Bangalore, karnataka. Annexure -II proforma for registration of



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RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.
ANNEXURE -II

PROFORMA FOR REGISTRATION OF

SUBJECTS FOR DISSERTATION.



1.

Name of the candidate & address



Dr. VIDYA SRINIVASAN

POST GRADUATE STUDENT,A.E.C.S MAARUTI COLLEGE OF DENTAL SCIENCES RESEARCH CENTRE, BANNERGHATTA ROAD,

BANGALORE-560076.





2.

Name of the Institution



A.E.C.S MAARUTI COLLEGE OF DENTAL SCIENCES RESEARCH CENTRE, BANNERGHATTA ROAD,

BANGALORE-560076.



3.

Course of the study & subject



MASTER OF DENTAL SURGERY IN

CONSERVATIVE DENTISTRY AND ENDODONTICS



4.

Date of admission to the course




30.05.2011



5.

TITLE OF THE TOPIC :

SEM EVALUATION OF SMEAR LAYER REMOVAL IN APICAL THIRD OF ROOT CANAL USING 17%EDTA,MTAD AND 2.25% PERACETIC ACID COUPLED WITH ULTRASONIC ACTIVATION: A COMPARATIVE IN VITRO STUDY.”









6.


BRIEF RESUME OF INTENDED WORK:
6.1 Need for the study :

Successful root canal treatment is dependent on the effective removal of bacteria and their by-products from the entire root canal system. In endodontic therapy, biomechanical preparation leads to formation of smear layer. Smear layer consists of organic and inorganic substances, including fragments of odontoblastic processes, microorganisms, their by- products and necrotic materials.

There are two schools of thought regarding the smear layer, one advocates the removal of smear layer and the other advocates maintaining the smear layer. Recent studies suggest removal of the smear layer as it facilitates the penetration of intracanal medicaments and sealers into dentinal tubules which can potentially improve the seal of the root canal filling.1

Irrigation is an essential part of root canal debridement. It helps by eliminating the microorganisms, flushing debris and removing the smear layer from the root canal system. The most commonly used method for removal of smear layer is the alternating use of 17% EDTA and 5.25% sodium hypochlorite.2 Other irrigating agents such as EDTA, citric acid and MTAD have also been used for removal of smear layer.

MTAD has been reported to be highly effective in removing smear layer, eliminating microbes that are resistant to conventional endodontic irrigants and medication. It is an aqueous solution containing 3% doxycycline, 4.25% citric acid and 0.5% polysorbate 80 detergent. MTAD is a biocompatible irrigant providing sustained antimicrobial activity.1

Peracetic acid is a disinfectant widely used in food industry and in hospitals. It is sporocidal, bacteriocidal, virucidal and fungicidal even in the presence of proteins. The fact that acetic acid is liberated from peracetic acid solution could be used after instrumentation to dissolve the smear layer and provide a thorough disinfection of the root canal system pretreated with sodium hypochlorite.3

The use of ultrasonics helps in activating a pre-delivered irrigant to facilitate deeper penetration into dentinal tubules. Passive ultrasonic irrigation refers to, an irrigation protocol where an ultrasonically activated file is placed into the root canal filled with an irrigant.4

The aim of this study is to assess the effect of 17% EDTA, MTAD and 2.25% peracetic acid on smear layer removal in the apical portion of the root canals coupled with passive ultrasonic activation for various time intervals.



6.2 REVIEW OF LITERATURE:
1)This study was undertaken to compare the efficacy of Bio-Pure MTAD, 17% EDTA and 42% citric acid in endodontic smear layer removal and degree of erosion in the apical third of endodontic canals. Evaluation by scanning electronmicroscopy showed no significant differences among test irrigants in removing the smear layer. However, the efficacy of BioPure MTAD and 17% EDTA in removing the smear layer was significantly greater than 5.25% NaOCl (control). The erosive effects of irrigating solutionscould not be evaluated.
2)The purpose of this study was to compare the efficacy of SmearClear, 17% EDTA and 10% citric acid in smear layer removal. The results showed that there were no significant differences in the efficacy of three chelating agents at all levels of the root canals. However, the efficacy of citric acid was significantly less in the apical third compared with the coronal and middle thirds of the canals.
3)This study was undertaken to evaluate the effects of EDTA, etidronic and peracetic acid when used in conjunction with sodium hypochlorite as root canal irrigant on calcium eluted from canals, smear layer and root dentine demineralization after instrumentation/irrigation. The decalcifying agents under investigation were all able to remove smear layer. However, they eroded the dentine wall differently.
4) The study evaluated in vitro effectiveness of 17% EDTA with and without ultrasonics on smear layer removal. A 1-minute application of combined use of EDTA and ultrasonics was shown to be efficient for smear layer and debris removal in the apical region of the root canal.
5) The study compared the ability of 17% EDTA and 7% maleic acid in removal the smear layer from the human root canal system. Final irrigation with 7% maleic acid is more efficient than 17% EDTA in the removal of smear layer from the apical third of the root canal system, which is a crucial area for disinfection.
6) The aim of this study was to investigate the cleaning ability of a self- adjusting file system regarding debris and smear layer removal using EDTA or MTAD. As a result it was found that MTAD removed smear layer in 85%,70% and 60% and of debris in 95%, 90% and 95% of the coronal, middle and apical third of the root canals respectively. While irrigation with EDTA removed smear layer in 80%, 60% and 50% and of debris in 95%, 90% and 85% of the coronal, middle and apical thirds of the root canal respectively.

6.3 AIMS AND OBJECTIVES OF THE STUDY:

The Aims and Objectives of this study are:



  1. To evaluate the effectiveness of 17% EDTA, MTAD and 2.25% peracetic acid for their ability to remove the smear layer in the apical portion of root canal, when coupled with ultrasonic agitation.

  2. To compare the smear layer removal by varying the duration of ultrasonic agitation.





7. MATERIALS AND METHODS:
7.1Source Of Data Or Materials :

Eighty extracted human single rooted teeth will be used for this study. They will be collected from the department of Oral and Maxillofacial Surgery, A.E.C.S.Maaruti College of Dental Sciences and Research Institute.




  • BioPure MTAD (Dentsply, Tulsa Endodontics, USA).

  • 17% EDTA (Pulpdent, USA).

  • 2.25% Peracetic acid (Leo Chemicals, India).

  • 3% Sodium hypochlorite.(Vensons, India)

  • Saline.(Ives drugs, India)

  • RaCeNickel Titanium Rotary files (FKG Switzerland).

  • ISO size 10# K-files (Mani, Japan).

  • Ultrasonic unit (EMS, Switzerland).

  • Ultrasonic endodontic K file size #20.

  • 27 guage hypodermic needle with beveled tip (Dispovan, India).

  • Paper points (Dentsply, USA).

  • Diamond disc (Horico, Germany).

  • Chisel (Manipal, India).

  • Scanning Electron Microscope (Cambridge).




    1. METHODOLGY:

Inclusion criteria:

    • Teeth with intact clinical crowns and single straight roots.

    • Teeth without dental caries.

    • Teeth extracted for periodontal reasons or orthodontic reasons.

    • Medium sized roots

Exclusion criteria:

    • Teeth with dental caries.

    • Teeth with cracks.

    • Teeth which are restored.

    • Teeth with developmental anomalies.

    • Teeth which exhibit attrition or abrasion.

    • Teeth with severely curved roots.

    • Teeth with internal or external resorption.

    • Deciduous teeth.


PREPERATION OF SAMPLES

The teeth will be decoronated to standardize the root lengthto 12mm. Working length will be established by inserting a No.10 K file into the canal until the tip is visible at the apical foramen. 1mm will be subtracted from this length and will be taken as working length for preparation of the root canal. Biomechanical preparation will be performed using RaCe nickel titanium rotary instruments in a crown down manner to a final apical size of 30/0.4%. The canals will be irrigated with 2ml of 3% sodium hypochlorite using 27 guage hypodermic needle with beveled tip between each instrument. All teeth will be randomly divided into four main groups, comprising of twenty teeth (n=20). All groups will in turn be divided into two subgroups depending on the duration for which it will be ultrasonically agitated.

After biomechanical preparation, the irrigation sequence comprises of placing 1ml of the testing solution in the canal and then ultrasonically activating it by placing an ultrasonic endodontic K file #20 at a distance of 1mm from the working length at a power setting of 2. After irrigating with the testing solutions, all the teeth will be irrigated with 1ml of 3% sodium hypochlorite using 27 guage hypodermic needle with beveled tip. The tip of the needle will be placed within 1-2mm from the working length.

GROUP I(Control) :

Group IA(n=10):1ml of 3% NaOCl for 1minute with passive ultrasonic agitation.

Group IB(n=10):1ml of 3%NaOCl for 3 minutes with passive ultrasonicagitation.
GROUPII(BioPure MTAD) :

Group II A(n=10): 1ml of MTAD for 1 minute with passive ultrasonic agitation.

Group II B(n=10): 1ml of MTAD for 3 minutes with passive ultrasonic agitation .
GROUP III (17%EDTA):

Group III A(n=10):1ml of 17% EDTA for 1 minute with passive ultrasonic agitation.

Group III B(n=10): 1ml of 17% EDTA for 3 minutes with passive ultrasonic agitation.
GROUP IV (2.25% Peracetic acid):

Group IV A(n=10):1ml of 2.25% peracetic acid for 1 minute with passive ultrasonic agitation.

Group IV B(n=10): 1ml of 2.25% peracetic acid for 3 minutes with passive ultrasonic agitation.
After irrigation of all teeth, the canals will be dried with paper points.Two longitudinal grooveswill be placed on the external surface of the roots, opposite to each other without penetration into the root canal, using a diamond disc. The roots will be split longitudinally into two halves with a chisel.For each root the half containing the most visible portion of the apex will be used for microscopic observation. The samples will be viewed under scanning electron microscope at a magnification of 2000X.
SEM EVALUATION

Cleanliness of the root canal will be evaluated at 2mm from the apical foramen andphotographed at 2000X magnification.

Evaluation will be performed independently by two observers and efficacy of smear layer removal will be assessed according to the scoring criteria mentioned below.
Score 1: All the dentinal tubules completely open.

Score 2: More than 50% dentinal tubules open.

Score 3: Less than 50% dentinal tubules open.

Score 4: None of the dentinal tubules remained open.


STATISTICAL ANALYSIS

The data obtained will be statistically analyzed using Wilcoxon SignedRank Test and Kruskal-Wallis Test.









7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY.
NOT APPLICABLE
7.4HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR

INSTITUTION?

YES
7.5 TRIAL TESTS DONE IF ANY?

YES









LIST OF REFERENCES:



1.

Manuele Mancini, EmilianoArmellin, Adriano Casaglia,

LoredanaCerroni, Luigi Cianconi,

“A Comparative Study of Smear Layer Removal and Erosion in Apical Intraradicular Dentine With Three Irrigating Solutions: A Scanning Electron Microscopy Evaluation.”

JOE,2009,35, 900-903.


2.

SedighehKhedmat and NoushinShokouhinejad

“Comparison of the Efficacy of Three Chelating Agents in Smear Layer Removal.”

JOE,2008,33, 599-602.


3.

S. Lottanti1, H. Gautschi, B. Sener& M. Zehnder

“Effects of ethylenediaminetetraacetic, etidronic and peracetic acid irrigation on human root dentine and the smear layer. ”

IEJ, 2009, 42, 335–343.


4.

Hong-Guan Kuah, Jeen-Nee Lui, Patrick S.K. Tseng and Nah-Nah Chen

“The Effect of EDTA with and without Ultrasonics on Removal of the Smear Layer.”

JOE ,2009,35, 393-396.


5.

NidamburVasudevBallal, SreeneshKandian, KundabalaMala,KadengodluSeetharamaBhat, and ShashirashmiAcharya

“Comparison of the Efficacy of Maleic Acid and Ethylenediaminetetraacetic Acid in Smear Layer Removal from Instrumented Human Root Canal: A Scanning Electron Microscopic Study. ”

JOE ,2009, 35, 1573-1576


6.

Adigüzel O, Yiğit-Özer S, Kaya S, Uysal I, Ganidağli-Ayaz S, Akkuş Z.

“ Effectiveness of ethylenediaminetetraacetic acid (EDTA) and MTAD on debris and smear layer removal using a self-adjusting file.”

OOOE, 2011, 112, 803-808.


Flow chart of intended study




Eighty single rooted teeth

(n=80)




Group I

(n=20)


3%Sodium Hypochlorite solution

Group I A(n=10): 1ml of 3% NaOCl for 1 minute with passive ultrasonic agitation.




Group I B(n=10): 1ml of 3% NaOCl for 3 minutes with passive ultrasonic agitation.



Group II

(n=20)


MTAD

Group II A(n=10): 1ml of MTAD for 1 minute with passive ultrasonic agitation.



Group II B(n=10): 1ml of MTAD for 3 minutes with passive ultrasonic agitation.



Group III

(n=20)


17%EDTA

Group III A(n=10): 1ml of 17% EDTAfor 1 minute with passive ultrasonic agitation.



Group III B(n=10): 1ml of 17%EDTA for 3 minutes with passive ultrasonic agitation.



Group IV

(n=20)


2.25%peracetic acid

Group IV A(n=10): 1ml of 2.25% peracetic acid for 1 minute with passive ultrasonic agitation.



Group IV B(n=10): 1ml of 2.25% peracetic acid for 3 minutes with passive ultrasonic agitation.



After irrigation with the testing solutions, all teeth will be irrigated with 1ml of 3% sodium hypochlorite using 27 guage hypodermic needle with beveled tip. The tip of the needle will be placed within 1-2mm from the working length.


All specimens will be dried with sterile paper points and then two parallel longitudinal grooves will be made on the external surface of the root and split using a chisel.

Gold/Silver sputter coated and viewed under Scanning Electron Microscope, 2mm from the apical foramen at 2000X magnification.


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