Scanning Electron Microscopic Evaluation of Smear Layer Removal and Estimation of Dentin Microhardness Using TRITON Endodontic Irrigant: An In Vitro Study
DOI:
https://doi.org/10.15218/edj.2024.25Keywords:
TRITON, NaOCL, EDTA, SEM, IrrigationAbstract
Background and objectives: Irrigation is essential in endodontic therapy, and traditional irrigation was done with NAOCl and EDTA to remove the smear layer and clean the canal, but it had several difficulties. Many solutions, such as Smearoff, Qmix and MTAD, are available as a single irrigant solution to disinfect and remove the smear layer. TRITON is a revolutionary two-in-one irrigant that can both remove smear layer and disinfect the canal. This study aims to evaluate the effect of Triton on smear layer removal and compare it with Qmix and conventional NaOCl and EDTA irrigation protocols.
Methods: Thirty extracted single canal teeth were divided into three groups; Group 1 was irrigated with NaOCl and EDTA. Group 2 received Triton treatment, but Group 3 received Qmix irrigation. Each tooth was then cut in half and subjected to Scanning electron microscope.
Results: There was no significant difference between the groups investigated, however, there was a significant difference between the middle and apical thirds in Group 2 (P=0.009).
Conclusion: Triton intracanal irrigant revealed effectual capability to eradicate smear layer from radicular dentin as conventional root canal irrigating solutions (NaOCl/EDTA). Triton can be used as an alternative to NaOCl+EDTA and Qmix as an irrigant.
References
Shokouhinejad N, Sharifian MR, Aligholi M, Assadian H, Tabor RK, Nekoofar MH. The sealing ability of resilon and gutta-parcha following different smear layer removal methods: an ex vivo study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;110(1):e45-e49. doi:10.1016/j.tripleo.2010.02.007
FEYZIANFARD, M. "The Effect of EDTA and Citric Acid on Smear Layer Removal of Mesial Canals of First Mandibular Molars, A Scanning Electron Microscopic Study." (2004): 27-35.
Shahravan A, Haghdoost AA, Adl A, Rahimi H, Shadifar F. Effect of smear layer on sealing ability of canal obturation: a systematic review and meta-analysis. J Endod. 2007;33(2):96-105. doi:10.1016/j.joen.2006.10.007
Pérez-Heredia M, Ferrer-Luque CM, González-Rodríguez MP, Martín-Peinado FJ, González-López S. Decalcifying effect of 15% EDTA, 15% citric acid, 5% phosphoric acid and 2.5% sodium hypochlorite on root canal dentine. Int Endod J. 2008;41(5):418-423. doi:10.1111/j.1365-2591.2007.01371.x
Baumgartner JC, Mader CL. A scanning electron microscopic evaluation of four root canal irrigation regimens. J Endod. 1987;13(4):147-157. doi:10.1016/s0099-2399(87)80132-2
Torabinejad M, Handysides R, Khademi AA, Bakland LK. Clinical implications of the smear layer in endodontics: a review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94(6):658-666. doi:10.1067/moe.2002.128962
Yamada RS, Armas A, Goldman M, Lin PS. A scanning electron microscopic comparison of a high volume final flush with several irrigating solutions: Part 3. J Endod. 1983;9(4):137-142. doi:10.1016/S0099-2399(83)80032-6
Brasseler usa - dental (2015) Triton FAQs. Available at: https://brasselerusadental.com/wp-content/uploads/sites/9/2022/01/Triton-FAQs-Final.pdf
Plotino G., 2020. Triton university research summary. Available at: https://brasselerusadental.com/wp-content/uploads/sites/9/2022/01/Triton-University-Research-Summary-12.30.21-1.pdf
Violich DR, Chandler NP. The smear layer in endodontics - a review. Int Endod J. 2010;43(1):2-15. doi:10.1111/j.1365-2591.2009.01627.x
Massoud SF, Moussa SM, Hanafy SA, El Backly RM. Evaluation of the microhardness of root canal dentin after different irrigation protocols (in vitro study). Alex Dent J. 2017;42:73-79
Peters OA, Peters CI. Cleaning and shaping of the root canal system. In: Hargreaves K, Cohen S, editors. Pathways of the Pulp. 11th ed. St. Louis, MO: Mosby; 2011. p. 283–348.
Ayranci LB, Arslan H, Akcay M, Capar ID, Gok T, Saygili G. Effectiveness of laser-assisted irrigation and passive ultrasonic irrigation techniques on smear layer removal in middle and apical thirds. Scanning. 2016;38(2):121-127. doi:10.1002/sca.21247
Jameel, Chener S., and Nawfal A. Zakaria. "Evaluation of Smear Layer Removal by Activation Ethylene Diamine Tetra Acetic Acid 17% with Erbium Chromium: Yttrium Scandium Gallium Garnet and Diode Laser: Scanning Electron Microscopy." Polytechnic Journal 10.1 (2020): 103-109.
Abdelgawad LM, ElShafei NAA, Eissa SA, Ibrahim DY. Efficacy of Photoinduced Photoacoustic Streaming and Diode Laser Irrigation Techniques on Smear Layer Removal, Sealer Penetration and Push-out Bond Strength. J Lasers Med Sci. 2022 Mar 18;13:e12. doi: 10.34172/jlms.2022.12. PMID: 35996490; PMCID: PMC9392877.
Kour S, Pradeep P R, Kumari V R, Chaudhury T, Syam A. Effect of final irrigating solutions on smear layer removal and penetrability of an epoxy resin-based sealer into dentinal tubules. International Journal of Contemporary Medical Research. 2019; 6(2): 3-8.
Sharma S, Farooq R, Purra A R, Ahanger F A, Bhagat P. Comparative Evaluation of Smear Layer Removal Efficacy of Different Final Irrigating Solutions: A Scanning Electron Microscopic Study. JAMDS.2020;8: 2348-6805
Shravya, S., Nadig, R.R. and Pai, V.S. Root canal irrigant combining salvadora persica with sodium hypochlorite - Antimicrobial, tissue dissolution, chelating action & changes in Ca/P of root dentin: In vitro study." International Journal of Scientific Research. 2020: 9:8:41-45.
Khedmat S, Shokouhinejad N. Comparison of the efficacy of three chelating agents in smear layer removal. J Endod. 2008;34(5):599-602. doi:10.1016/j.joen.2008.02.023
Hegde S, Shetty HK, Hegde S, et al.: Scanning Electron Microscopy Evaluation of the Smear Layer Removal Using Various Chelating Agents-An invitro Study. J. Int. Dent. Medical Res. 2022;15(1):15–20. [Google Scholar]
Arslan D, Guneser MB, Dincer AN, Kustarci A, Er K, Siso SH. Comparison of Smear Layer Removal Ability of QMix with Different Activation Techniques. J Endod. 2016;42(8):1279-1285. doi:10.1016/j.joen.2016.04.022
Souza MA, Hoffmann IP, Menchik VHS, et al. Influence of ultrasonic activation using different final irrigants on antimicrobial activity, smear layer removal and bond strength of filling material. Aust Endod J. 2019;45(2):209-215. doi:10.1111/aej.12310
Zafar QA, Malik WJ, Azam S. Comparison of 980 nm Diode Laser and Q-Mix solution alone and in combination on removal of smear layer from root canal surface; a scanning electron microscope study. Oral Health Dent Manag. 2019;30(18):64–9. [Google Scholar]
Matos FS, da Silva FR, Paranhos LR, Moura CCG, Bresciani E, Valera MC. The effect of 17% EDTA and QMiX ultrasonic activation on smear layer removal and sealer penetration: ex vivo study. Sci Rep. 2020 Jun 25;10(1):10311. doi: 10.1038/s41598-020-67303-z. PMID: 32587397; PMCID: PMC7316761.
Ballal NV, Narkedamalli R, Gandhi P, et al. Biological and chemical properties of 2-in-1 calcium-chelating and antibacterial root canal irrigants. J Dent. 2023;134:104526. doi:10.1016/j.jdent.2023.104526
Purakkal, Aparna T.; Peedikayil, Faizal C.; Shibuvardhanan, Y.1; Chandru, T. P.; Kottayi, Soni; Srikant, N.2. Comparison of Smear Layer Removal by MTAD, TetraClean, QMix, NaOCL, Coconut Water, and Saline as Irrigating Solutions in Primary Teeth: An in vitro Study. Journal of Dental Research and Review 7(3):p 97-104, Jul–Sep 2020. | DOI: 10.4103/jdrr.jdrr_39_20
Banode AM, Gade V, Patil S, Gade J, Chandhok D, Sinkar R. Comparative scanning electron microscopy evaluation of smear layer removal with 17% ethylenediaminetetraacetic acid, 10% citric acid and newer irrigant QMix: in vitro study. Indian J Oral Health Res. 2015; 1:56–61.
Baldasso FER, Roleto L, Silva VDD, Morgental RD, Kopper PMP. Effect of final irrigation protocols on microhardness reduction and erosion of root canal dentin. Braz Oral Res. 2017;31:e40. Published 2017 May 15. doi:10.1590/1807-3107BOR-2017.vol31.0040
Montero-Miralles P, Torres-Lagares D, Segura-Egea JJ, Serrera-Figallo MÁ, Gutierrez-Perez JL, Castillo-Dali G. Comparative study of debris and smear layer removal with EDTA and Er,Cr:YSGG laser. J Clin Exp Dent. 2018;10(6):e598-e602. Published 2018 Jun 1. doi:10.4317/jced.54936.
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