A Comparative evaluation of smear layer removal using: sonic, ultrasonic, and erbium, chromium: yttrium scandium gallium garnet Laser as activated irrigation techniques (an SEM study) .
Keywords:Irrigation, Smear layer, Sonic, Ultrasonic, Laser
Background and Objectives: In root canal treatment it is important to provide a reliable method that effectively removes the smear layer to ensure more successful results in endodontic treatment. This study aims to compare the efficacy of different irrigant activation methods (sonic, ultrasonic, and erbium, chromium: yttrium scandium gallium garnet Er,Cr:YSGG—2780nm laser) for the removal of smear layer at coronal, middle, and apical one-third of the root canal surface.
Methods: Sixty single-rooted mandibular premolar teeth were selected and instrumented to size 25/.08 (HyFlex EDM, Coltene). Samples were randomly divided into 4 groups of 15 roots each, depending on the system used to activate the irrigant solution. Group1, conventional needle irrigation with no activation (control), Group2 activated by EndoActivator (sonic group), Group3 activated by UltraX activator (ultrasonic group), and Group4 activated by Er,Cr:YSGG laser (laser group). Samples were irrigated with 1ml of EDTA 17% for 1 minute, then received 5ml of NaOCl 5.25% and activated for 1 minute. Scanning electron microscope investigations were conducted to evaluate the efficacy of suggested treatments.
Results: The laser group showed the least smear layer scores, followed by ultrasonic and then sonic groups with no statistically significant differences. All groups revealed better smear layer removal compared to the control group with significant differences at (p-value < 0.05).
Conclusion: All the activation techniques were useful in the removal of the smear layer with the favorite to laser technology that was the best one. Smear layer removal was more effective in the coronal and middle thirds than in the apical third for all groups.
Akcay M, Arslan H, Mese M, Durmus N, Capar ID. Effect of photon-initiated photoacoustic streaming, passive ultrasonic, and sonic irrigation techniques on dentinal tubule penetration of irrigation solution: a confocal microscopic study. Clin Oral Investig. 2017 Sep;21(7):2205–12.
Eki̇m ŞNA, Erdemi̇r A. Smear Layer and Removal Techniques in Endodontics. Türkiye Klin Endodonti - Özel Konular. 2015;1(2):31–40.
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 Apr;105(2):178–83.
Mancini M, Cerroni L, Iorio L, Dall’Asta L, Cianconi L. FESEM evaluation of smear layer removal using different irrigant activation methods (EndoActivator, EndoVac, PUI and LAI). An in vitro study. Clin Oral Investig. 2018 Mar 1;22(2):993–9.
Neelakantan P, Ounsi HF, Devaraj S, Cheung GSP, Grandini S. Effectiveness of irrigation strategies on the removal of the smear layer from root canal dentin. Odontology. 2019 Apr;107(2):142–9.
Mobaraki B, Yeşildal Yeter K. Quantitative analysis of SmearOFF and different irrigation activation techniques on removal of smear layer: A scanning electron microscope study. Microsc Res Tech. 2020;83(12):1480–6.
Rödig T, Bozkurt M, Konietschke F, Hülsmann M. Comparison of the Vibringe system with syringe and passive ultrasonic irrigation in removing debris from simulated root canal irregularities. J Endod. 2010 Aug;36(8):1410–3.
Kourti E, Strakas D, Pantelidou-Papadopoulou O, Tolidis K. Smear Layer Removal by Means of Erbium, Chromium: Yttrium Scandium Gallium Garnet (Er, Cr: YSGG) Laser Irradiation from Apical Third of Mesial Root Canals. Int J Dent Med. 2021 Sep 4;7(2):20.
Al-baker HS. 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(5):8.
Wu D, Ma Y zhen, Jia J, Xin B chang, Wang D shan, Sun D gang, et al. Removal of the root canal smear layer using Carisolv III and sodium hypochlorite. Medicine (Baltimore). 2020 May 29;99(22):e20372.
Abu Tahun IH, Kwak SW, Ha JH, Sigurdsson A, Kayahan MB, Kim HC. Effective Establishment of Glide-Path to Reduce Torsional Stress during Nickel-Titanium Rotary Instrumentation. Materials. 2019 Feb 5;12(3):493.
Di Nardo D, Gambarini G, Miccoli G, Di Carlo S, Iannarilli G, Lauria G, et al. Sonic vs Ultrasonic activation of sodium hypoclorite for root canal treatments. In vitro assessment of debris removal from main and lateral canals. G Ital Endodonzia. 2020 Jun 4;34(1):90–6.
Torabinejad M, Khademi AA, Babagoli J, Cho Y, Johnson WB, Bozhilov K, et al. A New Solution for the Removal of the Smear Layer. J Endod. 2003 Mar 1;29(3):170–5.
Suman S, Verma P, Prakash-Tikku A, Bains R, Kumar-Shakya V. A Comparative Evaluation of Smear Layer Removal Using Apical Negative Pressure (EndoVac), Sonic Irrigation (EndoActivator) and Er:YAG laser -An In vitro SEM Study. J Clin Exp Dent. 2017 Aug;9(8):e981–7.
Aalmohamed E, Ahmed F, Alfardan L, Abed RE, Khamis AH, Jamal M. Effect of sonic irrigation activation at different frequencies in smear layer removal; An in vitro experimental study. Saudi Endod J. 2022 Jan 1;12(1):106.
Machado R, Rother A, Comparin D, Pawar A, Matos F de S, Cunha TC, et al. Removal of the smear layer by passive and continuous ultrasonic irrigation: a scanning electron microscopy study. J Oral Res. 2021;10(6):1–8.
How to Cite
Copyright (c) 2023 Dara Zakaria Shakir , Ihsan Neimat Bahnam (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The copyright on any article published in Erbil Dental Journal is retained by the author(s) in agreement with the Creative Commons Attribution Non-Commercial ShareAlike License (CC BY-NC-SA 4.0).