A Comparative Evaluation of Different Irrigation Activation Techniques on Root Canal Cleanliness: A Scanning Electron Microscope Study

Lubna Ahmad; Prashant Bhasin; Hemanshi Kumar; Vrinda Vats; Prateek Madan; Monika Tandan

doi:10.1055/s-0044-1801306

European Journal of Dentistry, Table of Contents

CC BY 4.0 · Eur J Dent 2025; 19(04): 1071-1077
DOI: 10.1055/s-0044-1801306

Original Article

A Comparative Evaluation of Different Irrigation Activation Techniques on Root Canal Cleanliness: A Scanning Electron Microscope Study

Authors

Lubna Ahmad

¹Department of Conservative Dentistry and Endodontics, Sudha Rustagi College, Pandit Bhagwat Dayal Sharma University of Health Sciences, Faridabad, Haryana, India
Prashant Bhasin

¹Department of Conservative Dentistry and Endodontics, Sudha Rustagi College, Pandit Bhagwat Dayal Sharma University of Health Sciences, Faridabad, Haryana, India
Hemanshi Kumar

¹Department of Conservative Dentistry and Endodontics, Sudha Rustagi College, Pandit Bhagwat Dayal Sharma University of Health Sciences, Faridabad, Haryana, India
Vrinda Vats

¹Department of Conservative Dentistry and Endodontics, Sudha Rustagi College, Pandit Bhagwat Dayal Sharma University of Health Sciences, Faridabad, Haryana, India
Prateek Madan

¹Department of Conservative Dentistry and Endodontics, Sudha Rustagi College, Pandit Bhagwat Dayal Sharma University of Health Sciences, Faridabad, Haryana, India
Monika Tandan

²Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, India

Abstract

Objective

This article compares the effect of ultrasonic, sonic activation of intracanal heated 3% sodium hypochlorite and laser-activated 3% sodium hypochlorite (NaOCl) on root canal cleanliness using scanning electron microscope.

Materials and Methods

Eighty-eight permanent mandibular premolars were extracted and decoronated to obtain 14 mm of standardized root length. Working length was calculated and canals were prepared till size 25/0.04. Samples were randomly divided into four groups according to the method of irrigation employed (n = 22)—group A: passive ultrasonic irrigation (PUI) of 3% intracanal heated NaOCl, group B: sonic activation of 3% intracanal heated NaOCl, group C: activation of 3% NaOCl by diode laser, and group D: conventional needle irrigation (CNI). Samples were split into two halves and the presence of debris at these regions was graded under scanning electron microscope. The chi-square test was employed to assess significant differences in cleanliness scores and pairwise comparisons using the Dunn test were performed to identify specific group difference. A p-value of < 0.05 was kept as level of significance for all analysis.

Results

Group A and group B showed maximum cleanliness in middle third as compared with apical third. Group C (laser) showed better cleanliness in apical third as compared with middle third. While group D (CNI) irrigation showed the lowest cleaning efficiency both in the middle third and apical third.

Conclusion

It was concluded that PUI with intracanal heating of 3% NaOCl and diode laser activation of 3% NaOCl can be recommended as a potential irrigant activation strategy to effectively clean inaccessible areas of the root canal system.

Keywords

diode laser - root canal cleanliness - scanning electron microscope - sonic - ultrasonic activation

Full Text

References

References
1 Kandaswamy D, Venkateshbabu N. Root canal irrigants. J Conserv Dent 2010; 13 (04) 256-264
2 Iqbal A. Antimicrobial irrigants in the endodontic therapy. Int J Health Sci (Qassim) 2012; 6 (02) 186-192
3 Iandolo A, Abdellatif D, Amato M. et al. Dentinal tubule penetration and root canal cleanliness following ultrasonic activation of intracanal-heated sodium hypochlorite. Aust Endod J 2020; 46 (02) 204-209
4 de Gregorio C, Estevez R, Cisneros R, Heilborn C, Cohenca N. Effect of EDTA, sonic, and ultrasonic activation on the penetration of sodium hypochlorite into simulated lateral canals: an in vitro study. J Endod 2009; 35 (06) 891-895
5 Mozo S, Llena C, Forner L. Review of ultrasonic irrigation in endodontics: increasing action of irrigating solutions. Med Oral Patol Oral Cir Bucal 2012; 17 (03) e512-e516
6 Plazza FA, Dal-Fabbro R, Cosme-Silva L. et al. Effectiveness of passive ultrasonic irrigation protocols in simulated complex root canal cavities. Oral (Basel) 2022; 3 (01) 1-10
7 Tashkandi N, Alghamdi F. Effect of chemical debridement and irrigant activation on endodontic treatment outcomes: an updated overview. Cureus 2022; 14 (01) e21525
8 Rajakumaran A, Ganesh A. Comparative evaluation of depth of penetration of root canal irrigant after using manual, passive ultrasonic, and diode laser–assisted irrigant activation technique. J Pharm Bioallied Sci 2019; 11 (6, Suppl 2): S216-S220
9 De Santis R, Iaculli F, Lodato V. et al The efficacy of selected sodium hypochlorite heating methods for increasing and maintaining its intracanal temperature-an ex vivo study. Appl Sci (Basel) 2022; 12 (02) 891
10 Iandolo A, Amato M, Dagna A. et al. Intracanal heating of sodium hypochlorite: Scanning electron microscope evaluation of root canal walls. J Conserv Dent 2018; 21 (05) 569-573
11 Singh S. Microscopes in conservative dentistry and endodontics research. J Conserv Dent 2022; 25 (04) 333-337
12 Hülsmann M, Rümmelin C, Schäfers F. Root canal cleanliness after preparation with different endodontic handpieces and hand instruments: a comparative SEM investigation. J Endod 1997; 23 (05) 301-306
13 Iandolo A, Iandolo G, Malvano M, Pantaleo G, Simeone M. Modern technologies in endodontics. G Ital Endod 2016; 30 (01) 2-9
14 Eriksson AR, Albrektsson T. Temperature threshold levels for heat-induced bone tissue injury: a vital-microscopic study in the rabbit. J Prosthet Dent 1983; 50 (01) 101-107
15 Memon K, Hegde V, Chopra M. Comparative assessment of the antimicrobial efficacy of chitosan, ethylenediaminetetraacetic acid, sodium hypochlorite and chlorhexidine against enterococcus faecalis at different irrigant temperatures: an in vitro study. Int J Applied Dent Sci 2020; 6 (03) 665-670
16 Ahmad Ali I, Layous K, Alzoubi H. Evaluating the effectiveness of different irrigant activation techniques in removing the smear layer and opening the dentinal canals: a scanning electron microscopic study. Cureus 2023; 15 (01) e33961
17 Malentacca A, Uccioli U, Mannocci F. et al. The comparative effectiveness and safety of three activated irrigation techniques in the isthmus area using a transparent tooth model. Int Endod J 2018; 51 (Suppl. 01) e35-e41
18 Rajamanickam K, Teja KV, Ramesh S. et al Evaluation of root canal cleanliness on using a novel irrigation device with an ultrasonic activation technique: an ex vivo study. Appl Sci (Basel) 2023; 13 (02) 796
19 Abouzaid K, Dhaimy S. Efficacy of sonic versus ultrasonic irrigation in debris removal from the root canal system: a systematic review. Oral Heal Dent Sci 2021; 5 (03) 1-13
20 Jiang LM, Verhaagen B, Versluis M, van der Sluis LWM. Evaluation of a sonic device designed to activate irrigant in the root canal. J Endod 2010; 36 (01) 143-146
21 Jambagi N, Kore P, Dhaded NS, Patil SA, Shankar M. Comparison of antimicrobial efficacy of diode laser, ultrasonic activated and conventional irrigation with 2.5% NaOCl during RCT: an interventional study. J Contemp Dent Pract 2021; 22 (06) 669-673
22 Pelozo LL, Silva-Neto RD, Salvador SL, Sousa-Neto MD, Souza-Gabriel AE. Adjuvant therapy with a 980-nm diode laser in root canal retreatment: randomized clinical trial with 1-year follow-up. Lasers Med Sci 2023; 38 (01) 77
23 Romeo U, Palaia G, Nardo A. et al. Effectiveness of KTP laser versus 980 nm diode laser to kill Enterococcus faecalis in biofilms developed in experimentally infected root canals. Aust Endod J 2015; 41 (01) 17-23
24 Amin K, Masoodi A, Nabi S. et al. Effect of diode laser and ultrasonics with and without ethylenediaminetetraacetic acid on smear layer removal from the root canals: a scanning electron microscope study. J Conserv Dent 2016; 19 (05) 424-427
25 Raducka M, Piszko A, Piszko PJ. et al Narrative review on methods of activating irrigation liquids for root canal treatment. Appl Sci (Basel) 2023; 13 (13) 7733
26 Alghamdi F, Almehmadi A. Comparison of debridement efficacy and periapiacl repair using apical negative pressure irrigation versus syringe irrigation- a systematic review. Egypt Dent J 2019; 65 (04) 3535-3542
27 van der Sluis LWM, Versluis M, Wu MK, Wesselink PR. Passive ultrasonic irrigation of the root canal: a review of the literature. Int Endod J 2007; 40 (06) 415-426
28 Alzamzami ZT, Alqurashi AA, Almansour LA. et al. Current trends in irrigation solution and adjunct use during endodontic therapy among dental professionals in Jeddah, Saudi Arabia: a cross-sectional study. Cureus 2022; 14 (12) e32168
29 Tonini R, Salvadori M, Audino E, Sauro S, Garo ML, Salgarello S. Irrigating solutions and activation methods used in clinical endodontics: a systematic review. Front Oral Health 2022; 3: 838043
30 Singh R, Nikhil V, Jaiswal S, Gupta S, Raj S, Arora R. A comparative evaluation of the efficacy of activated irrigation protocol on root canal debridement – a scanning electron microscopic study. Endodontology 2020; 32 (01) 26
31 Liu C, Li Q, Yue L, Zou X. Evaluation of sonic, ultrasonic, and laser irrigation activation systems to eliminate bacteria from the dentinal tubules of the root canal system. J Appl Oral Sci 2022; 30: e20220199
32 Elkhodary S, Morsy D. Efficacy of diode laser activated irrigation (980 nm) and passive ultrasonic irrigation in terms of smear layer removal in oval-shaped canals: a comparative in-vitro study. Egypt Dent J 2023; 69 (02) 1709-1719