title: Root canal debridement efficacy of different final irrigation protocols.
abstract: OBJECTIVE
  To compare the smear layer and debris removal effectiveness of four root canal irrigation protocols as well as their effectiveness in removing remaining soft tissues in curved root canals.
  
  
  METHODS
  The mesiobuccal and mesial root canals of 107 extracted human maxillary and mandibular molars were instrumented using Mtwo rotary NiTi instruments then randomly divided into four groups according to a final rinse protocol: Group 1 (n = 28) - manual agitation of 1% NaOCl and 15% EDTA; Group 2 (n = 26) - CanalBrush agitation of 1% NaOCl and 15% EDTA; Group 3 (n = 26) - 3% H(2) O(2) alternated with 1% NaOCl; Group 4 (n = 27) - passive ultrasonic agitation of 1% NaOCl and 15% EDTA. All irrigation protocols were performed in a closed system. Eleven roots per group were prepared and histologically stained (H&E) to assess percentage of remaining pulpal tissues in the apical thirds. The remaining specimens were split longitudinally and examined under scanning electron microscope at ×2000 magnification to assess smear layer and debris removal. Image Pro Plus 6.0 software was used to analyse smear layer and remaining pulp tissue. Debris presence was scored by two blinded investigators using a five-point scale. Data were analysed using Univariate analysis of variance (GenStat 13, α = 0.05).
  
  
  RESULTS
  CanalBrush and passive ultrasonic irrigation were equally effective with significantly less smear layer and debris than manual agitation and H(2) O(2) alternated with NaOCl (P < 0.05). The H(2) O(2) alternated with NaOCl protocol was significantly more effective in removing pulp tissue remnants in the apical level than manual agitation (P = 0.009) and passive ultrasonic irrigation (P = 0.01).
  
  
  CONCLUSIONS
  CanalBrush was as effective as passive ultrasonic irrigation in smear layer and debris removal. Alternating H(2) O(2) with NaOCl was effective in removing soft tissues from root canal complexities. Further studies are required to evaluate effectiveness of this regimen taking into account irrigant volume differences and effect of root canal system configuration.
authors.affiliation: Melbourne Dental School, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Al-Ali
authors.forename: C
authors.initials: C
authors.lastname: Sathorn
authors.forename: P
authors.initials: P
authors.lastname: Parashos
mesh_terms: D003786:Dental Pulp Cavity / Q000648:ultrastructure; D004492:Edetic Acid / Q000627:therapeutic use; D006801:Humans; D006861:Hydrogen Peroxide / Q000627:therapeutic use; D008855:Microscopy, Electron, Scanning; D008963:Molar; D012388:Root Canal Irrigants / Q000627:therapeutic use*; D018915:Root Canal Preparation / Q000295:instrumentation* / Q000379:methods*; D016369:Smear Layer; D012973:Sodium Hypochlorite / Q000627:therapeutic use; D014464:Ultrasonic Therapy; D014732:Vibration
chemical_list: D012388:Root Canal Irrigants; D004492:Edetic Acid; D006861:Hydrogen Peroxide; D012973:Sodium Hypochlorite