• Restorative Dentistry and Endodontics
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• v.27 no.5
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• pp.535-542
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• 2002

The purpose of this study was to evaluate the effect of EDTA irrigant according to application time and temperature. 31 human mature extracted teeth with a single canal were sectioned with microtome in 3mm thickness and gained 62 samples of root canals. They were distributed randomly into 6 groups of 10 specimens each and control group of 2 specimens. Each specimen was prepared with GT rotary file (Dentsply, Maillefer Co., Swiss) and irrigated with 3 ml sodium hypochlorite every minute. Then smear layer was removed with EDTA solution (PULPDENT$^{\circledR}$, PULPDENT Co., USA.) except two control specimens. Specimens of each group were irrigated with 17% EDTA. The time and temperature of application were as follows : (Table omitted) All specimens were split longitudinally and prepared for examination by scanning electron microscopy. A set of reference micrographs was used to award a debris score as follows: 0 = no smear layer, all tubules clean and open; 1 = no superficial smear layer, tubule openings visible, but some contain debris plug or soft tissue remnants: 2 = moderate smear layer, some tubules open and others closed; 3 = heavy smear layer, most/all tubule openings obscured. Results were evaluated with Kruskal-Wallis test to determine whether there was statistically significant difference among six groups. Pairs of groups were analyzed using the Student-Newman-Keuls Method and Mann-Whitney test. The results were as follows : 1. Control specimens showed heavy smear layer at the canal walls 2. Among the groups applied with EDTA for 2 minutes, group 1 showed the heaviest smear layer, and there was statistically significant difference between group 1 and the other groups(p<0.05). 3. Among the groups applied with EDTA for 5 minutes, group 4 and group 6 showed smear layer but there was no significant difference between them. 4. Among the groups applied with EDTA for the same temperature, group 1 showed heavier smear layer than group 4, and there was statistically significant difference(p<0.05). 5. Among the groups applied with EDTA for the same temperature, group 2 showed heavier smear layer than group 5 and group 3 showed heavier smear layer than group 6. But there was no statistically significant difference among them. From the results above, it could be concluded, EDTA solution is effective in removing of smear layer when it is applied for 5 minutes. If EDTA is applied for 2 minutes, it should be applied above room temperature.

• Proceedings of the KACD Conference
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• 2002.11a
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• pp.720-720
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• 2002

A number of investigations have shown that the presence of bacteria is prerequisite for developing pulpal and/or periradicular pathosis. Depending on the stage of pulpal pathosis, various species of bacteria can be cultured from infected root canals. Kakehashi et al. showed that exposure of pulpal tissue in germ-free rats was characterized by minimal inflammation and dentinal bridging while exposure of pulpal tissue in conventional rats with normal oral flora was characterized by pulpal necrosis, chronic inflammation, and periapical lesions. Currently used methods of cleaning and shaping, especially rotary instrumentation techniques, produce a smear layer that covers root canal walls and the openings to the dentinal tubules. The smear layer contains inorganic and organic substances that include fragments of odontoblastic processes, microorganisms, their by products and necrotic materials. Because of its potential contamination and adverse effect on the outcome of root canal therapy, it seems reasonable to suggest removal of the smear layer for disinfection of the entire root canal system. Presence of this smear layer prevents penetration of intracanal medications into the irregularities of the root canal system and the dentinal tubules and also prevents complete adaptation of obturation materials to the prepared root canal surfaces. Removal of the smear layer by an intracanal irrigant and placement of an antibacterial agent in direct contact with the content of dentinal tubules should allow disinfection of this complex system and better outcome for the root canal therapy. A new solution, which was a mixture of a tetracycline, an acid, and a detergent(MTAD), was developed in the Department of Endodontics, Dental School. Lorna Linda University, USA. It has been demonstrated that MTAD was an effective solution for the removal of the smear layer and does not significantly change the structure of the dentinal tubules when used as a final irrigant in conjunction with 1 % NaOCl as a root canal irrigant. Studies are in progress to compare the anti- microbial properties of this newly developed solution with those of sodium hypochlorite and EDTA that are currently used to irrigate the root canals and remove the smear layer from the surfaces of instrumented root canals.canals.

• Restorative Dentistry and Endodontics
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• v.21 no.1
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• pp.267-279
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• 1996

Microorganisms are implicated the endodontic treatment failures. Persistent endodontic infection may be the result of retention of microorganisms in the dentin of the root canal walls. Dentinal tubules of the root canal walls have been shown to harbor microorganisms. The purpose of this study was to investigate the invasion of microorganism into the root dentin and dentinal tubules. The effects of irrigation solutions and smear layer on bacterial colonization of root canal were evaluated using a scanning electron microscopy. Canals of extracted human teeth with single and straight canals were stepback prepared using normal saline. Tooth samples were divided into four groups according to the irrigation solutions -5 % sodium hypochlorite and normal saline-and smear layer treatment. The smear layer was removed by 5% NaOCl and 20% EDTA for 10 min respectively. After sterilization, they were incubated with each strains of Streptococcus sanguis, Enterococcus faecalis, Staphylococcus aureus and Escherichia coli. Sodium hypochlorite solution reduced the adhesion of microorganisms effectively compared to normal saline. The smear layer inhibited colonization of E. faecalis, S. aureus and E. coli in the root canals due to their blocking of dentianl tubules. But S. sanguis invaded dentinal tubules in the root canals without smear layer. It was suggested that bacterial attachment might be different according to the strains. Sodium hypochlorite inhibited bacterial attachment in the dentinal tubules dramatically. The absence or presence of smear layer affected bacterial invasion of the dentinal tubules.

• Restorative Dentistry and Endodontics
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• v.25 no.4
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• pp.527-535
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• 2000

The purpose of this study was to evaluate effects of smear layer and dentin primers on the sealing ability of root canals. 126 extracted human teeth with single, straight canals and mature apices were used. The Samples were first classified into six groups as follows: presence of smear layer; absence of smear layer; Scotchbond Bond Multi-Purpose; All Bond 2; Mac Bond 2; Clearfil Liner Bond 2. A Positive control was also established. All teeth except the control group were then obturated with thermoplasticized gutta-percha and AH26. Electrochemical and dye penetration technique were later used to evaluate the degree of micro leakage through the root canal. Seventy teeth were then immersed in a 1% potassium chloride solution and An external power supply(DC 10 V) was then applied to the circuit for the electrochemical microleakage test. The degree of Microleakage was determined over period of 28 days before being evaluated. In total, 48 teeth were submitted to the dye infiltration technique. All specimen were suspended in 2% methylene blue dye for 1 week before being longitudinally split. The degree of dye infiltration was measured under a stereo microscope at ${\times}10$ magnification and evaluated. The results were as follows: 1. Apical microleakage increased throughout the test period in all group and one group having a smear layer showed a dramatic increase under electrochemical test (p<0.05). In the group having smear layer, the degree of apical microleakage was the highest, and the micro leakage was much higher than in the smear layer removed group in electrochemical test (p<0.05). Scotchbond Multi-Purpose, All Bond 2, Mac Bond 2 and Clearfil Liner Bond 2 showed lower micro leakage than one group having smear layer. The All Bond 2 and Clearfil Liner Bond 2 treated groups showed the lowest microleakage in electrochemical test (p<0.05). 2. There was no significant difference between the experimental groups in dye penetration technique. These results suggested that the removal of the smear layer from root canal and concomitantly the application of dentin primer into root canal could improve the sealing ability of root canal obturation.

• Restorative Dentistry and Endodontics
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• v.25 no.1
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• pp.116-122
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• 2000

On the instrumented root canal wall, amorphous, irregular smear layer can be observed with Scanning Electron Microscope(SEM). The purpose of this study was to evaluate the effect of the presence or absence of smear layer on the adhesion of Staphylococcus aureus to the dentin of the root canal. Human incisors, extracted within 7 days, with no caries, no fracture, no calcification of canal, were selected. After cutting crown portion at cemento-enamel junction, root canal preparation was done by modified crown-down technique using Profile and Gates - Glidden Drill. During canal preparation, 10ml physiologic saline solution(group1&3) or 10ml 3.5% NaOCl(group2&4) was used as irrigation solution. And 10ml physiologic saline solution(group1&3) or 10ml 0.5M EDTA(group2&4) was applicated for final flush. After vertical sectioning and ethylene oxide gas sterilization, samples(group1&2) were immersed into BHIYHM broth inoculated with Staphylococcus aureus (ATCC 31153) and incubated for 3hrs at $37^{\circ}C$. All samples were prepared for and observed with SEM(JEOL JSM840S). The data were analyzed by Mann-Whitney rank sum test. The conclusions are as follows ; 1. Smear layer covers entire root canal surface after root canal preparation. 2. Smear layer has been removed away and the entrances of dentinal tubules have opened widely, when applying 0.5M EDTA and 3.5% NaOCl. 3. A significantly higher number of bacteria were adhered to the root canal dentin without smear layer(p<0.0001). 4. Smear layer produced during root canal preparation impedes bacterial adhesion and colonization to dentin matrix, therefore inhibits canal reinfection.

• Restorative Dentistry and Endodontics
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• v.16 no.1
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• pp.167-180
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• 1991

The purpose of theis study was to evaluate the effectiveness of ultrasonic instrumentation in removing debris and smear layer from the root canal walls. 54 extracted, permanent single rooted teeth were randomly divided into 6 groups of 9 teeth. After canal preparation, the teeth were longitudinally sectioned. The sepcimens were then naturally dried for 2 days, given a maximun thickness gold coating, and examined under the SEM (JSM-35C type, JAPAN). Photographs of all specimens were then taken of the middle and the apical third of the root canal wall. The results were as follows: 1. In all groups, debris and the smear layer were not completely removed from the canal wall 2. There were no significant differences between at the apical third and at the middle third in removing debris and the smear layer in all groups. 3. There were no significant difference between the step - back group and the ultrasound group in removing debris and smear layer. 4. In general, the step - back/ultrasonund groups showed greater canal debridement than the step - back group or ultrasound group. 5. The step - back/ultrasound group with a No. 25 file for 3 min. showed significantly greater canal debridement than the step-back group (p<0.05), or the other step - back/ultrasound groups(p<0.05).

• Restorative Dentistry and Endodontics
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• v.14 no.2
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• pp.65-76
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• 1989

The purpose of this study was to observe the effect on the removal of dentinal smear layer and morphological changes of reduced dentin surfaces by various dentin surface conditioners. Thirty-two healthy human premolars extracted due to periodontal or orthodontic reasons were used. The teeth were cross-sectioned to expose dentin at the middle portion of the crown with diamond rotary saw. The specimens were then divided into 8 groups. The sectioned dentin surfaces in group 1 to 4 were grinded with No. 400 grit silicone abrasive paper and those in group 5 to 8 were cut with #700 carbide bur under air-water spray. The grinded or cut dentin surfaces were conditioned with 3% $H_2O$, Dentin Conditioner(GC Inter. Corp., Japan), and Scotchprep(3M Dent Prod., U.S.A) according to manufacturer's directions. All the specimens were dried in room temperature for 48 hours, and gold-coated with Eiko ion coater(Eik-engineering Co.), and observed in Hitachi S-450 Scanning electron microscope at 15-25 KV. The following results were obtained; 1. The dentin surfaces grinded with the silicon abrasive paper were rougher in texture and heavier in amount of smear layer than those cut with the carbide bur. 2. Scrubbing of 3% $H_2O_2$ was not effective in removing dentinal smear layer. 3. 20-second conditioning of Dentin Conditioner (GC Inter. Corp) resulted in the removal of a significant amount of the smear layer without removing the tubular plugs and dissolving the peritubular dentin. 4. Scotchprep removed the smear layer very effectively. But at the same time it dissolved the peritubular dentin. 5. Irrespective of the uses of the silicon carbide abrasive paper or the carbide bur the morphological changes of dentin surfaces treated with the same conditioning agents were similar.

• Restorative Dentistry and Endodontics
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• v.40 no.3
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• pp.216-222
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• 2015

Objectives: To evaluate the effects of copolymer of acrylic acid and maleic acid (Poly[AA-co-MA]) and calcium hypochlorite ($Ca(OCl)_2$) on root canal dentin using scanning electron microscope (SEM). Materials and Methods: Twenty-four single-rooted teeth were instrumented and the apical and coronal thirds of each root were removed, leaving the 5 mm middle thirds, which were then separated into two pieces longitudinally. The specimens were randomly divided into six groups and subjected to each irrigant for 5 min as follows: G1, $Ca(OCl)_2$; G2, Poly(AA-co-MA); G3, $Ca(OCl)_2$ + Poly(AA-co-MA); G4, sodium hypochlorite (NaOCl); G5, ethylenediaminetetraacetic acid (EDTA); G6, NaOCl+EDTA. The specimens were prepared for SEM evaluation. Smear layer, debris and erosion scores were recorded by two blinded examiners. One image from G3 was analyzed with energy dispersive spectroscopy (EDS) on suspicion of precipitate formation. Data were analyzed using the Kruskal-Wallis and Dunn tests. Results: G1 and G4 showed the presence of debris and smear layer and they were statistically different from G2, G3, G5 and G6 where debris and smear layer were totally removed (p < 0.05). In G1 and G4, erosion evaluation could not be done because of debris and smear layer. G2, G3 and G5 showed no erosion, and there was no significant difference between them. G6 showed severe erosion and was statistically different from G2, G3 and G5 (p < 0.05). EDS microanalysis showed the presence of Na, P, and Ca elements on the surface. Conclusions: Poly(AA-co-MA) is effective in removing the smear layer and debris without causing erosion either alone or with $Ca(OCl)_2$.

• Restorative Dentistry and Endodontics
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• v.45 no.3
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• pp.28.1-28.13
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• 2020

Objectives: To evaluate the outcome of in vitro studies comparing the effectiveness of QMix irrigant in removing the smear layer in the root canal system compared with other irrigants. Materials and Methods: The research question was developed by using Population, Intervention, Comparison, Outcome and Study design framework. Literature search was performed using 3 electronic databases PubMed, Scopus, and EBSCOhost until October 2019. Two reviewers were independently involved in the selection of the articles and data extraction process. Risk of bias of the studies was independently appraised using revised Cochrane Risk of Bias tool (RoB 2.0) based on 5 domains. Results: Thirteen studies fulfilled the selection criteria. The overall risk of bias was moderate. QMix was found to have better smear layer removal ability than mixture of tetracycline isonomer, an acid and a detergent (MTAD), sodium hypochlorite (NaOCl), and phytic acid. The efficacy was less effective than 7% maleic acid and 10% citric acid. No conclusive results could be drawn between QMix and 17% ethylenediaminetetraacetic acid due to conflicting results. QMix was more effective when used for 3 minutes than 1 minute. Conclusions: QMix has better smear layer removal ability compared to MTAD, NaOCl, Tubulicid Plus, and Phytic acid. In order to remove the smear layer more effectively with QMix, it is recommended to use it for a longer duration.

• Restorative Dentistry and Endodontics
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• v.31 no.3
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• pp.169-178
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• 2006

This study was to verify that the combined application of NaOCl and EDTA was more effective in removal of smear layer than the application of NaOCl alone. furthermore it was aimed to find out the optimal time for the application of EDTA. Thirty five single rooted teeth were cleaned and shaped. NaOCl solution was used as an irrigant during instrumentation. After instrumentation, root canals of the control group were irrigated with 5 ml of NaOCl for 2 minutes. 30 sec, 1 min, and 2 min group were irrigated with 5 ml of 17% EDTA for 30 sec, 1 min, and 2 min respectively. Then the roots were examined with scanning electron microscopy for evaluating removal of smear layer and erosion of dentinal tubule. The results were as follows; 1. The control group: The smear layer was not removed at all. 2. The other groups: 1) $Middle\frac{1}{3}$: All groups showed almost no smear layer. And the erosion occurred more frequently as increasing irrigation time. 2) $Apical\frac{1}{3}$: The cleaning effect of 2 min group was better than the others. The results suggest that 2 min application of 17% EDTA should be adequate to remove smear layer on both $apical\frac{1}{3}\;and\;middle\frac{1}{3}$.