Effectiveness of Continuous and Sequential Chelation and Different Agitation Techniques on Smear Layer Removal and Microhardness of Root Canal Dentin (An In Vitro Study)
Abstract
:1. Introduction
2. Materials and Methods
2.1. Sample Selection
2.2. Sample Preparation
2.3. Root Sectioning and Preparation for SEM and Microhardness Test
2.4. Statistical Analysis
3. Results
3.1. Smear Layer
3.2. Microhardness
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Ali, A.H.; Mahdee, A.F.; Fadhil, N.H.; Shihab, D.M. Prevalence of periapical lesions in non-endodontically and endodontically treated teeth in an urban Iraqi adult subpopulation: A retrospective CBCT analysis. J. Clin. Exp. Dent. 2022, 14, e953. [Google Scholar] [CrossRef] [PubMed]
- Fadhil, N.H.; Ali, A.H.; Al Hashimi, R.A.; Sabri Al-Qathi, O.; Foschi, F. Assessment of Treatment Quality Risk Factors Influencing the Radiographic Detection of Apical Periodontitis in Root-Filled Teeth: A Retrospective CBCT Analysis. Eur. Endod. J. 2024, 9, 252–259. [Google Scholar] [CrossRef] [PubMed]
- Saleh, A.; Ettman, W. Effect of endodontic irrigation solutions on microhardness of root canal dentine. J. Dent. 1999, 27, 43–46. [Google Scholar] [CrossRef] [PubMed]
- Ballal, N.V.; Jain, I.; Tay, F.R. Evaluation of the smear layer removal and decalcification effect of QMix, maleic acid and EDTA on root canal dentine. J. Dent. 2016, 51, 62–68. [Google Scholar] [CrossRef]
- Dineshkumar, M.K.; Dineshkumar, M.K.; Arathi, G.; Shanthisree, P.; Kandaswamy, D. Effect of ethylene diamine tetra-acetic acid, MTADTM, and HEBP as a final rinse on the microhardness of root dentin. J. Conserv. Dent. Endod. 2012, 15, 170–173. [Google Scholar]
- Adham, A.; Ali, A. The effectiveness of continuous versus sequential chelation in the removal of smear layer and their influence on push-out bond strength of Bio-C sealer (An in vitro study). Cumhur. Dent. J. 2023, 26, 112–120. [Google Scholar] [CrossRef]
- Grawehr, M.; Sener, B.; Waltimo, T.; Zehnder, M. Interactions of ethylenediamine tetraacetic acid with sodium hypochlorite in aqueous solutions. Int. Endod. J. 2003, 36, 411–415. [Google Scholar] [CrossRef]
- El-Banna, A.; Elmesellawy, M.Y.; Elsayed, M.A. Flexural strength and microhardness of human radicular dentin sticks after conditioning with different endodontic chelating agents. J. Conserv. Dent. Endod. 2023, 26, 344–348. [Google Scholar] [CrossRef]
- Ballal, N.V.; Ray, A.B.; Narkedamalli, R.; Urala, A.S.; Patel, V.; Harris, M.; Bergeron, B.E.; Tay, F.R. Effect of continuous vs sequential chelation on the mechanical properties of root dentin: An ex vivo study. J. Dent. 2024, 148, 105214. [Google Scholar] [CrossRef]
- Zehnder, M.; Schmidlin, P.; Sener, B.; Waltimo, T. Chelation in root canal therapy reconsidered. J. Endod. 2005, 31, 817–820. [Google Scholar] [CrossRef]
- Neelakantan, P.; Varughese, A.A.; Sharma, S.; Subbarao, C.V.; Zehnder, M.; De-Deus, G. Continuous chelation irrigation improves the adhesion of epoxy resin-based root canal sealer to root dentine. Int. Endod. J. 2012, 45, 1097–1102. [Google Scholar] [CrossRef]
- Adham, A.H.; Ali, A.H.; Mannocci, F. Continuous Chelation Concept in Endodontics. J. Baghdad Coll. Dent. 2022, 34, 59–69. [Google Scholar] [CrossRef]
- Zollinger, A.; Mohn, D.; Zeltner, M.; Zehnder, M. Short-term storage stability of NaOCl solutions when combined with Dual Rinse HEDP. Int. Endod. J. 2018, 51, 691–696. [Google Scholar] [CrossRef] [PubMed]
- Tonini, R.; Salvadori, M.; Audino, E.; Sauro, S.; Garo, M.L.; Salgarello, S. Irrigating solutions and activation methods used in clinical endodontics: A systematic review. Front. Oral Health 2022, 3, 838043. [Google Scholar]
- Zeng, C.; Everett, J.; Sidow, S.; Bergeron, B.E.; Tian, F.; Ma, J.; Tay, F.R. In vitro evaluation of efficacy of two endodontic sonic-powered irrigant agitation systems in killing single-species intracanal biofilms. J. Dent. 2021, 115, 103859. [Google Scholar] [CrossRef] [PubMed]
- Niu, L.-n.; Luo, X.-J.; Li, G.-H.; Bortoluzzi, E.A.; Mao, J.; Chen, J.-H.; Gutmann, J.L.; Pashley, D.H.; Tay, F.R. Effects of different sonic activation protocols on debridement efficacy in teeth with single-rooted canals. J. Dent. 2014, 42, 1001–1009. [Google Scholar] [CrossRef]
- Ruddle, C.J. Endodontic triad for success: The role of minimally invasive technology. Dent. Today 2015, 34, 76–80. [Google Scholar]
- Ballal, N.V.; Gandhi, P.; Shenoy, P.A.; Dummer, P.M.H. Evaluation of various irrigation activation systems to eliminate bacteria from the root canal system: A randomized controlled single blinded trial. J. Dent. 2020, 99, 103412. [Google Scholar] [CrossRef]
- Fahad, F.; Al-Hashimi, R.A.; Hussain, M.J. The Advancement in irrigation solution within the field of endodontics, A Review. J. Baghdad Coll. Dent. 2024, 36, 54–69. [Google Scholar] [CrossRef]
- McGillivray, A.; Dutta, A. The influence of laser-activated irrigation on post-operative pain following root canal treatment: A systematic review. J. Dent. 2024, 144, 104928. [Google Scholar] [CrossRef]
- D’Souza, N.; Santhosh, A.; Kumari, A.; Murthy, C.S.; Gowda, V.; Mallandur, S. Effect of different irrigation activation systems using continuous chelating irrigation protocol on the removal of smear layer in the apical third of root canals: An In Vitro scanning electron microscope study. Endodontology 2024, 36, 49–53. [Google Scholar] [CrossRef]
- Al-baker, H.S.; Al-Huwaizi, H.F. Efficacy of Smear Layer Removal from Root Canal Surface Using: Sonic, Ultrasonic, Different Lasers as Activation Methods of Irrigant (SEM study). J. Res. Med. Dent. Sci. 2021, 9, 65–72. [Google Scholar]
- Hülsmann, M.; Rümmelin, C.; Schäfers, F. Root canal cleanliness after preparation with different endodontic handpieces and hand instruments: A comparative SEM investigation. J. Endod. 1997, 23, 301–306. [Google Scholar] [CrossRef] [PubMed]
- Mankeliya, S.; Jaiswal, N.; Singhal, R.K.; Gupta, A.; Pathak, V.K.; Kushwah, A. A comparative evaluation of smear layer removal by using four different irrigation solutions like root canal irrigants: An in vitro SEM study. J. Contemp. Dent. Pract. 2021, 22, 527–531. [Google Scholar] [CrossRef] [PubMed]
- Ulusoy, Ö.İ.; Zeyrek, S.; Çelik, B. Evaluation of smear layer removal and marginal adaptation of root canal sealer after final irrigation using ethylenediaminetetraacetic, peracetic, and etidronic acids with different concentrations. Microsc. Res. Tech. 2017, 80, 687–692. [Google Scholar] [CrossRef]
- Deari, S.; Mohn, D.; Zehnder, M. Dentine decalcification and smear layer removal by different ethylenediaminetetraacetic acid and 1-hydroxyethane-1,1-diphosphonic acid species. Int. Endod. J. 2019, 52, 237–243. [Google Scholar] [CrossRef]
- Chodankar, S.S.; Ashwini, P.; Meena, N.; Gowda, V.; D’souza, N. Assessment of smear layer removing efficacy of different irrigation activation devices in mandibular premolar teeth using a scanning electron microscope: An in vitro comparative study. Endodontology 2023, 35, 210–216. [Google Scholar] [CrossRef]
- Urban, K.; Donnermeyer, D.; Schäfer, E.; Bürklein, S. Canal cleanliness using different irrigation activation systems: A SEM evaluation. Clin. Oral Investig. 2017, 21, 2681–2687. [Google Scholar] [CrossRef]
- Liu, C.; Li, Q.; Yue, L.; Zou, X. Evaluation of sonic, ultrasonic, and laser irrigation activation systems to eliminate bacteria from the dentinal tubules of the root canal system. J. Appl. Oral Sci. 2022, 30, e20220199. [Google Scholar] [CrossRef]
- Haupt, F.; Meinel, M.; Gunawardana, A.; Hülsmann, M. Effectiveness of different activated irrigation techniques on debris and smear layer removal from curved root canals: A SEM evaluation. Aust. Endod. J. 2020, 46, 40–46. [Google Scholar] [CrossRef]
- Foschi, F.; Nucci, C.; Montebugnoli, L.; Marchionni, S.; Breschi, L.; Malagnino, V.A.; Prati, C. SEM evaluation of canal wall dentine following use of Mtwo and ProTaper NiTi rotary instruments. Int. Endod. J. 2004, 37, 832–839. [Google Scholar] [CrossRef] [PubMed]
- Penukonda, R.; Teja, K.V.; Kacharaju, K.R.; Xuan, S.Y.; Sheun, L.Y.; Cernera, M.; Iaculli, F. Comparative evaluation of smear layer removal with Ultra-X device and XP-Endo Finisher file system: An ex-vivo study: Smear removal on using various activation devices. G. Ital. Di Endodonzia 2023, 37, 2. [Google Scholar]
- Huynh, A.; Poly, A.; Yamaguchi, M.; Jalali, P. Efficacy of Laser Activated vs Sonic Activated Irrigation for Debris Removal in Conservatively Instrumented Root Canals. J. Endod. 2025, 51, 332–339. [Google Scholar] [CrossRef] [PubMed]
- Meire, M.; De Moor, R.J. Principle and antimicrobial efficacy of laser-activated irrigation: A narrative review. Int. Endod. J. 2024, 57, 841–860. [Google Scholar] [CrossRef]
- Gregorčič, P.; Lukac, N.; Možina, J.; Jezeršek, M. In vitro study of the erbium: Yttrium aluminum garnet laser cleaning of root canal by the use of shadow photography. J. Biomed. Opt. 2016, 21, 015008. [Google Scholar] [CrossRef] [PubMed]
- Wang, L.; Feng, B.; Shi, S.; Sun, D.; Wu, D. The effect of different activation irrigations on intracanal smear layer removal: A vitro study. Front. Bioeng. Biotechnol. 2024, 12, 1507525. [Google Scholar] [CrossRef]
- Betancourt, P.; Merlos, A.; Sierra, J.M.; Camps-Font, O.; Arnabat-Dominguez, J.; Viñas, M. Effectiveness of low concentration of sodium hypochlorite activated by Er, Cr: YSGG laser against Enterococcus faecalis biofilm. Lasers Med. Sci. 2019, 34, 247–254. [Google Scholar] [CrossRef]
- Taneja, S.; Kumari, M.; Anand, S. Effect of QMix, peracetic acid and ethylenediaminetetraacetic acid on calcium loss and microhardness of root dentine. J. Conserv. Dent. Endod. 2014, 17, 155–158. [Google Scholar] [CrossRef]
- Rath, P.P.; Yiu, C.K.Y.; Matinlinna, J.P.; Kishen, A.; Neelakantan, P. The effects of sequential and continuous chelation on dentin. Dent. Mater. 2020, 36, 1655–1665. [Google Scholar] [CrossRef]
- Quteifani, M.; Madarati, A.A.; Layous, K.; Tayyan, M.A. A comparative ex-vivo study of effects of different irrigation protocols with/without laser activation on the root dentine’s micro-hardness. Eur. Endod. J. 2019, 4, 127–132. [Google Scholar] [CrossRef]
- Akbulut, M.B.; Terlemez, A. Does the photon-induced photoacoustic streaming activation of irrigation solutions alter the dentin microhardness? Photobiomodul. Photomed. Laser Surg. 2019, 37, 38–44. [Google Scholar] [CrossRef] [PubMed]
- Wu, L.; Jiang, S.; Ge, H.; Cai, Z.; Huang, X.; Zhang, C. Effect of optimized irrigation with photon-induced photoacoustic streaming on smear layer removal, dentin microhardness, attachment morphology, and survival of the stem cells of apical papilla. Lasers Surg. Med. 2021, 53, 1105–1112. [Google Scholar] [CrossRef] [PubMed]
- Souza, M.A.; Ricci, R.; Bischoff, K.F.; Reuter, E.; Ferreira, E.R.; Dallepiane, F.G.; Quevedo, L.M.; Pereira, L.H.B.; Bischoff, L.F.; Hofstetter, M.G.; et al. Effectiveness of ultrasonic activation over glycolic acid on microhardness, cohesive strength, flexural strength, and fracture resistance of the root dentin. Clin. Oral Investig. 2023, 27, 1659–1664. [Google Scholar] [CrossRef] [PubMed]
Group | The Sequence of Irrigation and Agitation Protocol |
---|---|
SC | 1. 2 mL 3% NaOCl for 1 min after each instrument change. 2. SC + CN subgroup: 5 mL 17% EDTA for 1 min. SC + EA, SC + UAI and SC + Laser subgroups: 5 mL 17% EDTA for 1 min with 3 cycles of agitation for 20 s each. 3. Final rinse of 5 mL distilled water for 1 min. |
CC | 1. 2 mL 3% NaOCl/9% Dual Rinse HEDP for 1 min after each instrument change. 2. CC + CN subgroup: 5 mL 3% NaOCl/9% Dual Rinse HEDP for 1 min. CC + EA, CC + UAI and CC + Laser subgroups: 5 mL 3% NaOCl/9% Dual Rinse HEDP for 1 min with 3 cycles of agitation for 20 s each. 3. Final rinse of 5 mL distilled water for 1 min. |
Group | Coronal | Middle | Apical | |||
---|---|---|---|---|---|---|
Median | Mean Rank | Median | Mean Rank | Median | Mean Rank | |
SC + CN | 2.00 | 23.00 a,* | 2.00 | 20.44 | 2.50 | 22.19 |
SC + EA | 1.50 | 17.00 | 1.50 | 13.50 | 2.00 | 15.00 |
SC + UAI | 1.50 | 17.00 | 2.00 | 18.56 | 2.00 | 13.56 |
SC + Laser | 1.00 | 9.00 a,* | 1.50 | 13.50 | 2.00 | 15.25 |
CC + CN | 2.00 | 17.63 | 2.00 | 16.81 | 3.00 | 24.88 a,b,* |
CC + EA | 2.00 | 16.13 | 2.00 | 15.25 | 2.00 | 11.75 a,* |
CC + UAI | 2.00 | 18.06 | 2.00 | 18.69 | 3.00 | 20.50 c,* |
CC + Laser | 2.00 | 14.19 | 2.00 | 15.25 | 2.00 | 8.88 b,c,* |
Section and Depth | Group | Mean (VHN) | SD | Group | Mean (VHN) | SD |
---|---|---|---|---|---|---|
Sequential Chelation | Continuous Chelation | |||||
Coronal_50 | SC + CN | 58.84 a,* | 18.69 | CC + CN | 79.45 | 6.87 |
SC + EA | 34.34 a,b,* | 6.49 | CC + EA | 59.96 a,* | 18.85 | |
SC + UAI | 43.72 | 8.99 | CC + UAI | 71.06 b,* | 25.56 | |
SC + Laser | 59.08 b,* | 7.61 | CC + Laser | 87.48 a,b,* | 14.81 | |
Middle_50 | SC + CN | 59.45 a,* | 14.93 | CC + CN | 75.57 | 6.84 |
SC + EA | 33.04 a,b,* | 9.87 | CC + EA | 61.15 | 22.87 | |
SC + UAI | 43.39 | 6.71 | CC + UAI | 69.77 | 20.67 | |
SC + Laser | 56.18 b,* | 6.26 | CC + Laser | 85.40 | 8.62 | |
Apical_50 | SC + CN | 60.29 a,* | 16.79 | CC + CN | 78.66 | 0.51 |
SC + EA | 36.42 a,b,* | 6.46 | CC + EA | 64.16 a,* | 13.10 | |
SC + UAI | 44.07 | 1.94 | CC + UAI | 70.56 b,* | 23.00 | |
SC + Laser | 58.76 b,* | 10.36 | CC + Laser | 90.06 a,b,* | 20.64 | |
Coronal_100 | SC + CN | 51.66 a,* | 14.81 | CC + CN | 75.44 | 3.08 |
SC + EA | 34.59 a,b,* | 8.95 | CC + EA | 51.46 a,* | 22.49 | |
SC + UAI | 42.24 | 9.74 | CC + UAI | 58.97 b,* | 24.97 | |
SC + Laser | 53.34 b,* | 7.23 | CC + Laser | 82.17 a,b,* | 12.24 | |
Middle_100 | SC + CN | 53.91 a,* | 13.09 | CC + CN | 78.25 | 5.84 |
SC + EA | 35.64 a,b,* | 4.76 | CC + EA | 54.52 | 25.22 | |
SC + UAI | 40.08 | 11.24 | CC + UAI | 66.30 | 19.32 | |
SC + Laser | 50.62 b,* | 5.18 | CC + Laser | 79.70 | 10.34 | |
Apical_100 | SC + CN | 50.52 a,* | 11.10 | CC + CN | 76.62 a,* | 1.41 |
SC + EA | 34.24 a,b,* | 10.99 | CC + EA | 56.58 a,b,* | 15.60 | |
SC + UAI | 42.61 | 7.52 | CC + UAI | 66.11 | 21.94 | |
SC + Laser | 52.84 b,* | 5.05 | CC + Laser | 81.14 b,* | 22.42 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Kamil, A.A.; Ali, A.H.; Foschi, F.; Mannocci, F. Effectiveness of Continuous and Sequential Chelation and Different Agitation Techniques on Smear Layer Removal and Microhardness of Root Canal Dentin (An In Vitro Study). Dent. J. 2025, 13, 221. https://doi.org/10.3390/dj13050221
Kamil AA, Ali AH, Foschi F, Mannocci F. Effectiveness of Continuous and Sequential Chelation and Different Agitation Techniques on Smear Layer Removal and Microhardness of Root Canal Dentin (An In Vitro Study). Dentistry Journal. 2025; 13(5):221. https://doi.org/10.3390/dj13050221
Chicago/Turabian StyleKamil, Asmaa Aamir, Ahmed Hamid Ali, Federico Foschi, and Francesco Mannocci. 2025. "Effectiveness of Continuous and Sequential Chelation and Different Agitation Techniques on Smear Layer Removal and Microhardness of Root Canal Dentin (An In Vitro Study)" Dentistry Journal 13, no. 5: 221. https://doi.org/10.3390/dj13050221
APA StyleKamil, A. A., Ali, A. H., Foschi, F., & Mannocci, F. (2025). Effectiveness of Continuous and Sequential Chelation and Different Agitation Techniques on Smear Layer Removal and Microhardness of Root Canal Dentin (An In Vitro Study). Dentistry Journal, 13(5), 221. https://doi.org/10.3390/dj13050221