The Effectiveness of Triton Used With XP-3D Adaptive Files and Active Irrigation on Smear Layer Removal During Root Canal Preparation: A Qualitative Scanning Electron Microscopy (SEM) Study

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2024 Nov 6

PMID 39502750

Authors

Charissa Bandoo

Samiyah Suliman

Emma Trestrail

Shivaughn M Marchan

Affiliations

Soon will be listed here.

Abstract

Background: Standard irrigating protocols during root canal treatment call for the use of sodium hypochlorite during chemo-mechanical preparation, followed by final irrigation with ethylenediaminetetraacetic acid (EDTA). This study determined the effectiveness of a new irrigant, Triton (Brasseler, USA), on smear layer removal during root canal treatment compared to that of 5.25% sodium hypochlorite and CanalPro EDTA 17% (Coltene).

Methodology: Twenty-one extracted anterior teeth were prepared for root canal treatment. The teeth were divided into three groups: five teeth were used as control with saline as the irrigant, eight teeth with sodium hypochlorite and 17% EDTA as irrigants, and eight teeth with Triton as the irrigant. Root canal preparation was done using the XP-3D shaper and finisher files (Brasseler, USA) for all teeth with respective irrigants. A single operator performed all root canal treatment procedures. The teeth were prepared for scanning electron microscopy (SEM), and analysis was performed by a second investigator. The smear layer removal was qualitatively assessed to determine the effectiveness of irrigants.

Results: Smear layer removal was most effective for teeth irrigated with 5.25% sodium hypochlorite, followed by 17% EDTA (Group B). Teeth irrigated with Triton (Group A) showed a similar appearance to the hypochlorite/EDTA group but with isolated instances of inter-tubular debris.

Conclusion: Sodium hypochlorite use followed by a final rinse with EDTA remains the gold standard for the removal of the smear layer created during canal instrumentation.

References

Baumgartner J, Ibay A . The chemical reactions of irrigants used for root canal debridement. J Endod. 1987; 13(2):47-51. DOI: 10.1016/S0099-2399(87)80153-X. View

Blank-Goncalves L, Nabeshima C, Martins G, Machado M . Qualitative analysis of the removal of the smear layer in the apical third of curved roots: conventional irrigation versus activation systems. J Endod. 2011; 37(9):1268-71. DOI: 10.1016/j.joen.2011.06.009. View

Gu L, Kim J, Ling J, Choi K, Pashley D, Tay F . Review of contemporary irrigant agitation techniques and devices. J Endod. 2009; 35(6):791-804. DOI: 10.1016/j.joen.2009.03.010. View

Zancan R, Di Maio A, Tomson P, Duarte M, Camilleri J . The presence of smear layer affects the antimicrobial action of root canal sealers. Int Endod J. 2021; 54(8):1369-1382. DOI: 10.1111/iej.13522. View

McComb D, Smith D . A preliminary scanning electron microscopic study of root canals after endodontic procedures. J Endod. 1975; 1(7):238-42. DOI: 10.1016/S0099-2399(75)80226-3. View

Sen B, Wesselink P, Turkun M . The smear layer: a phenomenon in root canal therapy. Int Endod J. 1995; 28(3):141-8. DOI: 10.1111/j.1365-2591.1995.tb00289.x. View

Goldman M, GOLDMAN L, Cavaleri R, Bogis J, Lin P . The efficacy of several endodontic irrigating solutions: a scanning electron microscopic study: Part 2. J Endod. 1982; 8(11):487-92. DOI: 10.1016/s0099-2399(82)80073-3. View

Violich D, Chandler N . The smear layer in endodontics - a review. Int Endod J. 2009; 43(1):2-15. DOI: 10.1111/j.1365-2591.2009.01627.x. View

Fukuzaki S . Mechanisms of actions of sodium hypochlorite in cleaning and disinfection processes. Biocontrol Sci. 2006; 11(4):147-57. DOI: 10.4265/bio.11.147. View

10.

Oksan T, Aktener B, Sen B, Tezel H . The penetration of root canal sealers into dentinal tubules. A scanning electron microscopic study. Int Endod J. 1993; 26(5):301-5. DOI: 10.1111/j.1365-2591.1993.tb00575.x. View

11.

Saunders W, Saunders E . The effect of smear layer upon the coronal leakage of gutta-percha fillings and a glass ionomer sealer. Int Endod J. 1992; 25(5):245-9. DOI: 10.1111/j.1365-2591.1992.tb01157.x. View

12.

Mader C, Baumgartner J, Peters D . Scanning electron microscopic investigation of the smeared layer on root canal walls. J Endod. 1984; 10(10):477-83. DOI: 10.1016/S0099-2399(84)80204-6. View

13.

Carvalho M, Zuolo M, Arruda-Vasconcelos R, Marinho A, Louzada L, Francisco P . Effectiveness of XP-Endo Finisher in the reduction of bacterial load in oval-shaped root canals. Braz Oral Res. 2019; 33:e021. DOI: 10.1590/1807-3107bor-2019.vol33.0021. View

14.

Sheng X, Yu J, Liu H, Wang Z, Deng S, Shen Y . Dual effectiveness of a novel all-in-one endodontic irrigating solution in antibiofilm activity and smear layer removal. Front Bioeng Biotechnol. 2023; 11:1254927. PMC: 10427723. DOI: 10.3389/fbioe.2023.1254927. View

15.

Karkehabadi H, Siahvashi Z, Shokri A, Hasani N . Cone-beam computed tomographic analysis of apical transportation and centering ratio of ProTaper and XP-endo Shaper NiTi rotary systems in curved canals: an in vitro study. BMC Oral Health. 2021; 21(1):277. PMC: 8147396. DOI: 10.1186/s12903-021-01617-w. View

16.

AlBatati M, AbuMostafa A . The effect of final irrigation with different solutions on smear layer removal and dentin erosion: A scanning electron microscope study. PLoS One. 2024; 19(8):e0308606. PMC: 11315290. DOI: 10.1371/journal.pone.0308606. View

17.

Grawehr M, Sener B, Waltimo T, Zehnder M . Interactions of ethylenediamine tetraacetic acid with sodium hypochlorite in aqueous solutions. Int Endod J. 2003; 36(6):411-7. DOI: 10.1046/j.1365-2591.2003.00670.x. View

18.

Torabinejad M, Handysides R, Khademi A, Bakland L . Clinical implications of the smear layer in endodontics: a review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002; 94(6):658-66. DOI: 10.1067/moe.2002.128962. View

19.

Tabbara A, Grigorescu D, Yassin M, Fristad I . Evaluation of Apical Dimension, Canal Taper and Maintenance of Root Canal Morphology Using XP-endo Shaper. J Contemp Dent Pract. 2019; 20(2):136-144. View

20.

Calt S, Serper A . Time-dependent effects of EDTA on dentin structures. J Endod. 2002; 28(1):17-9. DOI: 10.1097/00004770-200201000-00004. View