Antimicrobial properties and smear layer management of nine different root canal irrigation solutions

Abstract

The main objective of root canal therapy is cleaning, shaping and obturating the root canal system in three dimensions, as well as preventing reinfection. The objective of this in vitro study was: <ul> <li>to establish the antimicrobial efficacy of nine different root canal irrigation solutions, </li> <li>to determine the smear layer dissolving capabilities of these irrigating solutions, at various levels in straight root canals, and </li> <li>to examine the degree of erosion caused by the irrigation solutions on the root canal walls. </li></ul> Antimicrobial Effects: In this test the antimicrobial activity of nine irrigation solutions against E. faecalis was measured using a disc diffusion test. The antibacterial activity of materials was apparent from circular clear inhibition zones forming around the filtration paper. Effect on Smear Layer: Root canals were prepared by using Pro Taper nickel titanium rotary files. During preparation, the canals were irrigated with copious amounts of 3.5% sodium hypochlorite for 15 minutes. Thereafter, the teeth were randomly divided into nine groups. One group was kept as control. The other eight groups received a final rinse with one of the following irrigation solutions: 18% EDTA, Sterilox, Top Clear 17% EDTA, 2% Chlorhexidine, 10% Citric acid, Biopure MTAD, Ozonated water and Smear Clear. A total of 25ml of each solution was utilized to irrigate each root canal system, and left undisturbed in the root canal for 2 minutes. Biopure MTAD was left in the root canals for 5 minutes. Finally, the irrigation solutions were removed from the root canals with 10ml sterile distilled water. Each root was sectioned horizontally with a diamond disc in sections corresponding with the coronal, middle and apical levels of the root canal system. Each fragment was fractured laterally and prepared according to standard methods for biological SEM evaluation. The absence or presence of the smear layer as well as the amount of erosion of the peritubular dentine was assessed. The One-way ANOVA test was used to determine whether there were any statistical significant differences between the different test groups. No significant inhibition of E. faecalis was observed with sterile water (control) and the undiluted solutions of Sterilox, 10% Citric acid and Ozonated water. However, 3.5% NaOCl, 18% EDTA, Top Clear 17% EDTA, 2% Chlorhexidine, Biopure MTAD and Smear Clear showed significant inhibition of E. faecalis. For the 1/10 diluted solutions no inhibition of E. faecalis was observed with sterile water (control), 3.5% NaOCl, Sterilox, 10% Citric acid and Ozonated water. Biopure MTAD and Smear Clear demonstrated significant inhibition of E. faecalis compared to 18% EDTA, Top Clear 17% EDTA and 2% Chlorhexidine. Biopure MTAD was the only solution that showed significant inhibition of E. faecalis using a 1/100 diluted solution. No inhibition was observed with the 1/1000 diluted test solutions.Scanning electron microscope examination revealed that 3.5% NaOCl and Ozonated water had no visible effect on the smear layer. The 10% Citric acid solution slightly modified the smear layer at the coronal and middle levels of the root canals. There was no visible effect on the smear layer at the apical levels. Sterilox and 2% Chlorhexidine removed the smear layer at the coronal levels, modified it slightly in the middle levels and left the smear layer undisturbed in the apical levels of the root canals. 18% EDTA, Top Clear 17% EDTA, Biopure MTAD and Smear Clear removed the smear layer completely at the coronal levels. At the middle and apical levels of the root canals most of the smear layer was removed. However, there were less open dentinal tubules visible at the apical levels compared to the samples examined at the middle levels of the root canals. It was also noted that Top Clear 17% EDTA caused a significantly high percentage of erosion of the peritubular dentine at the coronal levels of the root canals compared to all the other irrigation solutions. Considering all the results of the present study Biopure MTAD demonstrated the best antimicrobial activity against E. faecalis, and removed most of the smear layer at all three levels of the root canal systems without significant erosion of the peritubular dentine.