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M. Goswami, N. Chhabra, Gyanendra Kumar, M. Verma, A. Chhabra (2014)
Sodium hypochlorite dental accidentsPaediatrics and International Child Health, 34
S. Seltzer, P. Farber (1994)
Microbiologic factors in endodontology.Oral surgery, oral medicine, and oral pathology, 78 5
D. Uroz-Torres, M. González-Rodríguez, C. Ferrer-Luque (2010)
Effectiveness of the EndoActivator System in removing the smear layer after root canal instrumentation.Journal of endodontics, 36 2
Z. Fedorowicz, M. Nasser, Patrick Sequeira-Byron, R. Souza, B. Carter, M. Heft (2012)
Irrigants for non-surgical root canal treatment in mature permanent teeth.The Cochrane database of systematic reviews, 9
M. Mozayeni, Yashar Zadeh, Payam Paymanpour, H. Ashraf, Maryam Mozayani (2013)
Evaluation of push-out bond strength of AH26 sealer using MTAD and combination of NaOCl and EDTA as final irrigationDental Research Journal, 10
S. Stojičić, Ya Shen, Wei Qian, B. Johnson, M. Haapasalo (2012)
Antibacterial and smear layer removal ability of a novel irrigant, QMiX.International endodontic journal, 45 4
S. Paiva, J. Siqueira, I. Rôças, F. Carmo, D. Ferreira, J. Curvelo, R. Soares, A. Rosado (2012)
Supplementing the antimicrobial effects of chemomechanical debridement with either passive ultrasonic irrigation or a final rinse with chlorhexidine: a clinical study.Journal of endodontics, 38 9
Koskinen Kp (1981)
Dissolution of dentin by endodontic irrigants., 77
I. Rôças, M. Hülsmann, J. Siqueira (2008)
Microorganisms in root canal-treated teeth from a German population.Journal of endodontics, 34 8
R. Clarkson, H. Podlich, N. Savage, A. Moule (2003)
A survey of sodium hypochlorite use by general dental practitioners and endodontists in Australia.Australian dental journal, 48 1
F. García, P. Murray, F. García-Godoy, K. Namerow (2010)
Effect of aquatine endodontic cleanser on smear layer removal in the root canals of ex vivo human teethJournal of Applied Oral Science, 18
R. Holliday, A. Alani (2014)
Traditional and contemporary techniques for optimizing root canal irrigation.Dental update, 41 1
A. Solovyeva, P. Dummer (2000)
Cleaning effectiveness of root canal irrigation with electrochemically activated anolyte and catholyte solutions: a pilot study.International endodontic journal, 33 6
N. Takemura, Y. Noiri, A. Ehara, Takashi Kawahara, Nobuo Noguchi, S. Ebisu (2004)
Single species biofilm-forming ability of root canal isolates on gutta-percha points.European journal of oral sciences, 112 6
Brent Crumpton, Gary Goodell, S. McClanahan (2005)
Effects on smear layer and debris removal with varying volumes of 17% REDTA after rotary instrumentation.Journal of endodontics, 31 7
D. Violich, N. Chandler (2010)
The smear layer in endodontics - a review.International endodontic journal, 43 1
Marcelo Gentil, Juliana Pereira, Y. Sousa, R. Pietro, Manoel Neto, L. Vansan, Suzelei França (2006)
In vitro evaluation of the antibacterial activity of Arctium lappa as a phytotherapeutic agent used in intracanal dressingsPhytotherapy Research, 20
C. Stuart, S. Schwartz, T. Beeson, Christopher Owatz (2006)
nterococcus faecalis: Its Role in Root Canal Treatment ailure and Current Concepts in Retreatment
M. Hülsmann, M. Heckendorff, Á. Lennon (2003)
Chelating agents in root canal treatment: mode of action and indications for their use.International endodontic journal, 36 12
G. De-Deus, C. Reis, S. Paciornik (2011)
Critical appraisal of published smear layer-removal studies: methodological issues.Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics, 112 4
NV Chakka, P. Ratnakar, Sanjib Das, Anandamy Bagchi, Sudhir Kumar, Lavanya Anumula (2012)
Do NiTi instruments show defects before separation? Defects caused by torsional fatigue in hand and rotary nickel-titanium (NiTi) instruments which lead to failure during clinical use.The journal of contemporary dental practice, 13 6
L. Peters, P. Wesselink, W. Moorer (1995)
The fate and the role of bacteria left in root dentinal tubules.International endodontic journal, 28 2
G. Ceschel, V. Bergamante, Valeria Calabrese, S. Biserni, C. Ronchi, Adamo Fini (2006)
Design and Evaluation In Vitro of Controlled Release Mucoadhesive Tablets Containing ChlorhexidineDrug Development and Industrial Pharmacy, 32
M. Czonstkowsky, Edmund Wilson, Floyd Holstein (1990)
The smear layer in endodontics.Dental clinics of North America, 34 1
R. Yamada, A. Armas, M. Goldman, P. Lin (1983)
A scanning electron microscopic comparison of a high volume final flush with several irrigating solutions: Part 3.Journal of endodontics, 9 4
A. Lloyd, Jonathan Uhles, D. Clement, F. García-Godoy (2014)
Elimination of intracanal tissue and debris through a novel laser-activated system assessed using high-resolution micro-computed tomography: a pilot study.Journal of endodontics, 40 4
S. Waal, T. Connert, A. Laheij, J. Soet, P. Wesselink (2014)
Free available chlorine concentration in sodium hypochlorite solutions obtained from dental practices and intended for endodontic irrigation: are the expectations true?Quintessence international, 45 6
B. Guilherme, D. Ferreira, I. Rôças, J. Provenzano, K. Santos, J. Siqueira (2011)
Herpesvirus carriage in saliva and posttreatment apical periodontitis: searching for association.Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics, 112 5
M. Brannström, K. Nordenvall, P. Glantz (1980)
The Effect of EDTA-containing Surface- active Solutions on the Morphology of Prepared Dentin: An in vivo StudyJournal of Dental Research, 59
Miriam Magro, Milton Kuga, Keli Victorino, Fernando Vázquez‐Garcia, Arturo Aranda‐Garcia, Norberto Faria‐Junior, G. Faria, André Shinohara (2014)
Evaluation of the interaction between sodium hypochlorite and several formulations containing chlorhexidine and its effect on the radicular dentin—SEM and push‐out bond strength analysisMicroscopy Research and Technique, 77
M. Torabinejad, A. Khademi, Jalil Babagoli, Yong-Soon Cho, W. Johnson, K. Bozhilov, Jayang Kim, S. Shabahang (2003)
A new solution for the removal of the smear layer.Journal of endodontics, 29 3
Harold Stanley, H. Swerdlow (1959)
Reaction of the human pulp to cavity preparation: results produced by eight different operative grinding technics.Journal of the American Dental Association, 58 5
Z. Mohammadi (2009)
Local applications of tetracyclines in endodontics and dental trauma: a review.Dentistry today, 28 1
K. Rao (1996)
Antibacterial activity of some medicinal plants of Papua New Guinea, 34
J. Huque, K. Kota, M. Yamaga, M. Iwaku, E. Hoshino (2002)
Bacterial eradication from root dentine by ultrasonic irrigation with sodium hypochlorite.International endodontic journal, 31 4
H. Kuah, J. Lui, Patrick Tseng, N. Chen (2009)
The effect of EDTA with and without ultrasonics on removal of the smear layer.Journal of endodontics, 35 3
A. Byström, R. Happonen, U. Sjögren, G. Sundqvist (1987)
Healing of periapical lesions of pulpless teeth after endodontic treatment with controlled asepsis.Endodontics & dental traumatology, 3 2
atricia Kho, J. Baumgartner (2006)
Comparison of the Antimicrobial Efficacy of NaOCl / iopure MTAD versus NaOCl / EDTA against nterococcus faecalis
Oleg Panasenko, I. Gorudko, Alexey Sokolov (2013)
Hypochlorous acid as a precursor of free radicals in living systemsBiochemistry (Moscow), 78
S. Fukuzaki (2006)
Mechanisms of actions of sodium hypochlorite in cleaning and disinfection processes.Biocontrol science, 11 4
A. Molander, C. Reit, G. Dahlén, T. Kvist (1998)
Microbiological status of root-filled teeth with apical periodontitis.International endodontic journal, 31 1
A. Law (2013)
Considerations for regeneration procedures.Journal of endodontics, 39 3 Suppl
J. Segura, A. Jiménez-Rubio, J. Guerrero, J. Calvo (1999)
Comparative effects of two endodontic irrigants, chlorhexidine digluconate and sodium hypochlorite, on macrophage adhesion to plastic surfaces.Journal of endodontics, 25 4
Bilge Şen, P. Wesselink, M. Türkün (1995)
The smear layer: a phenomenon in root canal therapy.International endodontic journal, 28 3
R. Clarkson, A. Moule (1998)
Sodium hypochlorite and its use as an endodontic irrigant.Australian dental journal, 43 4
M. Jeansonne, Robert White (1994)
A comparison of 2.0% chlorhexidine gluconate and 5.25% sodium hypochlorite as antimicrobial endodontic irrigants.Journal of endodontics, 20 6
Louis Lin, J. Skribner, P. Gaengler (1992)
Factors associated with endodontic treatment failures.Journal of endodontics, 18 12
Yusof Wz, Khoo Sp (1988)
Mucosal sensitivity to chlorhexidine mouthwash.Singapore dental journal, 13
M. Martín, M. Gallagher (2005)
An investigation of the efficacy of super–oxidised (Optident/Sterilox) water for the disinfection of dental unit water linesBritish Dental Journal, 198
J. Baumgartner, C. Mader (1987)
A scanning electron microscopic evaluation of four root canal irrigation regimens.Journal of endodontics, 13 4
C. Yeşilsoy, E. Whitaker, D. Cleveland, E. Phillips, M. Trope (1995)
Antimicrobial and toxic effects of established and potential root canal irrigants.Journal of endodontics, 21 10
M. Mancini, L. Cerroni, Lorenzo Iorio, E. Armellin, Gabriele Conte, L. Cianconi (2013)
Smear layer removal and canal cleanliness using different irrigation systems (EndoActivator, EndoVac, and passive ultrasonic irrigation): field emission scanning electron microscopic evaluation in an in vitro study.Journal of endodontics, 39 11
M. Torabinejad, Yong-Soon Cho, A. Khademi, L. Bakland, S. Shabahang (2003)
The effect of various concentrations of sodium hypochlorite on the ability of MTAD to remove the smear layer.Journal of endodontics, 29 4
M. Clegg, F. Vertucci, C. Walker, M. Bélanger, Leandro Britto (2006)
The effect of exposure to irrigant solutions on apical dentin biofilms in vitro.Journal of endodontics, 32 5
P. Nair, U. Sjögren, G. Krey, K. Kahnberg, G. Sundqvist (1990)
Intraradicular bacteria and fungi in root-filled, asymptomatic human teeth with therapy-resistant periapical lesions: a long-term light and electron microscopic follow-up study.Journal of endodontics, 16 12
L. Dai, Khaled Khechen, Sara Khan, Brian Gillen, Bethany Loushine, C. Wimmer, J. Gutmann, D. Pashley, F. Tay (2011)
The effect of QMix, an experimental antibacterial root canal irrigant, on removal of canal wall smear layer and debris.Journal of endodontics, 37 1
J. Yamashita, M. Filho, M. Leonardo, M. Rossi, L. Silva (2003)
Scanning electron microscopic study of the cleaning ability of chlorhexidine as a root-canal irrigant.International endodontic journal, 36 6
Gael Delany, Samuel Patterson, Chris Miller, Carl Newton (1982)
The effect of chlorhexidine gluconate irrigation on the root canal flora of freshly extracted necrotic teeth.Oral surgery, oral medicine, and oral pathology, 53 5
A. Kaufman, S. Keila (1989)
Hypersensitivity to sodium hypochlorite.Journal of endodontics, 15 5
A. Bhardwaj, N. Velmurugan, S. Ballal (2013)
Efficacy of passive ultrasonic irrigation with natural irrigants (Morinda citrifolia juice, Aloe Vera and Propolis) in comparison with 1% sodium hypochlorite for removal of E. faecalis biofilm: an in vitro study.Indian journal of dental research : official publication of Indian Society for Dental Research, 24 1
S. Shabahang, Joseph Aslanyan, M. Torabinejad (2008)
The substitution of chlorhexidine for doxycycline in MTAD: the antibacterial efficacy against a strain of Enterococcus faecalis.Journal of endodontics, 34 3
Y. Haïkel, R. Serfaty, T. Lwin, C. Allemann (1996)
Measurement of the cutting efficiency of endodontic instruments: a new concept.Journal of endodontics, 22 12
H. Martin (1991)
Cleanliness, disinfection, and sterilization of the root canal.Current opinion in dentistry, 1 6
M. Torabinejad, Robert Handysides, A. Khademi, L. Bakland (2002)
Clinical implications of the smear layer in endodontics: a review.Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics, 94 6
Yun-Zhong Fang, Sheng Yang, Guoyao Wu (2002)
Free radicals, antioxidants, and nutrition.Nutrition, 18 10
M. Leonardo, M. Filho, Léa Silva, P. Filho, K. Bonifácio, I. Ito (1999)
In vivo antimicrobial activity of 2% chlorhexidine used as a root canal irrigating solution.Journal of endodontics, 25 3
M. Zeltner, O. Peters, F. Paqué (2009)
Temperature changes during ultrasonic irrigation with different inserts and modes of activation.Journal of endodontics, 35 4
M. Mozayeni, G. Javaheri, Pardis Poorroosta, M. Ashari, H. Javaheri (2009)
Effect of 17% EDTA and MTAD on intracanal smear layer removal: a scanning electron microscopic study.Australian endodontic journal : the journal of the Australian Society of Endodontology Inc, 35 1
D. Bajrami, Veton Hoxha, O. Gorduysus, S. Muftuoglu, N. Zeybek, S. Küçükkaya (2014)
Cytotoxic effect of endodontic irrigants in vitroMedical Science Monitor Basic Research, 20
N. Shetty, S. Srinivasan, J. Holton, G. Ridgway (1999)
Evaluation of microbicidal activity of a new disinfectant: Sterilox 2500 against Clostridium difficile spores, Helicobacter pylori, vancomycin resistant Enterococcus species, Candida albicans and several Mycobacterium species.The Journal of hospital infection, 41 2
[Hundreds of bacterial species inhabit the mouth, because of bacterial interactions, nutrient availability and low oxygen potentials in root canals with necrotic pulp, the number of bacterial species present in endodontic infections are restricted. These selective conditions lead to the predominance of facultive and strictly anaerobic microorganisms that survive and multiply, causing infections that stimulate local bone resorption, and are more resistant to endodontic treatment. Instrumentation of the root canal alone is not sufficient to remove infected necrotic tissues. The root canal must never be instrumented dry, an irrigating solution is always needed to reduce the amount of friction between the instrument and dentin surface to prevent binding and sticking. An irrigating solution is also needed to improve the cutting effectiveness of the files and instruments, dissolve tissue, cool the file and tooth, wash debris from the root canal, and be bactericidal in areas of the canal which could not be instrumented. Sodium hypochlorite has been the most widely used root canal irrigating solution for several decades, because it is inexpensive, can quickly dissolve infected necrotic tissues and is bactericidal. Sodium hypochlorite is very toxic to tissues when undiluted and so accidental spillage is always a concern among dentists. A severe limitation of Sodium hypochlorite and most other irrigating solutions is that they are unable to dissolve the instrumentation debris on cut dentin surfaces, called smear layer. The smear layer is a 1 to 5 micron thick layer of cut debris created on the surface of instrumented dentin, composed of dentin, odontoblastic processes, non-specific inorganic contaminants and microorganisms. To remove smear layer a chelating agent must be used after the irrigating solution to help clean the instrumented root canal surfaces. The most widely used chelating agent inside the root canal is 17% ethylenediaminetetraacetic acid (EDTA). A solution of 17% EDTA is a very reliable endodontic chelating agent when used fresh and at room temperature, but its chelating effects are time sensitive. Testing and clinical evidence has shown that 17% EDTA needs to be placed inside the root canal for 1 minute to effectively dissolve organic components and smear layer. The EDTA then needs to be suctioned, dried with paper points, and/or rinsed with Sodium hypochlorite to ensure it has been completely removed from the root canal after use. The process of canal preparation with files, instruments, and irrigating solutions is usually sufficient to remove most of the necrotic and infected tissues. Some recent articles suggest that the ultrasonic activation of irrigating solutions by using a high-speed vacuum; the EndoVac system, and that a laser using photon-induced photoacoustic streaming (PIPS) can improve the debridement of root canals.]
Published: Jul 12, 2014
Keywords: Root Canal; Sodium Hypochlorite; Smear Layer; Dentin Surface; Endodontic Treatment
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