Effectiveness of 1 mol L-1 citric acid and 15% EDTA irrigation on smear layer removal.
OBJECTIVE
The aim of this study was to evaluate in vitro the cleansing and smear layer removal capability of alternate canal irrigation with citric acid and NaOCl.


METHODS
Eighty-one teeth were divided into three groups on the basis of the type of instrumentation, namely, manual stainless steel, Ni-Ti mechanized ProFile .04 taper or MACXim. The groups were further divided on the basis of irrigation protocol: 5% NaOCl alone, NaOCl alternated with 1 mol L-1 citric acid solution or a combination of 15% EDTA and Cetrimide solution. After longitudinal sectioning, dentinal walls were microphotographed with scanning electron microscopy at x300 and x1000 magnifications. Qualitative and quantitative cleansing level evaluations were performed using computerized image analysis software. Data were statistically evaluated using Kruskal-Wallis analysis and t-test.


RESULTS
Qualitative evaluation at x300 and x1000 showed no statistically significant differences in cleansing ability between citric acid, EDTA and NaOCl groups. Quantitative evaluation of smear layer removal, measured as open tubules/total dentinal surface ratio, showed that 1 mol L-1 citric acid solution was comparable to EDTA (11.97% vs. 10.36%) (NS); in samples treated with ProFile .04 taper instruments citric acid was most effective (16.17%), whilst in the group treated with manual instrumentation EDTA and Cetrimide were the most effective (11.94%). Specimens irrigated with 5% NaOCl demonstrated significantly more cleansing than those obtained in the other two groups (P < 0.001).


CONCLUSIONS
1 mol L-1 citric acid solution was as effective in removing smear layer as EDTA, but was superior in specimens treated with ProFile .04 taper instruments.
Di Lenarda
R
R
Institute of Odontology and Stomatology, University of Trieste, Trieste, Italy. dile_rdl@hotmail.com
Cadenaro
M
M
Sbaizero
O
O
D000077286:Cetrimonium; D002593:Cetrimonium Compounds / Q000494:pharmacology; D002614:Chelating Agents / Q000494:pharmacology*; D019343:Citric Acid / Q000494:pharmacology*; D003722:Dental Alloys; D003804:Dentin / Q000187:drug effects* / Q000648:ultrastructure; D003902:Detergents / Q000494:pharmacology; D004202:Disinfectants / Q000494:pharmacology; D004492:Edetic Acid / Q000494:pharmacology*; D004867:Equipment Design; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008855:Microscopy, Electron, Scanning; D009532:Nickel; D012388:Root Canal Irrigants / Q000494:pharmacology*; D018915:Root Canal Preparation / Q000295:instrumentation; D016369:Smear Layer; D012973:Sodium Hypochlorite / Q000494:pharmacology; D013193:Stainless Steel; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D014025:Titanium
D002593:Cetrimonium Compounds; D002614:Chelating Agents; D003722:Dental Alloys; D003902:Detergents; D004202:Disinfectants; D012388:Root Canal Irrigants; C040654:titanium nickelide; D013193:Stainless Steel; D019343:Citric Acid; D009532:Nickel; D004492:Edetic Acid; D014025:Titanium; D012973:Sodium Hypochlorite; D000077286:Cetrimonium