Comparative Evaluation of Smear Layer Removal Efficacy of Various Irrigation Activation Systems: A Micro-CT Study
High-Resolution Quantitative 3D Volumetric Micro-Computed Tomography Analysis in Curved Root Canals
Departemen Konservasi Gigi, Fakultas Kedokteran Gigi, Universitas Indonesia
hendra.sulistyo@ui.ac.id
Fakultas Kedokteran Gigi, Universitas Gadjah Mada
Abstrak
INTRODUCTION
Complete chemomechanical debridement of the root canal system is fundamental for achieving long-term endodontic success. Mechanical instrumentation creates an amorphous irregular smear layer covering the instrumented dentinal walls and occluding dentinal tubules in the apical third [1,2]. Because conventional syringe irrigation rarely penetrates beyond 1 mm from the needle tip in narrow or curved apical anatomy, adjunctive irrigation activation systems have been developed to enhance hydrodynamic shear stress and acoustic streaming [3].
MATERIALS AND METHODS
Sixty extracted human single-rooted mandibular premolars with curvatures between 15° and 25° were selected under institutional ethical approval. Root canals were instrumented up to ProTaper Gold F3 (30/.09) and randomly allocated into three experimental activation groups (n = 20): Group I (Conventional Side-Vented Syringe Irrigation), Group II (Sonic Activation / EndoActivator), and Group III (Passive Ultrasonic Irrigation / PUI using a #20 IrriSafe tip) with 2.5% NaOCl followed by 17% EDTA. High-resolution Micro-CT scans (isotropic voxel size 9.0 µm) were acquired before and after final irrigation activation.
RESULTS
Quantitative 3D volumetric Micro-CT reconstruction demonstrated statistically significant reductions in accumulated hard-tissue debris and apical smear layer scores in the Passive Ultrasonic Irrigation (PUI) group compared to sonic and syringe irrigation (p < 0.05) (Table 1). Acoustic cavitation in Group III achieved 91.4% tubule patency in the apical 3 mm segment (Figure 1).
DISCUSSION
The superior debridement efficacy of PUI in the apical third is attributed to high-frequency (28–32 kHz) acoustic microstreaming and transient cavitation, which effectively disrupt vapor locks and propel chelating solutions into lateral fins and isthmuses [3,4].
CONCLUSION
Passive Ultrasonic Irrigation (PUI) demonstrated superior smear layer and debris clearance in the apical third of curved root canals compared to sonic activation and conventional needle irrigation.
Gambar & Ilustrasi Klinis
Tabel Data
Table 1. Mean percentage of remaining apical debris volume (%) and dentinal tubule patency across irrigation activation systems (n = 20).
| Irrigation Group | Coronal Third (%) | Middle Third (%) | Apical Third (%) | p-value |
|---|---|---|---|---|
| Group I: Conventional Syringe | 14.2 ± 2.8 | 24.6 ± 3.9 | 41.8 ± 5.2 | 0.001* |
| Group II: Sonic Activation | 8.5 ± 1.9 | 13.4 ± 2.7 | 21.3 ± 3.6 | 0.001* |
| Group III: Passive Ultrasonic (PUI) | 4.1 ± 1.1 | 6.8 ± 1.5 | 8.6 ± 2.1 | 0.001* |
*Statistically significant difference at p < 0.05 (One-way ANOVA and post-hoc Tukey HSD test).
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Hak Cipta: Copyright © 2027 Indonesian Journal of Restorative Dentistry and Endodontics
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