The use of ultrasound for the removal of the smear

layer. The effect of sodium hypochlorite

concentration; SEM study
Jeffrey A. Cameron, BDS

Key words: Endodontics, root canals, smear layer,

sodium hypochlorite, ultrasound.
Abstract
This study was carried out to determine the optimum
concentration of sodium hypochlorite activated by
ultrasound needed to remove the smear layer from
an instrumented root canal wall. The results
indicated that under the conditions of this
experiment a 4 per cent solution of sodium hypochlorite removed all of the smear layer from all 5
specimens; a 2 per cent solution was almost as
effective; 1 per cent or 112 per cent solutions were
less effective, and water was the least effective. A
2 per cent solution of sodium hypochlorite activated
by ultrasound would appear to be the optimum
concentration for the production of a smear free root
canal wall under clinical conditions.

(Received for publication September 1986. Accepted

April 1987.)

Sodium hypochlorite has a long history as an

endodontic irrigant. In 1936 Walker' suggested the
judicious use of double strength chlorinated soda
in addition to mechanical cleansing of the root
canal. He commented upon its tissue solvent and
germicidal properties, with no apparent ill effect
on living tissue. Double-strength chlorinated soda
is a solution of sodium hypochlorite and sodium
chloride containing at least 5 per cent available
chlorine. In 1941 Grossman and Meirnan2 used
pulp tissue from freshly extracted teeth to investigate the solvent efficiency of agents such as
double-strength chlorinated soda, hydrochloric or
sulphuric acids, potassium or sodium hydroxides,
or a variety of enzymes. They found the doublestrength chlorinated soda to be the most effective
pulp tissue solvent of the chemicals tested. Since
Australian Dental Journal 1988;33(3):193-200.

that time many authors have used a wide variety

of tissue types to investigate the tissue solvent
properties of sodium hypochlorite and the effect of
dilution on the solvent efficiency of sodium
hypochlorite.
It is possible that this protein solvent capability
could be a factor in the ability of sodium hypochlorite ultrasonic irrigation to remove the smear
layer from the wall of an instrumented root canal.
Trepagnier, Madden, and Lazzari3used 0.5 per
cent, 2.5 per cent, and 5 per cent solutions of
sodium hypochlorite to dissolve the collagen
containing tissues remaining in the root canal of
instrumented human teeth. The 5 per cent and 2.5
per cent solutions showed no significant difference
in their solvent ability in the 5 minute treatment
time, while the 0.5 per cent solution had little
solvent action. Hand, Smith, and Harrison' used
necrotic rat epithelial and subcutaneous tissue to
investigate the effect of dilution on the solvent
action of sodium hypochlorite. They found a 5.2
per cent solution to be more effective than a 2.5
per cent solution which was more effective than a
1 per cent solution; a 0.5 per cent solution was
comparable with distilled water in its ability to
dissolve necrotic tissue. TheS used necrotic tissue
from the abdominal wall of a rat to confirm the
superior solvent action of a 3 per cent solution of
sodium hypochlorite compared with a 1 per cent
solution. Gordon, Damato, and ChristneP exposed
vital and necrotic bovine pulp tissue to 0, 1, 3 or
5 per cent sodium hypochlorite. The 3 per cent and
5 per cent solutions were equally effective in
dissolving the vital tissue. Concentrations of 1, 3
and 5 per cent were equally effective in dissolving
the necrotic tissue. Nakamura, Asai, Fujita, and
colleagues' concluded that 5 per cent and 2 per cent
solutions of sodium hypochlorite were equally
effective in dissolving bovine tendon collagen,
bovine pulp, and bovine gingiva.
193

Senia and Marshalla used 5.25 per cent sodium

hypochlorite as an endodontic irrigation solution
in the mesial root canals of human first molar teeth.
They concluded that 5.25 per cent sodium hypochlorite was more effective than normal saline in
dissolving human pulp tissue, but was of
questionable value as an endodontic irrigating agent
in the apical 3 mm of narrow root canals. McComb
and Smith9 used the scanning electron microscope
(SEM) to study the root canal wall after hand
instrumentation in conjunction with a variety of
irrigating solutions. Six per cent sodium hypochlorite was effective in removing superficial debris,
but was not capable of removing the smear layer
that was produced by standard instrumentation
techniques. This smear layer was thought to contain
dentine, remnants of odontoblastic processes, pulp
tissue and bacteria. Lester and Boyde'O commented
on the 'fuzzy' or 'smeared' appearance of the root
canal wall when 1 per cent sodium hypochlorite was
used as an irrigating solution during and after hand
instrumentation. Storage of these specimens in 5
per cent sodium hypochlorite for 3 days removed
part of the smear layer, but left the dentinal tubule
openings occluded with a plug of mineralized
debris.
Sodium hypochlorite has been used in
conjunction with other irrigating agents in an
attempt to achieve a debris free canal. Grossman"
believed the effervescence produced by the alternate
use of sodium hypochlorite and hydrogen peroxide
should remove debris from the root canal.
Experiments by McComb and Smith9 suggested
that the combination of 6 per cent sodium hypochlorite followed by 3 per cent hydrogen peroxide
produced a surface similar to that produced with
water irrigation, while Svec and Harrison1zconsidered the combination to be superior-to saline in the
apical third of the root canal. Rubin and colleague^'^
examined the flushing efficiency of 2.5 per cent
sodium hypochlorite alternated with 3 per cent
hydrogen peroxide and concluded that instrumentation was the most important aspect of
biomechanical preparation, while Baker and coworkers" stated that the flushing action of the
solutions, and not their tissue dissolving qualities,
appeared to be the significant factor. Rome, Doran,
and Walker15used Gly-Oxide in combination with
sodium hypochlorite (concentration not stated) and
concluded that the combination was no more
effective in preventing smear layer formation than
the use of sodium hypochlorite alone. McComb,
and Smith9 used REDTA* liberally during and

after hand instrumentation and produced a debris

laden smear layer in the apical region of the root
canal. Goldman and colleagues16used a perforated
needle to deliver high volumes of 5 per cent sodium
hypochlorite into the root canal. This delivery
system was able to remove the smear layer from
uninstrumented areas but not from instrumented
areas of the apical region of the root canal wall.
When the perforated needle was used to deliver
10 mL REDTA followed by 10 mL 5 per cent
sodium hypochlorite there was little evidence of a
smear layer in the apical third of the root canal."
This delivery system was not able to remove soft
tissue and debris from a large fin adjacent to a root
canal. Berg and co-workers18used REDTA while
instrumenting decoronated teeth to size #70 at the
apex, with 3 mL REDTA as a final irrigation. The
canal wall was clean in the coronal third but showed
debris plugs in the dentinal tubules in the middle
third of the canal.
Ultrasound has been suggested as a means of
increasing the efficiency of both instrumentation
and irrigation of root canals. Takagi19 and Moorer
and WesselinkzOfound that ultrasound markedly
improved the efficiency of sodium hypochlorite as
a tissue solvent. Crabbzl felt it was 'possible to
render root canals extremely clean using 5 per cent
sodium hypochlorite as an irrigating solution in
combination with ultrasonic agitation and with the
minimum of instrumentation . . .'. Cameronzzwas
able to remove the smear layer from the apical third
of a hand instrumented root canal by the ultrasonic
activation of 3 per cent sodium hypochlorite over
a 3 minute period. The ultrasonic energy was
delivered to the irrigant by a smooth broach held
in an endodontic insert PR30.t Cunningham and
Martinz3 used a continuous flow of 2.5 per cent
sodium hypochlorite through an endodontic insert
Pl05t for the ultrasonic preparation and irrigation
of the root canal. They found minimal smearing of
the canal wall in the apical region, with smear free
ramifications where instrumentation had not been
possible. Goodman, Reader, and Beckz4used 2.6
per cent sodium hypochlorite activated by ultrasound to irrigate canals instrumented by the
step-back technique. They found significantly less
soft tissue 1 mm from the apex after ultrasonic
irrigation, but no significant difference at the 3 mm
level. Langeland, Liao, and PasconzSwere unable
to achieve a totally clean canal when a continuous
flow of 1 per cent sodium hypochlorite was used
through the endodontic insert P105.Trauber and
colleaguesz6modified a scaler tip to activate 0.5 per

*Roth Drug Company, Chicago, Ill, USA.

194

tPR30/P105:Cavitron. Dentsply, York PA, USA.

Australian Dental Journal 1988;33:3.

cent sodium hypochlorite but were unable to

remove debris from the apical third of an
instrumented root canal.
This review of the literature would indicate that
the volume of irrigation solution, the concentration
of available chlorine and rate of fluid flow all have
an effect on the efficiency of sodium hypochlorite
as an endodontic irrigant. This experiment was
designed to standardize (1) the volume of irrigating
solution, (2) the source of ultrasonic energy, and
(3)the design of insert and probe used for the ultrasonic activation of the irrigant. The smear layer was
also standardized as far as possible by using water
as the irrigating liquid during hand instrumentation. The effect of varying the concentration of
available chlorine was to be assessed by studying
the apical third of the root canal with a scanning
electron microscope with particular reference to the
presence of a smear layer.

Materials and methods

Twenty-five recently extracted, single-rooted
human teeth were stored in water prior to
instrumentation. The apical funnel was enlarged by
two sizes of instrument and the canal slightly flared
using H files through a conventional access cavity;
one 2.2 mL cartridge of anaesthetic solution was
used to flush debris from the canal during
instrumentation. These teeth were allocated to 5
groups each containing 5 teeth on a random basis.
A stock solution of 4 per cent sodium hypochloritet
was diluted as necessary with distilled water to
provide test solutions containing either 4 per cent
(Group l), 2 per cent (Group 2), 1 per cent (Group
3), or 1/2 per cent (Group 4) available chlorine.
Diluted test solutions were prepared daily as
required. A cartridge of anaesthetic solution was
used to provide a test solution of 0 per cent available
chlorine (Group 5). Each group received 3 minutes
of ultrasonic irrigation using one of the concentrations of sodium hypochlorite as the irrigating
solution. The technique of ultrasonic irrigation was
described in the first part of this study.zzA smooth
broach without a spiral handleg was placed into an
endodontic insert PR30 so that approximately
25 mm of the broach extended from the hub of the
insert. Ultrasonic energy was provided by a dental
unit )I used at threequarter power in the prophylaxis
mode. The root canal and access cavity were filled

$Zho bleach. Ajax Chemicals, Sydney.

Micro Mega. Geneva, Switzerland.
IQvi Endo. Dentsply, York PA, USA.
Australian Dental Journal 1988;33:3.

with the test irrigant, the broach placed into the

root canal so that it did not touch the canal wall
and the tip of the broach was in the middle-third
of the root canal. The ultrasound unit was activated
for 20 seconds. Ten seconds was allowed to remove
the broach from the canal, replenish the irrigant,
and replace the broach into the canal. This process
was repeated so that every canal received 2 minutes
of ultrasound during a 3 minute test period. Any
further action of the sodium hypochlorite was
halted with a final irrigation of 2.2 mL of
anaesthetic solution. The apical half of the root was
removed and sectioned longitudinally with a
diamond wheel under a fine air water spray. The
specimens were mounted on a 10 mm diameter
brass stub, air dried, given a minimum thickness
of gold coating and viewed in a scanning electron
microscope.1 The image so obtained was recorded
on negative film** in a roll film back.?? All
specimens were viewed from end to end at x 500
magnification prior to photographing areas typical
of the apical seat, the apical funnel ( < 5 mm from
apex) and a region approximately 9 mm from the
apex. Magnifications were standardized at x 4500,
x 2000 and x 500. All photomicrographs presented
in this paper represent areas typical for 3-5 mm
from the apical seat.

Results
Group 1: 4 per cent sodium hypochlorite
Every specimen in this group showed a clean,
smear-free surface from one end of the specimen
to the other. The debris plug had been removed
from the openings of the dentinal tubules (Fig. 1).
Predentine had been dissolved from uninstrumented areas to reveal the calcospherite structure of
the mineralized surface of the root canal wall.
Group 2: 2 per cent sodium hypochlorite
Four specimens in this group presented a smearfree surface (Fig. 2) similar to specimens in Group
1. In one specimen some smeared areas were still
present at the apical seat and in the apical funnel.
This smear layer did not appear to be tightly bound
to the wall of the canal and dentinal tubule openings
were visible where the smear layer had lifted.
Group 3: 1 per cent sodium hypochlorite
All specimens in this group showed a smeared
instrumented surface with some evidence of the

(IEOL JSM 840. JEOL, Tokyo, Japan.

++IlfordFF4. Ilford Ltd, Cheshire, UK.
ttMamiya Camera Company, Tokyo, Japan.
195

Fig. ].-Four per cent sodium hypochlorite activated by ultrasound removed the superficial smear layer and debris plugs from the
dentinal tubules. Orig. x 2000.
Fig. 2.-Ultrasonic irrigation with 2 per cent sodium hypochlorite produced a smear free surface in 4 of the 5 specimens in this group.
Orig. x2000.
Fig. 3.-Specimens irrigated with 1 per cent sodium hypochlorite retained most of the superficial smear layer; some tubule openings
are visible. Orig. x 2000.
196

Australian Dental Journal 1988;33:3.

Fig. 4. -Half per cent sodium hypochlorite irrigation removed most soft tissue debris but appeared to have no effect on the superficial
smear layer. Orig. x 2000.
Fig. 5.-Ultrasonic irrigation with water did not remove the superficial smear layer or retained soft tissue debris. Orig. ~ 2 0 0 0 .

smear layer lifting to reveal the dentinal tubules

below (Fig. 3). There was little variation from area
to area or from specimen to specimen.

the smear layer (Fig. 5). The small cracks in the

smear layer were thought to have occurred during
preparation of the specimens.

Group 4: 1/2 per cent sodium hypochlorite

All specimens in this group presented an intact
smear layer on all instrumented surfaces. Some
cracks were present in the smear layer, but it was
felt that these were as a result of shrinkage during
specimen preparation (Fig. 4).

Discussion
In the literature reviewed, the efficiency of a root
canal irrigation technique was evaluated by the light
microscope or by the scanning electron microscope
(SEM). The light microscope was used to study
stained, serial, horizontal sections of the root canal.
This technique demonstrated soft tissue within the
main canal and the contents of any uninstrumented
fin or cul-de-sac. The scanning electron microscope
was used to study longitudinal sections of the root
canal. It could demonstrate gross debris within the

Group 5: water
A heavy, tightly adherent smear layer was present
on the surface of every specimen. There was
evidence of soft tissue remnants on the surface of
Australian Dental Journal 1988;33:3.

197

canal, the presence of a smear layer on the canal

wall or debris in the mouth of a dentinal tubule.
Because of the proven efficiency of ultrasonic
irrigation using a higher concentration of sodium
hypochloriteyzZit was felt that the finer detail
offered by the SEM would be needed to demonstrate differences in the experimental groups. It had
not been planned to carry out a statistical analysis
of the results, but rather to present photomicrographs of the least smeared and most smeared
regions in each group. However, the appearance of
the instrumented areas in 4 of the 5 experimental
groups was so consistent that one photograph could
be used to represent a particular group. Only the
2 per cent sodium hypochlorite group showed a
range of smeared and smear-free instrumented
areas. In this group the one specimen with some
retained smear layer was a fine upper lateral incisor
that had been enlarged by two instrument sizes to
file size #35 at the apex. It was possible that the
narrow diameter of the root canal was a factor in
the retention of some of the smear layer. The smear
layer produced on the root canal wall during hand
instrumentation will contain organic tissue in the
form of pulpal soft tissue, predentine and the
organic component of dentine. Lester and Boyde'O
suggested that 'it is composed of translocated
dentine deformed under high pressure'. In the early
stages of instrumentation the smear layer could have
a relatively high organic pulpal content. As
instrumentation progressed less pulpal tissue would
remain to be included in the smear layer, so the
protein solvent capability of sodium hypochlorite
would be less relevant. At the completion of
instrumentation, when the apical seat had been
formed and the canal wall had been flared, the
smear layer could have an inorganic content
approaching the 65 per cent inorganic content of
intact dentine. This 'mineralized' smear layer could
react with EDTA more readily than with sodium
hypochlorite. This hypothesis is in agreement with
the results obtained by Berg and colleagues'8 who
used EDTA to remove the smear layer from a canal
instrumented to file size #70 at the apex. It is also
possible that part of the success of their experiment
could be attributed to the large diameter of the root
canal.
All of the specimens receiving ultrasonic sodium
hypochlorite irrigation showed smear-free
uninstrumented areas surrounded by instrumented
areas, yet the ultrasonic water specimens showed
an intact, completely smeared canal wall. As all of
the specimens were enlarged to the same degree,
one would anticipate uninstrumented areas to be
present in these Group 5 specimens. It was
198

concluded that the uninstrumented areas were

obscured by a smear layer on the surface of the
predentine. It is possible that this area of smear
layer was a debris slurry plastered onto the surface
of the predentine, and was similar in appearance
to the smear layer formed by the pressure of
instrumentation on the dentine surface. This
concept of smear layer formation in uninstrumented
regions would help explain why some areas of smear
layer adhere to the instrumented root canal wall
while in other areas the smear layer lifts off quite
readily. After 3 minutes of ultrasonic irrigation with
1/2 per cent sodium hypochlorite the smear layer
and predentine had been removed from uninstrumented areas to reveal clean calcospherite structures
on the canal wall. It is possible that the most
efficient way of obtaining a clean, smear-free canal
would be to keep instrumentation to a minimum,
so that smear layer formation was minimized; the
organic debris would be dissolved by a protein
solvent rather than mechanically removed by hand
instrument at ion.
In order to keep the experimental variables to a
minimum it was decided to use water as the irrigant
during instrumentation rather than the concentration of sodium hypochlorite appropriate for each
experimental group. While this was a departure
from clinical practice for hand instrumentation, it
did ensure that the significance of hypochlorite
concentration during ultrasonic irrigation was
emphasized. Another factor influencing this
decision was the development of ultrasonic and
sonic devices that utilize water as the irrigant during
root canal preparation. The manufacturers of some
of these ultrasonic devices have suggested the use
of ultrasound with either sodium hypochlorite or
EDTA as the final irrigation of the root canal.
It has been shown that fluid flow improved the
protein solvent activity of sodium hypochloritez0.2'
and that ultrasound was an effective method of
producing fluid flow. When assessing the efficiency
of any ultrasonic irrigation technique one would
have to consider the nominal power of the ultrasound generator, the power of the insert (if
applicable), and the efficiency of the probe in transmitting the energy from the insert to the irrigation
liquid. Most dental ultrasound prophylaxis units
have enough power to activate an endodontic insert.
Of the two endodontic inserts presently available
for magnetostrictive units the older design PR30
is the more powerful and is more suited to ultrasonic irrigation; the less powerhl P105 with a flow
through irrigation system seems better suited to
canal instrumentation. A piezo electronic unit with
a well designed endodontic instrument holder
Australian Dental Journal 1988;33:3.

should be able to transmit adequate power for both

ultrasonic irrigation and instrumentation. The
author has had no success in creating an efficient
endodontic insert by modifying a periodontal insert.
Endodontic hand instruments welded onto a periodontal insert tended to break, and a spring loaded
clip welded to the insert was not efficient in transmitting ultrasonic energy to the retained instrument. Conventional hand instruments such as
reamers, files, smooth broaches or hand pluggers
have been used in the endodontic insert in pilot
studies by the author. The most efficient instrument
was a smooth broach without a spiral handle; one
brand4 of smooth broach seemed to be very efficient
in transmitting ultrasonic energy and did not
fracture as easily as any other brand tested.
In this experiment ultrasonic water irrigation had
no apparent effect on the smear layer, so it would
appear that ultrasound per se does not mechanically
remove the smear layer. McComb and Smith' found
that 6 per cent sodium hypochlorite did not remove
the smear layer, so the efficiency of ultrasonic
irrigation with either 4 per cent or 2 per cent
solutions must have been as a result of the fluid flow
within the system. In this study the tip of the ultrasonic probe did not extend beyond the middle-third
of the root canal, yet in groups 1 and 2 the effects
of the fluid flow extended right to the apical seat.
This ability to clean a canal wall by the use of ultrasonic irrigation has benefits beyond the removal of
the smear layer. Hand instrumentation does not
prepare all surfaces on the canal wall equally,I4 nor
do all operators use hand instruments with the same
e f f i c i e n c ~With
. ~ ~ ultrasonic irrigation the operator
holds the tip of the ultrasonic probe within the
irrigating liquid, and the ultrasound forces the
liquid against the canal wall. This minimizes the
effects of operator technique, and permits the
cleansing of irregularities in the canal wall. Ultrasonic irrigation has the ability to exert its cleansing
ability beyond the main root canal into an adjacent
fin or into the isthmus in a lower molar
Because of this ability to clean beyond the main
canal, ultrasonic irrigation must be considered
superior to EDTA or the EDTA/sodium hypochlorite combination, which tends to leave debris
in a fin."

Summary and conclusions

Twenty-five recently extracted human teeth were
enlarged by two instrument sizes using Hedstrom
files with water as the irrigant. Each group of five
teeth received 3 minutes of ultrasonic irrigation
with either 4 per cent, 2 per cent, 1 per cent, 1/2
per cent or 0 per cent sodium hypochlorite as the
Australian Dental Journal 1988;33:3.

irrigant. The scanning electron microscope was

used to determine the presence or absence of a
smear layer in the apical third of each specimen.
It was concluded that ultrasonic irrigation with 4
per cent or 2 per cent sodium hypochlorite was an
efficient method of removing the smear layer from
instrumented areas of the root canal; ultrasonic
irrigation with 1/2 per cent sodium hypochlorite
was capable of removing the smear layer from
uninstrumented areas of the canal wall. A 2 per cent
solution of sodium hypochlorite activated by an
efficient ultrasound delivery system is recommended for the final cleansing of instrumented root
canals.

Acknowledgements
The author wishes to thank the Australian Dental
Research Fund for its financial assistance; Mr Gary
Weber of the Electron Microscope Unit, University
of Newcastle, for his technical assistance, and Miss
Robyn Westbury for processing the manuscript.
References
1. Walker A. A definite and dependable therapy for pulpless
teeth. J Am Dent Assoc 1936;23:1418-25.
2. Grossman LI, Meiman BW. Solution of pulp tissue by
chemical agents. J Am Dent Assoc 1941;28:223-5.
3. Trepagnier CM, Madden RM, Lazzari EP. Quantitative
study of sodium hypochlorite as an in virro endodontic
irrigant. J Endod 1977;3: 194-6.
4. Hand RE, Smith ML, Harrison JW. Analysis of the effect
of dilution on the necrotic tissue dissolution properties of
sodium hypochlorite. J Endod 1978;4:60-4.
5. ThC SD. The solvent action of sodium hypochlorite on fmed
and unfixed necrotic tissue. Oral Surg 1979;47:558-61.
6. Gordon TM, Damato D, Christner P. Solvent effect of
various dilutions of sodium hypochlorite on vital and necrotic
tissue. J Endod 1981;7:466-9.
7. Nakamura H, Asai K, Fujita H, et al. The solvent action
of sodium hypochlorite on bovine tendon collagen, bovine
pulp, and bovine gingiva. Oral Surg 1985;60:322-6.
8. Senia ES;Marshall FJ. The solvent action of sodium hypochlorite on pulp tissue of extracted teeth. Oral Surg
1971;31:96-103.
9. McComb D, Smith DC. A preliminary scanning electron
microscopic study of root canals after endodontic procedures.
J Endod 1975;1:238-42.
10. Lester KS, Boyde A. Scanning electron microscopy of
instrumented, irrigated and filled root canals. Br Dent J
1977;143:359-67.
11. Grossman LI. Irrigation of root canals. J Am Dent Assoc
1943;30: 1915.
12. Svec TA, Harrison JW.
Chemomechanical removal of pulpal
and dentinal debris with sodium hypochlorite and hydrogen
peroxide vs normal saline solution. J Endod 1977;3:49-53.
13. Rubin LM, Skobe Z, Krakow AA, Gron P. The effect of
instrumentation and flushing of freshly extracted teeth in
endodontic therapy: a scanning electron microscope study.
J Endod 1979;5:328-35.
199

14. Baker NA. Eleazer PD, Averbach RE, Seltzer S. Scanning

electron microscopic study of the efficacy of various irrigating
solutions. J Endod 1975;1:127-35.
15. Rome WJ, Doran JE, Walker WA. The effectiveness ofGlyOxide and sodium hypochlorite in preventing smear layer
formation. J Endod 1985;11:281-8.
16. Goldman LB, Goldman M, Kronman JH, Peck SL.
Scanning electron microscope study of a new irrigation
method in endodontic treatment. Oral Surg 1979;48:79-83.
17. Goldman M, Goldman LB, Cavaleri R, Bogis J, Peck SL.
The efficacy of several endodontic irrigating solutions: a
scanning electron microscopic study: part 2. J Endod
1982;8:487-92.
18. Berg MS, Jacobsen EL, BeGole EA, Remeikis NA. A
comparison of five irrigating solutions: A scanning electron
microscope study. J Endod 1986;12:192-7.
19. Takagi K. Basic clinical studies of root canal irrigation by
ultrasound. Aichi Gakuin J Dent Sci 1977;14:341-62.
20. Mwrer WR, Wesselink PR. Factors promoting the tissue
dissolving capability of sodium hypochlorite. Int Endod J
1982;15:187-96.
21. Crabb HSM. The cleansing of root canals. Int Endod J
1982;15:62-6.

200

22. Cameron JA. The use of ultrasonics in the removal of the

smear layer: A scanning electron microscope study. J Endod
1983;9:289-92.
23. Cunningham WT, Martin H. A scanning electron microscope evaluation of root canal debridement with the
endosonic ultrasonic synergistic system. Oral Surg
1982;53:527-31.
24. Goodman A, Reader A, Beck M, et al. An in wirm comparison
of the efficacy of the step-back technique versus a step-back
ultrasonic technique in human mandibular molars. J Endod
1985;11:249-56.
25. Langeland K, Liao K, Pascon EA. Work-saving devices in
endodontics: Efficacy of sonic and ultrasonic techniques. J
Endod 1985;11:499-510.
26. Tauber R, Morse DR, Sinai IA, Furst L. A magnifying lens
comparative evaluation of conventional and ultrasonically
energized filing. J Endod 1983;9:269-274.

Address for correspondencdreprints:

PO Box 101,
Charlestown, New South Wales, 2290.

Australian Dental Journal 1988;33:3.