Evaluation of the Efficacy of Different Irrigation Systems on the Removal of Root Canal Smear Layer: A Scanning Electron Microscopic Study

Irrigation represents a crucial step in endodontics for bacteria disinfection and smear layer removal. Several irrigation strategies have been proposed, although their effects are controversial. This study aims to assess the comparison of four different irrigation systems on the smear layer removal utilizing scanning electron microscopy (SEM). Forty sound monoradicular teeth were collected and casually allocated into four groups (n = 10): Group A, conventional irrigation; Group B, IrriFlex irrigation; Group C, ultrasonic irrigation system; Group D, apical negative pressure irrigation. After chemo-mechanical preparation and longitudinal root separation, the three root thirds were analyzed by SEM. Micrographs were carried out at x2000 to analyze the smear layer residual in each third of the root canal. Statistically significant differences were found between Group A and Group D (p < 0.05). Groups B and C showed satisfactory results in the coronal and middle thirds, while Group D was the only system that achieved satisfactory results in the apical third. However, the complete smear layer removal in the root canal was never achieved with any of the four systems tested. In conclusion, among the four tested irrigation systems, the greatest efficacy on smear layer removal was reached by Group D.