Efficacy of Smear Layer Removal at the Apical One-Third of the Root Using Different Protocols of Erbium-Doped Yttrium Aluminium Garnet (Er:YAG) Laser
<i>Background and Objectives:</i> Smear layer forms during cleaning and shaping can obstruct the entry of both irrigant and sealant into the dentinal tubules, resulting in the accumulation of the bacteria and their byproducts. To ensure effective adhesion and better periapical healing, i...
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MDPI AG
2023-02-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/59/3/433 |
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| author | Amel Yousif Habshi Nausheen Aga Khadija Yousif Habshi Muna Eisa Mohamed Hassan Ziaullah Choudhry Muhammad Adeel Ahmed Azeem Ul Yaqin Syed Rizwan Jouhar |
| author_facet | Amel Yousif Habshi Nausheen Aga Khadija Yousif Habshi Muna Eisa Mohamed Hassan Ziaullah Choudhry Muhammad Adeel Ahmed Azeem Ul Yaqin Syed Rizwan Jouhar |
| author_sort | Amel Yousif Habshi |
| collection | DOAJ |
| description | <i>Background and Objectives:</i> Smear layer forms during cleaning and shaping can obstruct the entry of both irrigant and sealant into the dentinal tubules, resulting in the accumulation of the bacteria and their byproducts. To ensure effective adhesion and better periapical healing, it is strongly advised to remove the smear layer before proceeding with root canal obturation. This study was designed to compare the efficiency of laser-activated irrigation (LAI) in removing the smear layer and debriding the most apical third of the root canal. <i>Materials and Methods:</i> Sixty-five extracted human teeth with straight single roots were randomly and equally divided into four laser and one control groups. Root canals in all samples were shaped using prime size TruNatomy rotary files. During preparation, each canal was irrigated with 3 mL of 3% NaOCl and 3 mL of 17% EDTA alternately, followed by the irrigation with 10 mL of distilled water to avoid the prolonged effect of EDTA and NaOCl solutions. Final irrigation of 5 mL of 17% EDTA of the root canal was done to eliminate the smear layer and was subsequently activated by an endodontic ultrasonic tip for 20 s three times (control group), a flat-end laser tip (test groups 1 and 3) or a taper-end laser tip (test groups 2 and 4) for two cycles. The time of each cycle activation was 10 s (groups 1 and 2) or 20 s (groups 3 and 4) in which the Er:YAG laser of 2940 nm was used. The laser operating parameters were 15 Hz and 50 μs pulse duration. The samples were then split longitudinally and subjected to scanning electron microscopy (SEM). <i>Results:</i> The remaining smear layer at the apical part of the root canals was statistically significant between the control group and the laser groups 1 (<i>p</i> = 0.040) and 2 (<i>p</i> = 0.000). Within the laser groups, the exposed tubules count was greater in the laser with the flat tip as compared with the tapered tip (Laser 1 > Laser 2 and Laser 3 > Laser 4). Finally, no significant differences in the count of debris between the laser groups and control group were observed, except for laser 4 (<i>p</i> < 0.05), which had the highest count of debris. <i>Conclusion:</i> LAI to remove debris and smear layer at the apical third of the root canal is inferior to the current ultrasonic technique. However, when using the Er:YAG LAI, it is recommended to use a flat tip design for 10 s for two cycles to ensure maximum debridement of the apical dentin surface. |
| first_indexed | 2024-03-11T06:13:45Z |
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| language | English |
| last_indexed | 2024-03-11T06:13:45Z |
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| spelling | doaj.art-d08d3668c0b442d18164a421072cb5992023-11-17T12:30:33ZengMDPI AGMedicina1010-660X1648-91442023-02-0159343310.3390/medicina59030433Efficacy of Smear Layer Removal at the Apical One-Third of the Root Using Different Protocols of Erbium-Doped Yttrium Aluminium Garnet (Er:YAG) LaserAmel Yousif Habshi0Nausheen Aga1Khadija Yousif Habshi2Muna Eisa Mohamed Hassan3Ziaullah Choudhry4Muhammad Adeel Ahmed5Azeem Ul Yaqin Syed6Rizwan Jouhar7Emirates Health Service, Ministry of Health and Prevention, Sharjah P.O. Box 3241, United Arab EmiratesSchool of Dentistry, University of Dundee, Dundee DD1 4HN, Scotland, UKEmirates Health Service, Ministry of Health and Prevention, Sharjah P.O. Box 3241, United Arab EmiratesDepartment of Preventive and Restorative Dentistry, University of Sharjah, Sharjah P.O. Box 1962, United Arab EmiratesProsthodontics Department, Dr Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi 74200, PakistanDepartment of Restorative Dental Sciences, College of Dentistry, King Faisal University, Al-Ahsa 31982, Saudi ArabiaDepartment of Prosthodontics, College of Dentistry, University of Science and Technology of Fujairah, Fujairah P.O. Box 2202, United Arab EmiratesDepartment of Restorative Dental Sciences, College of Dentistry, King Faisal University, Al-Ahsa 31982, Saudi Arabia<i>Background and Objectives:</i> Smear layer forms during cleaning and shaping can obstruct the entry of both irrigant and sealant into the dentinal tubules, resulting in the accumulation of the bacteria and their byproducts. To ensure effective adhesion and better periapical healing, it is strongly advised to remove the smear layer before proceeding with root canal obturation. This study was designed to compare the efficiency of laser-activated irrigation (LAI) in removing the smear layer and debriding the most apical third of the root canal. <i>Materials and Methods:</i> Sixty-five extracted human teeth with straight single roots were randomly and equally divided into four laser and one control groups. Root canals in all samples were shaped using prime size TruNatomy rotary files. During preparation, each canal was irrigated with 3 mL of 3% NaOCl and 3 mL of 17% EDTA alternately, followed by the irrigation with 10 mL of distilled water to avoid the prolonged effect of EDTA and NaOCl solutions. Final irrigation of 5 mL of 17% EDTA of the root canal was done to eliminate the smear layer and was subsequently activated by an endodontic ultrasonic tip for 20 s three times (control group), a flat-end laser tip (test groups 1 and 3) or a taper-end laser tip (test groups 2 and 4) for two cycles. The time of each cycle activation was 10 s (groups 1 and 2) or 20 s (groups 3 and 4) in which the Er:YAG laser of 2940 nm was used. The laser operating parameters were 15 Hz and 50 μs pulse duration. The samples were then split longitudinally and subjected to scanning electron microscopy (SEM). <i>Results:</i> The remaining smear layer at the apical part of the root canals was statistically significant between the control group and the laser groups 1 (<i>p</i> = 0.040) and 2 (<i>p</i> = 0.000). Within the laser groups, the exposed tubules count was greater in the laser with the flat tip as compared with the tapered tip (Laser 1 > Laser 2 and Laser 3 > Laser 4). Finally, no significant differences in the count of debris between the laser groups and control group were observed, except for laser 4 (<i>p</i> < 0.05), which had the highest count of debris. <i>Conclusion:</i> LAI to remove debris and smear layer at the apical third of the root canal is inferior to the current ultrasonic technique. However, when using the Er:YAG LAI, it is recommended to use a flat tip design for 10 s for two cycles to ensure maximum debridement of the apical dentin surface.https://www.mdpi.com/1648-9144/59/3/433endodonticsroot canal treatmentcleaningEr:YAG lasersmear layer |
| spellingShingle | Amel Yousif Habshi Nausheen Aga Khadija Yousif Habshi Muna Eisa Mohamed Hassan Ziaullah Choudhry Muhammad Adeel Ahmed Azeem Ul Yaqin Syed Rizwan Jouhar Efficacy of Smear Layer Removal at the Apical One-Third of the Root Using Different Protocols of Erbium-Doped Yttrium Aluminium Garnet (Er:YAG) Laser Medicina endodontics root canal treatment cleaning Er:YAG laser smear layer |
| title | Efficacy of Smear Layer Removal at the Apical One-Third of the Root Using Different Protocols of Erbium-Doped Yttrium Aluminium Garnet (Er:YAG) Laser |
| title_full | Efficacy of Smear Layer Removal at the Apical One-Third of the Root Using Different Protocols of Erbium-Doped Yttrium Aluminium Garnet (Er:YAG) Laser |
| title_fullStr | Efficacy of Smear Layer Removal at the Apical One-Third of the Root Using Different Protocols of Erbium-Doped Yttrium Aluminium Garnet (Er:YAG) Laser |
| title_full_unstemmed | Efficacy of Smear Layer Removal at the Apical One-Third of the Root Using Different Protocols of Erbium-Doped Yttrium Aluminium Garnet (Er:YAG) Laser |
| title_short | Efficacy of Smear Layer Removal at the Apical One-Third of the Root Using Different Protocols of Erbium-Doped Yttrium Aluminium Garnet (Er:YAG) Laser |
| title_sort | efficacy of smear layer removal at the apical one third of the root using different protocols of erbium doped yttrium aluminium garnet er yag laser |
| topic | endodontics root canal treatment cleaning Er:YAG laser smear layer |
| url | https://www.mdpi.com/1648-9144/59/3/433 |
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