• Restorative Dentistry and Endodontics
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• v.24 no.4
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• pp.578-584
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• 1999

The purpose of this experiment was to determine: (1) the safe automatic apical reverse setting that prevents overinstrumentation of the root canal, using Tri Auto ZX$^{(R)}$ and (2) the effect of various irrigant on such instrumentation. The instrumentation was carried out with the automatic apical reverse setting of 0.5, 1.0, 1.5, and 2.0. The root canal irrigants used in usual manner were normal saline(0.9%), NaOCl(2.5%), and RC Prep$^{(R)}$. For each reverse setting and each irrigant, ten teeth were used with the total of 120 teeth. The distance between the file tip and the apical constriction was determined by stereomicroscope using the point that the file began to rotate in reverse direction. When the reverse setting mode was set to 0.5, 18 of 30 were overinstrumented. If these were discriminated by irrigant, 10 of 6 with 0.9% saline, 10 of 6 with NaOCl, and 10 of 6 with RC Prep$^{(R)}$ has the file tip located 0.57${\pm}$0.30mm, 0.73${\pm}$0.39mm, and 0.26${\pm}$0.25mm beyond the apical constriction respectively. In 1.0 setting 15 of 29 were over the apical constriction, and the distribution was 6 in saline, 5 in NaOCl, and 4 in RC Prep$^{(R)}$. The mean distance over the apical constriction was 0.28${\pm}$0.13mm with saline, 0.75${\pm}$0.61mm with NaOCl, and 0.25${\pm}$0.17mm with RC Prep$^{(R)}$. When the autoatic reverse mode was set to 1.5, and 2.0, 5, and 1 teeth were found to be overinstrumented in respective settings. But there were large variations in overinstrumented distances when an attempt was made to compare the effect of irrigants on this overinstrumentations and they were meaningless for the small sample size. When all of the autoreverse setting were combined to compare the number of overinstrumented teeth with each irrigant, there were no significant differences (14 for normal saline, 12 for NaOCl, 13 for RC Prep$^{(R)}$). When 0.5 or 1.0 automatic apical reverse setting mode was used the Tri Auto ZX$^{(R)}$ in clinical application, the possibility of overinstrumentation beyond the apical constriction exists in 55.9% of cases. Therefore 1.5 or 2.0 setting is safer for the preparation inside the canal but this type setting needs additional apical hand preparation of the root canal because the accuracy is lower than 0.5 or 1.0 setting.

• Restorative Dentistry and Endodontics
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• v.33 no.6
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• pp.560-569
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• 2008

Microorganism survived in the root canal after root canal cleaning and shaping procedure is a main cause of root canal treatment failure. There are several mechanisms for the bacteria to survive in the root canal after chemomechanical preparation and root canal irrigation. Bacteria organized as biofilm has been suggested as an etiology of persistent periapical lesion. Recent studies were focus on removal of Enterococcus faecalis biofilm due to the report that the persistence of this bacteria after root canal treatment may be associated with its ability to form biofilm. Several investigations demonstrated that current root canal treatment protocol including use of NaOCl, EDTA and Chlorhexidine as irrigants is quite effective in eliminating E. faecalis biofilm. However, this microorganism still can survive in inaccessible areas of root canal system and evade host immune response, suppress immune activity and produce biofilm. Up to date, there is no possible clinical method to completely get rid of bacteria from the root canal. Once the root canal treatment failure occurred, and conventional treatment incorporating current therapeutic protocol has failed, periapical surgery or extraction should be considered rather than prolong the in effected retreatment procedure.

• Restorative Dentistry and Endodontics
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• v.18 no.1
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• pp.95-102
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• 1993

Two functions of root canal medicaments and irrigants are to reduce microorganisms and to encourge the repair of apical tissues. The biocompatibility of endodontic materials has been tested using in vitro cell culture techniques. The purpose of this study Was to evaluate and compare the cytotoxic effects of 2 root canal irrigation solutions and 4 antiseptics on HEp-2 and McCoy cells. Two irrigation solutions were sodium hypochlorite. $H_2O_2$ and 4 antiseptics were povidone, ethanol, glutaraldehyde and benzalkonium chloride. Each solutions were serially diluted to 1:1, 1:10, 1:$10^2$, 1:$10^3$, 1:$10^4$, 1:$10^5$, 1:$10^6$. And each diluted solutions were added to the cells and cytotoxic effects were measured with the absorbance of formazan formed cells by ELISA READER. The results were as follows : 1. Benzalkonium chloride was the most cytotoxic on HEp-2 cell. (P<0.05) 2. $H_2O_2$ was the most cytotoxic on McCoy cell. (P<.05) 3. Povidone and ethanol showed mild cytotoxic effect on HEp-2 and McCoy cell. (P<0.05).

• Restorative Dentistry and Endodontics
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• v.42 no.1
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• pp.54-59
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• 2017

Objectives: The purpose of this study was to compare the antibacterial activity of urushiol against Enterococcus faecalis (E. faecalis) to that of NaOCl. Materials and Methods: The canals of thirty two single rooted human teeth were instrumented with Ni-Ti files (ProTaper Next X1, X2, X3, Dentsply). A pure culture of E. faecalis ATCC 19433 was prepared in sterile brain heart infusion (BHI) broth. The teeth were submerged in the suspension of E. faecalis and were incubated at $37^{\circ}C$ for 7 days to allow biofilm formation. The teeth were randomly divided into three experimental groups according to the irrigant used, and a negative control group where no irrigant was used (n = 8). Group 1 used physiologic normal saline, group 2 used 6% NaOCl, and group 3 used 10 wt% urushiol solution. After canal irrigation, each sample was collected by the sequential placement of 2 sterile paper points (ProTaper NEXT paper points, size X3, Dentsply). Ten-fold serial dilutions on each vials, and 100 µL were cultured on a BHI agar plate for 8 hours, and colony forming unit (CFU) analysis was done. The data were statistically analyzed using Kruskal-Wallis and Mann-whitney U tests. Results: Saline group exhibited no difference in the CFU counts with control group, while NaOCl and urushiol groups showed significantly less CFU counts than saline and control groups (p < 0.05). Conclusions: The result of this study suggests 10% urushiol and 6% NaOCl solution had powerful antibacterial activity against E. faecalis when they were used as root canal irrigants.

• Restorative Dentistry and Endodontics
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• v.33 no.4
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• pp.397-404
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• 2008

The purpose of this study was to evaluate the effects of MTAD, EDTA and sodium hypochlorite(NaOCl) as final irrigants on coronal leakage resistance to Enterococcus faecalis. Forty extracted human maxillary molars were used in this experiment. The teeth were randomly divided into positive control group (Group 1; n = 5), negative control group (Group 2; n = 5) and three experimental groups (n = 30). In Group 3 (n = 10), the root canals were irrigated with sodium hypochlorite. In Group 4 (n = 10) and 5 (n = 10), the root canals were irrigated with sodium hypochlorite and rinsed with EDTA and MTAD, respectively. The teeth in each group were cleaned and shaped to #40 profile with .04 taper, and obturated with gutta-percha and AH-26 root canal sealer. The coronal portion of each tooth was placed in contact with inoculum of Enterococcus faecalis in Brain Heart Infusion (BHI) culture media. Each root tip was placed in a vial containing sterile culture media. The vials were placed in anaerobic chamber and observed everyday for turbidity for 180 days. Statistical analysis was performed using Fisher's Exact Test. After 180 days, Group 3, 4, and 5 showed 7, 4 and 5 leaking samples respectively. The differences in leakage resistance were not statistically significant among Group 3, 4 and 5.

• Restorative Dentistry and Endodontics
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• v.9 no.1
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• pp.59-68
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• 1983

The purpose of this study was to examine the influence of canal irrigants and the method of canal filling on the quality of canal obturation. Sixty extracted human teeth with single root were selected and divided into three different groups; In group I (control); 5 cc normal saline irrigated after each instrumentation In group II; 2.5 cc-3% NaOCl in combination with 2.5 cc-3% $H_2O_2$ In group III; RC-Prep in combination with 5 cc-3% NaOCl All specimens were cleaned, shaped(#50 file size), irrigated and obturated by lateral condensation and automated thermatic condensation filling method of gutta-percha and AH-26. After all the specimens were immersed in 2% methylene blue dye solution in $37^{\circ}C$ for 7 days and the degree of dye penetration into the canals observed by magnifying glass(${\times}$20) and reflected light microscope The results were as follows: 1. All the the teeth showed some degree of the dye penetration. 2. There were no significant difference among three groups in the degree of the dye penetration in each canal filling method. 3. There were no significant difference of the dye penetration between each canal filling method in group I. 4. There were no statistically significant difference of the dye penetration between each canal filling method in group II and group III, but lateral condensation group was showed slightly more than automated thermatic condensation group.

• Restorative Dentistry and Endodontics
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• v.45 no.3
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• pp.28.1-28.13
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• 2020

Objectives: 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. Materials and Methods: 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. Results: 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. Conclusions: 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.

• Restorative Dentistry and Endodontics
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• v.42 no.2
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• pp.105-110
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• 2017

Objectives: This study investigated the cleaning ability of ultrasonically activated irrigation (UAI) and a novel activation system with reciprocating motion (EC, EasyClean, Easy Equipamentos $Odontol\acute{o}gicos$) 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. Materials and Methods: 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). Results: 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). Conclusions: 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 Journal of Advanced Prosthodontics
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• v.5 no.4
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• pp.457-463
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• 2013

PURPOSE. The purpose of this study was to compare the effect of a diode laser and traditional irrigants on the bond strength of self-adhesive cement. MATERIALS AND METHODS. Fifty-five incisors extracted due to periodontal problems were used. All teeth were instrumented using a set of rotary root canal instruments. The post spaces were enlarged for a No.14 (diameter, 1.4 mm) Snowlight (Abrasive technology, OH, USA) glass fiber reinforced composite post with matching drill. The teeth were randomly divided into 5 experimental groups of 11 teeth each. The post spaces were treated with the followings: Group 1: 5 mL 0.9% physiological saline; Group 2: 5 mL 5.25% sodium hypochlorite; Group 3: 5 mL 17% ethylene diamine tetra acetic acid (EDTA), Group 4: 37% orthophosphoric acid and Group 5: Photodynamic diode laser irradiation for 1 minute after application of light-active dye solution. Snowlight posts were luted with self-adhesive resin cement. Each root was sectioned perpendicular to its long axis to create 1 mm thick specimens. The push-out bond strength test method was used to measure bond strength. One tooth from each group was processed for scanning electron microscopic analysis. RESULTS. Bond strength values were as follow: Group 1 = 4.15 MPa; Group 2 = 3.00 MPa; Group 3 = 4.45 MPa; Group 4 = 6.96 MPa; and Group 5 = 8.93 MPa. These values were analysed using one-way ANOVA and Tukey honestly significant difference test (P<.05). Significantly higher bond strength values were obtained with the diode laser and orthophosphoric acid (P<.05). There were no differences found between the other groups (P> .05). CONCLUSION. Orthophosphoric acid and EDTA were more effective methods for removing the smear layer than the diode laser. However, the diode laser and orthophosphoric acid were more effective at the cement dentin interface than the EDTA, Therefore, modifying the smear layer may be more effective when a self-adhesive system is used.

• Restorative Dentistry and Endodontics
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• v.26 no.4
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• pp.307-315
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• 2001

The application of Nd:YAG laser and irrigants to the root surface can change its surface configurations. The purpose of this study was to investigate the effects of Nd:YAG laser and irrigants on the apical seal of obturated canals. In this study, 66 single rooted teeth were randomly assigned to 4 group of 14 teeth each. 8 teeth were served us positive and negative controls. The teeth were divided into 6 groups as follows. Group A: Nd:YAG laser, 5% NaOCl + Rc-prep Group B: Nd:YAG laser, Saline Group C: 5% NaOCl + Rc-prep Group D: Saline Group E: Positive control Group F: Negative control 66 teeth were instrumented using Maillefer ProFile$^{\circledR}$ (Orifice Shapers, .04 taper, .06 taper Dentsply, Switzerland). Two of each group were selected at random, and the canal wall surfaces were examined under a SEM. 12 teeth of each group were obturated using by lateral condensation technique. Specimens were immersed in india ink for 7days, decalcified by 10% nitric acid, dehydrated by 75. 80. 85, 90, 95 and 100% alcohol in order cleared by methyl salicylate and then measured of dye penetration with stereomicroscope($\times$15 magnification) and Image Pro plus. The data were analyzed statistically by one-way ANOVA test and Duncan's Multiple Range test. The results were as follows : 1. The mean leakage was 0.128$\pm$0.376 for group A, 0.237$\pm$0.325 for group B, 0.397$\pm$0.468 for group C, 0.586$\pm$0.402 for group D, and there were statistically significant differences between group A and group D, group B and group D. (p<0.05). 2. Group A had better sealing ability than Group C, but there was statistically no significant differences. (p>0.05). 3. Group B had better sealing ability than Group D and there was statistically significant difference. (p<0.05). 4 Group A had better sealing ability than Group B, but there was statistically no significant difference. (p>0.05). 5. Group C had better sealing ability than Group D, but there was statistically no significant difference. (p>0.05). 6. As a result of observation under SEM, Smear layers were removed in Group A, B. but Smear layers were partially removed and smear plugs were remained in Group C, Smear layers were not removed in Group D. To be specially, Melting of smear layer were showed in Group C. 7. These results suggests that the laser has a potential in reducing the apical microleakage of obturated canals.