The Effectiveness of Different Irrigation Techniques on Debris and Smear Layer Removal in Primary Mandibular Second Molars: An In Vitro Study

Claire El Hachem; Walid Nehme; Marc Krikor Kaloustian; Nabil Ghosn; Maha Daou; Carla Zogheib; Mia Karam; Rami Mhanna; Valentina Macaluso; Naji Kharouf; Jean Claude Abou Chedid

doi:10.5005/jp-journals-10024-3440

The Effectiveness of Different Irrigation Techniques on Debris and Smear Layer Removal in Primary Mandibular Second Molars: An In Vitro Study

J Contemp Dent Pract. 2022 Nov 1;23(11):1173-1179. doi: 10.5005/jp-journals-10024-3440.

Authors

Affiliations

¹ Department of Pediatric and Community Dentistry, Saint Joseph University, Beirut, Lebanon, Phone: +0096170107702, e-mail: claire.elhachem@gmail.com.
² Department of Endodontics, Saint Joseph University, Beirut, Lebanon; Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, United States of America, Orcid: https://orcid.org/0000-0002-1589-1454.
³ Department of Endodontics, Faculty of Dental Medicine, Saint Joseph University, Beirut, Lebanon, Orcid: https://orcid.org/0000-0002-0811-6935.
⁴ Faculty of Dental Medicine, Craniofacial Research Laboratory, Saint Joseph University, Beirut, Lebanon, Orcid: https://orcid.org/0000-0003-1524-5310.
⁵ Faculty of Dental Medicine, Saint Joseph University, Beirut, Lebanon; McGill University, Montreal, Canada, Orcid: https://orcid.org/0000-0001-6882-9227.
⁶ Department of Endodontics, Faculty of Dental Medicine, Saint Joseph University, Beirut, Lebanon, Orcid: https://orcid.org/0000-0003-0857-6998.
⁷ Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon, Orcid: https://orcid.org/0000-0002-9783-3334.
⁸ Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon, Orcid: https://orcid.org/0000-0003-0345-625X.
⁹ ESTA, School of Business & Technology, Belfort, France, Orcid: https://orcid.org/0000-0002-6503-9841.
¹⁰ Department of Biomaterials and Bioengineering, INSERM UMR_S1121, Strasbourg University, Strasbourg, France; Department of Endodontics, Faculty of Dental Medicine, Strasbourg University, Strasbourg, France, Orcid: https://orcid.org/0000-0001-6768-138X.
¹¹ Department of Pediatric and Community Dentistry, Faculty of Dental Medicine, Saint Joseph University, Beirut, Lebanon, Orcid: https://orcid.org/0000-0001-5161-8693.

PMID: 37073943
DOI: 10.5005/jp-journals-10024-3440

Abstract

Aims: The aim of the present in vitro study was to compare the effectiveness of passive ultrasonic irrigation (PUI), sonic irrigation, and mechanic dynamic activation on the removal of debris and smear layer from primary mandibular second molars during pulpectomy.

Materials and methods: Mesial roots of 48 primary mandibular second molars were prepared with an R-motion 21 mm file (30/0.04) (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland), irrigated with 1% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA), and divided into four groups (n = 24 canals) according to the final irrigation activation technique: control group without activation, PUI with Ultra-X (Eighteeth, Changzhou, China), mechanical activation with XP-endo Finisher (FKG), and sonic irrigation with EQ-S (Meta Biomed, Chungcheongbuk-do, Korea). The roots were split longitudinally and analyzed using scanning electron microscopy (SEM). The presence of debris and smear layer was assessed using a 5-grade scoring scale with 200× and 1000× magnification, respectively. The Kruskal-Wallis and Friedman tests were used for data analysis.

Results: The activation of the irrigant significantly improved debris and smear layer removal (p < 0.001). There was no significant difference between Ultra-X, XP-endo Finisher, and EQ-S (p > 0.05). No activation technique was able to completely eliminate debris and smear layer from the root canals of primary mandibular second molars.

Conclusions: During pediatric pulpectomy, the irrigation protocol must include activation of the irrigation solutions using either ultrasonic, sonic, or mechanical activation techniques to enhance the removal of debris and smear layer for a better prognosis.

Clinical significance: During root canal treatment on primary teeth, the clinician must incorporate an activation technique in the irrigation protocol to enhance the removal of debris and smear layer and increase the success of the treatment.

Keywords: Endodontic irrigation; Passive ultrasonic irrigation; Primary teeth pulpectomy; Smear layer Sonic irrigation..

MeSH terms

Child
Dental Pulp Cavity
Edetic Acid / therapeutic use
Humans
Microscopy, Electron, Scanning
Molar
Root Canal Irrigants / therapeutic use
Root Canal Preparation / methods
Smear Layer*
Sodium Hypochlorite / therapeutic use
Therapeutic Irrigation / methods

Substances

Root Canal Irrigants
Edetic Acid
Sodium Hypochlorite