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Abstract：
BACKGROUND: Smear layer removal from root canals aid in the penetration of both irrigants and endodontic sealer into the dentinal tubules, thereby improving the efficacy of endodontic treatment. The aim of this in vitro study was to compare the smear layer removal ability of a conventional endodontic irrigation regimen, MTAD (mixture of tetracycline, acid, and detergent), and QMix™ (Dentsply Sirona, Charlotte, North Carolina, United States) with that of a mixture of herbal irrigants, namely, aqueous extracts of Azadirachta indica (neem) and Citrus limon (lemon), evaluated using scanning electron microscopy (SEM).
METHODS: We selected 40 extracted human premolar teeth for the study, which we randomly divided into five groups (eight samples each) according to irrigation solution: (i) Group A (normal saline); (ii) Group B (conventional endodontic regimen, 3% sodium hypochlorite (NaOCl) + 17% ethylenediamine tetraacetic acid (EDTA) + 2% chlorhexidine (CHX)); (iii) Group C (MTAD); (iv) Group D (QMix 2-in-1); and (v) Group E (aqueous extracts of Azadirachta indica and Citrus limon). After we prepared the canals with ProTaper Universal nickel-titanium (Ni-Ti) rotary files (Dentsply Sirona) and the respective irrigants, we split the teeth longitudinally to evaluate the amount of remnant smear layer in the coronal, middle, and apical thirds using SEM photomicrographs. We performed statistical analyses of the data using the Kruskal-Wallis and Mann-Whitney U tests, where the level of significance was set at 0.05.
RESULTS: The SEM analysis of the coronal third showed mean values of 3.83 in Group A, 3.67 in Group B, 2.79 in Group C, 3.63 in Group D, and 4.00 in Group E. The SEM analysis of the middle third showed mean values of 4.00 in Group A, 3.88 in Group B, 3.75 in Group C, 3.50 in Group D, and 3.50 in Group E. The SEM analysis of the apical third showed mean values of 3.92 in Group A, 3.63 in Group B, 3.71 in Group C, 3.88 in Group D, and 3.17 in Group E. Therefore, we found that there were significant statistical differences between the groups when an overall comparison was done for the coronal, middle, and apical third, with a p-value of 0.001. On multiple comparisons across the different tooth-section thirds. Groups A and B showed statistically significant differences in the apical third (p-value=0.017). Groups A and C showed statistically significant differences in the coronal third and middle third (p-values=0.001 and 0.010, respectively). Groups A and D showed statistically significant differences in the middle third (p-value=0.001). Groups A and E showed statistically significant differences in all thirds (p-values=0.039, 0.001, and 0.001, respectively) Conclusion: The conventional needle irrigation with MTAD showed the highest level of smear layer removal ability on the root canal surface, followed by QMix 2-in-1, the Azadirachta indica leaf and Citrus limon extract mixture, and the conventional endodontic regimen. Normal saline showed the lowest smear layer removal effect.
METHODS: We selected 40 extracted human premolar teeth for the study, which we randomly divided into five groups (eight samples each) according to irrigation solution: (i) Group A (normal saline); (ii) Group B (conventional endodontic regimen, 3% sodium hypochlorite (NaOCl) + 17% ethylenediamine tetraacetic acid (EDTA) + 2% chlorhexidine (CHX)); (iii) Group C (MTAD); (iv) Group D (QMix 2-in-1); and (v) Group E (aqueous extracts of Azadirachta indica and Citrus limon). After we prepared the canals with ProTaper Universal nickel-titanium (Ni-Ti) rotary files (Dentsply Sirona) and the respective irrigants, we split the teeth longitudinally to evaluate the amount of remnant smear layer in the coronal, middle, and apical thirds using SEM photomicrographs. We performed statistical analyses of the data using the Kruskal-Wallis and Mann-Whitney U tests, where the level of significance was set at 0.05.
RESULTS: The SEM analysis of the coronal third showed mean values of 3.83 in Group A, 3.67 in Group B, 2.79 in Group C, 3.63 in Group D, and 4.00 in Group E. The SEM analysis of the middle third showed mean values of 4.00 in Group A, 3.88 in Group B, 3.75 in Group C, 3.50 in Group D, and 3.50 in Group E. The SEM analysis of the apical third showed mean values of 3.92 in Group A, 3.63 in Group B, 3.71 in Group C, 3.88 in Group D, and 3.17 in Group E. Therefore, we found that there were significant statistical differences between the groups when an overall comparison was done for the coronal, middle, and apical third, with a p-value of 0.001. On multiple comparisons across the different tooth-section thirds. Groups A and B showed statistically significant differences in the apical third (p-value=0.017). Groups A and C showed statistically significant differences in the coronal third and middle third (p-values=0.001 and 0.010, respectively). Groups A and D showed statistically significant differences in the middle third (p-value=0.001). Groups A and E showed statistically significant differences in all thirds (p-values=0.039, 0.001, and 0.001, respectively) Conclusion: The conventional needle irrigation with MTAD showed the highest level of smear layer removal ability on the root canal surface, followed by QMix 2-in-1, the Azadirachta indica leaf and Citrus limon extract mixture, and the conventional endodontic regimen. Normal saline showed the lowest smear layer removal effect.
摘要：
背景：从根管去除涂抹层有助于冲洗剂和牙髓封闭剂渗透到牙本质小管中，从而提高牙髓治疗的疗效。这项体外研究的目的是比较常规牙髓冲洗方案的涂片层去除能力，MTAD(四环素的混合物，酸,和洗涤剂)，和QMix™(DentsplySirona，夏洛特,北卡罗来纳州,美国）与草药灌溉剂的混合物，即,印本水提物（印em）和柑橘柠檬（柠檬），使用扫描电子显微镜(SEM)进行评估。
方法：我们选择了40颗提取的人类前磨牙进行研究，根据冲洗液随机分为五组（每组8个样本）：（i）A组（生理盐水）；（ii）B组（常规牙髓治疗方案，3%次氯酸钠(NaOCl)+17%乙二胺四乙酸(EDTA)+2%氯己定(CHX));(iii)C组(MTAD);(iv)D组(QMix2-in-1);和(v)E组(印染和柑橘的水提取物)。在我们用ProTaper通用镍钛（Ni-Ti）旋转文件（DentsplySirona）和各自的灌溉准备了运河之后，我们将牙齿纵向分开，以评估冠状区的残余污迹层的数量，中间,和顶端三分之一使用SEM显微照片。我们使用Kruskal-Wallis和Mann-WhitneyU检验对数据进行统计分析，其中显著性水平设定为0.05。
结果：冠状第三号的SEM分析显示，A组中的平均值为3.83，B组中的3.67，C组2.79，D组3.63，和E组4.00。中三分之一的SEM分析显示A组的平均值为4.00，B组3.88，C组3.75，D组3.50，E组的心尖第三组的SEM分析显示A组的平均值为3.92，B组中3.63，C组3.71，D组3.88，E组3.17，因此，我们发现，当对冠状区进行总体比较时，组间存在显著的统计学差异，中间,和顶端第三，p值为0.001。在不同牙齿部分的多重比较中。A组和B组在根尖三分之一处显示出统计学上的显着差异（p值=0.017）。A组和C组在冠状三分之一和中间三分之一处显示出统计学上的显着差异（p值分别为0.001和0.010）。A组和D组在中间三分之一处显示出统计学上的显着差异（p值=0.001）。A组和E组在所有三个方面均显示出统计学上的显着差异（p值分别为0.039、0.001和0.001）结论：用MTAD进行的常规针头冲洗在根管表面显示出最高水平的涂抹层去除能力，其次是QMix2合1，印染叶和柑橘柠檬提取物混合物，和传统的牙髓治疗方案。生理盐水显示最低的涂抹层去除效果。
方法：我们选择了40颗提取的人类前磨牙进行研究，根据冲洗液随机分为五组（每组8个样本）：（i）A组（生理盐水）；（ii）B组（常规牙髓治疗方案，3%次氯酸钠(NaOCl)+17%乙二胺四乙酸(EDTA)+2%氯己定(CHX));(iii)C组(MTAD);(iv)D组(QMix2-in-1);和(v)E组(印染和柑橘的水提取物)。在我们用ProTaper通用镍钛（Ni-Ti）旋转文件（DentsplySirona）和各自的灌溉准备了运河之后，我们将牙齿纵向分开，以评估冠状区的残余污迹层的数量，中间,和顶端三分之一使用SEM显微照片。我们使用Kruskal-Wallis和Mann-WhitneyU检验对数据进行统计分析，其中显著性水平设定为0.05。
结果：冠状第三号的SEM分析显示，A组中的平均值为3.83，B组中的3.67，C组2.79，D组3.63，和E组4.00。中三分之一的SEM分析显示A组的平均值为4.00，B组3.88，C组3.75，D组3.50，E组的心尖第三组的SEM分析显示A组的平均值为3.92，B组中3.63，C组3.71，D组3.88，E组3.17，因此，我们发现，当对冠状区进行总体比较时，组间存在显著的统计学差异，中间,和顶端第三，p值为0.001。在不同牙齿部分的多重比较中。A组和B组在根尖三分之一处显示出统计学上的显着差异（p值=0.017）。A组和C组在冠状三分之一和中间三分之一处显示出统计学上的显着差异（p值分别为0.001和0.010）。A组和D组在中间三分之一处显示出统计学上的显着差异（p值=0.001）。A组和E组在所有三个方面均显示出统计学上的显着差异（p值分别为0.039、0.001和0.001）结论：用MTAD进行的常规针头冲洗在根管表面显示出最高水平的涂抹层去除能力，其次是QMix2合1，印染叶和柑橘柠檬提取物混合物，和传统的牙髓治疗方案。生理盐水显示最低的涂抹层去除效果。
