CODS - Journal of Dentistry

Register      Login

VOLUME 15 , ISSUE 1 ( January-June, 2023 ) > List of Articles

Original Article

Effect of Using 5% Apple Vinegar Irrigation Solution Adjunct to Diode Laser on Smear Layer Removal and Calcium/Phosphorus Ion Ratio during Root Canal Treatment

Tarek AA Salam, Haythem SA Kader, Elsayed E Abdallah

Keywords : Apple vinegar, Diode laser, Endo, Smear layer, Scanning electron microscopy, Scanning electron microscopy–energy dispersive X-ray

Citation Information : Salam TA, Kader HS, Abdallah EE. Effect of Using 5% Apple Vinegar Irrigation Solution Adjunct to Diode Laser on Smear Layer Removal and Calcium/Phosphorus Ion Ratio during Root Canal Treatment. CODS J Dent 2023; 15 (1):3-8.

DOI: 10.5005/jp-journals-10063-0151

License: CC BY-NC 4.0

Published Online: 25-04-2024

Copyright Statement:  Copyright © 2023; The Author(s).


This study was adjusted to assess the cleaning efficacy of using 5% apple vinegar irrigation in adjunct with diode laser 980 nm in removing the smear layer and its effect on the atomic concentration of the calcium/phosphorus (Ca/P) ions by scanning electron microscopy (SEM) and energy dispersive X-ray (EDX) spectroscopy, respectively. A total of 60 maxillary incisor teeth were selected to be endodontically treated, prepared biomechanically, and divided equally into three main groups according to irrigation used—the control group—irrigation with 5% sodium hypochlorite (NaOCl) only, group I: irrigation with 5% NaOCl + 17% ethylenediaminetetraacetic acid (EDTA), group II: irrigation with 5% NaOCl + 5% apple vinegar. Diode laser 980 nm, 2 W/CW applied for 10 seconds. Three times in half the number of samples. All samples were divided longitudinally for SEM and SEM-EDX analysis at the coronal, middle, and apical root sections. Results showed group II had a statistically significant lower median smear layer score at the apical third (p < 0.05) when compared to group I and the control group. This study concluded that during root canal treatment, irrigation of 5% apple vinegar irrigation with 5% NaOCl in adjunct to diode laser 980 nm is better than17% EDTA and 5% NaOCl or 5% NaOCl alone in cleaning the intraradicular dentinal walls from the smear layer and also did not alter the atomic concentration of Ca/P ions ratio.

  1. Muana HL, Nassar M, Dargham A, et al. Effect of smear layer removal agents on the microhardness and roughness of radicular dentin. Saudi Dent J 2021;33(7):661–665. DOI: 10.1016/j.sdentj.2020.05.001
  2. Alhadi D, Jaber FM, Agha MT, et al. The effect of diode laser irradiation on root canal dentin. J Int Dent Med Res 2019;12(1):49–53.
  3. Al-Mafrachi RM, Awazli LG, Al-Maliky MA. The effect of using a 940 nm diode laser in comparison with endoactivator on radicular dentin permeability and smear layer removal: an in vitro study. Iraqi J Laser 2018;17:9–15.
  4. Altaf A, Basher A, Mir N. Assessment of efficacy of two root canal irrigation solutions on smear layer removal during root canal therapy: a comparative study. J Advance Med Dent Sci Res 2019;7:173–175.
  5. Alyamany MA, Abd Allah A, Abass AN, et al. Evaluation of the antibacterial effect of apple cider vinegar, black tea and sodium hypochlorite irrigant solutions on infected root canal microorganisms of primary teeth: an in-vitro study. AJDS 2022;25(1):99–104. DOI: 10.21608/AJDSM.2021.71055.1196
  6. Karunakar P, Solomon RV, Kumar BS, et al. Evaluation of smear layer removal of radicular dentin in comparison with different irrigation devices: an in vitro study. J Conserv Dent 2021;24(3):236–240. DOI: 10.4103/JCD.JCD_208_19
  7. Jhingan P, Sandhu M, Jindal G, et al. An in-vitro evaluation of the effect of 980 nm diode laser irradiation on intra-canal dentin surface and dentinal tubule openings after biomechanical preparation: Scanning electron microscopic study. Indian J Dent 2015;6(2):85–90. DOI: 10.4103/0975-962X.155889
  8. Rome WJ, Doran JE, Walker WA 3rd. The effectiveness of gly-oxide and sodium hypochlorite in preventing smear layer formation. J Endod 1985;11(7):281–288. DOI: 10.1016/S0099-2399(85)80158-8
  9. Deari S, Mohn D, Zehnder M. Dentine decalcification and smear layer removal by different ethylenediaminetetraacetic acid and 1-hydroxyethane-1,1-diphosphonic acid species. Int Endod J 2019;52(2):237–243. DOI: 10.1111/iej.12987
  10. Scholz KJ, Federlin M, Hiller KA, et al. EDX-analysis of fluoride precipitation on human enamel. Sci Rep 2019;9(1):13442. DOI: 10.1038/s41598-019-49742-5
  11. Katirci G, Ermis RB. Microindentation hardness and calcium/phosphorus ratio of dentin following excavation of dental caries lesions with different techniques. Springerplus 2016;5(1):1641. DOI: 10.1186/s40064-016-3289-8
  12. Küçükkaya Eren S, Uzunoğlu E, Sezer B, et al. Mineral content analysis of root canal dentin using laser-induced breakdown spectroscopy. Restor Dent Endod 2018;43(1):e11. DOI: 10.5395/rde.2018.43.e11
  13. Shahriari S, Kasraei S, Roshanaei G, et al. Efficacy of sodium hypochlorite activated with laser in intracanal smear layer removal: an SEM study. J Lasers Med Sci 2017;8(1):36–41. DOI: 10.15171/jlms.2017.07
  14. Xavier F, Nevares G, Albuquerque DS, et al. Analysis of the effect of ultrasonic agitation on the cleaning of root canals using different periods during the final irrigation. RSBO 2014;11(4):321–327. DOI: 10.21726/rsbo.v11i4.872
  15. Vallabhaneni K, Kakarla P, Avula SSJ, et al. Comparative analyses of smear layer removal using four different irrigant solutions in the primary root canals - a scanning electron microscopic study. J Clin Diagn Res 2017;11(4):ZC64–ZC67. DOI: 10.7860/JCDR/2017/24163.9684
  16. Sood A, Munjal S. Comparison of the effect of different irrigants on smear layer removal during root canal preparation. IDA Lud J Dent 2018;2:17–21. DOI: 10.21276/ledent.2018.02.03.07
  17. Amin K, Masoodi A, Nabi S, et al. Effect of diode laser and ultrasonics with and without ethylenediaminetetraacetic acid on smear layer removal from the root canals: a scanning electron microscope study. J Conserv Dent 2016;19(5):424–427. DOI: 10.4103/0972-0707.190005
  18. Teixeira CS, Felippe MC, Felippe WT. The effect of application time of EDTA and NaOCl on intracanal smear layer removal: an SEM analysis. Int Endod J 2005;38(5):285–290. DOI: 10.1111/j.1365-2591.2005.00930.x
  19. Santos Felippe MC, Vitor C, Cristina S, et al. Removal of intracanal smear layer by doxycycline: SEM analysis. Aust Endod J 2010;36(2):64–69. DOI: 10.1111/j.1747-4477.2009.00191.x
  20. Rao SA, Sowjanya KI, Sunith L. Comparison of smear layer removal ability and the effect on root dentin strength of garlic extract and EDTA used as final irrigants – an in vitro study. Indian J Conserv Endodont 2016;1(3):81–85.
  21. Torabinejad M, Cho Y, Khademi AA, et al. The effect of various concentrations of sodium hypochlorite on the ability of MTAD to remove the smear layer. J Endod 2003;29(4):233–239. DOI: 10.1097/00004770-200304000-00001
  22. Goldman M, Goldman LB, Cavaleri R, et al. The efficacy of several endodontic irrigating solutions: a scanning electron microscopic study: Part 2. J Endod 1982;8(11):487–492. DOI: 10.1016/s0099-2399(82)80073-3
  23. Torabinejad M, Khademi AA, Babagoli J, et al. A new solution for the removal of the smear layer. J Endod 2003;29(3):170–175. DOI: 10.1097/00004770-200303000-00002
  24. Abdelghany ME, Kamel WH, Bastawy HA. Efficacy of apple vinegar as final irrigating solution in removing smear layer using XP-endo finisher file. ADJ Girls 2020;7:95–103. DOI: 10.21608/ADJG.2019.7841.1117
  25. Candeiro GT, Matos IB, Costa CF, et al. A comparative scanning electron microscopy evaluation of smear layer removal with apple vinegar and sodium hypochlorite associated with EDTA. J Appl Oral Sci 2011;19(6):639–643. DOI: 10.1590/s1678-77572011000600016
  26. Caligiani A, Acquotti D, Palla G, et al. Identification and quantification of the main organic components of vinegars by high resolution 1H NMR spectroscopy. Anal Chim Acta 2007;585(1):110–119. DOI: 10.1016/j.aca.2006.12.016
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.