Clinical Oral Investigations

, Volume 23, Issue 2, pp 681–687 | Cite as

Micro-CT evaluation of different final irrigation protocols on the removal of hard-tissue debris from isthmus-containing mesial root of mandibular molars

  • Emmanuel João Nogueira Leal SilvaEmail author
  • Carla Rodrigues Carvalho
  • Felipe Gonçalves Belladonna
  • Marina Carvalho Prado
  • Ricardo Tadeu Lopes
  • Gustavo De-Deus
  • Edson Jorge Lima Moreira
Original Article



This study aimed to compare four final irrigation protocols (passive ultrasonic irrigation [PUI], EndoVac, Self-Adjusting File [SAF] and EasyClean) on the removal of accumulated hard-tissue debris (AHTD) from mesial canals of mandibular molars through microcomputed tomographic (micro-CT) analysis.

Materials and methods

Forty mesial roots of mandibular molars presenting isthmuses type I or III were scanned in a micro-CT device and instrumented up to Reciproc R40 instrument. After the completion of canal preparations, root canals of each group were submitted to a final rinse using 20 mL of solution (16 mL of 5.25% NaOCl and 4 mL of 17% EDTA) in a total time of 5 min according to one of the four final irrigation protocols (n = 10): PUI, EndoVac, SAF and EasyClean operated at reciprocating motion. The sample was scanned again after canal preparation and after the use of the final irrigation protocols, and the registered data sets were examined to evaluate the percentage of AHTD. Data were statistically compared using the Tukey test with a significance level set at 5%.


All groups presented a decrease on the accumulation of hard-tissue debris after the use of the final irrigation protocols (P < 0.05). No significant differences in the removal of AHTD were observed among the final irrigation protocols (P > 0.05).


All final irrigation protocols showed the same effectiveness in the removal of AHTD. None of them was able to render mesial canals of mandibular molars completely free from packed debris.

Clinical relevance

This study highlighted that all final irrigation protocols (PUI, EndoVac, SAF, and EasyClean) promoted a similar removal of AHTD. However, none of the final irrigation protocols was able to render mesial canals of mandibular molars completely free from packed debris.


Debris EasyClean Micro-CT Passive ultrasonic irrigation Root canal irrigation 



The authors deny any conflicts of interest related to this study. This study was partially funded by FAPERJ and CNPq.


This study was partially funded by FAPERJ.

Compliance with ethical standards

Conflict of interest

Emmanuel João Nogueira Leal Silva, Carla Rodrigues Carvalho, Felipe Gonçalves Belladonna, Marina Carvalho Prado, Ricardo Tadeu Lopes, Gustavo De-Deus, and Edson Jorge Lima Moreira declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.


  1. 1.
    Metzger Z, Solomonov M, Kfir A (2013) The role of mechanical instrumentation in the cleaning of root canals. Endod Top 29:87–109CrossRefGoogle Scholar
  2. 2.
    Paqué F, Laib A, Gautschi H, Zehnder M (2009) Hard-tissue debris accumulation analysis by high-resolution computed tomography scans. J Endod 35:1044–1047CrossRefGoogle Scholar
  3. 3.
    De-Deus G, Marins J, Silva EJ, Souza E, Belladonna FG, Reis C et al (2015) Accumulated hard tissue debris produced during reciprocating and rotary nickel-titanium canal preparation. J Endod 41:676–681CrossRefGoogle Scholar
  4. 4.
    Lopes RMV, Marins FC, Belladonna FG, Souza EM, De-Deus G, Lopes RT et al. (2017) Untouched canal areas and debris accumulation after root canal preparation with rotary and adaptive systems. Aust Endod J. Google Scholar
  5. 5.
    Zuolo ML, Zaia AA, Belladonna FG, Silva EJNL, Souza EM, Versiani MA et al. (2017) Micro-CT assessment of the shaping ability of four root canal instrumentation systems in oval-shaped canals. Int Endod J 51:564–71CrossRefGoogle Scholar
  6. 6.
    Siqueira JF Jr (2003) Microbial causes of endodontic flare-ups. Int Endod J 36:453–463CrossRefGoogle Scholar
  7. 7.
    De-Deus G, Reis C, Beznos D, de Abranches AM, Coutinho-Filho T, Paciornik S (2008) Limited ability of three commonly used thermoplasticized gutta-percha techniques in filling oval-shaped canals. J Endod 34:1401–1405CrossRefGoogle Scholar
  8. 8.
    Nusstein JM (2015) Sonic and ultrasonic irrigation. In: Bettina B (ed) Endodontic irrigation: chemical disinfection of the root canal system. Springer, Cham, pp 173–198CrossRefGoogle Scholar
  9. 9.
    Nielsen BA, Baumgartner JC (2007) Comparison of the EndoVac system to needle irrigation of root canals. J Endod 33:611–615CrossRefGoogle Scholar
  10. 10.
    Metzger Z, Teperovich E, Zary R, Cohen R, Hof R (2010) The self-adjusting file (SAF). Part 1: respecting the root canal anatomy—a new concept of endodontic files and its implementation. J Endod 36:679–690CrossRefGoogle Scholar
  11. 11.
    Andrade-Junior CV, Batista RM, Marceliano-Alves M, Alves F, Silva EJNL (2016) Efficacy of a new activation device in irrigant penetration into simulated lateral canals. Eur Endod J 1:2–5Google Scholar
  12. 12.
    Kato AS, Cunha RS, da Silveira Bueno CE, Pelegrine RA, Fontana CE, de Martin AS (2016) Investigation of the efficacy of passive ultrasonic irrigation versus irrigation with reciprocating activation: an environmental scanning electron microscopic study. J Endod 42:659–663CrossRefGoogle Scholar
  13. 13.
    Schneider SW (1971) A comparison of canal preparations in straight and curved root canals. Oral Surg Oral Med Oral Pathol 32:271–275CrossRefGoogle Scholar
  14. 14.
    Fan B, Pan Y, Gao Y, Fang F, Wu Q, Gutmann JL (2010) Three-dimensional morphologic analysis of isthmuses in the mesial roots of mandibular molars. J Endod 36:1866–1869CrossRefGoogle Scholar
  15. 15.
    Susin L, Liu Y, Yoon JC, Parente JM, Loushine RJ, Ricucci D, Bryan T, Weller RN, Pashley DH, Tay FR (2010) Canal and isthmus debridement efficacies of two irrigant agitation techniques in a closed system. Int Endod J 43:1077–1090CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Fedorov A, Beichel R, Kalpathy-Cramer J, Finet J, Fillion-Robin JC, Pujol S, Bauer C, Jennings D, Fennessy F, Sonka M, Buatti J, Aylward S, Miller JV, Pieper S, Kikinis R (2012) 3D slicer as an image computing platform for the quantitative imaging network. Magn Reson Imaging 30:1323–1324CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Neves AA, Silva EJ, Roter JM, Belladona FG, Alves HD, Lopes RT, Paciornik S, de-Deus GA (2015) Exploiting the potential of free software to evaluate root canal biomechanical preparation outcomes through micro-CT images. Int Endod J 48:1033–1042CrossRefGoogle Scholar
  18. 18.
    Perez R, Neves AA, Belladonna FG, Silva EJNL, Souza EM, Fidel S, Versiani MA, Lima I, Carvalho C, de-Deus G (2017) Impact of needle insertion depth on the removal of hard-tissue debris. Int Endod J 50:560–568CrossRefGoogle Scholar
  19. 19.
    de Pablo OV, Estevez R, Peix Sanchez M, Heilborn C, Cohenca N (2010) Root anatomy and canal configuration of the permanent mandibular first molar: a systematic review. J Endod 36:1919–1931CrossRefGoogle Scholar
  20. 20.
    Paragliola R, Franco V, Fabiani C, Mazzoni A, Nato F, Tay FR, Breschi L, Grandini S (2010) Final rinse optimization: influence of different agitation protocols. J Endod 36:282–285CrossRefGoogle Scholar
  21. 21.
    Siqueira JF Jr, Alves FRF, Versiani MA, Rôças IN, Almeida BM, Neves MA et al (2010) Correlative bacteriologic and micro-computed tomographic analysis of mandibular molar mesial canals prepared by Self-Adjusting File, Reciproc, and Twisted File systems. J Endod 39:1044–1050CrossRefGoogle Scholar
  22. 22.
    Ordinola-Zapata R, Bramante CM, Aprecio RM, Handysides R, Jaramillo DE (2014) Biofilm removal by 6% sodium hypochlorite activated by different irrigation techniques. Int Endod J 47:659–666CrossRefGoogle Scholar
  23. 23.
    Peters OA (2004) Current challenges and concepts in the preparation of root canal systems: a review. J Endod 30:559–567CrossRefGoogle Scholar
  24. 24.
    Versiani MA, Alves FR, Andrade-Junior CV, Marceliano-Alves MF, Provenzano JC, Rôças IN et al (2016) Micro-CT evaluation of the efficacy of hard-tissue removal from the root canal and isthmus area by positive and negative pressure irrigation systems. Int Endod J 49:1079–1087CrossRefGoogle Scholar
  25. 25.
    van der Sluis LW, Shemesh H, Wu MK, Wesselink PR (2007) An evaluation of the influence of passive ultrasonic irrigation on the seal of root canal fillings. Int Endod J 40:356–361CrossRefGoogle Scholar
  26. 26.
    ElAyouti A, Kiefner P, Hecker H, Chu A, L€ost C, Weiger R (2009) Homogeneity and adaptation of endodontic fillings in root canals with enlarged apical preparation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 108:e141–e146CrossRefGoogle Scholar
  27. 27.
    Brunson M, Heilborn C, Johnson DJ, Cohenca N (2010) Effect of apical preparation size and preparation taper on irrigant volume delivered by using negative pressure irrigation system. J Endod 36:721–724CrossRefGoogle Scholar
  28. 28.
    Thomas AR, Velmurugan N, Smita S, Jothilatha S (2014) Comparative evaluation of canal isthmus debridement efficacy of modified EndoVac technique with different irrigation systems. J Endod 40:1676–1680CrossRefGoogle Scholar
  29. 29.
    Freire LG, Iglecias EF, Cunha RS, Dos Santos M, Gavini G (2015) Micro-computed tomographic evaluation of hard tissue debris removal after different irrigation methods and its influence on the filling of curved canals. J Endod 41:1660–1666CrossRefGoogle Scholar
  30. 30.
    Keleş A, Alçin H, Sousa-Neto MD, Versiani MA (2016) Supplementary steps for removing hard tissue debris from isthmus-containing canal systems. J Endod 42:1677–1682CrossRefGoogle Scholar
  31. 31.
    Topçuoglu HS, Akti A, Düzgün S, Ceyhanli KT, Topçuoglu G (2015) Effectiveness of different irrigation procedures for removal of dentin debris from a simulated internal resorption cavity. Int J Artif Organs 38:165–169CrossRefGoogle Scholar
  32. 32.
    Yamada RS, Armas A, Goldman M, Lin PS (1983) A scanning electron microscopic comparison of a high volume final flush with several irrigating solutions: part 3. J Endod 9:137–142CrossRefGoogle Scholar
  33. 33.
    Baker NA, Eleazer PD, Averbach RE, Seltzer S (1975) Scanning electron microscopic study of the efficacy of various irrigating solutions. J Endod 1:127–135CrossRefGoogle Scholar
  34. 34.
    Fornari VJ, Silva-Sousa YT, Vanni JR, Pécora JD, Versiani MA, Sousa-Neto MD (2010) Histological evaluation of the effectiveness of increased apical enlargement for cleaning the apical third of curved canals. Int Endod J 43:988–994CrossRefGoogle Scholar
  35. 35.
    Prado MC, Leal F, Simão RA, Gusman H, do Prado M (2017) The use of auxiliary devices during irrigation to increase the cleaning ability of a chelating agent. Restor Dent Endod 42:105–110CrossRefPubMedCentralGoogle Scholar
  36. 36.
    De-Deus G, Marins J, Neves Ade A, Reis C, Fidel S, Versiani MA et al (2014) Assessing accumulated hard-tissue debris using micro-computed tomography and free software for image processing and analysis. J Endod 40:271–276CrossRefGoogle Scholar
  37. 37.
    Paqué F, Boessler C, Zehnder M (2011) Accumulated hard tissue debris levels in mesial roots of mandibular molars after sequential irrigation steps. Int Endod J 44:148–153CrossRefGoogle Scholar
  38. 38.
    Leoni GB, Versiani MA, Silva-Sousa YT, Bruniera JF, Pécora JD, Sousa-Neto MD (2017) 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 50:398–406CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Emmanuel João Nogueira Leal Silva
    • 1
    • 2
    Email author
  • Carla Rodrigues Carvalho
    • 1
  • Felipe Gonçalves Belladonna
    • 3
  • Marina Carvalho Prado
    • 1
  • Ricardo Tadeu Lopes
    • 4
  • Gustavo De-Deus
    • 3
  • Edson Jorge Lima Moreira
    • 1
  1. 1.Department of EndodonticsGrande Rio UniversityDuque de CaxiasBrazil
  2. 2.Department of Endodontics - Dental School - Grande Rio University (UNIGRANRIO)NiteróiBrazil
  3. 3.Department of EndodonticsFluminense Federal UniversityNiteróiBrazil
  4. 4.Nuclear Engineering ProgramFederal University of Rio de JaneiroRio de JaneiroBrazil

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