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SEM Analysis and Pulp Tissue Dissolution Following Retrograde Preparation and Irrigation in Surgical Endodontics: A
Cosimo Ferraro1, Mariangela Cernera2, Dina Abdellatif3
1Department of Medicine, Surgery and Dentistry, 'Scuola Medica Salernitana', University of Salerno, Salerno, Italy.
European Endodontic Journal
|September 25, 2025
Summary
Ultrasonic activation of EDTA and NaOCl gel significantly improves cleaning during retrograde endodontic surgery. This novel irrigation protocol enhances organic tissue dissolution and allows for more conservative apical resections.
Area of Science:
- Endodontics
- Dental materials science
Background:
- Retrograde endodontic surgery requires effective cleaning of the root apex.
- Conventional irrigation methods may be insufficient for complete debris and tissue removal.
Purpose of the Study:
- To evaluate the efficacy of a novel ultrasonic-activated irrigation protocol using EDTA and NaOCl gels in retrograde endodontic procedures.
- To compare this new method against conventional irrigation and no irrigation techniques.
Main Methods:
- Two experiments were conducted: SEM analysis of root-end cleanliness in human teeth and pulp dissolution assessment in a 3D-printed artificial canal system.
- Groups included saline irrigation, ultrasonically activated EDTA/NaOCl gels, and no irrigation.
Main Results:
- The ultrasonic-activated gel group demonstrated significantly reduced smear layer and debris compared to saline or no irrigation (p<0.001).
- Complete dissolution of simulated organic pulp tissue was achieved exclusively by the ultrasonic-activated NaOCl gel group (p<0.001).
Conclusions:
- Ultrasonic activation of EDTA and NaOCl gels is highly effective for cleaning and organic tissue dissolution in retrograde endodontic surgery.
- This enhanced efficacy supports a more conservative approach to apical resection.
