This study evaluated the impact of different methods of irrigant agitation on smear layer removal in the apical third of curved mesial canals of 3 dimensionally (D) printed mandibular molars.

Sixty 3D-printed mandibular second molars were used, presenting a 70° curvature and a Vertucci type II configuration in the mesial root. A round cavity was cut 2 mm from the apex using a trephine of 2 mm in diameter, 60 bovine dentin disks were made, and a smear layer was formed. The dentin disks had the adaptation checked in the apical third of the teeth with wax. The dentin disks were evaluated in environmental scanning electron microscope before and after the following irrigant agitation methods: G1(PIK Ultrasonic Tip), G2 (Passive Ultrasonic Irrigation with Irrisonic– PUI), G3 (Easy Clean), G4 (HBW Ultrasonic Tip), G5 (Ultramint X Ultrasonic tip), and G6 (conventional irrigation-CI) (n = 10). All groups were irrigated with 2.5% sodium hypochlorite and 17% ethylenediaminetetraacetic acid.

All dentin disks were 100% covered by the smear layer before treatment, and all groups significantly reduced the percentage of the smear layer after treatment. After the irrigation protocols, the Ultra-X group showed the lowest coverage percentage, statistically differing from the conventional, PIK, and HBW groups (p < 0.05). There was no significant difference among Ultramint X, PUI-Irrisonic, and Easy Clean (p > 0.05). None of the agitation methods could remove the smear layer altogether.

Ultramint X resulted in the most significant number of completely clean specimens.

This study evaluated the dentinal penetration depth of 2.5% sodium hypochlorite (NaOCl) in root canals with and without preparation and different irrigant activation protocols.

Sixty-three bovine mandibular incisors were randomly allocated to 6 groups (n = 10): G1, preparation + conventional needle irrigation (CNI); G2, preparation + passive ultrasonic irrigation (PUI); G3, preparation + Odous Clean (OC); G4, no preparation + CNI; G5, no preparation + PUI; G6, no preparation + OC; and CG (negative control; n = 3). Samples were filled with crystal violet for 72 hours. Irrigant activation was performed. Samples were sectioned perpendicularly along the long axis, 3 mm and 7 mm from the apex. Images of the root thirds of each block were captured with a stereomicroscope and analyzed with an image analysis software. One-way analysis of variance, followed by the Tukey post hoc test, and the Student’s t-test were used for data analysis, with a significance level of 5%.

The NaOCl penetration depth was similar when preparation was performed, regardless of the method of irrigation activation (p > 0.05). In the groups without preparation, G6 showed greater NaOCl penetration depth (p < 0.05). The groups without preparation had a greater NaOCl penetration depth than those with preparation (p = 0.0019).

The NaOCl penetration depth was similar in groups with root canal preparation. Without root canal preparation, OC allowed deeper NaOCl penetration. The groups without preparation had greater NaOCl penetration than those undergoing root canal preparation.

This study evaluated the effects of different smear layer preparations on the dentin permeability and microtensile bond strength (µTBS) of 2 self-etching adhesives (Clearfil SE Bond [CSE] and Clearfil Tri-S Bond Universal [CTS]) under dynamic pulpal pressure.

Human third molars were cut into crown segments. The dentin surfaces were prepared using 4 armamentaria: 600-grit SiC paper, coarse diamond burs, superfine diamond burs, and carbide burs. The pulp chamber of each crown segment was connected to a dynamic intra-pulpal pressure simulation apparatus, and the permeability test was done under a pressure of 15 cmH₂O. The relative permeability (%P) was evaluated on the smear layer-covered and bonded dentin surfaces. The teeth were bonded to either of the adhesives under pulpal pressure simulation, and cut into sticks after 24 hours water storage for the µTBS test. The resin-dentin interface and nanoleakage observations were performed using a scanning electron microscope. Statistical comparisons were done using analysis of variance and post hoc tests.

Only the method of surface preparation had a significant effect on permeability (p < 0.05). The smear layers created by the carbide and superfine diamond burs yielded the lowest permeability. CSE demonstrated a higher µTBS, with these values in the superfine diamond and carbide bur groups being the highest. Microscopic evaluation of the resin-dentin interface revealed nanoleakage in the coarse diamond bur and SiC paper groups for both adhesives.

Superfine diamond and carbide burs can be recommended for dentin preparation with the use of 2-step CSE.

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.

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.

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.

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.

The aim of this systematic review was to critically analyze previously published studies of the effects of dentin surface pretreatment with deproteinizing agents on the bonding of self-etch (SE) adhesives to dentin. Additionally, a meta-analysis was conducted to quantify the effects of the above-mentioned surface pretreatment methods on the bonding of SE adhesives to dentin.

An electronic search was performed using the following databases: Scopus, PubMed and ScienceDirect. The online search was performed using the following keywords: ‘dentin’ or ‘hypochlorous acid’ or ‘sodium hypochlorite’ and ‘self-etch adhesive.’ The following categories were excluded during the assessment process: non-English articles, randomized clinical trials, case reports, animal studies, and review articles. The reviewed studies were subjected to meta-analysis to quantify the effect of the application time and concentration of sodium hypochlorite (NaOCl) and hypochlorous acid (HOCl) deproteinizing agents on bonding to dentin.

Only 9 laboratory studies fit the inclusion criteria of this systematic review. The results of the meta-analysis revealed that the pooled average microtensile bond strength values to dentin pre-treated with deproteinizing agents (15.71 MPa) was significantly lower than those of the non-treated control group (20.94 MPa).

In light of the currently available scientific evidence, dentin surface pretreatment with deproteinizing agents does not enhance the bonding of SE adhesives to dentin. The HOCl deproteinizing agent exhibited minimal adverse effects on bonding to dentin in comparison with NaOCl solutions.

This study evaluated smear layer removal by different chemical solutions used with or without ultrasonic activation after post preparation.

Forty-five extracted uniradicular human mandibular premolars with single canals were treated endodontically. The cervical and middle thirds of the fillings were then removed, and the specimens were divided into 9 groups: G1, saline solution (NaCl); G2, 2.5% sodium hypochlorite (NaOCl); G3, 2% chlorhexidine (CHX); G4, 11.5% polyacrylic acid (PAA); G5, 17% ethylenediaminetetraacetic acid (EDTA). For the groups 6, 7, 8, and 9, the same solutions used in the groups 2, 3, 4, and 5 were used, respectively, but activated with ultrasonic activation. Afterwards, the roots were analyzed by a score considering the images obtained from a scanning electron microscope.

EDTA achieved the best performance compared with the other solutions evaluated regardless of the irrigation method (p < 0.05).

Ultrasonic activation did not significantly influence smear layer removal.

This study investigated the cleaning ability of ultrasonically activated irrigation (UAI) and a novel activation system with reciprocating motion (EC, EasyClean, Easy Equipamentos Odontológicos) when used with a relatively new chelating agent (QMix, Dentsply). In addition, the effect of QMix solution when used for a shorter (1 minute) and a longer application time (3 minutes) was investigated.

Fifty permanent human teeth were prepared with K3 rotary system and 6% sodium hypochlorite. Samples were randomly assigned to five groups (n = 10) according to the final irrigation protocol: G1, negative control (distilled water); G2, positive control (QMix 1 minute); G3, QMix 1 minute/UAI; G4, QMix 1 minute/EC; G5, QMix 3 minutes. Subsequently the teeth were prepared and three photomicrographs were obtained in each root third of root walls, by scanning electron microscopy. Two blinded and pre-calibrated examiners evaluated the images using a four-category scoring system. Data were statistically analyzed using Kruskal-Wallis and Dunn tests (p < 0.05).

There were differences among groups (p < 0.05). UAI showed better cleaning ability than EC (p < 0.05). There were improvements when QMix was used with auxiliary devices in comparison with conventional irrigation (p < 0.05). Conventional irrigation for 3 minutes presented significantly better results than its use for 1 minute (p < 0.05).

QMix should be used for 1 minute when it is used with UAI, since this final irrigation protocol showed the best performance and also allowed clinical optimization of this procedure.

The aim of this study was to test the hypothesis, that the effectiveness of irrigation in removing smear layer in the apical third of root canal system is dependent on the depth of placement of the irrigation needle into the root canal and the enlargement size of the canal.

Eighty sound human lower incisors were divided into eight groups according to the enlargement size (#25, #30, #35 and #40) and the needle penetration depth (3 mm from working length, WL-3 mm and 9 mm from working length, WL-9 mm). Each canal was enlarged to working length with Profile.06 Rotary Ni-Ti files and irrigated with 5.25% NaOCl. Then, each canal received a final irrigation with 3 mL of 3% EDTA for 4 min, followed by 5 mL of 5.25% NaOCl at different level (WL-3 mm and WL-9 mm) from working length. Each specimen was prepared for the scanning electron microscope (SEM). Photographs of the 3mm area from the apical constriction of each canal with a magnification of ×250, ×500, ×1,000, ×2,500 were taken for the final evaluation.

Removal of smear layer in WL-3 mm group showed a significantly different effect when the canal was enlarged to larger than #30. There was a significant difference in removing apical smear layer between the needle penetration depth of WL-3 mm and WL-9 mm.

Removal of smear layer from the apical portion of root canals was effectively accomplished with apical instrumentation to #35/40 06 taper file and 3 mm needle penetration from the working length.