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Table of Contents   
ORIGINAL ARTICLE  
Year : 2014  |  Volume : 17  |  Issue : 1  |  Page : 40-44
Effect of final irrigating solution on smear layer removal and penetrability of the root canal sealer


1 Department of Conservative Dentistry and Endodontics, Yenepoya Dental College, Mangalore, India
2 Department of Conservative Dentistry and Endodontics, SIBAR Dental College, Guntur, India
3 Department of Oral Pathology, Yenepoya Dental College, Mangalore, India

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Date of Submission10-Jul-2013
Date of Decision07-May-2013
Date of Acceptance17-Jul-2013
Date of Web Publication1-Jan-2014
 

   Abstract 

Objective: To evaluate the effect of final rinsing solution on smear layer removal through penetrability of the root canal sealer.
Materials and Methods: Each of the 30 teeth selected was decoronated and the root length standardized at 16 mm measured from the apex of the tooth to the cementoenamel junction (CEJ). A size 10-k file was used and working length was determined by subtracting 1mm from the measured length so that the length of the sample was 15mm. A combination of step back and crown down technique was done and apical portion was prepared till H-file no. 30. 3% NaOCl was used during cleaning and shaping of the canals. Finally the teeth were divided into three groups of 10 teeth each. Group-I was irrigated with 17% EDTA, Group-II with TUBLICID plus, and Group-III with Biopure MTAD® . ISO 30 size gutta-percha points were selected as master cones. The Acroseal sealer was mixed with approximated concentration 0.1% fluorescent rhodamine B isothiocyanate dye. Obturation was done and after 48 hours, the roots were sectioned and subjected to confocal laser scanning microscopy.
Results: Comparisons among the three groups were done by two-way analysis of variance (ANOVA) and Newman-Keuls multiple post-hoc procedures. The two-way ANOVA showed statistically highly significant results. The maximum depth of sealer penetration was observed in Group II followed by Group III and Group I.
Conclusion: The use of -Tubulicid plus as a final irrigant provided better smear layer removal than Biopure a mixture of doxicycline, citric acid and a detergent (Tween 80) (MTAD® ) and 17% EDTA.

Keywords: Biopure MTAD® ; ethylene diamine tetra-acetic acid; smear layer; step back; tubulicid

How to cite this article:
Shenoy A, Ahmaduddin, Bolla N, Raj S, Mandava P, Nayak S. Effect of final irrigating solution on smear layer removal and penetrability of the root canal sealer. J Conserv Dent 2014;17:40-4

How to cite this URL:
Shenoy A, Ahmaduddin, Bolla N, Raj S, Mandava P, Nayak S. Effect of final irrigating solution on smear layer removal and penetrability of the root canal sealer. J Conserv Dent [serial online] 2014 [cited 2014 Aug 29];17:40-4. Available from: http://www.jcd.org.in/text.asp?2014/17/1/40/124132

   Introduction Top


Obtaining a bacteria tight seal is an important part of the root canal therapy. This is accomplished through the use of core material and sealer cement. It is important to seal the root canal system three dimensionally in order to overcome the problems associated with microleakage, which may eventually lead to treatment failure. Microleakage can occur apically and coronally as a result of improper seal between the core obturating material and the root canal dentin. [1],[2] The sealer used may possess some biological, physical, and antimicrobial properties. [3],[4],[5] During obturation it fills the voids and irregularities in between the core material and the dentin such as any lateral, fulcral canals, ramifications, and reticular canals. The conventional irrigation protocols and intracanal medicaments may not be able to completely eradicate bacteria harboring in the dentinal tubules. This may be attributed to the presence of smear layer and low antimicrobial ability of the irrigant or medicament. It has been reported that bacteria can penetrate from 300 to800 μm into the radicular dentin. [6] This may be of immense concern as the existing bacteria can cause reinfection of the root canal system. To contain such a situation, scrupulous sealing of the dentinal tubules with an antimicrobial sealer is desired, which confines the bacteria within dentinal tubules and restricts their multiplication.

Ethylene Diamine Tetra-acetic Acid (EDTA) over time has been irrigant of choice among clinicians for removal of smear layer. [7] But it is not antimicrobial and is used along with NaOCl for effective irrigation of root canal. Calt et al., in a study on time dependant action of EDTA, observed that when used for prolonged periods it caused excessive tubular and intertubular dentin erosion. [8],[9] Endodontic irrigants developed recently such as (a mixture of doxicycline, citric acid and a detergent (Tween 80) (MTAD)® (DENTSPLY Tulsa Dental, Tulsa, OK) and Tubulicid plus (Dental therapeutics AB, Sweden) have been reported to have acceptable antimicrobial activity and cleansing ability. [10],[11],[12] MTAD® was introduced by Torabinejad et al., in the year 2003. [10] They demonstrated that MTAD® when used as a final rinsing solution after NaOCl (5.25%) effectively removed smear layer and did not significantly change the structure of the dentinal tubules as compared with irrigation with EDTA and 5.25% NaOCl. Moreover, MTAD® was shown to effectively remove the smear layer from the apical third of the canal. [13] Liolios et al., reported effective removal of smear layer using Tubulicid plus as a final irrigating solution after the use of 1% NaOCl. [14] It is an effective smear layer removing agent and consists of cocoamphodiacetate, benzalkonium chloride, disodium edetate dihydrate, phosphate buffer solution, and aqua dest.

The effectiveness of final rinsing solution has been an established phenomenon for removal of smear layer after the cleaning and shaping of the root canal system. [15],[16] Some studies reported that the presence of smear layer obstructed the sealer penetration into dentinal tubules; [17],[18] hence the complete removal of smear layer is essential for adaptation and penetration of the sealer. The percentage and depth of sealer penetration in dentinal tubules may act as an indicator for degree of smear layer removal after the final irrigation. [19] Based on the above evidence, this study was designed aiming to know the effect of final rinsing solution on smear layer removal through penetrability of the root canal sealer.


   Materials and Methods Top


Thirty single rooted mandibular premolars, which were extracted for Orthodontic purpose, were taken for this study. The teeth were examined under operating loupes for cracks and defects and such teeth were excluded. All the teeth were kept in 3% NaOCl for 15 minutes to remove tissue debris. The access cavities were prepared and the teeth were checked for the presence of a single root canal. Selected teeth were stored in isotonic saline. Each tooth was decoronated and root length standardized at 16 mm measured from the apex of the tooth to the cementoenamel junction (CEJ).

A size 10-k file (Mani, Tokyo, Japan) was inserted into canal until its tip was just visible at the apical foramen and length was measured. Working length was determined by subtracting 1 mm from the measured length so that the length of the sample was 15 mm. Instrumentation was done by combination of step back and crown down technique. Apical one-third was prepared gradually by using H files up to ISO 30 size (Mani, Tokyo, Japan). Coronal preparation was done using gate-glidden drills (Mani, Tokyo, Japan) Nos. 3, 2, 1. During the cleaning and shaping of the canals 3 ml of 3% NaOCl was used. The canals were dried with sterile paper points (DENTSPLY Maillefer) and were randomly divided into three groups of 10 teeth each. Later as a final irrigant regimen the samples in Group-I (positive control group) were irrigated with 17% EDTA (Pulpdent, USA), Group-II were irrigated with Tubilicid plus (Dental therapeutics AB, Sweden) and Group-III irrigated with Biopure MTAD® (DENTSPLY Tulsa Dental, Tulsa, OK). Nearly 4 ml of irrigant was used for each sample with the help of side vent needles. The canals were then irrigated with 4 ml normal saline solution and dried with paper points. ISO 30 size gutta-percha points were selected as master cones. The teeth were mounted on resin to facilitate handling of the samples. The Acroseal (Septodont, India) sealer was dispensed and mixed with approximated concentration 0.1% fluorescent rhodamine B isothiocyanate dye (Sigma-Aldrich, India) according to manufacturers recommendations. The sealer was applied in root canals using No. 25 lentulo spirals (Mani, Tokyo, Japan) at a moderate speed. The sealer was applied to snugly fitting master cones and the cones were placed in the root canals and the obturation was done with a lateral condensation technique.

After 48 hours, 1 mm thick cross sections were cut from each coronal, middle, and apical section of the mounted acrylic blocks. The sections were sub grouped as A (coronal), B (middle), C (apical) under each group. The samples were cleaned under tap water for removal of any debris and dried. The specimens obtained were subjected to confocal laser scanning microscope (CLSM) (Olympus FV 100, Germany) to evaluate the depth of sealer penetration at 10x. The sections were scanned to get Z sections at each 20 μm depth intervals in every section with the help of the Olympus FV 1000 software. The depth of penetration of sealer was measured from the lumen of the canal to maximum depth penetrated into the tubules and an average of values was taken into account.

Comparisons among the three groups (Group-I, Group-II, and Group-III) and three sections (Coronal, middle, and apical) of Sealer penetration in dentinal tubules were done by two-way analysis of variance (ANOVA) and Newman-Keuls multiple post-hoc procedures. The measurements were taken with the help of Olympus FLV 1000 software.


   Results Top


The two-way ANOVA showed statistically highly significant results (P < 0.01). The evaluated specimens showed fluorescence throughout the circumference of the root canal lumen, but the penetration of the sealer was not equal into the dentin all around the canal walls. The images taken in a CLSM are shown in [Figure 1].
Figure 1: CLSM images of sealer penetration in apical (a) middle (m) and coronal (c) sections

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The means and standard deviations were calculated for all the three groups and all the three sections [Table 1] and [Table 2].
Table 1: Means and SD value of sealer penetration of the three groups

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Table 2: Mean and SD value of Sealer penetration in dentinal tubules in three sections (coronal, middle, and apical)

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The maximum depth of sealer penetration was observed in Group II (irrigated with Tubulicid plus) followed by Group III (irrigated with Biopure MTAD® ) and Group I (irrigated with 17% EDTA). The coronal sections of all the groups regardless of the type of final irrigant used showed maximum sealer penetration compared with the middle and apical sections.

[Figure 1] and [Figure 2] shows the modified CLSM images.
Figure 2: Images modifi ed and measurements taken with help of Olympus FLV 1000 software

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   Discussion Top


The penetration of sealer into the dentinal tubules is of clinical importance, the formation of sealer tags into the dentin provides good adaptation between the sealer cement and the dentin interface. [20] This may further reduce the microleakage frequently caused due to improper obturation of the root canal. The intimate contact of the sealer with the bacteria may potentiate the antibacterial efficacy of the sealer. Infiltration of the sealer into dentinal tubules may depend upon the physical characteristics of the sealer such as viscosity and the level of the root canal system. [21] Gharib et al., in a similar study, found that there was significantly less percentage and depth of penetration of sealer in apical sections than in the coronal and middle sections. [22] The present study is also in agreement with it as it demonstrated that more amount of sealer penetration in the coronal followed by the middle and apical section.

Ronald et al. stated that there was no statistical significance in depth of penetration among the three different sealers after irrigation with 2 ml of 17% EDTA for smear layer removal. [23] Another study with a similar methodology found that there was better penetration of sealer into the dentinal tubules after irrigation with 17% EDTA alone, which did not increase on further irrigation with 3.5% NaOCl. [19] Kandaswamy et al. have evaluated the shear bond strength of the resin-based sealer after treating with different final irrigants and concluded that the EDTA treated teeth showed highest bond strength followed by HEBP and MTAD® , which can be explained by the better removal of smear layer by 17% EDTA [24] The need for effective irrigating solution for removal of smear layer is ever desired. The smear layer may harbor bacteria [23],[25] and [26] and may restrict the adaptation and penetration of sealer into the dentinal tubules. [17],[18] Since the present study showed better sealer penetration in Tubulicid plus group, further studies regarding the evaluation of shear bond strength using this irrigant are to be conducted.

In this study a final irrigation regimen of 17% EDTA, Tubulicid plus and Biopure MTAD® was followed. Each sample was irrigated with 4 ml of either of the solutions. It was observed that the samples Group-II, which were irrigated with Tubulicid plus showed better penetration of sealer followed by the Group III (MTAD® ) and Group I (EDTA). However, there was significantly less amount of sealer penetration in the apical sections [17],[20]

The samples irrigated with Tubulicid plus showed better penetration at all the three levels compared with MTAD® and 17% EDTA. The penetration depth in Group III (MTAD® ) was superior to that of Group I, but significantly less than Group II.

Singh studied the penetration depth of different sealers and concluded that resin-based sealers showed better penetration in to dentinal tubules. [27] The resin sealer used in this study (Acroseal Septodont, India) was selected for its simple manipulative procedures with auto mixing syringe, which would not change significantly for any given sample. The rhodamine B dye was mixed with the sealer with extremely low concentration (0.1%), which would not affect the properties of the sealer.

The confocal laser Scanning microscope (Olympus FV 1000) used in this study utilizes a software for analyzing the images. Analogous to previous studies the use of other software's was not needed for measuring the depth of the sealer penetration [20] With the help of the software it was possible to measure the depth of the sealer as it has the same calibrations and pixels that of the CLSM. The CLSM has a definite advantage over the Scanning Electron Microscope [ SEM] for the evaluation of sealer penetration as it is possible to get the images in various depths of a given sample.


   Conclusion Top


Within the parameters of this in vitro study it can be concluded that the use of a final irrigating solution has a definite effect on smear layer removal and may improve sealer penetration into dentinal tubules. The use of Tubulicid plus as a final irrigant provided better smear layer removal than Biopure MTAD® and 17% EDTA.

The authors are thankful to Daniel Kratt and Dental therapeutics AB for their support and kind cooperation.

 
   References Top

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2.Park DS, Torabinejad M, Shabahang S. The effect of MTAD on the coronal leakage of obturated root canals. J Endod 2004;30:890-3.  Back to cited text no. 2
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Correspondence Address:
Amarnath Shenoy
Department of Conservative Dentistry and Endodontics, Yenepoya Dental College, Mangalore 575 018
India
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DOI: 10.4103/0972-0707.124132

PMID: 24554859

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