International Research Journal of Dentistry IRJD

Vol. 1(1), pp. 007-012, April, 2017. www.premierpublishers.org. ISSN: 2326-7221

Research Article

Investigating smear layer removal from root canal

surface during irradiated with 940 nm diode laser with
different aqueous irrigants
Sheimaa A. Al-Zand1*, Mohammed Al-Maliky 2, Ali S. Mahmood3, Tamara Al-Karadaghy4
1*,2,3,4
Department of Medical and Biological applications, Institute of Laser for Postgraduate Studies, University of
Baghdad, Iraq.

The agitation of chemical irrigants was more effective in smear layer removal when canal
irradiated with laser. The aim of this work was to study the effect of laser on root canal
surface with agitation of different irrigants. A total of (12) teeth were used and randomly
divided into 6 groups (n=2), treated with different protocols; with and without chemical
irrigants and laser, then prepared for SEM imaging in 2 locations; apical and middle parts
of the root. SEM images showed superior effect on smear layer when using 3% NaOCl with
15 % EDTA and 1.5 W of 940 nm diode laser. Within the present parameters, The SEM
images showed that diode laser alone do not remove smear layer but cause its melting. It
is more effective when used with EDTA and NaOCl irrigation.

Key-words: Diode laser, 940 nm, SEM, smear layer, root canal irrigants

Key Messages: The use of diode laser in endodontic for removal of smear layer and deep cleaning from bacteria
harboured within, in combination with public irrigation solutions as NaOCl and EDTA

INTRODUCTION

The smear layer acts as harbor for the bacteria and
provides a suitable growth environment; therefore, its
removal may facilitate the antibacterial effect of
chemical irrigants and also improve the adaptation of
the filing material and guarantee a better opturation and
more successful endodontic therapy (Wang X et al.
2005).
Sodium hypochlorite (NaOCl) and EDTA improved the
endodontic treatment results, but since such chemical
agents require a direct contact with dentin surface.
(Bilkay U Aktener BO 1993; Takeda FH et al. 1999;
Schoop U et al. 2007).
The most recent development in endodontic treatment
is the use of lasers. (Bergmans L et al. 2006). The
smear layer that covers the prepared walls of canal
also impair the cleaning because it covers the root
canal wall by superficial layer of 1-2 m in thickness
and deep layer congested in dentinal tubules to depth
of 40 m (Mader CL et al. 1984). This layer contains
organic and inorganic materials with bacteria and
Investigating Smear Layer Removal from Root Canal Surface during Irradiated with 940 nm Diode Laser with Different Aqueous irrigants
necrotic debris (Torabinejad M et al. 2002). (Haapasalo
M and D, Orstavik 1986.).
Hmud et al proved the removal of smear layer and
debris with using both diode lasers (980 nm, 940 nm)
with 200 m fiber (Hmud R et al. 2010), and since
these wavelengths have lack of affinity with water, then
higher powers would be needed to produce thermal
energy, consequently, fluid heating inside canal
increases and elevate the capability of smear layer
removal by cavitations action. Therefore the authors
reported another study to show the safety of using such
high powers without overcoming the threshold
temperature (Hmud R et al. 2010).
*Corresponding Author: Sheimaa A. Al-Zand,
Department of Medical and Biological applications,
Institute of Laser for Postgraduate Studies, University
of Baghdad. Email: dr.sheimaa@gmail.com
Al-Zand et al. 008
Later Castelo-Baz et al reported the effect of combining
NaOCl with 940 nm diode laser in eliminating the E.
faecalis biofilm, the SEM test presented extensive
disinfection by the dual effect of laser irradiation and
the heated NaOCl (Pablo Castelo-Baz et al. 2012).
Arslan et al. stated the high effect of EDTA agitation
during irradiating the canal with 808 nm diode laser on
removing the smear layer in apical portion of the
canal(Arslan H et al. 2013)(Arslan, Ayranc et al. 2013).
The combination of Laser and irrigants took a wide
space in the latest studies, and diode laser was used
as an activator for EDTAC and this was proved to
enhance its action on smear layer removal (Camargo
Selma 2012; Manfred Lagemann et al. 2014). When
KTP lasers were compared with diode lasers in (2015)
as bactericidal agent, the study evaluated the residual
bacterial load accompanied with chemo-mechanical
treatments and proved that both laser systems are
more effective in bacterial reduction compared with
conventional methods (Umberto Romeo et al. 2015).
A study in (2016) found that the Nd:YAG and diode
lasers increased the retention of epoxy-based sealers
to the root canal walls and hence increased the filling
seal (Helena Suleiman de Macedo et al. 2016). The
latest published studies in 2017 used the photodynamic
therapy in endodontic disinfection by laser and
chromophormes to reduce the E. faecal is. This novel
method provided a better results with total elimination
of bacteria (Charis Beltes et al. 2017).
The aim of this study was to evaluate the effect of 940
nm diode laser on the canal surface when used as
assistant in endodontic treatment as a sterilizing tool.
Subjects and Methods
Laser system used was 940 nm epic 10 diode laser
(Biolase, USA), with end firing tip (diameter = 200 m,
length = 14 mm).
Samples preparation:
Total of (12) sound single canal premolars were
collected, cleaned, and sectioned from cementoenamel
junction to 14 mm length for investigating the ultra
structural changes on root canal surface during lasing.
The flaring of the canal was done by nickel-titanium
ProTaper manual system (Dentsply, Switzerland) to
size #F3, 1 mm from the apex. D.W was used as
irrigant during preparation and then stored with saline
at 4C. Scanning Electron Microscope was used and
samples were divided randomly into 6 groups (n = 2),
named (A, B, C, D, E and F). The magnification was
1500X. The sample size is noticed to be little since it is
a morphological study and (n) is not necessary to be
high. The analysis of the work depended on the reading
of the images and try to explain the effect and the
change in comparison between the groups, therefore,
no statistical work was performed.
Lasing protocol:
Lasing time for both groups was as follows Irradiation
begins with the tip moving coronally in a helicoid motion
Investigating Smear Layer Removal from Root Canal Surface during Irradiated with 940 nm Diode Laser with Different Aqueous irrigants
in speed of about 1.5 mm/s in a canal filled with DW.
Total irradiation time is 20 s, the total working time for
each canal= 50 s
5s 10 s 5 s 10 s 5 s 10 s 5 s
Lasing Rest Lasing Rest Lasing Rest Lasing
Samples were treated according to the following
protocols:
Group A: (Control) After preparation, Samples were
irrigated with 2.5 ml of 3% NaOCl for 120 s. then
irrigated finally with 10 ml of distilled water.
Group B:After preparation, Samples were irrigated with
2.5 ml of EDTA for 120 s, then 2.5 ml of 3% NaOCl for
120 s. finally, irrigated finally with 10 ml of distilled
water.
Group C:After preparation, Samples were irradiated
with laser of 1.5 W power CW irradiation, while saline
inside canal.
Group D: After preparation, Samples were irradiated
with laser of 2.5 W power Pulsed mode with 20 Hz
irradiation, while saline inside canal.
Group E: After preparation Samples were irrigated with
2.5 ml of EDTA for 120 s, and then irradiated with laser
of 1.5 W power CW irradiation while EDTA inside canal,
then flushed well with 10 ml saline, followed by 2.5 ml
of 3% NaOCl for 120 s.
Group F:After preparation, Samples were irrigated with
2.5 ml of EDTA for 120 s, then irradiated with laser of
2.5 W power Pulsed mode with 20 Hz irradiation while
EDTA inside canal, then flushed well with 10 ml saline,
followed by 2.5 ml of 3% NaOCl for 120 s.
All samples of SEM imaging were sectioned in two
halves by making grooves along the buccal and palatal
surface of the root without penetrating into the canal to
avoid spoiling the canal surface or smear layer, then a
bi tapered chisel and surgical hammer were used to
crack the tooth in two halves through the grooves. And
then samples were placed in eppendorf tube. Later the
samples went into fixation process using 2.5% buffer
gluteraldehyde and 0.1 M Sodium Cocodylate (pH =
7.4) at 4 C for 12 h, then washed with distilled water
for 3 min and immersed in this water for 1 h while
changing the water every 20 min. Dehydration process
then started afterwards, using an ascending Ethanol
series: 25% for 20 min , 50% for 20 min, 75% for 20
min, 95% for 30 min, and lastly 100% (absolute) for 60
min. After dehydration, the samples were placed at
incubators at room temperature for 24 h(Melissa
Andria Marchesan et al. 2008). Later, samples were
fixed on stubs with double faced carbon tape, then
coated with a gold-platinum layer and placed in a
vacuum apparatus. The dentin surface of the canal was
examined with SEM operating at 20 kV. Multi images
were taken at 1500X magnification at points on each
sample located at 4 mm and 8 mm from the apex,
representing the apical and middle portions
respectively.
RESULTS
Since this study is mainly a morphological analysis and
contain no statistics, the results depended on the
 Int. Res. J. of Dent. 009

A B

D
C

C D

E F
Figure 1. SEM images of Apical portion with (1500X) , A- Group A(control group) B- group B ( EDTA
+ NaOCl) C- group C (laser 1.5 W) D- group D (laser 2.5 W) E- group E (laser 1.5 W +EDTA) F-
group F (laser 2.5 W+ EDTA).

reading of the SEM images and trying to understand
and explain the effects and changes on the root surface
depending on other similar studies and the opinion of
the authors.
In Control Group A the root canal walls were almost
totally covered with heavy smear layer and there were
debris closing most of the dentinal tubules, especially in
the apical part of the root as shown in Figure 1 A.
Investigating Smear Layer Removal from Root Canal Surface during Irradiated with 940 nm Diode Laser with Different Aqueous irrigants
In the second group B, the dentinal tubules were almost
totally opened and cleaned in middle portion, and the
effect of EDTA was clear Figure 2B, in contrast to
apical part which showed no effect.
The next group C was treated with 1.5 W laser without
any chemical irrigant. The dentinal tubules were slightly
opened and the smear layer melted (globules shape)
due to the thermal effect of laser. Also in Group D, in
which laser power 2.5 W was used. The melting of
Al-Zand et al. 010

A B

C D

E F
Figure 2. SEM images of Middle portion with (1500X) , A- Group A(control group) B- group B (
EDTA + NaOCl) C- group C (laser 1.5 W) D- group D (laser 2.5 W) E- group E (laser 1.5 W
+EDTA) F- group F (laser 2.5 W+ EDTA).

smear layer was more obvious and the globules were
bigger in size. The dentinal tubules were opened in a
satisfactory way in the middle part Figure 2 C and D
and less in the apical part Figure 1 C and D.
The last two groups (F, G) when we combine the effect
of laser with the chemical irrigants, showed the superior
results in cleaning the root surface and opening the
dentinal tubules especially in the middle third Figure 2
E and F, while in apical third Figure 1 the images
showed a slight cleaning in E and closing of the tubules
by melting in F.. All the groups had no signs of sever
melting or cracking over the root surface.
DISCUSSION
The no effect of this laser on smear layer is
considered shortening of its action in endodontic
treatment; in order to overcome this, we needed to use
other effective method to remove the smear layer.
Our SEM results came in accordance with Arslan SEM;
the images showed an increase in the number of the
opened dentinal tubules in middle and apical parts of
the root when irradiated with 20 s of diode laser (Arslan
H et al. 2013).
The SEM results come in along with Alfredo work (Afredo

Investigating Smear Layer Removal from Root Canal Surface during Irradiated with 940 nm Diode Laser with Different Aqueous irrigants

E et al. 2009), and also with Saraswathi(Saraswathi MV
et al. 2012). In SEM images, the control group where
roots treated with NaOCl alone, the least number of
dentinal tubules was opened and the surface was
covered with smear layer, since the NaOCl has the
ability to remove only the organic material of smear
layer and has limited bactericidal action on the surface
(Estrela C et al. 2002).
In the image of middle portion in case of combining the
effect of EDTA with NaOCl Figure 2 B the results were
stunning; total removal of smear layer; as EDTA
dissolved the inorganic component of the smear layer,
and NaOCl removed the organic components, and they
both washed the root surface adequately.; while they
had no obvious effect on the apical part. This came in
acceptance with Teixeira study (CS Teixeira et al.
2005). Also the size of the dentinal orifices is larger
than in apical part; this may permit the circulation and
entrance of the irrigants to be more effective and
consequently, produce better results in washing the
smear layer.
On laser Groups, the temperature increase due to
lasing caused melting and fusion of the smear layer,
which appeared as globules in the images, and this
caused opening of the dentinal tubules. This appeared
more obvious when laser power increased. Both laser
powers did not cause any crack or fissure on the root
surface.
In the Apical portion Figure 1 E and F the images
showed a week effect of irrigants and laser in washing
the surface with limited number of dentinal tubules
opened, these results disagreed the results of Wang
(Xiaogu Wang et al. 2005) who reported that diode
lasers clean the apical third more effectively than
middle third due to the narrow space and melting of the
smear layer. The different wavelength and power
settings and irradiation duration might explain the
difference between the two studies. While it came in
acceptance with Parirokh et al.(Masoud Parirokh et al.
2008) stated that in apical part of the root, most of the
dentinal tubules were closed due to dentine melting in
the narrow canal. Our results also came in agreement
with Saraswathi (Saraswathi MV et al. 2012) who
noticed a better removal of smear layer when agitated
NaOCl and EDTA with laser. The use of higher power
of diode lasers to 5 W were found to cause vaporization
of smear layer and consequently opening of the
dentinal tubules in most of the canal walls, while cause
localized melting, fusion, and recrystallization of canal
walls in the apical part of the canal(Melissa Andria
Marchesan et al. 2008).
When comparing (C and D) with (E and F), the
difference can be noticed due to the removal of smear
layer by irrigant in the later groups especially in middle
third. The samples that are treated by laser alone
without chemical irrigants showed clustering shapes
that represent the melted smear layer from the thermal
energy that was directed to the dentinal matrix, while
the other images that are treated with EDTA that had
less or no smear layer the melting was not clear and
the ultra structural alterations showed melting only in
peri and intratubular dentin which cause to reduce the
Investigating Smear Layer Removal from Root Canal Surface during Irradiated with 940 nm Diode Laser with Different Aqueous irrigants
Int. Res. J. of Dent. 011
diameter of the tubule and appeared as white shadows
around the orifice specially with the settings of higher
powers.
In this wavelength limit, some of the energy is absorbed
by the mineral structures of dentine such as phosphate
and carbonate, the laser thermal ablation cause
disturbance of its crystal arrangement which appear as
melting of smear layer, this become more clear when
laser parameters increase(Alfredo E et al. 2009).
CONCLUSION
The SEM images showed that diode laser alone do not
remove smear layer but cause its melting. It is more
effective when used with EDTA and NaOCl irrigation.
REFERENCES
Aktener BO, Bilkay U (1993). Smear layer removal with
different concentrations of EDTA-ethylenediamine
mixtures. JOE19(5): 228-231.
Beltes C, Hercules S, Nikolaos E, Chrissanthy P
(2017). Antimicrobial photodynamic therapy using
Indocyanine green and near-infrared diode laser in
reducing Entrerococcus faecalis. Photodiagnosis
Photodyn Ther.17: 5-8.
Estrela C, Estrela CR, Barbin EL, Span JC,
Marchesan MA and Pcora JD. (2002). Mechanism
of action of sodium hypochlorite. Braz. Dent. J.13(2):
113-117
Camargo S (2012). The antibacterial effects of lasers in
endodontics. Roots.1: 32-43.
Castelo-Baz, P, Martn-Biedma B, Francisco G, De
Moor R (2012). "Combined Sodium Hypochlorite and
940 nm Diode Laser Treatment Against Mature E.
Faecalis Biofilms in-vitro." Lasers Med. Sci.3(3).
Mader CL, Baumgartner JC, Peters DD (1984).
"Scanning electron microscopic investigation of the
smeared layer on root canal walls." JOE.10: 477-483.
Alfredo E, Souza-Gabriel AE, Silva SR, Sousa-Neto
MD, Brugnera-Junior A, Silva-Sousa YT (2009).
"Morphological alterations of radicular dentine
pretreated with different irrigating solutions and
irradiated with 980-nm diode laser." Microsc. Res.
Tech.72(1): 22-27.
Takeda FH, Harashima T, Kimura Y, Matsumoto K.
(1999). A comparative study of the removal of smear
layer by three endodontic irrigants and two types of
laser. Int. Endod J.32(1): 32-39.
Arslan Ayranc LB, Karatas E, Topuolu HS, Yavuz
MS, Kesim B (2013). "Effect of Agitation of EDTA with
808-Nanometer Diode Laser on Removal of Smear
Layer." JOE39(12): 1589-1592.
Bergmans L, Moisiadis P, Teughels W (2006).
Bactericidal effect of Nd: YAG laser irradiation on
some endodontic pathogens ex vivo." Int. Endod
J.39: 547-557.
Lagemann M, Roy G, Lei C, Laurence JW (2014).
"Activation of ethylenediaminetetraacetic acid by a
940 nm diode laser for enhanced removal of smear
Al-Zand et al. 012
layer." Aust. Endod. J.40(2): 72-75.
Haapasalo M, Orstavik D (1986.). " In vitro infection and
disinfection of dentinal tubules." J Dent Res 66: 1375-
1379.
Torabinejad M, Handysides R, Khademi AA and et al
(2002). " Clinical implications of the smear layer in
endodontics: a review." Oral Surg Oral Med Oral
Pathol 94: 658-666.
Macedo Helena Suleiman de, Danielle Cristine Furtado
Messias, Fuad Jacob Rached-Jnior, Ligia Teixeira
de Oliveira, Yara Teresinha Correa Silva-Sousa and
Walter Raucci-Neto (2016). "1064-nm Nd: YAG and
980-nm Diode Laser EDTA Agitation on the Retention
of an Epoxy-Based Sealer to Root Dentin." Braz.
Dent. J.27(4): 424-429.
Marchesan, Melissa Andria, Aldo Brugnera-Junior,
Aline Evangelista Souza-Gabriel, Silvio Rocha
Correa-Silva and Manoel D Sousa-Neto (2008).
"Ultrastructural analysis of root canal dentine
irradiated with 980-nm diode laser energy at different
parameters." Photomed Laser Surg.26(3): 235-240.
Saraswathi MV, Ballal NV, Padinjaral I, Bhat S (2012).
"Ultra morphological changes of root canal dentin
induced by 940 nm diode laser: An in-vitro study."
SEJ.2(3): 131-135.
Parirokh Masoud, Mohammad Jafar Eghbal, Saeed
Asgary, Jamileh Ghoddusi, Sally Stowe and Farshid
Forghani (2008). "Effect of 808nm diode laser
irradiation on root canal walls after smear layer
removal: A scanning electron microscope study."
Iran. Endod J.2(2): 37-42.
Hmud R, Kahler WA, Walsh LJ ( 2010). "Temperature
changes accompanying near infrared diode laser
endodontic treatment of wet canals." JOE. 36(5): 908-
911.
Hmud R, Kahler WA, George R, Walsh LJ. (2010).
"Cavitational effects in aqueous endodontic irrigants
generated by near-infrared lasers." JOE.36(2): 275-
278.
Romeo U, Gaspare P, Alessia N, Gianluca T, Vito T,
Roly K, Del Vecchio A, Alessandra F, Piera V,
Francesca B (2015). "Effectiveness of KTP laser
Investigating Smear Layer Removal from Root Canal Surface during Irradiated with 940 nm Diode Laser with Different Aqueous irrigants
versus 980 nm diode laser to kill Enterococcus
faecalis in biofilms developed in experimentally
infected root canals." Aust. Endod. J. 41(1): 17-23.
Teixeira CS, Felippe, Felippe WT (2005). "The effect of
application time of EDTA and NaOCl on intracanal
smear layer removal: an SEM analysis." Int. Endod.
J.38(5): 285-290.
Schoop U, Goharkhay K, Klimscha J, Zagler M,
Wernisch J, Georgopoulos A (2007). "The use of the
erbium, chromium: yttrium-scandium-gallium-garnet
laser in endodontic treatment: the results of an in vitro
study." J Am Dent Assoc.138(7): 949-955.
Wang X, Yichao S, Yuichi K (2005). Effects of Diode
Laser Irradiation on Smear Layer Removal from Root
Canal Walls and Apical Leakage after Obturation.
Photomed Laser Surg.23(6): 575581.
Wang X, Sun Y, Kimura Y, Kinoshita JI, Ishizaki NT,
Matsumoto K (2005). "Effects of Diode Laser
Irradiation on Smear Layer Removal from Root Canal
Walls and Apical Leakage after Obturation."
Photomed Laser Surg.23(6): 575581.
Accepted 11 April, 2017
Citation: Al-Zand SA, Al-Maliky M, Mahmood AS, Al-
Karadaghy T (2017). Investigating Smear Layer
Removal from Root Canal Surface during Irradiated
with 940 nm Diode Laser with Different Aqueous
irrigants. International Research Journal of Dentistry
1(1): 007-012.
Copyright: 2017 Al-Zand et al. This is an open-
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