Abstract
Objectives
To compare the cleanliness and erosion of root canal walls after the use of a new HEDP (1-hydroxyethane-1,1-diphosphonic acid) -based irrigant with that achieved by irrigation with sodium hypochlorite followed by EDTA.
Materials and methods
Forty recently extracted single-rooted teeth were prepared with ProTaper Next files to size X3, using either HEDP-containing 3% sodium hypochlorite, throughout the procedure (n = 20), or 3% sodium hypochlorite followed by a final rinse with 17% EDTA (n = 20), which were both applied with a syringe and needle. Ten additional teeth were prepared and irrigated with saline and served as negative controls. The teeth were split longitudinally and subjected to SEM evaluation for the presence of a smear layer, debris, and erosion of the root canal wall. The Pearson chi-square test was used to compare the results, and the level of significance was set at p < 0.05.
Results
In both groups, there were more cases with a smear layer in the apical third of the root canal than in the coronal third, but the groups did not differ from each other significantly (p = 0.545). The root canal walls in both groups were almost free of debris, showing no difference between the groups (p = 0.342). Moderate erosion of the root dentine was found in 10–26% of the cases in both groups, but severe erosion was detected in only one case in each of the groups, which did not differ significantly from each other (p = 0.606).
Conclusion
Within the limitations of the present study, the HEDP-based irrigation solution did not differ from 3% sodium hypochlorite followed by EDTA in terms of cleanliness or the incidence of erosion of the canal wall.
Clinical relevance
When used with syringe and needle irrigation, the new HEDP-based irrigant is convenient and safe but should not be expected to result in cleaner canal walls than 3% sodium hypochlorite followed by 17% EDTA.
Similar content being viewed by others
References
Eick JD, Wilko RA, Anderson CH, Sorensen SE (1970) Scanning electron microscopy of cut tooth surfaces and identification of debris by use of the electron microprobe. J Dent Res 49:1359–1368
McComb D, Smith DC (1975) A preliminary scanning electron microscopic study of root canals after endodontic procedures. J Endod 1:238–242
Hülsmann M, Rümmelin C, Schäfers F (1997) Root canal cleanliness after preparation with different endodontic handpieces and hand instruments: a comparative SEM investigation. J Endod 23:301–306
Gambarini G, Laszkiewicz J (2002) A scanning electron microscopic study of debris and smear layer remaining following use of GT rotary instruments. Int Endod J 35:422–427
Jeon IS, Spångberg LS, Yoon TC, Kazemi RB, Kum KY (2003) Smear layer production by 3 rotary reamers with different cutting blade designs in straight root canals: a scanning electron microscopic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 96:601–607
Foschi F, Nucci C, Montebugnoli L, Marchionni S, Breschi L, Malagnino VA, Prati C (2004) SEM evaluation of canal wall dentine following use of Mtwo and ProTaper NiTi rotary instruments. Int Endod J 37:832–839
Yang G, Wu H, Zheng Y, Zhang H, Li H, Zhou X (2008) Scanning electron microscopic evaluation of debris and smear layer remaining following use of ProTaper and Hero Shaper instruments in combination with NaOCl and EDTA irrigation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 106:e63–e71
Goldberg F, Abramovich A (1977) Analysis of the effect of EDTAC on the dentinal walls of the root canal. J Endod 3:101–105
Hülsmann M, Heckendorff M, Lennon A (2003) Chelating agents in root canal treatment: mode of action and indications for their use. Int Endod J 36:810–830
Lottanti S, Gautschi H, Sener B, Zehnder M (2009) Effects of ethylenediaminetetraacetic, etidronic and peracetic acid irrigation on human root dentine and the smear layer. Int Endod J 42:335–343
Grawehr M, Sener B, Waltimo T, Zehnder M (2003) Interactions of ethylenediamine tetraacetic acid with sodium hypochlorite in aqueous solutions. Int Endod J 36:411–417
Zehnder M, Schmidlin P, Sener B, Waltimo T (2005) Chelation in root canal therapy reconsidered. J Endod 31:817–820
Zollinger A, Mohn D, Zeltner M, Zehnder M (2017) Short-term storage stability of NaOCl solutions when combined with Dual Rinse HEDP. Int Endod J 51:691–696
Biel P, Mohn D, Attin T, Zehnder M (2017) Interactions between the tetrasodium salts of EDTA and 1-hydroxyethane 1,1-diphosphonic acid with sodium hypochlorite irrigants. J Endod 43:657–661
Neelakantan P, Varughese AA, Sharma S, Subbarao CV, Zehnder M, De-Deus G (2012) Continuous chelation irrigation improves the adhesion of epoxy resin-based root canal sealer to root dentine. Int Endod J 45:1097–1102
Paqué F, Rechenberg DK, Zehnder M (2012) Reduction of hard-tissue debris accumulation during rotary root canal instrumentation by etidronic acid in a sodium hypochlorite irrigant. J Endod 38:692–695
Morago A, Ordinola-Zapata R, Ferrer-Luque CM, Baca P, Ruiz-Linares M, Arias-Moliz MT (2016) Influence of smear layer on the antimicrobial activity of a sodium hypochlorite/etidronic acid irrigating solution in infected dentin. J Endod 42:1647–1165
Solovyeva AM, Dummer PM (2000) Cleaning effectiveness of root canal irrigation with electrochemically activated anolyte and catholyte solutions: a pilot study. Int Endod J 33:494–504
Caron G, Nham K, Bronnec F, Machtou P (2010) Effectiveness of different final irrigant activation protocols on smear layer removal in curved canals. J Endod 36:1361–1366
Metzger Z, Teperovich E, Cohen R, Zary R, Paqué F, Hülsmann M (2010) The self-adjusting file (SAF). Part 3: removal of debris and smear layer-a scanning electron microscope study. J Endod 36:697–702
Kaya S, Yiğit-Özer S, Adigüzel Ö (2011) Evaluation of radicular dentine erosion and smear layer removal capacity of Self-Adjusting File using different concentrations of sodium hypochlorite as an initial irrigant. Oral Surg Oral Med Oral Pathol Oral Radio Endod 112:524–530
Arias-Moliz MT, Ordinola-Zapata R, Baca P, Ruiz-Linares M, Ferrer-Luque CM (2014) Antimicrobial activity of a sodium hypochlorite/etidronic acid irrigant solution. J Endod 40:1999–2002
Saleh AA, Ettman WM (1999) Effect of endodontic irrigation solutions on microhardness of root canal dentine. J Dent 27:43–46
Marending M, Paque F, Fischer J, Zehnder M (2007) Impact of irrigant sequence on mechanical properties of human root dentine. J Endod 33:1325–1328
Mai S, Kim YK, Arola DD, Gu L, Kim JR, Pashley DH, Tay FR (2010) Differential aggressiveness of ethylendiamine tetraacetic acid in causing canal wall erosion in the presence of sodium hypochlorite. J Dent 38:201–206
Tartari T, Bachmann L, Zancan RF, Vivan RR, Duarte MAH, Bramante CM (2018) Analysis of the effects of several decalcifying agents alone and in combination with sodium hypochlorite on the chemical composition of dentine. Int Endod J 51:e42–e54
Peters OA, Barbakow F (2000) Effects of irrigation on debris and smear layer on canal walls prepared by two rotary techniques: a scanning electron microscopic study. J Endod 26:6–10
Versümer J, Hülsmann M, Schäfers F (2002) A comparative study of root canal preparation using ProFile .04 and Lightspeed rotary Ni-Ti instruments. Int Endod J 35:37–46
Paqué F, Musch U, Hülsmann M (2005) Comparison of root canal preparation using RaCe and ProTaper rotary Ni-Ti instruments. Int Endod J 38:8–16
Metzger Z, Solomonov M, Kfir A (2013) The role of mechanical instrumentation in the cleaning of root canals. Endod Top 29:87–109
Elnaghy AM, Mandorah A, Elsaka SE (2017) Effectiveness of XP-endo Finisher, EndoActivator, and File agitation on debris and smear layer removal in curved root canals: a comparative study. Odontol 105:178–183
Funding
The work was supported by a grant from the Bender Foundation of the Israeli Endodontic Society.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
The study was approved by the Institutional Ethics Committee of Tel Aviv University (09231424_20180226).
Informed consent
Since the study was performed using teeth that were selected from a random collection of extracted teeth, which were previously extracted for a variety of reasons not related to the present study, no informed consent was required nor was it possible to achieve. Approved by the Institutional Ethics Committee.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kfir, A., Goldenberg, C., Metzger, Z. et al. Cleanliness and erosion of root canal walls after irrigation with a new HEDP-based solution vs. traditional sodium hypochlorite followed by EDTA. A scanning electron microscope study. Clin Oral Invest 24, 3699–3706 (2020). https://doi.org/10.1007/s00784-020-03249-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00784-020-03249-w