The Evaluation of Dentin Microhardness After Use of 17% EDTA, 17% EGTA, 10% Citric Acid, MTAD Used as Chelating Agents Combined With 2.5% Sodium Hypochlorite After Rotary Instrumentation: An In Vitro SEM Study

Effect of Different Irrigating Solutions on Root Canal Dentin Microhardness-A Systematic Review with Meta-Analysis

The aim of this study was to evaluate the effect of different irrigating solutions as well as their combination and activation modes on root canal dentin microhardness. The protocol was registered in PROSPERO and PRISMA guidelines were followed. The structured question was as follows: "Which type of irrigating solution used in endodontic treatment causes more change in dentin microhardness?" The literature was screened via PubMed, Google Scholar, Scopus, and Science Direct. The last search was carried out in February 2023 with English language restriction. Two reviewers independently performed screening and evaluation of articles. A total of 470 articles were retrieved from all the databases, whereas only 114 articles were selected for full-text analysis. After applying eligibility criteria, 44 studies were evaluated and included in this review. The results showed that with increased contact time with irrigants, dentin microhardness decreases. Increased contact time with sodium hypochlorite (NaOCl) was associated with more reduction in dentin microhardness compared with other irrigants. Other irrigants, with the exception of distilled water, including EDTA, citric acid, herbal irrigants, glycolic acid, phytic acid, etc., in this study significantly decreased dentin microhardness. The maximum reduction in dentin microhardness was seen with 2.5% NaOCl after 15 min of contact time. The use of irrigating solutions alters the chemical composition of dentin, thereby decreasing its microhardness, which affects the clinical performance of endodontically treated teeth.

Comparative evaluation of Sapindus Mukorossi extract with 17% EDTA on smear layer removal in various parts of the tooth root

OBJECTIVES

This study aimed to compare the effectiveness of an experimental root canal irrigant and 17% Ethylene-di-amine tetra acetic acid for removal of the smear layer in the coronal, middle and apical portions of the root canal.

MATERIALS AND METHODS

Ninety human single rooted maxillary and mandibular teeth were selected for this study. The teeth were randomly divided into two experimental groups and one control group as follows: Group A (Ethanolic extract of Sapindus Mukorossi), Group B (17% EDTA), and Group C (Distilled water). The root canals of all three groups were prepared with stainless steel K-files by means of the standard step-back technique and irrigated with 5.25% sodium hypo chloride. The teeth were decoronated, following the irrigation and divided longitudinally into two-halves and visualized using scanning electron microscope (SEM) for the amount of smear layer present utilizing the three-point score system. The observations were noted both before and after the treatment. Nonparametric tests were applied for the comparison and p-value ⩽ 0.05 was considered as statistically significant.

RESULTS

It was evident from that smear layer was completely removed in coronal portion of 27 out of 30 teeth in-group A. For middle and apical areas of group A, 24 and 19 teeth showed complete smear layer removal. In-group B it was found that there were 24, 21, and 3 teeth at coronal, middle and apical, areas respectively where smear layer were completely absent. Intra group comparison showed a significant difference (p = 0.002) in smear layer removal was found for group A at coronal, middle and apical thirds. Similarly, a significant difference (p = 0.001) was also found for group B; however heavy smear layer was found among the three parts of the canal for group C.

CONCLUSIONS

Ethanolic extract of Sapindus Mukorossi have higher effectiveness in removing the smear layer from the root canal in comparison to 17% EDTA.

The effect of intracanal medication variations on microhardness of simulated immature root dentin

The effect of different medicaments and irrigation solutions on root dentin microhardness (MH) was evaluated depending on time. After initial measurements, MH of 60 maxillary incisors (n = 15 per group) was measured after 3 steps: irrigation with 2.5% sodium hypochlorite, exposure to medicaments [triple antibiotic (TAP) or calcium hydroxide (CH) pastes, 1 week or 1 month)] and final irrigation [20 mL of 17% EDTA or 20 mL 1% phytic acid (PA)]. The percentage of MH reduction was calculated. Data were analysed statistically at P < 0.05. Treatments caused a significant decrease in MH values compared to baseline and pre-measurements (P < 0.05). TAP significantly reduced the MH values of the samples over time (P < 0.05). Removal of TAP after 1 month with PA resulted in a significant reduction in MH compared to removing TAP after 1 week and CH removing after 1 month (P < 0.05). Considering the chemical preparation steps, the most hazardous effect on MH was observed after the first irrigation.

Comparative evaluation of Chloroquick with Triphala, sodium hypochlorite, and ethylenediaminetetraacetic acid on the microhardness of root canal dentin: An in vitro study

BACKGROUND

Irrigating solutions used for the elimination of microorganisms during root canal preparation affect the chemical and physical properties of dentin, thereby rendering the tooth more prone to fracture. Therefore, the careful and judicious selection of irrigant is required which has maximum benefits with minimum undesirable properties.

AIM

The study aimed to compare and evaluate the effect of Chloroquick with composition of 18% etidronic acid+ 5% sodium hypochlorite (NaOCl) with other irrigants such as Triphala, NaOCl, and ethylenediaminetetraacetic acid (EDTA) on the microhardness of root canal dentin.

METHODS

Forty freshly extracted non-carious single-rooted human teeth were collected and decoronated at CEJ to standardize the canal length. The roots were sectioned longitudinally to get two halves. Baseline microhardness evaluation was done using Vickers microhardness test before the immersion in irrigants; samples were then randomly divided into four groups (n=20), based on the irrigant used as follows: Group 1 - Saline; Group 2 - 5% NaOCl +17% EDTA; Group 3 - Triphala; and Group 4 - Chloroquick. Later, the samples were immersed in the irrigating solutions for 15 min at 37°C for each group and were then subjected to post-treatment microhardness testing. Microhardness values were recorded and statistically analyzed using one-way ANOVA and intergroup comparison with post hoc Tukey test (P<0.05).

RESULTS

The results of the present study showed that all the tested specimens showed a decrease in the microhardness values following application of different irrigating solutions except the control group. The use of Triphala and Chloroquick has minimal effect on the microhardness of root canal dentin post-treatment when compared with 5% NaOCl and 17% EDTA.

CONCLUSION

Chloroquick, as well as 0.005% Triphala, can be used safely as an irrigating solution with less detrimental effects on the hardness of root dentin.

RELEVANCE FOR PATIENTS

The newer irrigant Chloroquick shows less effect on dentin microhardness, thereby reducing the incidence of root fractures in patients postoperatively.