Evaluation of Root Canal Cleaning and Irrigant Penetration Using Different Irrigation Protocols: A Combined SEM and Single-Tooth Micro-CT Study

IF 1.7 Q3 DENTISTRY, ORAL SURGERY & MEDICINE

Clinical and Experimental Dental Research Pub Date : 2025-07-17 DOI:10.1002/cre2.70175

Alfredo Iandolo, Niccolò Giuseppe Armogida, Davide Mancino, Gianrico Spagnuolo, Mariangela Cernera, Dina Abdellatif

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Abstract

Objectives

This study evaluated the effectiveness of different irrigation techniques in removing debris and smear layers and in improving irrigant penetration within root canals. Particular attention was given to the 3D Cleaning technique, which combines ultrasonic activation with internal heating of sodium hypochlorite.

Material and Methods

Fifty-one single-rooted human mandibular premolars were used. Group A (n = 50) was divided into five subgroups (n = 10 each), each receiving a different irrigation protocol (control, syringe irrigation, sonic activation, ultrasonic activation, and 3D Cleaning). Scanning electron microscopy (SEM) at ×1000 magnification was used to evaluate debris and smear layer removal based on a validated scoring system. Group B (n = 1) consisted of a single premolar with a lateral canal in the apical third, examined using microcomputed tomography (micro-CT). The same tooth underwent all five irrigation protocols in sequence, with radiopaque irrigant penetration evaluated after each and confirmed through sequential micro-CT scans. A power analysis confirmed the adequacy of sample size (n = 50; α = 0.05, power = 80%). Non-parametric tests were used, including Kruskal–Wallis ANOVA for intergroup comparisons, followed by Mann–Whitney U tests with Bonferroni correction for post hoc pairwise analysis (p < 0.05 considered significant).

Results

The 3D Cleaning technique (ultrasonic activation + internal heating) achieved the lowest debris and smear layer scores and the highest irrigant penetration depth (~0.6 mm) into the lateral canal. The control group showed no penetration and the highest debris scores. Conventional syringe and sonic activation showed moderate cleaning and penetration (0.2–0.3 mm), while ultrasonic activation alone showed slightly better results (~0.4 mm).

Conclusion

The 3D Cleaning technique demonstrated superior effectiveness in root canal cleaning and irrigant penetration compared to conventional irrigation methods. These results support the clinical relevance of heating-activated irrigation protocols to enhance root canal disinfection.

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不同灌洗方案对根管清洁和灌洗剂渗透的评价：SEM和单牙微ct联合研究

目的：本研究评估了不同灌洗技术在清除根管碎片和涂抹层以及改善根管内灌洗剂渗透方面的有效性。特别注意的是3D清洗技术，它结合了超声波激活和次氯酸钠的内部加热。材料与方法使用51颗单根人下颌前磨牙。A组（n = 50）分为5个亚组（每组n = 10），每个亚组接受不同的冲洗方案（对照、注射器冲洗、声波激活、超声激活和3D清洗）。扫描电子显微镜（SEM）在×1000放大使用评估碎片和涂抹层去除基于一个验证的评分系统。B组（n = 1）采用微型计算机断层扫描（micro-CT）检查，包括单个前磨牙和顶部三分之一的外侧管。同一颗牙齿依次接受了所有五种冲洗方案，每一种方案后都评估了不透射线的冲洗渗透，并通过连续的微ct扫描确认。功效分析证实了样本量的充分性(n = 50；α = 0.05，功率= 80%)。采用非参数检验，包括组间比较采用Kruskal-Wallis方差分析，事后两两分析采用Mann-Whitney U检验，Bonferroni校正（p <； 0.05认为显著）。结果三维清洗技术（超声激活+内部加热）获得了最低的碎片和涂抹层评分和最高的冲洗深度（~0.6 mm）进入外侧管。对照组没有穿透，碎片得分最高。常规注射器和超声激活的清洁和穿透程度中等（0.2-0.3 mm），而超声单独激活的效果略好（~0.4 mm）。结论3D清洁技术在根管清洁和灌洗渗透方面优于传统的灌洗方法。这些结果支持加热激活冲洗方案的临床意义，以加强根管消毒。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Experimental Dental Research DENTISTRY, ORAL SURGERY & MEDICINE-

CiteScore

3.30

自引率

5.60%

发文量

165

审稿时长

26 weeks

期刊介绍： Clinical and Experimental Dental Research aims to provide open access peer-reviewed publications of high scientific quality representing original clinical, diagnostic or experimental work within all disciplines and fields of oral medicine and dentistry. The scope of Clinical and Experimental Dental Research comprises original research material on the anatomy, physiology and pathology of oro-facial, oro-pharyngeal and maxillofacial tissues, and functions and dysfunctions within the stomatognathic system, and the epidemiology, aetiology, prevention, diagnosis, prognosis and therapy of diseases and conditions that have an effect on the homeostasis of the mouth, jaws, and closely associated structures, as well as the healing and regeneration and the clinical aspects of replacement of hard and soft tissues with biomaterials, and the rehabilitation of stomatognathic functions. Studies that bring new knowledge on how to advance health on the individual or public health levels, including interactions between oral and general health and ill-health are welcome.