The choice of irrigant during hand instrumentation and ultrasonic irrigation of the root canal: a scanning electron microscope study

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Abstract
The purpose of this study was to investigate the use of 4 per cent sodium hypochlorite and 15 per cent EDTAC, either alone or in conjunction, as irrigants during hand instrumentation and ultrasonic irrigation of the root canal. Thirty-six extracted human teeth, each with a single, straight root 21–25 mm long were hand-instrumented through a clinical access cavity to file size 40. One millilitre of the test irrigant was used after each instrument size. Canal debridement was completed with an intermittent flush irrigation technique with one or both of the test irrigants activated by ultrasound at a medium effective power output. The specimens were sectioned longitudinally, viewed in a scanning electron microscope and scored for the presence or absence of debris and smear layer at levels less than 1 mm, 5 mm, and 10 mm from the apical seat. Under the conditions of this experiment the most effective regime was irrigation with 1 mL EDTAC after each instrument size, followed by two 30 second exposures to ultrasound + EDTAC then four 30 second exposures to ultrasound + 4 per cent sodium hypochlorite. The specimens in this group were free from retained pulp tissue and superficial smear layer, had the lowest debris scores at the < 1 mm and 5 mm levels, and the lowest total debris score. All of the techniques tested produced smear-free canals at the 10 mm level.