Effectiveness of different irrigant activation techniques in removing smear layer: a scanning electron microscope study

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Okba Mahmoud
Sura Alsanafi
Hajir AlKhazraji
Karwan Alyouzbaky

Abstract

Background: This study evaluated the effectiveness of Laser-Activated Irrigation (LAI), XP-Endo Finisher, and Endo Activator in removing the smear layer from root canal walls by assessing dentinal tubule opening in the coronal, middle, and apical thirds using scanning electron microscopy. Materials and Methods: Thirty single-rooted human anterior teeth were decoronated to a standardized length and prepared using the WaveOne Gold primary rotary system. The samples were randomly divided into three experimental groups (n=10): LAI, XP-Endo Finisher, and Endo Activator, along with a control group irrigated using a conventional syringe technique. The roots were split longitudinally and examined under SEM at 1000x magnification. Images were obtained from the coronal, middle, and apical thirds. Data were analyzed using the Kruskal–Wallis test, with statistical significance set at p<0.05. Results: No statistically significant differences were observed among the three experimental groups in any root third. However, all experimental groups showed significantly better smear layer removal compared with the control group. LAI demonstrated minimal smear layer and greater dentinal tubule openness in the coronal and middle thirds, although remnants persisted apically. The XP-Endo Finisher showed superior performance in the apical third, producing a thinner smear layer. The Endo Activator was most effective in the middle third but left substantial smear layer coverage apically. Complete smear layer removal in the apical third was not achieved by any method. Conclusions: XP-Endo Finisher was most effective apically; Endo Activator in the middle third; and LAI coronally. Utilizing advanced and varied techniques improves smear removal over conventional irrigation.

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1.
Mahmoud O, Alsanafi S, AlKhazraji H, Alyouzbaky K. Effectiveness of different irrigant activation techniques in removing smear layer: a scanning electron microscope study. J Bagh Coll Dent [Internet]. 2026 Mar. 15 [cited 2026 Mar. 15];38(1):1-13. Available from: https://jbcd.uobaghdad.edu.iq/index.php/jbcd/article/view/4146

References

Zehnder M. Root canal irrigants. J Endod. 2006;32:389–398.

Alghamdi F, Shakir M. The influence of Enterococcus faecalis as a dental root canal pathogen on endodontic treatment: a systematic review. Cureus, 2020 Mar 13. 12(3):e7257.

A Mader CL, Baumgartner JC, Peters DD. Scanning electron microscopic investigation of the smeared layer on root canal walls. J Endod. (1984) 10:477–83.

Van der Sluis LW, Versluis M, Wu MK, Wesselink PR. Passive ultrasonic irrigation of the root canal: a review of the literature. Int Endod J. 2007 Jun; 40(6):415-26.

Crumpton BJ, Goodell GG, McClanaban SB. Effects on smear layer and debris removal with varying volumes of 17% REDTA after rotary instrumentation. J Endod. 2005; 31:536–8.

Baumgartner JC, Mader CL. A scanning electron microscopic evaluation of four root canal irrigation regimens. J Endod. 1987;13:147–57.

Teixeira CS, Felippe MC, Felippe WT. The effect of application time of EDTA and NaOCl on intracanal smear layer removal: An SEM analysis. Int Endod J. 2005;38:285–90.

Khedmat S, Shokouhinejad N. Comparison of the efficacy of the three chelating agents in smear layer removal. J Endod. 2008;34:599–602.

Senia ES, Marshall FJ, Rosen S. The solvent action of sodium hypochlorite on pulp tissue of extracted teeth. Oral Surg Oral Med Oral Pathol. 1971;31:96–103,

Baker NA, Eleazer PD, Averbach RE, Seltzer S. Scanning electron microscopic study of the efficacy of various irrigating solutions. J Endod. 1975;1:127–35.

Koçak S, Bağcı N, Çiçek E, Türker SA, Can Sağlam B, Koçak MM. Influence of passive ultrasonic irrigation on the efficiency of various irrigation solutions in removing smear layer: a scanning electron microscope study. Microsc Res Tech. 2017;80:537–542.

Cunningham WT, Balekjian AY. Effect of temperature on collagen-dissolving ability of sodium hypochlorite endodontic irrigant. Oral Surg Oral Med Oral Pathol. 1980;49:175–177.

de Hemptinne F, Slaus G, Vandendael M, Jacquet W, De Moor RJ, Bottenberg P. In vivo intracanal temperature evolution during endodontic treatment after the injection of room temperature or preheated sodium hypochlorite. J Endod. 2015;41:1112–1115.

Iandolo A, Amato M, Dagna A, Poggio C, Abdellatif D, Franco V, et al. Intracanal heating of sodium hypochlorite: Scanning electron microscope evaluation of root canal walls. J Conserv Dent. 2018 Sep-Oct;21(5):569-573.

Blanken JW, Verdaasdonk RM. Cavitation as a working mechanism of the Er, Cr:YSGG laser in endodontics: a visualization study. Open J Stomatol, 2012:2:286-291.

George R, Meyers IA, Walsh LJ. Laser activation of endodontic irrigants with improved conical laser fiber tips for removing smear layer in the apical third of the root canal. J Endod. 2008;34:1524–1527

Lloyd A, Uhles JP, Clement DJ, Garcia-Godoy F. Elimination of intracanal tissue and debris through a novel laser-activated system assessed using high-resolution micro-computed tomography: a pilot study. J Endod. 2014;40:584–587

de Groot SD, Verhaagen B, Versluis M, Wu MK, Wesselink PR, van der Sluis LW. Laser-activated irrigation within root canals: cleaning efficacy and flow visualization. Int Endod J. 2009;42:1077–1083

Blanken J, De Moor RJ, Meire M, Verdaasdonk R. Laser induced explosive vapor and cavitation resulting in effective irrigation of the root canal. Part 1: a visualization study. Lasers Surg Med. 2009;41:514–519

Simeone M, Valletta A, Giudice A, Di Lorenzo P, Iandolo A The activation of irrigation solutions in Endodontics: a perfected technique. Ital Endod. 2015;29:65–69.

Alves FR, Marceliano-Alves MF, Sousa JC, Silveira SB, Provenzano JC, Siqueira JF. Removal of root fillings in curved canals using either reciprocanting single-or rotary multi-instrument systems and a supplementary step with the XP-endo finisher. J Endod. 2016; 42: 1114–1119.

Shalan LA, Al-Huwaizi HF. Cleaning Efficiency of Root Canal after Irrigation with New Irrigation Technique: A Scanning Electron Microscopic Study. Iran Endod J. 2018 Winter;13(1):102-107.

Ulusoy OI, Savur IG, Alacam T, Celik B. The effectiveness of various irrigation protocols on organic tissue removal from simulated internal resorption defects. Int Endod J. 2018; 51: 1030–1036.

Pacheco-Yanes J, Provenzano JC, Marceliano-Alves MF, Gazzaneo I, Perez AR, Goncalves LS, et al. Distribution of sodium hypochlorite throughout the mesial root canal system of mandibular molars after adjunctive irrigant activation procedures: a micro-computed tomographic study. Clin Oral Investig. 2020; 24: 907–914

Haupt F., Meinel M., Gunawardana A., Hulsmann M. Effectiveness of different activated irrigation techniques on debris and smear layer removal from curved root canals: A SEM evaluation. Aust. Endod. J. 2019;46:40–46.

Zhu L, Tolba M, Arola D, Salloum M, Meza F. Evaluation of effectiveness of Er,Cr:YSGG laser for root canal disinfection: theo-retical simulation of temperature elevations in root dentin. J Biomech Eng. 2009 Jul;131(7):071004.

Martins MR, Carvalho MF, Vaz IP, Capelas JA, Martins MA, Gutknecht N. Efficacy of Er,Cr:YSGG laser with endodontical radial firing tips on the outcome of endodontic treatment: blind randomized controlled clinical trial with six-month evaluation. Lasers Med Sci. 2013 Jul;28(4):1049-55.

Caron G, Nham K, Bronnec F, Machtou P. Effectiveness of different final irrigant activation protocols on smear layer removal in curved canals. J Endod. 2010;36(08):1361–1366

Steel B. Lingual Split Versus Surgical Bur Technique in the Extraction of Impacted Mandibular Third Molars: A Systemic Review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114:294.

Azimian S, Bakhtiar H, Azimi S, Esnaashari E. In vitro effect of XP-Endo Finisher on the amount of residual debris and smear layer on the root canal walls. Dent Res J. 2019; 16: 179–184.

Takeda FH, Harashima T, Kimura Y, Matsumoto K. A comparative study of the removal of smear layer by three endodontic irrigants and two types of laser. Int Endod J. 1999;32:32–39.

Armengol V, Jean A, Marion D. Temperature rise during Er: YAG and Nd: YAG laser ablation of dentin. J Endod. 2000;26:138–41.

FKG Dentaire SA. The XP-endo finisher file brochure. Dec 16, 2021.

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.

Nasab Mobarakeh NM, Taheri A, Rahmanian H, Jafarpour D, Rahmanian S. Effect of various irrigating devices on the removal of two different forms of calcium hydroxide from internal resorption cavities. Int J Dent, 2020 Sep 12:2020:8881177.

Parikh M, Kishan KV, Solanki NP, Parikh M, Savaliya K, Bindu VH, et al. Efficacy of removal of calcium hydroxide medicament from root canals by endoactivator and endovac irrigation techniques: a Systematic review of in vitro studies. Contemp Clin Dent. 2019;10(1):135.

Ali A, Bhosale A, Pawar S, Kakti A, Bichpuriya A, Agwan MA. Current trends in root canal irrigation. Cureus. 2022 May 8:14(5):e24833.

Adham AH, Ali AH, Mannocci F. Continuous Chelation Concept in Endodontics. J Bagh Coll Dent [Internet]. 2022 Dec. 15 ;34(4):59-6.

Versiani MA, Carvalho KKT, Mazzi-Chaves JF, Sousa-Neto MD. Micro-computed tomographic evaluation of the shaping ability of XP-endo Shaper, iRaCe, and EdgeFile systems in long oval-shaped canals. J. Endod. 2018;44:489–495.

Miguéns-Vila R, Martín-Biedma B, Aboy-Pazos S, Uroz-Torres D, Álvarez-Nóvoa P, Dablanca-Blanco AB, et al. Effectiveness of Different Irrigant Activation Systems on Smear Layer Removal: A Scanning Electron Microscopic Study. J Clin Med. 2022 Feb 15;11(4):1003.

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