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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 30  |  Issue : 1  |  Page : 50-54

Comparison of effect of ethylenediaminetetraacetic acid solution and ethylenediaminetetraacetic acid paste on canal transportation using cone beam computed tomography: An in vitro study


1 Department of Conservative Dentistry and Endodontics, Crown and Bridge and Implantology, CSMSS Dental College and Hospital, Aurangabad, Maharashtra, India
2 Department of Prosthodontics, Crown and Bridge and Implantology, CSMSS Dental College and Hospital, Aurangabad, Maharashtra, India

Date of Web Publication4-Jun-2018

Correspondence Address:
Dr. Rohit Anil Tambake
A/4, Mitra Nagar, Shelgi, South Solapur - 413 006, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/endo.endo_73_17

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  Abstract 

Aims: The aim of the present study was to compare the effect of saline, ethylenediaminetetraacetic acid (EDTA) 17% solution and EDTA paste on root canal transportation.
Subjects and Methods: Moderately curved mesiobuccal roots of 24 maxillary molars were standardized in length and randomized into one control and two experimental groups. All teeth were scanned by cone beam computed tomography (CBCT) to determine the root canal shape and measure the parameters required for comparison before instrumentation. The canals were instrumented with 0.06 taper rotary files to size #25. All groups were irrigated with saline. Group 1 was prepared with RC-Prep (Premier Dental, Philadelphia, PA, USA) and in Group 2, EDTA 17% solution (Pulpdent Corp., Watertown, MA, USA) was used. After preparation, postinstrumentation scan was performed. Pre- and post-instrumentation images were obtained at three levels, 3 mm from the apical end of the root (apical level) and 3 mm below the orifice from the coronal level (15 mm from the apex) and the mid-root level (8 mm from the apex) were compared using CBCT software. The amount of canal transportation was assessed.
Statistical Analysis Used: The data were analyzed with one-way analysis of variance (α = 0.05) and the Tukey post hoc test.
Results: Less canal transportation was observed in experimental groups than the control group. Group 1 showed significantly less canal transportation than Group 2 and control group.
Conclusions: EDTA preparation had a significant effect on canal transportation.

Keywords: Canal transportation, cone beam computed tomography, ethylenediaminetetraacetic acid


How to cite this article:
Tambake RA, Daokar S, Patil K, Tambake SS, Mapari PS, Raktade P. Comparison of effect of ethylenediaminetetraacetic acid solution and ethylenediaminetetraacetic acid paste on canal transportation using cone beam computed tomography: An in vitro study. Endodontology 2018;30:50-4

How to cite this URL:
Tambake RA, Daokar S, Patil K, Tambake SS, Mapari PS, Raktade P. Comparison of effect of ethylenediaminetetraacetic acid solution and ethylenediaminetetraacetic acid paste on canal transportation using cone beam computed tomography: An in vitro study. Endodontology [serial online] 2018 [cited 2018 Sep 26];30:50-4. Available from: http://www.endodontologyonweb.org/text.asp?2018/30/1/50/233751


  Introduction Top


Cleaning and shaping are an important stages of endodontic treatment which predicts success rate if performed properly. Ideally, root canal shaping should create a continuous tapered preparation from crown to apex while maintaining the original path of the canal and keeping the foramen size as small as possible.[1]

Instrumentation of the root canal can be performed by either manual or mechanized techniques, which produces a smear layer that covers the instrumented root canal walls. This smear layer has an organic and inorganic component such as pulp tissue debris, microorganisms, and calcified tissues.[2]

There can be deleterious effects if the smear layer is not removed during cleaning and shaping procedure. Microorganisms remaining in the smear layer after the instrumentation of an infected root canal space can survive and reinfect the canal. The smear layer has also been shown to hinder the penetration of intracanal medicaments and sealers into dentinal tubules and has the potential of compromising the seal of the root filling.[2],[3],[4]

For the removal of smear layer use of ethylenediaminetetraacetic acid (EDTA) has been commonly recommended, which can dissolve both organic and inorganic components.[5]

History

In 1957, the use of EDTA solution in endodontics was proposed by Østby. He recommended the use of 15% EDTA in cleaning and shaping procedure in calcified, narrow or blocked canals, because of its ability to foster the chelation of the calcium ions at a pH close to neutral (Hill 1959).[6]

Hill and Goldberg and Abramovich concluded that the effect of 15% EDTA was enhanced by the addition of quaternary ammonium bromide (cetavlon) by reducing its surface tension because EDTA solution acts only through direct contact with the substrate. Guerisoli et al.[7] stated that the association of EDTA with a wetting agent enhances its bacteriostatic effectiveness.

Stewart et al. in 1969, introduced RC-Prep that contains 15% EDTA, 10% urea peroxide, and glycol. Oxygen that is set free by the reaction of RC-Prep and sodium hypochlorite irrigant facilitates the removal of pulpal remnants and blood coagulates from the root canal wall.


  Subjects and Methods Top


Source of data

Twenty-four recently extracted maxillary first molars were collected from the Department of Oral and Maxillofacial Surgery, CSMSS Dental College, Aurangabad, Maharashtra.

The selection of teeth was made on the basis of following

Inclusion criteria

  • First maxillary permanent molars
  • Teeth with normal fully formed apices
  • Teeth with relatively straight, nonfused, divergent roots
  • Angle of curvature within 10°–30° (according to Schneider method).


Exclusion criteria

  • Teeth with grossly destructed tooth structure, dilacerated roots, root with calcified canals, root caries, root <10 mm in length, root with 2 canals and ribbon-shaped canal were excluded
  • Teeth selected were sterilized according to occupational safety and health hazards (OSHA norms) and stored in normal saline until further use.


Tooth preparation

Endodontic access cavities were prepared using carbide burs and the primary mesiobuccal canal orifice was located. The instruments were gently introduced by hand to working length in ascending order beginning with #10K file. 10 No. K file was used to ensure canal patency. The palatal root and palatal portion of crown of each tooth were removed for convenience. Tooth length was standardized to 19 mm by removing coronal tooth structure; the working length for each specimen was 18 mm. All measurements were confirmed with a #10 K file and a digital caliper.

All the teeth were mounted in standardized manner in heavy body condensation silicone. The small metal pin was inserted on one side for side orientation. Buccal surfaces of each tooth were made to face toward metal pin.

All teeth were scanned by cone beam computed tomography to determine the root canal shape before and after instrumentation.

Randomization and experimental groups

The 24 specimens were assigned a reference number and randomized into three groups (n = 8). Control specimens were irrigated with 2.0 ml 0.9% saline between files.

In Group 1, the pulp chamber was filled with RC-Prep and carried into the canals using files. Canals were irrigated with 2.0 ml 0.9% saline between each file.

In Group 2, the canals and pulp chamber were flooded with EDTA 17% solution before using each file.

Saline irrigation was performed between each file, as in the other groups.

All liquid irrigants were delivered using a 30-gauge, side-vented needle.

Both chelating agents were used according to manufacturer's instructions.

Canal preparation

All specimens were instrumented using a crown-down technique with rotary ProTaper NiTi File system.

Pro-Taper SX, S1, and S2 were used to flare the orifices, coronal and middle third of the root canals and to get straight line access.

A glide path was established preparing the canals with K-file size 15 and size 20 to working length. Shaping of the canals was continued using S1, S2, F1, F2, and F3 to working length. Once the instrument had negotiated the root canal and had rotated freely, it was removed. The total instrumentation and irrigant contact time for each tooth was standardized to 9 min.

Evaluation of canal transportation

The amount of canal transportation was determined by measuring the shortest distance from the edge of uninstrumented canal to the periphery of the root (mesial and distal) and then comparing this with the same measurements obtained from the instrumented images.[8]

The values were obtained from three different levels of prepared canals: 3 mm from apical end, 8 mm from apical end, and 3 mm from coronal end.

All values were measured by two evaluators and a mean value was taken.

Formula = J (a1 − a2) − (b1 − b2) j.

Statistical analysis

Two-way analysis of variance (ANOVA) was used to test for an interaction between the canal cross-sectional level and irrigant (saline, EDTA 17% solution, or RC-Prep) on canal transportation. One-way ANOVA identified significant differences in the mean canal transportation with respect to the chelating agent used.


  Results Top


The mean transportation for Group 1 at 3 mm apical, 8 mm apical, and 3 mm coronal was 0.0525 ± 0.010 mm, 0.055 ± 0.013 mm, and 0.07 ± 0.014 mm, respectively.

The mean transportation for Group 2 at 3 mm apical, 8 mm apical, and 3 mm coronal was 0.0662 ± 0.014 mm, 0.085 ± 0.018 mm, and 0.1225 ± 0.016 mm, respectively.

The mean transportation for control group at 3 mm apical, 8 mm apical and 3 mm coronal was 0.08 ± 0.024, 0.11 ± 0.013, and 0.11625 ± 0.025 mm, respectively [Table 1].
Table 1: Distribution of mean and standard deviation values of apical transportation at 3 mm apical, 3 mm coronal, and 8 mm apical in Groups 1, 2 and control group

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  Discussion Top


In the present day dentistry, so much has been discussed about efficient disinfection of the root canal space with the considerable removal of dentin.[9],[10] At the same time, the importance of preserving the natural root canal anatomy after its instrumentation has been discussed and researched on. Professionals need to balance well between the concepts of controlled instrumentation and removal of contaminated dentin.

Canal transportation is an undesirable deviation from the natural canal path. Canal transportation basically depends on physical properties of canal preparing instruments, but it also depends on irrigation technique or chelating agents.[9]

It has been highlighted from various literatures that the canal centering ability is better within Ni-Ti instruments.[11] However, there are studies suggesting that there is an increased tendency for canal transportation as the diameter of the files increases. Hence, greater taper of >0.06 should be avoided for apical enlargement especially in curved canal. The occurrence of up to 0.15 mm of canal transportation has been considered acceptable and should not be above 0.30 mm at the apical end.[12]

Chelating agent was introduced into endodontics as an aid for the preparation of narrow canal and calcified root canal in 1957 by Nygaard-Ostby.

Chelates are stable complexes of metal ions with organic substances as a result of ring-shaped bonds. This stability is a result of the bond between the chelator which has more than one pair of free electrons, and the central metal ion. Based on the principle of constant solubility product, Nygaard-Ostby explained the demineralization of dental hard tissue by EDTA and its sodium salt.[13]

In the present study, two different agents were used during canal preparation for the purpose of removal of smear layer. Smear layer act as a negative factor while sealing the root canal because of its weak adherence to the root canal walls, hindering sealer adhesion.[2] Thus, the removal before obturation to allow intimate contact of the sealer with the dentin surface is mandatory.[14]

This study evaluates the canal transportation of ProTaper NiTi file systems with two different preparation of chelating agent, which are EDTA 17% solution and RC-Prep. The results obtained suggested that two agents used in this study for canal transportation showed significant variations.

Canals prepared with RC-Prep (Group 1) showed significantly less transportation than those prepared with EDTA 17% solution (Group 2) or saline (control group) (P< 0.05). This could be attributed to the presence of polyethylene glycol base in the RC-Prep that inhibited the demineralization of dentin caused by EDTA present in the paste.[165 Furthermore, in this group, more canal transportation was seen at the coronal third area (3 mm coronal) than the apical third area which was due to more availability of the paste at the coronal one-third of the root canal.[16],[17]

Group 2 showed more canal transportation than Group 1 but less than control group. In the present study, it was observed that more canal transportation was seen at the coronal third of Group 2 than Group 1 and control group. This was due to increase the volume of EDTA solution leading to more demineralization of the dentin.

In the control group, canal was prepared with saline. Saline has no chelating ability or demineralizing property. Saline removes only debris created during instrumentation. In this group, canal transportation was occurred mainly due to physical and mechanical properties of NiTi instruments.[1]

In all the groups, the magnitude of canal transportation was more at coronal third area than apical and middle third of the canal. These could be attributed to more availability of the irrigating solution, resulting in greater contact of the solution with the root dentin at the coronal 3rd causing more demineralization.[18]

This finding is compatible with the results of Whitbeck et al.,[19] study showing that less canal transportation with RC-Prep than 17% EDTA solution.

These results are consistent with Verdelis et al.[18] study, in which neutral EDTA extracted significantly more calcium and phosphorus from the coronal two-thirds of the root than RC-Prep.

During cleaning and shaping procedure, canal transportation was observed in all the cases to some extent as the files have the tendency to regain their original shape. The three groups showed canal transportation of 0.03 mm to 0.15 mm, which is within the acceptable range. Many studies have evaluated and compared the effects of different file systems on canal transportation; however, a literature search did not reveal any previous studies on the effects of different irrigation solutions on canal transportation during root canal preparation except Whitbeck et al. study.[8],[19] Therefore, further studies should be undertaken to evaluate whether different endodontic irrigation solutions are generally associated with an increased canal transportations.


  Conclusion Top


This study concluded that canal instrumented with RC-Prep showed significantly less canal transportation than EDTA 17% solution and control group. It was observed that the experimental group with EDTA 17% solution and control group showed no significant difference in canal transportation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Torabinejad M, Handysides R, Khademi AA, Bakland LK. Clinical implications of the smear layer in endodontics: A review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:658-66.  Back to cited text no. 4
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Singh S, Acharya SR, Ballal V, Rijesh M. Evaluation of the effect of EDTA, EDTAC, RC-Prep and BioPure MTAD on the microhardness of root canal dentine. An in vitro study. Endodontology 2009;21:35-41.  Back to cited text no. 6
    
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Guerisoli DM, Marchesan MA, Walmsley AD, Lumley PJ, Pecora JD. Evaluation of smear layer removal by EDTAC and sodium hypochlorite with ultrasonic agitation. Int Endod J 2002;35:418-21.  Back to cited text no. 7
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Tambe VH, Nagmode PS, Abraham S, Patait M, Lahoti PV, Jaju N, et al. Comparison of canal transportation and centering ability of rotary protaper, one shape system and wave one system using cone beam computed tomography: An in vitro study. J Conserv Dent 2014;17:561-5.  Back to cited text no. 8
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Park H. A comparison of greater taper files, ProFiles, and stainless steel files to shape curved root canals. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:715-8.  Back to cited text no. 9
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Matwychuk MJ, Bowles WR, McClanahan SB, Hodges JS, Pesun IJ. Shaping abilities of two different engine-driven rotary nickel titanium systems or stainless steel balanced-force technique in mandibular molars. J Endod 2007;33:868-71.  Back to cited text no. 10
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López FU, Fachin EV, Camargo Fontanella VR, Barletta FB, Só MV, Grecca FS, et al. Apical transportation: A comparative evaluation of three root canal instrumentation techniques with three different apical diameters. J Endod 2008;34:1545-8.  Back to cited text no. 11
    
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Peters OA. Current challenges and concepts in the preparation of root canal systems: A review. J Endod 2004;30:559-67.  Back to cited text no. 12
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Hülsmann M, Heckendorff M, Lennon A. Chelating agents in root canal treatment: Mode of action and indications for their use. Int Endod J 2003;36:810-30.  Back to cited text no. 13
    
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Bystrom A, Sundqvist G. The antibacterial action of sodium hypochlorite and EDTA in 60 cases of endodontic therapy. Int Endod J 1985;18:35-40.  Back to cited text no. 14
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Cameron JA. The use of ultrasound and an EDTA-urea peroxide compound in the cleansing of root canals. An SEM study. Aust Dent J 1984;29:80-5.  Back to cited text no. 15
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Stewart GG, Kapsimalas P, Rappaport H. EDTA and urea peroxide for root canal preparation. J Am Dent Assoc 1969;78:335-8.  Back to cited text no. 16
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Verdelis K, Eliades G, Oviir T, Margelos J. Effect of chelating agents on the molecular composition and extent of decalcification at cervical, middle and apical root dentin locations. Endod Dent Traumatol 1999;15:164-70.  Back to cited text no. 18
    
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