Efficacy of Four Different Irrigation Techniques Combined with 60oC 3% Sodium Hypochlorite and 17% EDTA in Smear Layer Removal

Background: Efforts to improve the efficacy of smear layer removal by applying irrigant activation at the final irrigation or by elevating the temperature of the irrigant have been reported. However, the combination of such activation protocols with 60°C 3% sodium hypochlorite (NaOCl) has seldom been mentioned. The aim of this study was to compare the efficacy in smear layer removal of four different irrigation techniques combined with 60oC 3% NaOCl and 17% EDTA. Methods: Fifty single-rooted teeth were randomly divided into five groups (n=10) according to the irrigant agitation protocols used during chemomechanical preparation as following: a side-vented needle group, a ultrasonic irrigation (UI) group, a NaviTip FX group, an EndoActivator group, and a control group (no agitation). The root canals were prepared with the crown-down technique by using ProTaper nickel-titanium rotary instrument up to size F3. After each instrumentation, the root canals were irrigated with 1 mL of 3% NaOCl at 60oC for 1 minute, and after the whole instrumentation, the root canals were rinsed with 1 mL of 17% EDTA for 1 minute. Both NaOCl and EDTA were activated with one of the five irrigation protocols. The efficacy of smear layer removal was scored at the apical, middle and coronal thirds. The Data were statistically analyzed using SAS version 9.2 for Windows (rank sum test for a randomised block design and ANOVA). Results: No significant differences among the NaviTip FX group, EndoActivator group and control groups, and each of these groups showed a lower score than that of UI group (P < 0.05). Within each group, all three thirds were ranked in the following order: coronal > middle > apical (P < 0.05). In the coronal third, the NaviTip FX group was better than UI group. In the middle and apical third, the differences were not significant among any of the groups. Conclusions: Even without any activation, the combination of 60oC 3% NaOCl used as irrigant during root canal preparation and 17% EDTA as the final irrigant could remove the smear layer effectively, similar to NaviTip FX or EndoActivator, and these three protocols were more effective than UI. However, regardless of different types of irrigation technique used, complete removal of the smear layer, particularly in the apical third, was not achieved