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A comparative study of root canal preparation with HERO 642 and Quantec SC rotary Ni-Ti instruments.

AIM: The purpose of this study was to compare several parameters of root canal preparation using two different rotary nickel-titanium instruments: HERO 642 (Micro-Mega, Besancon, France) and Quantec SC (Tycom, Irvine, CA, USA). METHODOLOGY: Fifty extracted mandibular molars with root canal curvatures between 20 micro and 40 micro were imbedded into a muffle system. All root canals were prepared to size 45 (Quantec SC), or 40 (HERO 642), respectively. The following parameters were evaluated: straightening of curved root canals, postoperative root canal diameter, safety issues (file fractures, perforations, apical blockages, loss of working length), cleaning ability, and working time. RESULTS: Both Ni-Ti-systems maintained curvature well; the mean degree of straightening was 2.3 degrees for Quantec SC and 1.6 degrees for HERO 642. Most procedural incidents occurred with Quantec SC instruments (five fractures, three apical blockages, eight cases of loss of working length), HERO 642 preparation resulted in three blockages and one perforation. Following preparation with HERO 642, 63% of the root canals showed a round, 24% an oval, and 17% an irregular diameter; Quantec SC preparations resulted in a round diameter in 24% of the cases, oval shape in 29%, and irregular cross-section in 47% of the cases. Mean working time was shorter for HERO 642 (52 s) than for Quantec (117 s). Cleanliness of the root canal walls was investigated under the SEM using a five-score system for debris and smear layer. For debris HERO 642 achieved better results (80% scores 1 and 2) than Quantec SC (76%). The results for smear layer were similar: cleaner root canal walls were found after preparation with HERO 642 (53% scores 1 and 2), followed by Quantec SC (41%). CONCLUSIONS: Both systems respected original root canal curvature well and showed good cleaning ability; Quantec SC showed deficiencies in terms of safety.

Anti-Infective Agents, Local↗

Root and canal morphology of Burmese maxillary molars.

AIM: To investigate the root and canal morphology of Burmese maxillary molars using a canal staining and tooth clearing technique. METHODOLOGY: Maxillary molars (239) were collected from indigenous Burmese patients and designated; first (90), second (77), third (72) molars. Following pulp tissue removal and canal system staining with Indian ink, the teeth were decalcified with 10% nitric acid, dehydrated and cleared with methyl salicylate. The following features were evaluated: (i) number of roots and morphology; (ii) number of canals per root: (iii) root canal configuration (Vertucci's classification); (iv) number of apical foramina per root; (v) number and location of lateral canals; and (vi) the presence of intercanal communications. RESULTS: All first and second molars had three separate roots, whilst third molars had one of five different root forms, of which three separate (25%) or fused (31%) roots were most prevalent. The majority of palatal (100%) and disto-buccal (96%) roots possessed one canal (type I). The prevalence of mesio-buccal roots with two canals decreased from first to third molars (68%, 49%, 39%, respectively); type II (two orifices, one apical foramen) and IV (two orifices, two apical foramina) configurations were the most common. Single/fused rooted third molars had a range of number and type of canals. Most roots in all molars had one apical foramen, those with four apical foramina were confined to third molars. Intercanal communications were most prevalent in mesio-buccal roots and two/three fused rooted third molars. Lateral canals were most prevalent in the apical third of the roots of all molars. CONCLUSIONS: The mesio-buccal roots of Burmese maxillary molars possessed a variety of canal system types. Over 50% of the first and second molars had a second mesio-buccal canal, of which over 20% had intercanal communications. The palatal and disto-buccal canals mainly had type I canals. Lateral canals were equally prevalent in all tooth types but were most common in the apical third.

Adult↗

Correlation between clinical success and apical dye penetration.

AIM: This study was undertaken to examine whether a correlation exists between apical dye penetration and the clinical performance of root fillings. METHODOLOGY: Apical dye penetration into 116 roots of human teeth that had been root-filled at least 6 months prior to extraction was tested in vitro using a vacuum technique and by measuring the length of dye penetration. Endodontic treatment was classified as clinically successful or unsuccessful and results for these groups were compared using analysis of variance and the Student's t-test. Positive and negative controls were used to test the experimental system. RESULTS: All controls performed as expected. Dye penetrated significantly further in unsuccessful cases although the raw data suggested little difference. Overall, dye penetrated 99.5% of the specimens, indicating that the presence of dye in the canal is a poor indicator of whether the technique or material will succeed. However, the extent of dye penetration may be related to the clinical outcome. CONCLUSIONS: Clinically placed root canal fillings do not provide an apical seal that prevents fluid penetration. The outcome of treatment cannot be predicted from the results of apical dye leakage studies.

Coloring Agents↗

Endodontic treatment of teeth associated with a large periapical lesion.

AIM: To report the healing of a large periapical lesion following non-surgical root canal treatment. SUMMARY: A 12-year-old male with a large periapical lesion around the apices of his mandibular incisors is described. The lesion formed after trauma to the mandibular anterior teeth 5 years previously. During root canal treatment, chlorhexidine gluconate was used for irrigation, and calcium hydroxide was used both for the intracanal dressing and as a base of the root canal sealer. Periapical healing was observed 3 months after obturation and continued at the 12-month review. Key learning points Root canal treatment, including the use of chlorhexidine gluconate and calcium hydroxide for infection control, led to substantial healing of a large periapical lesion. This report confirms that large periapical lesions can respond favourably to non-surgical treatment.

Anti-Infective Agents, Local↗

In vivo performance of the new non-instrumentation technology (NIT) for root canal obturation.

AIM: The aim of this in vivo study was to compare the radiographic quality of root fillings performed by the NIT-obturation method versus conventional mechanical obturation. METHODOLOGY: Sixty-six patients needing root canal treatment participated in this study. The treatments were performed by three private practitioners. The root canals were instrumented with K-Flexofiles to a master apical file between sizes 25 and 60, followed by step-back flaring up to size 70. Copious irrigation was used throughout the instrumentation procedure with NaOCl (3%). The teeth were obturated either by lateral condensation, the McSpadden technique (control) or by the new non-instrumentation technology (NIT) with and without using gutta-percha points. In the NIT method, a low pressure was created within the tooth, and AH 26 sealer was sucked into the root canal system. Radiographs of the root-filled teeth were analysed and the length of the root filling, the presence of voids and the area of any other fillings determined. RESULTS: The root canal fillings of the control group (0.1 +/- 0.1 mm) and those of the NIT/gutta-percha group (0.3 +/- 0.1 mm) were both overextended when taking the apical constriction as a reference point. Root canal fillings of the NIT/gutta-percha group were statistically (P < 0.05) significantly longer than those of the NIT without gutta-percha group. The latter showed slightly underextended root canal fillings (-0.14 +/- 0.1 mm). CONCLUSIONS: The present investigation demonstrated the performance of the NIT-obturation method in vivo. Root canals filled by the reduced-pressure-method using sealer combined with gutta-percha cones exhibited equivalent radiographic quality compared to conventionally filled canals.

Analysis of Variance↗

Reduction in intracanal bacteria during root canal preparation with and without apical enlargement.

AIM: To compare in vitro intracanal bacterial reduction using nickel-titanium rotary instruments with and without apical enlargement. METHODOLOGY: Thirty-eight palatal roots of maxillary molar teeth, with mature apices were subdivided according to lengths and then randomly assigned to two experimental and one control groups. The roots were sterilized and then reinfected with Enterococcus faecalis, which served as a bacteriological marker. All roots in the experimental groups were prepared in a step-down sequence with engine-driven GT rotary files at 350 rpm. In experimental group A (n = 16) additional apical enlargement to ISO size 35 was performed. In group B (n = 16) a serial step-back technique was followed with no apical enlargement. This was combined in groups A and B with irrigation with NaOCl and EDTA. In the control group (group C, n = 6) irrigation only was carried out, with no mechanical preparation. Samples were then taken from the root canals to determine the numbers of remaining bacteria. RESULTS: In groups A and B, 15 (94%) and 13 (81%) specimens were rendered bacteria-free, respectively. In the control group C none of the specimens were bacteria-free. There was a significant difference (P < 0.001) in the antibacterial effects of experimental and control regimens. There was, however, no significant difference (P = 0.276) between the preparation methods used in the experimental groups. CONCLUSIONS: There was no significant difference in intracanal bacterial reduction when Ni-Ti GT rotary preparation with NaOCl and EDTA irrigation was used with or without apical enlargement preparation technique. It may therefore not be necessary to remove dentine in the apical part of the root canal when a suitable coronal taper is achieved to allow satisfactory irrigation of the root canal system with antimicrobial agents.

Analysis of Variance↗

A preliminary study of the percentage of gutta-percha-filled area in the apical canal filled with vertically compacted warm gutta-percha.

AIM: The aim of this study was to determine the influence of the width of apical root canals and the depth of heat application during warm vertical compaction on the percentage of gutta-percha-filled area (PGFA) in the apical root canal. METHODOLOGY: Two groups of extracted human canines (total 60) were instrumented and filled with vertically compacted warm gutta-percha up to the apical foramen (AF). Using the Touch 'n Heat device heat was applied 4 mm from the AP in one group and 2 mm in the other. The number of teeth with gutta-percha extrusion was recorded. A horizontal section was cut 1.5 mm from the AF of each tooth. The cross-sectional area of the canal and the gutta-percha was measured using an image-analysis programme. The PGFA was then calculated. Multiple linear regression was performed to investigate the association between the experimental variables and the PGFA, and the occurrence of gutta-percha extrusion. RESULTS: A significant association was seen between the depth of heat application and the PGFA (P= 0.000), and between the canal area and the PGFA (P= 0.038). The average PGFA reached 96.1% when heated to 2 mm, as compared with 87.0% when heated to 4 mm. PGFAs were lower in wide apical canals than in small canals. Gutta-percha extruded in seven teeth (12%) and was independent of experimental variables. CONCLUSIONS: After warm vertical compaction, the quality of adaptation of gutta-percha to the wall of the apical root canal varies; the influencing factors in this study were the depth of heat application and the width of the apical root canal.

Cuspid↗

A six-canal maxillary first molar: case report.

AIM: The aim of this case report is to describe an unusual six-canal maxillary first molar tooth. CASE REPORT: The maxillary left first molar of a young African-American male was treated as an emergency at the first visit. At the second visit, the five canals (MB1 and 2, Pal1 and 2 and DB) were easily identified at high magnification of 16-25 under an operating microscope. The canals were then instrumented and filled using the Microseal technique. A careful radiographic examination of the final fill indicated that there was a third canal in the palatal root as suggested by a slight extrusion of the filling material between the two canals. At the third visit, the fillings of the palatal canals were removed and the apical 4mm was re-examined. The existence of a third palatal canal exiting between the two apices was verified and subsequently instrumented and obturated. KEY LEARNING POINTS: It should be assumed that all molar teeth have more than the traditionally expected three canals. The location of root canals should be identified at high magnification under the microscope. Careful radiographic re-examination of the fillings should be done in order to identify possibly missed canals.

Adult↗

Influence of calcium hydroxide intracanal medication on apical seal.

AIM: The aim of this study was to determine the influence of calcium hydroxide intracanal medication and various techniques for its removal on the sealing ability of gutta-percha root fillings with a zinc oxide-eugenol sealer. METHODOLOGY: Eighty extracted mature human mandibular molar roots were divided into three groups of similar root-canal configuration. Calcium hydroxide paste was made by mixing calcium hydroxide powder with distilled water at a powder to liquid ratio of 1:1.25. After root canals were prepared and enlarged to a minimum of size 30 with the Profile 0.06 system, calcium hydroxide paste was placed in the canals of two groups, but no medication was placed in the control group. The intracanal calcium hydroxide was removed with two different techniques, 1 week after medication: K-files one size larger than the master apical file (MAF) were used with 2.5% NaOCl and 15% EDTA solutions in one group, whilst K-files the same size as the MAF were used with 2.5% NaOCl solution in another group. Canals were obturated with gutta-percha and Tubli-Seal cement using the lateral condensation technique. The apical sealing-ability was assessed by dye leakage and cross-sections of the specimens were examined under a stereomicroscope. The dye-penetration level was measured and analyzed using Fisher's exact test and Duncan's multiple range test. RESULTS: The calcium hydroxide-medicated groups showed significantly more dye leakage than the non-medicated control group (P < 0.05). However, there was no significant difference between the two calcium hydroxide-medicated groups (P > 0.05). The stereomicroscopic views showed a relatively uneven and thicker layer of sealer in the calcium hydroxide-medicated groups. CONCLUSION: Calcium hydroxide intracanal medication may increase apical leakage of gutta-percha root fillings when a zinc oxide-eugenol sealer is used.

Calcium Hydroxide↗

Prevalence of different periapical lesions associated with human teeth and their correlation with the presence and extension of apical external root resorption.

AIM: The aim of this study was to determine the prevalence of various periapical pathologies and their association with the presence and extent of apical external inflammatory root resorption in human teeth. METHODOLOGY: One hundred and four root apices from extracted teeth with periapical lesions were examined. Semi-serial sections of soft tissue lesions were stained with HE. The lesions were classified as noncystic or cystic, each with different degrees of acute inflammation: 0, 1, 2 and 3, increasing in severity. The root apices were analysed by SEM. External root resorption was classified according to site, as periforaminal or foraminal, and the extension of the resorbed area graded in increasing area as 0, 1, 2 or 3. RESULTS: Cysts accounted for 24.5% of the samples, 84% of which were associated with marked inflammation. The most prevalent diagnosis was noncystic periapical abscess with varying degrees of severity (63.7%). Periapical granuloma was not a frequent finding. SEM analysis showed that 42.2% of the root apices had periforaminal resorption extending over 50% of their circumference. When the foraminal resorption was evaluated, 28.7% had resorption affecting >50% of the periphery. Only 8.9% of the samples showed no periforaminal or foraminal resorption. CONCLUSIONS: In the sample of extracted teeth investigated, 24.5% of the periapical lesions were cysts. Most periapical lesions (84.3%) displayed acute inflammation, whether cystic or not. Periforaminal resorption was present in 87.3% of the cases, and foraminal resorption in 83.2%. Periforaminal and foraminal resorptions were independent entities. There was no association between external root resorption and the nature of the periapical lesions.

Analysis of Variance↗

Dens invaginatus type III: report of a case and 10-year radiographic follow-up.

AIM: The purpose of this article is to report the 10-year follow-up of a right mandibular central incisor with 'dens invaginatus' that was root filled. SUMMARY: 'Dens invaginatus' is a rare malformation of teeth, probably resulting from an infolding of the dental papilla during tooth development. It has alternatively been called 'dens in dente' and 'dilated composite odontome'. Radiographic examination may clearly demonstrate this feature, although no signs may be recognized clinically. If no entrance to the invagination can be detected and there are no signs of pulp pathosis, then no treatment is required other than fissure sealing of the invagination. In deep invaginations, it is likely that root-canal treatment may be required. Occasionally, when the tooth has an immature root, apexification is necessary. Root-canal treatment of a right mandibular central incisor with 'dens invaginatus' is described along with 10-year follow-up. KEY LEARNING POINTS: Both clinical and radiographic examinations are necessary to determine morphological features of teeth before root-canal treatment. Sensibility testing to determine the pulp condition is critical prior to treatment.

Child↗

A quantitative evaluation of apical leakage of four root-canal sealers.

AIM: This in vitro study evaluated the microleakage of root fillings involving four root-canal sealers including AH Plus (De-Trey, Switzerland), RoekoSeal (Roeko, Germany). Ketac-Endo (ESPE, (Germany) and Sultan (Sultan Chemists, USA. METHODOLOGY: Forty extracted human maxillary anterior teeth were used. The coronal part of each tooth was removed and the root canals were prepared using the step-back technique and apical enlargement to size 60 file. The specimens were randomly divided into four groups of 10 samples, filled with one of the test materials and gutta-percha cones by the cold lateral condensation technique. A fluid filtration method was used for quantitative evaluation of apical leakage. The leakage was measured by the movement of an air bubble in a capillary glass tube connected to the experimental root section. Measurements of fluid movement were made at 2-min intervals for 8 min. Water transport through existing voids in the obturated canals could be measured reproducibly in this way. The quality of the seal of each specimen was measured after 7,14 and 21 days. RESULTS: Statistical analysis indicated that all the root fillings showed less leakage after 21 days (P < 0.05). Fillings incorporating Sultan showed significantly more leakage than all other sealers. CONCLUSIONS: Root fillings with RoekoSeal in combination with cold lateral condensation technique showed better sealing than those with Ketac-Endo, AH Plus and Sultan sealers after 21 days. The fluid filtration test used in this study gave quantitative results and allowed nondestructive long-term evaluation of specimens.

Analysis of Variance↗

Clinical evaluation of the cleansing properties of the noninstrumental technique for cleaning root canals.

AIM: The purpose of the present study was to evaluate noninstrumentation technology (NIT) for root-canal cleansing in vivo. METHODOLOGY: A total of 22 teeth that were to be extracted in 18 patients were treated with NIT for 30 min with 3.0% NaOCl. After extraction, the remaining organic debris in the root canals was evaluated histologically and categorized as the percentage of the corresponding canal length in the apical middle and coronal regions of the roots. Percentage of residual debris was categorized as follows: D1, 0%; D2, 1-50% and D3, 51-100%. RESULTS: In the coronal region, 55% of the roots were totally clean (Dl), whereas 12% and 33% were scored as D2 and D3, respectively. The middle section was evaluated as D1 in 27%, D2 in 18% and D3 in 55%. In the apical region, only 21% of the roots were totally cleaned: the remaining 79% were scored as D3. CONCLUSION: The results indicate that the noninstrumental technique for cleaning root canals needs further modifications for achieving acceptable results under clinical conditions.

Chi-Square Distribution↗

Light and scanning electron microscopic evaluation of Glyde File Prep in smear layer removal.

AIM: To evaluate the effectiveness of Glyde File Prep used in conjunction with sodium hypochlorite irrigation in the removal of smear layer produced during root canal instrumentation. METHODOLOGY: Thirty-nine extracted human teeth with single root canals were used. Access cavities were prepared and the teeth divided into three groups of 13 teeth each. Each group was treated by one of the three different regimes of irrigation and conditioning during root canal instrumentation. Group A: 0.5 mL of 1% NaOCl irrigation after each file size with an additional final irrigation of 10 mL 1% NaOCl; group B: 0.5 mL of 1% NaOCl irrigation after each file size with an additional final irrigation of 10 mL 17% EDTA; group C: Glyde File Prep coated on each instrumentation file used in conjunction with 0.5 mL 1% NaOCl irrigation after each file size and an additional final irrigation of 10 mL 1% NaOCl. The teeth were then longitudinally grooved and sectioned. Root canal cleanliness was evaluated with the aid of a Nikon light microscope (x40 and x100) and scanning electron microscope (x1000 and x3000). The debris scores obtained at three canal regions were compared statistically within the same group and among different groups using repeated measurements of analysis of variance (anova) with Bonferroni adjustments and anova with posthoc Tukey HSD, respectively. RESULTS: The canals treated with EDTA and Glyde File Prep were significantly cleaner than those treated with NaOCl alone. The apical region of the root canals generally displayed more residual smear layer, but the difference was not significant. CONCLUSIONS: Used in conjunction with NaOCl irrigation, Glyde File Prep was effective in removing smear layer produced during root canal instrumentation.

Analysis of Variance↗

Scanning electron microscopic study of the cleaning ability of chlorhexidine as a root-canal irrigant.

AIM: To evaluate in vitro the cleaning of root-canal walls after irrigation with different irrigants. METHODOLOGY: A total of 36 recently extracted human teeth were divided into four experimental groups according to the irrigating solution used: saline; 2% chlorhexidine; 2.5% sodium hypochlorite; and 2.5% sodium hypochlorite + EDTA. The cleaning of the apical, middle and coronal thirds of the root canals was evaluated by scanning electron microscope examination using a 4-point scoring system. RESULTS: The best cleaning was obtained using 2.5% sodium hypochlorite and EDTA, followed by 2.5% sodium hypochlorite only (P < 0.05), whose cleaning was similar to chlorhexidine only in the cervical third. Cleaning by saline and 2% chlorhexidine was worse than the other two groups and was similar in all thirds. Better cleaning was found in the cervical and middle thirds for all groups with the worst results in the apical third. CONCLUSIONS: The apical third of the root canals was not cleaned as well as the middle and coronal thirds. Cleaning by chlorhexidine and saline was inferior compared to the cleaning by sodium hypochlorite with and without EDTA.

Analysis of Variance↗

Root canal shaping with manual stainless steel files and rotary Ni-Ti files performed by students.

AIM: To investigate root canal shaping with manual stainless steel files and rotary Ni-Ti files by students. METHODOLOGY: Two hundred and ten simulated root canals with the same geometrical shape and size in acrylic resin blocks were prepared by 21 undergraduate dental students with manual stainless steel files using a stepback technique or with rotary Ni-Ti files in crown-down technique. Preparation length, canal shape, incidence of fracture and preparation time were investigated. RESULTS: Zips and elbows occurred significantly (P < 0.001) less frequently with rotary than with manual preparation. The correct preparation length was achieved significantly (P < 0.05) more often with rotary Ni-Ti files than with manual stainless steel files. Fractures occurred significantly (P < 0.05) less frequently with hand instrumentation. The mean time required for manual preparation was significantly (P < 0.001) longer than that required for rotary preparation. Prior experience with a hand preparation technique was not reflected in an improved quality of the subsequent engine-driven preparation. CONCLUSIONS: Inexperienced operators achieved better canal preparations with rotary Ni-Ti instruments than with manual stainless steel files. However, rotary preparation was associated with significantly more fractures.

Chi-Square Distribution↗

In vitro evaluation of apical microleakage following canal filling with a coated carrier system compared with lateral and thermomechanical Gutta-Percha condensation techniques.

AIM: The apical sealing ability of a coated carrier system was evaluated in extracted human teeth and compared with lateral and thermomechanical condensation techniques using dye penetration. METHODOLOGY: Sixty-four extracted single-rooted teeth were instrumented to an apical size 30 using 4% taper Hero 642 trade mark instruments (Micromega, Besançon, France). The sample was divided into three experimental groups. Twenty teeth were randomly obturated with lateral condensation, 20 with thermomechanical compaction and 20 teeth with the Herofill trade mark Soft-Core system. Four teeth were used as positive and negative controls. The teeth were covered with nail varnish up to 2 mm from the apical foramen and immersed in a 2% aqueous methylene blue dye solution for 1 week and then washed, dehydrated and embedded in resin. The apical 1 mm of each tooth was removed to reveal the apical limit of the preparation. Transverse sections of the teeth were taken at 500, 1000 and 1500 micro m from this point and evaluated for apical leakage. Significant differences between the preparations were analysed with a semiautomatic analyser and the ratio of the dye-penetrated surface to the total dentinal surface was calculated. RESULTS: Statistical analysis of the results demonstrated significantly less leakage for the Herofill trade mark Soft-Core system compared to lateral condensation in terms of total mean dentinal surface and at the 500 micro m level. No other differences were noted between Herofill trade mark Soft-Core and thermomechanical or lateral condensation, either for the total mean value or at each level. CONCLUSIONS: The Herofill trade mark Soft-Core system was a reliable obturation system in the apical portion and compared favourably with other gutta-percha filling techniques.

Coloring Agents↗

Preliminary in vitro evaluation of Carisolv as a root canal irrigant.

AIM: To test the null hypothesis that Carisolv is no better than PBS in removing organic debris from uninstrumented root canals. METHODOLOGY: The pulps of two uniform groups of 36 immature, sheep mandibular incisors were grossly removed with barbed broaches immediately prior to the study. Roots in group 1 were irrigated with phosphate buffered saline (PBS), strong sodium hypochlorite (4.5%) or Carisolv without ultrasonic agitation, whilst in group 2 the same irrigants were activated with ultrasound. Canal walls were exposed to irrigants for 10, 20 or 30 min at 37 degree C. In group 2, ultrasound was applied for 30 s at 2, 5 and 7 min within each 10 min incubation period. After washing irrigants free and immersion in fixative, all teeth were split longitudinally, critical point dried and sputter coated for SEM analysis. SEM photomicrographs were recorded of representative areas in the coronal, middle and apical canal thirds and debris scored by a single assessor against a five-point scale. Intraobserver reliability was assessed by Cohens kappa scores and debris scores analysed by the non-parametric Kruskal-Wallis test at P < 0.05. RESULTS: Sodium hypochlorite was significantly better than Carisolv and PBS in cleaning root canals (P < 0.0001), whether or not ultrasound was applied. Carisolv was shown to clean canals better than PBS, again whether or not ultrasound was applied (P = 0.01). Both incubation time and ultrasound enhanced the action of Carisolv (P < 0.001) whilst the activity of PBS was not significantly improved by exposure time or the application of ultrasound. Kappa scores of 0.90-0.95 indicated excellent consistency in debris scoring. CONCLUSIONS: Within the limitations of this preliminary study (i). Carisolv cleaned root canals better than PBS and shows promise as an adjunct to root canal preparation; (ii). the action of Carisolv was enhanced by incubation times beyond 20 min whether or not ultrasound was applied; (iii). sodium hypochlorite solution remains the gold standard endodontic irrigant, provided that it is used with care and is contained in the canal system.

Animals↗