A comparative study of the removal of smear layer by three endodontic irrigants and two types of laser

Abstract

Aim: The effects of three endodontic irrigants and two types of laser on a smear layer created by hand instrumentation were evaluated in vitro in the middle and apical thirds of root canals.

Methodology: Sixty human mature extracted mandibular premolar teeth with a single root canal and a closed apex were distributed randomly into five groups of 12 teeth each. Whilst cleaning and shaping up to a size 60 master apical file with a step-back technique, the root canals were irrigated with 3 mL of 5.25% NaOCL and 3% H2O2, alternately, between each file size. Group 1 (G1) were control specimens that were irrigated with a final flush of 17% EDTA. The teeth in group 2 (G2) were irrigated with a final flush of 6% phosphoric acid, and group 3 (G3) with 6% citric acid. In the specimens of group 4 (G4) the root canals were irradiated with a carbon dioxide (CO2) laser, and specimens of group 5 (G5) were irradiated using an Er:YAG laser. The teeth were split longitudinally and prepared for examination by scanning electron microscopy.

Results: Control specimens (G1) showed clean root-canal walls with open dentinal tubules in the middle one-third, but in some specimens thick smear layer was observed in the apical one-third. Specimens irrigated with a final flush of 6% phosphoric acid (G2) or 6% citric acid (G3) were cleaner than with 17% EDTA, showing very clean root canal surfaces in the middle one-third but in the apical one-third the smear layer was not completely removed, especially at the openings of the dentinal tubules. The specimens irradiated with the CO2 laser (G4) showed clean root-canal walls with the smear layer absent, charred, melted, recrystallized and glazed in both middle and apical thirds. The root-canal walls of the specimens irradiated with the Er:YAG laser (G5) revealed an absent smear layer with open dentinal tubules in the middle and apical thirds. Statistical analysis showed no significant difference in the cleanliness of root-canal wall between G1 and G2, and G1 and G3. However, there were statistically significant differences (P < 0.01) between G1 and G4, and G1 and G5 in the cleanliness of the middle and apical one-thirds of the root canals.

Conclusions: Irrigation with 17% EDTA, 6% phosphoric acid and 6% citric acid did not remove all the smear layer from the root-canal system. In addition, these acidic solutions demineralized the interbular dentine around tabular openings, which became enlarged. The CO2 laser was useful in removing and melting the smear layer on the instrumented root-canal walls and the Er:YAG laser was the most effective in removing the smear layer from the root-canal wall.