Comparative Evaluation of Intracanal Smear Layer Removal by Different Root Canal Irrigants: A Scanning Electron Microscope Study
S Sudhakar, Nidhi Gupta, Natasha Ghambir, Rashi Singh, Divya Singh
Apple cider vinegar, Neem extract, Root canal irrigants, Sodium hypochlorite
Citation Information :
Sudhakar S, Gupta N, Ghambir N, Singh R, Singh D. Comparative Evaluation of Intracanal Smear Layer Removal by Different Root Canal Irrigants: A Scanning Electron Microscope Study. Int J Clin Pediatr Dent 2023; 16 (4):633-638.
Aim: The purpose of the study is to compare and evaluate the efficacy of different root canal irrigants—100, 75, 50, and 25% neem extract, 100, 75, 50, and 25% apple cider vinegar (ACV), a combination of 5.25% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA), and saline on smear layer removal using a scanning electron microscope (SEM).
Materials and methods: A total of 80 freshly extracted single-rooted teeth were collected and divided into 10 groups—group I: normal saline (negative control), group II: NaOCl with EDTA (positive control), group III: 100% neem extract, group IV: 75% neem extract, group V: 50% neem extract, group VI: 25% neem extract, group VII: 100% ACV, group VIII: 75% ACV, group IX: 50% ACV, and group X: 25% ACV. The samples were irrigated with a specific group of irrigants, then split in a longitudinal axis and processed for analysis in an SEM. Microphotographs were obtained and scored according to Torabinejad et al.
Results: Microphotographs were assessed and showed that 100% neem extract was similar to NaOCl with EDTA, followed by 75% neem extract and 100% ACV.
Conclusion: This study showed that 100% neem extract removed the smear layer, similar to the NaOCl with EDTA.
Hariharan VS, Nandlal B, Srilatha KT. Efficacy of various root canal irrigants on removal of smear layer in the primary root canals after hand instrumentation: a scanning electron microscopy study. J Indian Soc Pedod Prev Dent 2010;28(4):271–277. DOI: 10.4103/0970-4388.76157
Tabrizizadeh M, Kazemipoor M, Hekmati-Moghadam SH, et al. Impact of root canal preparation size and taper on coronal-apical micro-leakage using glucose penetration method. J Clin Exp Dent 2014;6(4):e344–349. DOI: 10.4317/jced.51452
Shah S, Venkataraghavan K, Choudhary P, et al. Evaluation of antimicrobial effect of azadirachtin plant extract (Soluneem (™)) on commonly found root canal pathogenic microorganisms (viz. Enterococcus faecalis) in primary teeth: a microbiological study. J Indian Soc Pedod Prev Dent 2016;34(3):210–261. DOI: 10.4103/0970-4388.186741
Mônika CM, Fröner IC. A scanning electron microscopic evaluation of different root canal irrigation regimens. Braz Oral Res 2006;20(3):235–240. DOI: 10.1590/s1806-83242006000300010
Beltz RE, Torabinejad M, Pouresmail M. Quantitative analysis of the solubilizing action of MTAD, sodium hypochlorite, and EDTA on bovine pulp and dentin. J Endod 2003;29(5):334–337. DOI: 10.1097/00004770-200305000-00004
Lui JN, Kuah HG, Chen NN. Effect of EDTA with and without surfactants or ultrasonics on removal of smear layer. J Endod 2007;33(4):472–475. DOI: 10.1016/j.joen.2006.12.007
Morgan J, Shibeeb S. The potential of apple cider vinegar in the management of type 2 diabetes. Int J Diabetes Res 2016;5(6):129–134. DOI: 10.5923/j.diabetes.20160506.02
Rao SS, Karthik L, Kumar P, et al. Comparative evaluation of smear layer removal by EDTA, apple cider vinegar and fumaric acid when used as irrigant - an invitro atomic force microscopic study. Int J Dent Sci Innov Res 2020;3(4):280–287.
Torabinejad M, Khademi AA, Babagoli J, et al. A new solution for the removal of the smear layer. J Endod 2003;29(3):170–175. DOI: 10.1097/00004770-200303000-00002
Lakshmi T, Krishnan V, Rajendran R, et al. Azadirachta indica: a herbal panacea in dentistry - an update. Pharmacogn Rev 2015;9(17):41–44. DOI: 10.4103/0973-7847.156337
Prashant GM, Chandu GN, Murulikrishna KS, et al. The effect of mango and neem extract on four organisms causing dental caries: Streptococcus mutans, Streptococcus salivavius, Streptococcus mitis, and Streptococcus sanguis: an in vitro study. Indian J Dent Res 2007;18(4):148–151. DOI: 10.4103/0970-9290.35822
Islam B. Dental Caries: From infection to prevention. Med Sci Monit 2017;13(11):196–203.
Babaji P, Jagtap K, Lau H, et al. Comparative evaluation of antimicrobial effect of herbal root canal irrigants (Morinda citrifolia, Azadirachta indica, Aloe vera) with sodium hypochlorite: An in vitro study. J Int Soc Prev Community Dent 2016;6(3):196–199. DOI: 10.4103/2231-0762.183104
Jones RN, Marshall SA, Pfaller MA, et al. Nosocomial enterococcal blood stream infections in the SCOPE Program: antimicrobial resistance, species occurrence, molecular testing results, and laboratory testing accuracy. SCOPE Hospital Study Group. Diagn Microbiol Infect Dis 1997;29(2):95–102. DOI: 10.1016/s0732-8893(97)00115-6
Portenier I, Waltimo TMT, Haapasalo M Enterococcus faecalis- the root canal survivor and ”star” in post-treatment disease. Endodont Topics 2003;6(1):135–159. DOI: 10.1111/j.1601-1546.2003.00040.x
Teja KV, Janani K, Srivastava KC, et al. Comparison of herbal agents with sodium hypochlorite as root canal irrigant: a systematic review of in vitro studies. Evid Based Complement Alternat Med 2021;2021:8967219. DOI: 10.1155/2021/8967219
Clarkson RM, Moule AJ. Sodium hypochlorite and its use as an endodontic irrigant. Aust Dent J 1998;43(4):250–256. DOI: 10.1111/j.1834-7819.1998.tb00173.x
Karataş E, Ayaz N, Uluköylü E, et al. Effect of final irrigation with sodium hypochlorite at different temperatures on postoperative pain level and antibacterial activity: a randomized controlled clinical study. J Appl Oral Sci 2021;29:e20200502. DOI: 10.1590/1678-7757-2020-0502
Panchal V, Gurunathan D, Muralidharan NP. Comparison of antibacterial efficacy of cinnamon extract, neem extract as irrigant and sodium hypochlorite against Enterococcus faecalis: An in vitro study. Indian J Dent Res 2020;31(1):124–128. DOI: 10.4103/ijdr.IJDR_177_18
Sharma A, Chopra H. Chlorhexidine urticaria: a rare occurrence with a common mouthwash. Indian J Dent Res 2009;20(3):377–379. DOI: 10.4103/0970-9290.57368
Divia AR, Nair MG, Varughese JM, et al. A comparative evaluation of Morinda citrifolia, green tea polyphenols, and Triphala with 5% sodium hypochlorite as an endodontic irrigant against Enterococcus faecalis: an in vitro study. Dent Res J (Isfahan) 2018;15(2):117–122. DOI: 10.4103/1735-3327.226526
Patil PH, Gulve MN, Kolhe SJ, et al. Efficacy of new irrigating solution on smear layer removal in apical third of root canal: A scanning electron microscope study. J Conserv Dent 2018;21(2):190–193. DOI: 10.4103/JCD.JCD_155_17
Vemuri S, Kolanu SK, Varri S, et al. Effect of different final irrigating solutions on smear layer removal in apical third of root canal: A scanning electron microscope study. J Conserv Dent 2016;19(1):87–90. DOI: 10.4103/0972-0707.173207
Demirel A, Yüksel BN, Ziya M, et al. The effect of different irrigation protocols on smear layer removal in root canals of primary teeth: an SEM study. Acta Odontol Scand 2019;77(5):380–385. DOI: 10.1080/00016357.2019.1577491
Goldstein J, Newbury DE, Echlin PE, et al. Scanning electron microscope and x-ray microanalysis. 3rd ed. New York: Kluwer Academic Publishers; 2003.
Nanoscience instruments. 2022.Phoenix, USA.
Podar R, Kulkarni GP, Dadu SS, et al. In vivo antimicrobial efficacy of 6% Morinda citrifolia, Azadirachta indica, and 3% sodium hypochlorite as root canal irrigants. Eur J Dent 2015;9(4):529–534. DOI: 10.4103/1305-7456.172615
Wolinsky LE, Mania S, Nachnani S, et al. The inhibiting effect of aqueous Azadirachta indica (Neem) extract upon bacterial properties influencing in vitro plaque formation. J Dent Res 1996;75(2):816–822. DOI: 10.1177/00220345960750021301
Chhabra N, Gyanani H, Kamatagi L. Smear layer removal efficacy of combination of herbal extracts in two different ratios either alone or supplemented with sonic agitation: An in vitro scanning electron microscope study. J Conserv Dent 2015;18(5):374–378. DOI: 10.4103/0972-0707.164035
Ranjitha GR, Mutha SR, Anithakumari R, et al. Comparative evaluation of smear layer removal efficacy of three herbal irrigants in the apical third of the root canal: An in vitro scanning electron microscopic study. SRM J Res Dent Sci 2020;11(2):61–65. DOI: 10.4103/srmjrds.srmjrds_2_20
Afshan T, Parwez A, Prasanna PL, et al. Comparison of antimicrobial efficacy of herbal root canal irrigants (Azadirachta indica, Morinda citrifolia) against Enterococcus faecalis. World J Dent 2020;11(3):206–210. DOI: 10.5005/jp-journals-10015-1733
Rajasekaran C, Meignanam E, Vijayakumar V, et al. Investigation on antibacterial activity of leaf extracts of Azadirachta indica and A.juss (Meliaceae): A traditional medicinal plant of India. Ethnobot Leafl 2008;12:1213–7.
Maragathavalli S, Brindha S, Kaviarasi S et al. Antimicrobial activity in leaf extract of neem (Azadirachta indica). Int J Sci Nat 2012;3(1):110–113.
Alyamany M, Ismai ADAM, Abbas AN, et al. Evaluation of the antibacterial effect of apple cider vinegar, black tea, and sodium hypochlorite irrigant solutions on infected root canal microorganisms of primary teeth: an in vitro study. Al-Azhar J Dent Sci 2022;25(1):99–104.
Mohanty S, Ramesh S, Muralidharan NP. Antimicrobial efficacy of apple cider vinegar against Enterococcus faecalis and Candida albicans: an in vitro study. J Adv Pharm Edu Res 2017;7(2):137–141.