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Table of Contents   
ORIGINAL RESEARCH  
Year : 2019  |  Volume : 30  |  Issue : 3  |  Page : 420-423
Evaluation of debris and smear layer removal with XP-endo finisher: A scanning electron microscopic study


Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, Sri Ramachandra University, Chennai, Tamil Nadu, India

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Date of Web Publication9-Aug-2019
 

   Abstract 

Context: The presence of smear layer and debris can prevent the irrigant and sealer from penetrating the dentinal tubules thereby compromising the seal of the root canal filling. Aim: This study aims to evaluate the efficacy of XP-endo Finisher with ProTaper Next and HyFlex in smear layer and debris removal. Materials and Methods: Thirty-two extracted mandibular premolar teeth were selected and sectioned at the cementoenamel junction. The roots were then randomly divided into 4 groups. In group 1 and 2, canals were instrumented with X2 ProTaper Next (25 0.06 taper). In group 3 and 4, canals were instrumented with HyFlex system (25 0.06 taper). The canals in group 2 and 4 were further finished with XP-endo Finisher. Irrigation was carried out using 3% sodium hypochlorite during instrumentation, and 17% ethylenediaminetetraacetic acid was used as the final rinse. The roots were then split longitudinally. The canal wall was observed under the scanning electron microscope in coronal, middle, and apical thirds at a magnification of ×400 and ×1000 for evaluation of debris and smear layer, respectively. Photomicrographs were taken, and qualitative assessment for debris and smear layer removal was done. Statistical Analysis Used: The results were analyzed using Kruskal–Wallis test and Mann–Whitney U-test. Results: Lower debris and smear layer scores were seen in canal thirds instrumented with ProTaper Next and XP-endo Finisher (P < 0.01). Conclusion: The use of XP-endo Finisher as an adjuvant during shaping and cleaning produced cleaner root canal walls.

Keywords: Cleaning efficacy, ProTaper Next, smear layer removal, XP-endo Finisher

How to cite this article:
Jayakumaar A, Ganesh A, Kalaiselvam R, Rajan M, Deivanayagam K. Evaluation of debris and smear layer removal with XP-endo finisher: A scanning electron microscopic study. Indian J Dent Res 2019;30:420-3

How to cite this URL:
Jayakumaar A, Ganesh A, Kalaiselvam R, Rajan M, Deivanayagam K. Evaluation of debris and smear layer removal with XP-endo finisher: A scanning electron microscopic study. Indian J Dent Res [serial online] 2019 [cited 2019 Aug 24];30:420-3. Available from: http://www.ijdr.in/text.asp?2019/30/3/420/264127

   Introduction Top


Successful endodontic therapy depends on complete debridement of root canal system. Various studies have reported that irrigant and sealer penetration into dentinal tubules are affected by the presence of a smear layer, which affects the three-dimensional seal of canal.[1],[2] XP-endo Finisher (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) is a recently introduced nickel-titanium rotary finishing file, used after any shaping and cleaning protocol. Dentin conservation and superior cleaning of the root canal were reported to be achieved by XP-endo Finisher. When the file touches the canal wall, the tip squeezes against the wall, initiating an expansion simulating a curved bulb with a diameter up to 6 mm. The advantage of XP-endo Finisher lies in its inherently small core size (ISO 25 in diameter) and zero taper providing better flexibility.[3],[4] Hence, the aim of the present study was to evaluate the efficacy of XP-endo Finisher, after instrumentation with ProTaper Next and HyFlex in improving the smear layer and debris removal.


   Materials and Methods Top


The study protocol (CSP/16/SEP/51/268) was approved by the Institutional Research Ethics Committee. Thirty-two extracted mandibular premolars teeth were selected. At the level of the cementoenamel junction, the crown of each tooth was removed. The teeth were randomly divided into 4 groups as follows:

  • Group 1 (ProTaper Next) – canal instrumented with ProTaper Next rotary system (Dentsply)
  • Group 2 (ProTaper Next + XP-endo Finisher) – canal instrumented with ProTaper Next rotary system and finished with XP-endo Finisher
  • Group 3 (HyFlex) – canal instrumented with HyFlex rotary system. (Coltene)
  • Group 4 (HyFlex + XP-endo Finisher) – canal instrumented with HyFlex rotary system and finished with XP-endo Finisher.


A size 10 K file was used to determine the working length. In Group 1 and 2, the canals were instrumented with X2 ProTaper Next (25 0.06 taper). The canals in Group 2 alone were further finished with XP-endo Finisher. In Group 3 and 4, the canals were instrumented with HyFlex system (25 0.06 taper). The canals in Group 4 alone were further finished with XP-endo Finisher. Irrigation was carried out using 3% sodium hypochlorite between the instruments, while 17% ethylenediaminetetraacetic acid (10 ml) was used as the final rinse. In groups 2 and 4, where the XP-endo Finisher instrument was used, it was placed in the canal filled with the irrigant. Using gentle movements of insertion and withdrawal, the XP-endo Finisher was applied in each canal for 1 min to complete the finishing procedure.

On completion of the shaping and cleaning procedure, the roots were split longitudinally. The dentinal wall of each tooth was observed under the scanning electron microscope (SEM) (Phenom XL) in the region of coronal, middle, and apical thirds at a magnification of ×400 for the evaluation of debris. Further, ×1000 magnification was used for the evaluation of smear layer removal. Photomicrographs were taken. The qualitative assessment of the debris and smear layer on root canal walls was based on the criteria of Hülsmann et al.[5] [Table 1] and [Table 2].
Table 1: Qualitative assessment of the smear layer on root canal walls

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Table 2: Qualitative assessment of the debris layer on root canal walls

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Statistical analysis

The results of the present study were analyzed using Kruskal–Wallis Test and Mann–Whitney U-test. P ≤ 0.05 was considered to be statistically significant.


   Results Top


In the present study, when the canals were instrumented with ProTaper Next and HyFlex (Group 1 and 3 respectively), ProTaper Next showed significantly lower (P < 0.05), debris and smear layer scores at coronal, middle, and apical thirds of the canals [Figure 1], [Figure 2] and [Table 3].
Figure 1: Representative scanning electron microscope photomicrographs of debris of different tested groups at the coronal, middle, and apical thirds. a) The coronal third of the canal wall in group 1; b) The middle third of the canal wall in group 1; c) The apical third of the canal wall in group 1; d) The coronal third of the canal wall in group 2; e) The middle third of the canal wall in group 2; f) The apical third of the canal wall in group 2; g) The coronal third of the canal wall in group 3; h) The middle third of the canal wall in group 3; i) The apical third of the canal wall in group 3; j) The coronal third of the canal wall in group 4; k) The middle third of the canal wall in group 4; l) The apical third of the canal wall in group 4

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Figure 2: Representative scanning electron microscope photomicrographs of smear layer of different tested groups at the coronal, middle, and apical thirds a) The coronal third of the canal wall in group 1; b) The middle third of the canal wall in group 1; c) The apical third of the canal wall in group 1; d) The coronal third of the canal wall in group 2; e) The middle third of the canal wall in group 2; f) The apical third of the canal wall in group 2; g) The coronal third of the canal wall in group 3; h) The middle third of the canal wall in group 3; i) The apical third of the canal wall in group 3; j) The coronal third of the canal wall in group 4; k) The middle third of the canal wall in group 4; l) The apical third of the canal wall in group 4

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Table 3: Mean and standard deviation of Groups 1 and 3 at coronal, middle, and apical thirds of the canals for debris and smear layer score

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When the canals were instrumented with ProTaper Next and HyFlex, along with the XP-endo Finisher (Group 2 and 4 respectively), ProTaper Next + XP-endo Finisher showed significantly lower (P < 0.01) debris and smear layer scores at coronal, middle, and apical thirds of the canals [Figure 1], [Figure 2] and [Table 4].
Table 4: Mean and standard deviation of Groups 2 and 4 at coronal, middle, and apical thirds of the canals for debris and smear layer score

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   Discussion Top


In the process of root canal preparation, 1–2 mm thick smear layer composed of mostly inorganic materials is created. Debris is composed of dentinal shavings created during shaping procedures along with vital or necrotic pulp tissue that are adherent to the root canal walls, usually infected with bacteria. Penetration of irrigants and sealers into the dentinal tubules is affected by the presence of smear layer and debris which in turn leads to the compromised seal of root canal filling. SEM evaluation was performed in ×400 and ×1000 magnifications for the analysis of debris and smear layer. Large amounts of debris can also easily be observed at low magnification. Higher magnification is however required for the identification of dentinal tubules and observation of the remnants of the smear layer.

In the current study, irrespective of the instrumentation system used, the coronal thirds of the root canal showed more cleanliness when compared to the middle and apical third of the canals.[6] In both the instrumentation groups, the apical thirds of canals were observed to have less cleanliness when compared to the middle and apical third parts. The ProTaper Next file system showed significantly lower debris and smear layer score when compared to the HyFlex instruments. The above-mentioned findings were in accordance with few previous reports [7],[8] that also showed ProTaper Next to be superior in cleaning efficacy. The cleaning efficacy of ProTaper Next could be attributed to its offset design, the swaggering effect which helps in lesser file engagement, more cross-sectional space for improved cutting, loading, and augering debris.[8],[9] The HyFlex system had significantly higher debris and smear layer score at all the three levels of the canal. The irregular geometry of the file design could be responsible for creating a nonuniform shape of root canal, which in turn could have prevented the flushing of debris and smear layer adequately.[10]

The groups 2 and 4 used ProTaper Next and HyFlex system along with XP-endo Finisher and showed significant reduction in debris and smear layer score. The shape-memory principles of the NiTi alloy and its inherent metallurgy contributed to the efficiency of the XP-endo Finisher. In the cooled state, the file remained straight in its martensitic phase. The shape memory property of the NiTi alloy allows the file to take on the austenitic phase and convert to a sickle shape, when subjected to the body temperature (the canal), thereby increasing its ability to clean and contact areas during the rotation mode.[3],[11],[12] The above-mentioned advantage is difficult to achieve with conventional instrumentation. Once cooled, the file returns to the original martensitic phase and regains its straight shape.


   Conclusion Top


The results of this study seem to point out in the direction that the XP-endo Finisher can be considered as a necessary adjuvant with all contemporary rotary systems to significantly increase the cleaning efficacy of the root canals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Kuruvilla A, Jaganath BM, Krishnegowda SC, Ramachandra PK, Johns DA, Abraham A, et al. A comparative evaluation of smear layer removal by using edta, etidronic acid, and maleic acid as root canal irrigants: An in vitro scanning electron microscopic study. J Conserv Dent 2015;18:247-51.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Acauana MD, Dongaa A, Morgentala RD, Kopperb PM, Luisib SM, Vier-Pelissera FV. Cleaning efficacy of hand and rotary instrumentation techniques in oval-shaped root canals: Scanning electron microscopic study. Rev Odonto Cienc 2013;28:66-70.  Back to cited text no. 2
    
3.
Azim AA, Aksel H, Zhuang T, Mashtare T, Babu JP, Huang GT, et al. Efficacy of 4 irrigation protocols in killing bacteria colonized in dentinal tubules examined by a novel confocal laser scanning microscope analysis. J Endod 2016;42:928-34.  Back to cited text no. 3
    
4.
Leoni GB, Versiani MA, Silva-Sousa YT, Bruniera JF, Pécora JD, Sousa-Neto MD, et al. Ex vivo evaluation of four final irrigation protocols on the removal of hard-tissue debris from the mesial root canal system of mandibular first molars. Int Endod J 2017;50:398-406.  Back to cited text no. 4
    
5.
Hülsmann M, Rümmelin C, Schäfers F. Root canal cleanliness after preparation with different endodontic handpieces and hand instruments: A comparative SEM investigation. J Endod 1997;23:301-6.  Back to cited text no. 5
    
6.
Nazari Moghaddam K, Mehran M, Farajian Zadeh H. Root canal cleaning efficacy of rotary and hand files instrumentation in primary molars. Iran Endod J 2009;4:53-7.  Back to cited text no. 6
    
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Vamshi Krishna V, Sujatha I, Jayalakshmi KB, Prasanna Latha Nadig, Sharath Chandra SM, Mayur GN, et al. Comparison of the cleaning effectiveness of Mtwo & protaper next rotary systems in permanent molar root canals: An in vitro study. Int J Appl Dent Sci 2016;2:19-23.  Back to cited text no. 7
    
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Suparna SG, Poorvi S, Sandeep D, Shubham K. Comparison of root canal cleaning ability of ProTaper NEXT and WaveOne rotary file systems – A scanning electron microscopic (SEM) study. Endodontology 2015;27:124-8.  Back to cited text no. 8
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Capar ID, Arslan H, Akcay M, Ertas H. An in vitro comparison of apically extruded debris and instrumentation times with ProTaper universal, ProTaper next, twisted file adaptive, and HyFlex instruments. J Endod 2014;40:1638-41.  Back to cited text no. 9
    
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Poggio C, Dagna A, Chiesa M, Beltrami R, Bianchi S. Cleaning effectiveness of three NiTi rotary instruments: A focus on biomaterial properties. J Funct Biomater 2015;6:66-76.  Back to cited text no. 10
    
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Elnaghy AM, Mandorah A, Elsaka SE. Effectiveness of XP-endo finisher, EndoActivator, and file agitation on debris and smear layer removal in curved root canals: A comparative study. Odontology 2017;105:178-83.  Back to cited text no. 11
    
12.
Zand V, Mokhtari H, Reyhani MF, Nahavandizadeh N, Azimi S. Smear layer removal evaluation of different protocol of bio race file and XP- endo finisher file in corporation with EDTA 17% and NaOCl. J Clin Exp Dent 2017;9:e1310-4.  Back to cited text no. 12
    

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Correspondence Address:
Dr. Arathi Ganesh
Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, Sri Ramachandra University, Porur, Chennai - 600 116, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.IJDR_655_17

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    Figures

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    Tables

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