Intracanal heating of sodium hypochlorite: Scanning electron microscope evaluation of root canal walls

The aim of this study is to evaluate the surface of root canals dentine using scanning electron microscope (SEM) after instrumentation with rotary Nickel-Titanium systems and two different protocols of activation of sodium hypochlorite (NaOCl) (extracanal heating at 50°C and intracanal heating at 180°C), to assess the presence/absence of smear layer and also the presence/absence of open dentinal tubules along the walls at the coronal, middle, and apical third of each sample.

Thirty-six single-rooted teeth were selected, divided into three groups and shaped with ProTaper Universal instruments following irrigation protocols with 5.25% NaOCl. At the end of the preparation, three different protocols of activation were used: nonheated NaOCl in Group A, extra-canal heated NaOCl at 50°C for Group B and intracanal heated NaOCl at 180°C for Group C. Specimens were cut longitudinally and analyzed by SEM at standard magnification of ×1000. The presence/absence of the smear layer as well as the presence/absence of open tubules at the coronal, middle, and apical third of each canal were estimated using a five-step scale for scores. Numeric data were analyzed using Kruskal-Wallis and Mann-Whitney U statistical tests and significance was predetermined at P < 0.05.

Kruskal-Wallis analysis of variance (ANOVA) for debris score showed significant differences among the Ni-Ti systems (P < 0.05). Mann-Whitney test confirmed that Group A presented significantly higher score values than other Ni-Ti systems. The same results were assessed considering the smear layer scores. ANOVA confirmed that the apical third of the canal maintained a higher quantity of debris and smear layer after preparation of all the samples.

Intra-canal heating of NaOCl at 180°C proved to be more effective in obtaining clean canal walls. On the other hand, extra-canal heating at 50°C of NaOCl left a higher quantity of debris and the smear layer was widely represented.