ENDODONTICS
RERMOVING SMEAR LAYER DURING ENDODONTIC TREATMENT BY DIFFERENT TECHNIQUES- A INVITRO STUDY. A CLINICAL CASE- ENDODONTIC TREATMENT WITH ER: YAG LASER
Sharonit Sahar-Helft 1a *, Adam Stabholtz 1b
1
Department of Endodontics, School of Dental Medicine, Hebrew University – Hadassah, Jerusalem, Israel a
DMD b
DMD, Professor
Received: October 13, 2016 Accepted: October 15, 2016
Available online: October 16, 2016
Cite this article: Sahar-Helft S, Stabholtz A. Rermoving smear layer during endodontic treatment by different techniques- a invitro study. A clinical case- Endodontic treatment with Er: YAG Laser. Stoma Edu J. 2016; 3( 2): 162-167.
ABSTRACT
Introduction: Cleaning and shaping the root canal system during endodontic treatment produces a smear layer and hard tissue debris. Removing smear layer through irrigation is a critical adjunct. Objectives: The aim of this study was( 1) to evaluate in vitro the effect of irrigation techniques, irrigation with syringe-needle and laser-activated irrigation with 17 % EDTA in root canals and( 2) to demonstrate the effect of laser activated irrigation in a patient case. Materials and Methods: Sixty extracted teeth were divided into three equal groups; Group 1: treated only with ProTaper™ F3 Ni-Ti files. Group 2: positive-pressure irrigation: 17 % EDTA was used for 60-second irrigation, with a syringe. Group 3: Er: YAG laser-activated irrigation with 17 % EDTA irrigation was used for 60 second, Laser flat tip was inserted in the upper coronal third of the root canal. Results: Scanning electron microscopy showed that the smear layer is removed most efficiently using laser-activated irrigation with a 17 % EDTA. Conclusion: Smear-layer removal was most effective when the root canals were irrigated using Er: YAG laser at low energy with 17 % EDTA solution. This effect was not observed with the positivepressure techniques. A clinical case demonstrate the effect of using Er: YAG laser activated 17 % EDTA inside root canal. Keywords: endodontic, root canal irrigants, Er-YAG laser, scanning electron microscope, smear layer.
1. Introduction
Root canal treatment is performed to prevent or treat apical periodontitis. Effective endodontic treatment includes cleaning and shaping complex three-dimensional microstructure in which irregular structures such as isthmuses, apical deltas, and lateral canals may be present. The shaping phase aims to enlarge the canal. However creates a smear layer along the root canal walls 1. The smear layer consists of a superficial layer on the surface of the root canal wall approximately 1-2 µ thick and a deeper layer packed into the dentinal tubules to a depth of up to 40 µ 2. It contains inorganic and organic substances, including microorganisms and necrotic debris 3. In addition to the possibility that the smear layer may be infected, it can also protect the bacteria already present in the dentinal tubules by obstructing intra-canal disinfection agents 4.
Pashley 5 considered that a smear layer containing bacteria or bacterial products might provide a reservoir of irritants. Thus, complete removal of the smear layer would be consistent with the elimination of irritants from the root canal system 6. Peters et al. clearly 7 demonstrated that more than 35 % of the surface area of the canals remained unchanged following instrumentation of the root canal using four Ni-Ti preparation techniques. Mechanical instrumentation is always combined with irrigation in order to clean the areas that cannot be reached by instruments, to remove the smear layer, and to promote disinfection. Irrigation of the root canal is traditionally performed using a syringe-needle combination. However, the penetration of the irrigant in the apical third is limited 8-9. Activation of the irrigation solution is suggested to improve their distribution in the canal system and increase irrigation effectiveness. Recent
* Corresponding author:
Dr. Sharonit Sahar-Helft, Department of Endodontics, School of Dental Medicine, The Hebrew University – Hadassah P. O. Box 12272, IL-91120 Jerusalem, Israel tel: 972-2-6777828, fax: 972-2-6778996, e-mail: helft1 @ bezeqint. net
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