 42: 1114–1119. [PubMed] [Google Scholar]
  • 25. Kfir A, Blau-Venezia N, Goldberg T, Abramovitz I, Wigler R. Efficacy of self-adjusting file, XP-endo finisher and passive ultrasonic irrigation on the removal of calcium hydroxide paste from an artificial standardized groove. Aust Endod J. 2018; 44: 26–31. [PubMed] [Google Scholar]
  • 26. Bao P, Shen Y, Lin J, Haapasalo M. In vitro efficacy of XP-endo finisher with 2 different protocols on biofilm removal from apical root canals. J Endod. 2017; 43: 321–325. [PubMed] [Google Scholar]
  • 27. De-Deus G, Belladonna FG, Zuolo AS, Cavalcante DM, Carvalhal JCA, Carvalho M, et al. XP-endo Finisher R instrument optimizes the removal of root filling remman-ts in oval-shaped canals. Int Endod J. 2019; 52: 899–907. [PubMed] [Google Scholar]
  • 28. Ulusoy OI, Savur IG, Alacam T, Celik B. The effectiveness of various irrigation protocols on organic tissue removal from simulated internal resorption defects. Int Endod J. 2018; 51: 1030–1036. [PubMed] [Google Scholar]
  • 29. Pacheco-Yanes J, Provenzano JC, Marceliano-Alves MF, Gazzaneo I, Perez AR, Goncalves LS, et al. Distribution of sodium hypochlorite throughout the mesial root canal system of mandibular molars after adjunctive irrigant activation procedures: a micro-computed tomographic study. Clin Oral Investig. 2020; 24: 907–914. [PubMed] [Google Scholar]
  • 30. Aziman. In vitro effect of XP-Endo Finisher on the amount of residual debris and smear layer on the root canal walls. Dent Res J. 2019; 16: 179–184. [PMC free article] [PubMed] [Google Scholar]
  • 31. De-Deus G, Belladonna FG, Zuolo AS, Cavalcante DM, Carvalhal JCA, Carvalho M, et al. Micro-CT comparison of XP-endo Finisher and passive ultrasonic irrigation as a final irrigation protocols on the removal of accumulated hard-tissue debris from oval shaped-canals. Clin Oral Investiga. 2019; 23: 3087–3093. [PubMed] [Google Scholar]
  • 32. Elnaghy AM, Mandorah A, Elsaka SE. Effectiveness of XP-endo Finisher, EndoActivator, and File agitation on debris and smear layer removal in curved root canals: a comparative study. Odontology. 2017; 105: 178–183. [PubMed] [Google Scholar]
  • 33. Paque F, Rechenberg DK, Zehnder M. Reduction of hard-tissue debris accumulation during rotary root canal instrumentation by etidronic acid in a sodium hypochlorite irrigant. J Endod. 2012; 38: 692–695. [PubMed] [Google Scholar]
  • 34. Zand V, Mokhtari H, Reyhani MF, Nahavandizadeh N, Azimi S. Smear layer removal evaluation of different protocol of Bio Race file and XP-endo Finisher file in corporation with EDTA 17% and NaOCl. J Clin Exp Dent. 2017; 9: 1310–1314. [PMC free article] [PubMed] [Google Scholar]
  • 35. Lee SJ, Wu MK, Wesselink PR. The effectiveness of syringe irrigation and ultrasonics to remove debris from simulated irregularities within prepared root canal walls. Int Endod J. 2004; 37: 672–678. [PubMed] [Google Scholar]
  • 36. Conde AJ, Manrique de Lara Gomez-Acebo C, Gomez Sueiras MA, Estevez R, Cisneros R. Activation tips Eddy®: With regard to a case. Endodoncia. 2016; 34: 157–164. [Google Scholar]
  • 37. Plotino G, Özyurek T, Grande NM, Gündogar M. Influence of size and taper of basic root canal preparation on root canal cleanliness: a scanning electron microscopy study. Int Endod J. 2019; 52: 343–341. [PubMed] [Google Scholar]
  • 38. Boutsioukis C, Lambrianidis T, Kastrinakis E, Bekiaroglou P. Measurement of pressure and flow rates during irrigation of a root canal ex vivo with three endodontic needles. Int Endod J. 2007; 40: 504–513. [PubMed] [Google Scholar]
  • 39. Dotto L, Sarkis Onofre R, Bacchi A, Rocha Pereira GK. Effect of Root Canal Irrigants on the Mechanical Properties of Endodontically Treated Teeth: A Scoping Review. J Endod. 2020; 46: 596–604. [PubMed] [Google Scholar]
  • 40. Dutner J, Mines P, Anderson A. Irrigation trends among American Association of Endodontists members: a web based survey. J Endod. 2012; 38: 37–44. [PubMed] [Google Scholar]
  • 41. Calt S, Serper A. Time-dependent effects of EDTA on dentin structures. J Endod. 2002; 28: 17–19. [PubMed] [Google Scholar]
  • 42. Yoshioka WN, Kobayashi C, Suda H. A scanning electron microscopic study of dentinal erosion by final irrigation with EDTA and NaOCl solutions. Int Endod J. 2002; 35: 934 –939. [PubMed] [Google Scholar]
  • 43. Adcock JM, Sidow SJ, Looney SW, Liu Y, McNally K, Lindsey K, et al. Histologic Evaluation of canal and isthmus debridement efficacies of two different irrigant delivery techniques in a closed system. J Endod. 2011; 37: 544–548. [PubMed] [Google Scholar]
  • 44. Bramante CM, Betti LV. Comparative analysis of curved root canal preparation using nickel-titanium instruments with or without EDTA. J Endod. 2000; 26: 278–278. [PubMed] [Google Scholar]
  • 45. Trope M, Debelian G. XP-3D Finisher TM file-the next step in restorative endodontics. Endodontic Practice. 2015; 8: 22–24. [Google Scholar]
  • 46. Keskin C, Sariyilmaz E, Sariyilmaz Ö. Efficacy of XP endo Finisher file in removing calcium hydroxide from simulated internal resorption cavity. J Endod. 2017; 43: 126–133. [PubMed] [Google Scholar]
  • 47. Leoni GB, Versiani MA, Silva-Sousa YT, Bruniera JF, Pécora JD, Sousa-Neto MD. Ex vivo evaluation of four final irrigation protocols on the removal of hard-tissue debris from the mesial root canal system of mandibular first molars. Int Endod J. 2017; 50: 398–406. [PubMed] [Google Scholar]
  • 48. Estevez R, Conde AJ, Valencia de Pablo O, De la Torre F, Rossi-Fedele G, Cisneros R. Effect of Passive Ultrasonic Activation on Organic Tissue Dissolution from Simulated Grooves in Root Canals Using Sodium Hypochlorite with or without Surfactants and EDTA. J Endod. 2017; 43:1161–1165. [PubMed] [Google Scholar]
  • 49. Kamel WH, Kataia EM. Comparison of the efficacy of smear clear with and without a canal brush in smear layer and debris removal from instrumented root canal using WaveOne versus ProTaper: a scanning electron microscopic study. J Endod . 2014;40:446–455.