title: Efficacy of four different irrigation techniques combined with 60 °C 3% sodium hypochlorite and 17% EDTA in smear layer removal.
abstract: BACKGROUND
  Efforts to improve the efficacy of smear layer removal by applying irrigant activation at the final irrigation or by elevating the temperature of the irrigant have been reported. However, the combination of such activation protocols with 60 °C 3% sodium hypochlorite (NaOCl) has seldom been mentioned. The aim of this study was to compare the efficacy in smear layer removal of four different irrigation techniques combined with 60 °C 3% NaOCl and 17% EDTA.
  
  
  METHODS
  Fifty single-rooted teeth were randomly divided into five groups (n = 10) according to the irrigant agitation protocols used during chemomechanical preparation(Dentsply Maillefer, Ballaigues, Switzerland): a side-vented needle group, a ultrasonic irrigation (UI) group, a NaviTip FX group, an EndoActivator group, and a control group (no agitation). After each instrumentation, the root canals were irrigated with 1 mL of 3% NaOCl at 60 °C for 1 minute, and after the whole instrumentation, the root canals were rinsed with 1 mL of 17% EDTA for 1 minute. Both NaOCl and EDTA were activated with one of the five irrigation protocols. The efficacy of smear layer removal was scored at the apical, middle and coronal thirds. The Data were statistically analyzed using SAS version 9.2 for Windows (rank sum test for a randomised block design and ANOVA).
  
  
  RESULTS
  No significant differences among the NaviTip FX group, EndoActivator group and control groups, and each of these groups showed a lower score than that of UI group (P < 0.05). Within each group, all three thirds were ranked in the following order: coronal > middle > apical (P < 0.05). In the coronal third, the NaviTip FX group was better than UI group. In the middle and apical third, the differences were not significant among any of the groups.
  
  
  CONCLUSIONS
  Even without any activation, the combination of 60 °C 3% NaOCl and 17% EDTA could remove the smear layer effectively, similar to NaviTip FX or EndoActivator, and these three protocols were more effective than UI. However, regardless of different types of irrigation technique applied, complete removal of the smear layer was not achieved, particularly in the apical third.
authors.forename: Xiangjun
authors.initials: X
authors.lastname: Guo
authors.forename: Hui
authors.initials: H
authors.lastname: Miao
authors.forename: Lei
authors.initials: L
authors.lastname: Li
authors.forename: Shasha
authors.initials: S
authors.lastname: Zhang
authors.forename: Dongyan
authors.initials: D
authors.lastname: Zhou
authors.forename: Yan
authors.initials: Y
authors.lastname: Lu
authors.affiliation: From the Department of Endodontics, School of Stomatology, Tianjin Medical University, #12 Qi Xiang Tai Road, He Ping District, Tianjin 300070, PR China. wu_ligeng@yahoo.com.
authors.forename: Ligeng
authors.initials: L
authors.lastname: Wu
mesh_terms: D003786:Dental Pulp Cavity / Q000187:drug effects* / Q000648:ultrastructure; D003804:Dentin / Q000187:drug effects / Q000648:ultrastructure; D004492:Edetic Acid / Q000627:therapeutic use*; D006358:Hot Temperature; D006801:Humans; D008855:Microscopy, Electron, Scanning; D012388:Root Canal Irrigants / Q000627:therapeutic use*; D018915:Root Canal Preparation / Q000295:instrumentation / Q000379:methods*; D016369:Smear Layer; D012973:Sodium Hypochlorite / Q000627:therapeutic use*; D007507:Therapeutic Irrigation / Q000295:instrumentation / Q000379:methods*; D019227:Tooth Apex / Q000187:drug effects / Q000648:ultrastructure; D016896:Treatment Outcome; D014465:Ultrasonics / Q000295:instrumentation
chemical_list: D012388:Root Canal Irrigants; D004492:Edetic Acid; D012973:Sodium Hypochlorite