388-400

Neuro Quant Ology | October 2022 | Volume 20 | Issue 13 | Page 388-400 | Doi: 10.14704/NQ.2022.20.13.
NQ88052
Latifa Mohamed Abdelgawad, Hebatallah Hamed Anis, Engy M. Kataia, Ghada Salem,/ Effect Of Agitation Of Salvadora Persica Extract And
Sodium Hypochlorite Final Irrigating Solutions With Er,Cr: YSGG-Laser Using Radial-Firing Tips On Removal Of Smear Layer: A Scanning
Electron Microscopic Evaluation
Effect Of Agitation Of Salvadora Persica Extract

And Sodium Hypochlorite Final Irrigating
Solutions With Er,Cr:YSGG-Laser Using Radial-
Firing Tips On Removal Of Smear Layer: A
Scanning Electron Microscopic Evaluation
Latifa Mohamed Abdelgawad1*, Hebatallah Hamed Anis2, Engy M. Kataia3, Ghada Salem4
Abstract
Introduction: to compare the effect of Er,Cr:YSGG-laser-activated and conventional irrigation techniques on
intracanal smear layer elimination at the apical, middle, and coronal segments of root canal walls using
environmental scanning electron microscope (ESEM).
Methods: Thirty-six freshly extracted human single-rooted single-canal anterior teeth were selected for this study.
The root canals were conventionally accessed, then prepared by using ProTaper Next® system to size X4, 0.06
taper and divided into two equal groups (n = 18); syringe/needle- and laser-activated groups. Each group was
further subdivided into three subgroups; saline, NaOCl, and salvadora P (6 teeth each). Er,Cr:YSGG-laser was
emitted at pulse energy of 25 mJ, pulse width of 60 μs, pulse frequency of 50 Hz and delivered by a radial firing tip.
Teeth were longitudinally sectioned for ESEM assessment. Data were collected and statistically analyzed by
Kruskal-Wallis and Mann-Whitney tests. 388
Results: Er,Cr:YSGG-laser-activated generally showed better smear layer removal results than syringe/needle
activated group. The statistical significant differences occurred between NaOCl and salvadora P subgroups at
coronal and middle, and apical thirds, respectively. Salvadora P presented higher statistical smear layer removing-
capacity than the other comparative subgroups at coronal third when Er:Cr:YSSG-laser-activated technique was
used and at coronal and middle thirds when the conventional technique was applied.
Conclusion: Er,Cr:YSGG-laser-activated irrigation technique had a positive effect on removing of smear layer.
Laser-activated Salvadora P was effectively removed smear layer from the entire root dentin while the
conventionally-activated salvadora P was more potent at coronal and middle thirds.
Clinical significance: Er,Cr:YSGG-laser can effectively activate the intracanal irrigants.
Keywords:Er, Cr:YSGG laser, RFT, smear layer removal, root canal irrigation
DOI Number: 10.14704/NQ.2022.20.13.NQ88052 NeuroQuantology 2022; 20(13):388-400
Introduction al., 2021). Therefore, the rationales of root

Failure in root canal therapy is a result of the canal therapy are optimizing the cleaning of the
residual microorganisms settle inside the root root canal system and the removal of root canal
canal space and wall during and after debris and completing dense, three-dimensional
completing root canal therapy or due to the root canal obturation (Peters O. et al., 2021).
bacterial pathogens invades and re-colonize the Because of mechanical preparation of the root
filled canal system after treatment (Peters O. et canal unfortunately lefts 30–50% of the dentin
*corresponding author: -Latifa Mohamed Abdelgawad: Latifa@niles.edu.eg
Address: 1Medical Laser Applications Department, National Institute of Laser Enhanced Sciences (NILES), Cairo University
2,4Orthodontics and Pedodontics Department, Oral and Dental Institute, National Research Centre
3Endodontic Dep., The British University in Egypt (BUE)
Relevant conflicts of interest/financial disclosures: The authors declare that the research was conducted in the absence
of any commercial or financial relationships that could be construed as a potential conflict of interest
Received: Accepted:
eISSN1303-5150 www.neuroquantology.com
Neuro Quant Ology | October 2022 | Volume 20 | Issue 13 | Page 388-400 | Doi: 10.14704/NQ.2022.20.13.NQ88052
wall of root canal untouched, in additional it canals, canal fins, cul-de-sacs, canal isthmi
creates smear layer consisting dentine fragments, without fluid agitation (Mancini, M. et al.,
pulp debris, and microorganisms, irrigation 2022). Residual bacterial pathogens and their
with disinfection agents should be applied by-product, and pulp tissue remnants existing at
during conventional endodontic treatment in untouched zones of root canal system definitely
order to get rid of utmost microorganisms and cause persistent periradicular inflammation
root canal debris for avoiding failure of (Yao Y. et al., 2021).The contemporary
accomplishing root canal procedure (Jhajharia methods and systems of root canal agitation can
K. et al., 2015). be categorized into manual and machine-
Numerous researchers have been investigated assisted agitation approaches (Krongbaramee
various chemical and natural components in T. et al., 2020).
different concentrations and application Apparently, lasers can be employed to
techniques for using them as intracanal irrigant decontaminate the infected root canal system
(Shravya, S. et al., 2020). Currently, 1-5.25% with /without using intracanal irrigating
sodium hypochloride is considered the most solution (Olivi G. and Olivi M., 2016). The
common irrigant used for disinfection the root conventional LAI was the first laser method
canal (Singh M. et al., 2021). NaOCl irrigant is employed to activate the intracanal irrigation
favorable since it is greatly able to dissolve solutions (Olivi G. and Olivi M. 2016). Different
necrotic dental pulp structures and organic laser wavelengths have been utilized for
constituents of the smear layer (Shravya, S. et agitation the root canal irrigants (Olivi G. and
al., 2020). Besides, it significantly destroys the Olivi M. 2016). The medium infrared Erbium
pathogens of root canal present in biofilm and in laser family (Er:YAG 2940 nm and Er,Cr:YSGG
dentinal tubules (Shravya, S. et al., 2020). 2780 nm) are the most suitable laser irradiation
Despite the advantageous properties of sodium wavelengths can be used for activating the
hypochloride, this irrigant has a cytotoxic effect intracanal irrigant due to their specific affinity
on vital biological structures leading to to water (Olivi G. and De Moor R., 2016).
haemolysis, skin ulceration and necrosis A conventional tip of Erbium family lasers
(Perotti S. et al., 2018). Additionally, it should induces laser emission from their end o 389
be utilized along with another agent capable to intracanl irrigant without capability to deliver
remove inorganic elements of smear layer such laser energy laterally to dentinal wall of root
as 17% EDTA which may increase time of canal. In contrast, more recent radial firing tip
endodontic procedure exacerbate operator’s can permit some lateral laser emission which
fatigue (Shravya, S. et al., 2020). can laterally irradiate the root surfaces and
Lately, several studies had concerned with surrounding intracanal irrigating fluid solution
herbal irrigants as they are more available, (Olivi G. and Olivi M. 2016).
more cost effective, more limited for bacterial Actually, few studies had been carried out to
resistance, and lower cytotoxcity than chemical evaluate the solution of S. persica extract
ones (Shravya, S. et al., 2020). Antibacterial, regarding its ability to eliminate the smear
antioxidant, anti-cariogenic characteristics of layer. Also, there are no studies have
Salvadora persica or pilu (S. persica) as well its investigated the conventional laser-assisted
chelation actions encouraged the endodontists irrigation method using Er,Cr:YSGG-laser with a
to examine its biochemical effects during radial-firing tip on smear layer removing-
cleansing and decontamination of root canal capacity of the S. persica extract irrigating
methods (Shravya, S. et al., 2020). Literature solution. Consequently, this study aimed to
revealed that applying of S. persica solutions microscopically assess the agitation of S. persica
have positive outcomes in the matter of smear extract and sodium hypochlorite final irrigating
layer removal, pulpal tissue dissolution, and solutions with Er,Cr:YSGG-laser using radial-
antimicrobial activity (Shravya, S. et al., 2020). firing tip on smear layer removal and dentinal
The anatomical complexity of root canal system tubules opening by environmental scanning
impedes the intracanal irrigant for clean-up the electron microscope (ESEM). The null hypothesis
areas of root canal system beyond the central was that there are no differences in smear layer
body of the root canal (Mancini, M. et al., removal with different intracanal irrigating
2022). Intracanal irrigant cannot reach lateral
solutions as well as irrigant activation techniques sodium chloride 0.9 W/V (normal saline) (Adl
will be used. A. et al., 2019).
Root canal therapy of all teeth was stared with
Materials & Methods standard access cavity preparation of each tooth
Ethical approval: (Dagher J. et al., 2019). These prepared
This in-vitro study was approved by the cavities were performed by using a high-speed
Scientific Research Ethics Committee of contra-angle handpiece connected to a tapered
National Institute of Laser Enhanced Sciences diamond bur (Dagher J. et al., 2019). Next a
(NILES), Cairo University, Egypt. size#10, sterile, stainless-steel, hand K-file was
inserted inside root canal space for measuring
Sample size calculation: the apical potency (Kanaan C. et al., 2020).
Sample size calculation was executed by using R When the k-file tip searched to the same level of
statistical package, version 3.3.1 (21-0-2016) apical foramen, the apical potency was
copyright (C) 2016, based on (Bolhari B. et al., determined (Kanaan C. et al., 2020).
2014). Therefore, 6 samples for each group Instrumentation of root canal was achieved by
were found to be enough, with an 80% power ProTaper Next® files (Dentsply Maillefer,
and a significance level of 0.05. NewYork, USA) up to size# x4(Abd-Elgawad R.
and Fayyad D., 2017). The working length of
Preparation of S. persica extracts solution: mechanical preparation of each root canal was
Preparation of Salvadora persica extracts was 0.5 mm short of its apical potency (Majumdar
performed in accordance to (Balto H. et al., T. et al., 2021). The engine-driven files were
2012; Balto H. et al., 2015) studies. Therefore, employed at torque of 2N/m and rotational
10% water in ethanol was utilized as a solvent speed of 300 rpm (Abd-Elgawad R. and Fayyad
to extract Salvadora persica juice from fresh D., 2017). Each NiTi file was used for three
ground roots of Arak shrub (Balto H. et al., canals only (Elemam R. et al., 2016). Distilled
2012; Balto H. et al., 2015). Cryodesiccation water was utilized as a root canal irrigant after
method was applied to entirely take out the 10% each instrumentation procedure.After that,
water in ethanol from Salvadora persica extracts distilled water root canal irrigation had been 390
(Balto H. et al., 2012; Balto H. et al., 2015). applied before the instrumented root canals
Then, the extracted product was dissolved in were subjected to final flush (Kaushal R. et al.,
dimethyl sulfoxide (DMSO) (Balto H. et al., 2020).
2012; Balto H. et al., 2015). For recruiting Subsequently, teeth were randomly allocated to
Salvadora persica extracts in irrigating the root two groups (18 teeth in each) in accordance to
canal system, a sterile physiological saline at a the irrigating technique of the root canal:
pH of 7.4.was used to obtain Salvadora persica conventional syringe/needle irrigation technique
extract with working concentrations of 5 mg/ml (group I) and 2780-nm Er,Cr:YSGG laser-
(Balto H. et al., 2015). assisted irrigation technique (group II). Teeth of
each group were further subdivided into three
Samples’selection, grouping and preparation: subgroups of 6 teeth each in respect with the
A total thirty-six freshly extracted human type of the final intracanal irrigant: sodium
anterior teeth were selected for this study. chloride 0.9 W/V, normal saline solution
Teeth were clinically intact and free of dental (subgroup A), 5% sodium hypochlorite solution
caries, restoration and crack (Ayranci L. et al., (subgroup B) and a solution of Salvadora Persica
2016; Majumdar Y. et al., 2021). Also, teeth L extract (subgroup C).
roots were radiographically closed-apex, single- 5 ml of each examined intracanal irrigant was
rooted without resorption or calcification gradually applied for one minute (Nakamura V.
(Ayranci L. et al., 2016; Majumdar Y. et al., et al., 2013; Shravya, S. et al., 2020;
2021). The apical curvature of teeth roots Murugesan K. et al., 2022). During conventional
doesn’t than 20 degree (Ayranci L. et al., 2016; syringe/needle irrigation technique, the side-
Majumdar Y. et al., 2021). vented needle (Monoject, Sherwood Medical,
Teeth surfaces had been cleaned with ultrasonic Switzerland) was placed with the root canal at 1
scaler and washed with tap water (Obeid M. mm shorter than its working length (Tan L. et
and Nagy M., 2015) before they were stored in al., 2022).
Regarding 2780-nm Er,Cr:YSGG laser-assisted The coronal, middle and apical thirds of dentinal
irrigation technique laser beam was emitted at wall of the sections were microscopically
pulse energy of 25 mJ, pulse width of 60 μs, examined by environmental scanning electron
pulse frequency of 50 Hz (Al-Mafrachi R., microscopeESEM (FEI Quanta 250 FEG, Berlin,
2019) for 20 second in cycle using Er,Cr:YSGG- Germany) with an electron accelerating voltage
laser device (Waterlase iPlus, Biolase Technology, of 20 KVat a standard magnification of ×2000
Irvine, CA, USA). Total time of laser irradiation (Sukhbir K. et al., 2019; Kharouf N. et al.
was 60 sec: 20 second (time of irradiation) X 3 2020; Sharma S. et al., 2020; Mohamed N. et
(number of irradiation cycles). Thewater and air al., 2022) for measuring the smear layer
sprays of the laser device were shut off (Peeters removing-capacity and the presence of dentinal
H. et al., 2018). The photon energy was tubules’ opening.
delivered in contact mode with the intacanal Two well-trained qualified evaluators independently
irrigant through 415-μm-diameter, 21-mm- assessed the FESEM images (Alakshar A. et al.,
length radial firing tip (RFT) (Waterlase laser tip 2020). SEM evaluations were carried out with
RF3-21, Biolase, Technology, Irvine, CA, USA) with the 5- point method of scoring by means of
0.85 calibration factor (Al-Mafrachi R., 2019). numerical assessment scale established by
In each irradiation cycle, RFT tip had been firstly (Hülsmann M. et al., 1997).The scores were as
positioned within the root canal space at 2 mm follows- Score 1: no smear layer was revealed on
short of root apex (Al-Mafrachi R., 2019) then the root canal surface besides the orifices of
it was helicoidally moved in a speed of 1mm/s dentinal tubules were clearly opened; Score 2:
towards coronally direction (Al-Mafrachi R., diminutive amount of smear layer was revealed
2019). The irradiation cycle was identically on the root canal surface, additionally some
repeated three times. open dentinal tubule were present; Score 3:
After that, the root canals were subjected to homogenous smear layer along approximately
distilled water (5 ml) flush using side-vent the whole dentinal wall on root canal, in
needle & plastic syringe (Vineetha C. et al, addition a small number of open dentinal
2022) and were dried with ProTaper Next® tubules were observed; Score 4: the complete
paper point x4. dentinal wall of root canal covered with a 391
homogenous smear layer with no open dentinal
(Table 1): Laser specifications, parameters and technique tubules was found; Score 5: a heavy,
used in this study homogeneous smear layer covering the whole
dentinal wall of root canal with no open dentinal
tubules was seen (Hülsmann M. et al., 1997).
Figure (1): showed the ESEM (a), Er,Cr:YSGG laser device

SEM evaluation: (b), RFT attached with a handpiece(c) and cutting machine
Firstly, a single absorbent paper point size# X4 (d) used in this study. Additionally, it presented a sample
was properly seated inside the root canal during (e) and after sectioning (f).
(Khaord P. et al., 2015). Teeth were
longitudinal sectioned into two halves. The Statistical analysis
samples’ sectioning was carried out onthe Data of ESEM assessment were recorded and
proximal aspects parallel to long axis of tooth analyzed using SPSS (Statistical Packages for the
root (Chatterjee S. et al., 2021) using a low- Social Sciences 26.0, IBM, Armonk, NY, USA)..
speed diamond water-cooled diamond saw Cohen’s kappa coefficient was utilized to
(Isomet 4000, Buehler Ltd, Lake Bluff, IL, USA). determine inter- & intra-evaluators reliability.
Also, Kolmogorov-Smirnov and Shapiro-Wilk
tests employed to check the study data normality. activated (group II) irrigation techniqueexcept
Moreover, Kruskal-Wallis nonparametric analysis of the three segments of Er,Cr:YSGG-laser
variance and Mann-Whitney test were activated irrigant (Tables 5 and 6).
conducted to statistically analyze the numeric
data of the examined groups in accordance to Table (2):The mean, standard deviation (SD) and p-value
the intracanal irrigant type and the examined of smear layer scores of different groups conventional and
laser-activated irrigation techniques using saline, NaOCl
root segment considering the level of statistical and salvadora P at coronal, middle, and apical thirds.
significance was set at 0.05.
Results
Analysis of data extracted from this in-vitro
study demonstrated that the mean values of
smear layer score of the samples that were
irrigated with Er,Cr,YSGG-laser-activated NaOCl
(group II, subgroup B) salvadora P (group II,
subgroup C) irrigants recorded lower values
than those that were received the conventional
syringe/needle irrigations with the same
intracanal irrigant; NaOCl (group I, subgroup B)
and salvadora P (group I, subgroup C) at
different examined root segments; coronal,
middle, and apical root thirds. There were
statistical significant differences between two
groups when they had been activated NaOCl
(subgroup B) and salvadora P (subgroup C)
intracanal irrigants. These significant differences
occurred at coronal and middle root thirds of
NaoCl irrigant’s specimens and at apical root 392
third of salvadora P irrgant’s samples (Table 2).
Regarding the results of the examined root canal
irrigants at each root segment, there were
statistical significant differences between the
root canal irrigants activated by conventional
syringe/needle technique (group I) at coronal
third (between saline; subgroup A and NaOCl;
subgroup B) and middle third (between NaOCl;
subgroup B and salvadora P; subgroup
C)(Tables 3 and 4).
There were statistical differences between
Er,Cr:YSGG-laser-activated root canal irrigants
(group II) in all evaluated root segments. These
statistical differences occurred between saline
(subgroup I) and salvadora P (subgroup III) at
coronal, middle and apical root thirds (Tables 3
and 4).
Concerning the results of the examined
intracanal irrigants measured at different root
segments; coronal, middle and apical root Figure (2): The mean of smear layer scores in different
thirds, there were statistical differences groups; conventional and laser-activated irrigation
between the smear layer scores recorded technique groups using saline, NaOCl and salvadora P at
coronal, middle, and apical thirds.
between the tested root canal irrigants at the
different root segments whether the irrigants
activated by conventionally (group I) orlaser-
Table (3): The mean, standard deviation (SD) and kruskal- Table (5): The mean, standard deviation (SD) and kruskal-
Wallis statistics of smear layer scores of different Wallis statistics of smear layer scores of different root
subgroup; saline, NaOCl and salvadoraP at coronal, middle, canal segments; coronal, middle, and apical
and apical thirds.
Table (4): Mann whiteny U statistics of smear layer scores

of different subgroup; saline, NaOCl and salvadora P at
coronal, middle, and apical thirds.
Table (6): Mann whiteny U statistics of smear layer scores

of different root canal segments; coronal, middle, and
apical.
393
Figure (3): The mean of smear layer scores in different

subgroups; saline, NaOCl and salvadora P at coronal,
middle, and apical thirds.
(Bolhari B. et al., 2014; Bhagwat S. et al.,
2016), sealing ability and adaption of root canal
gutta percha and sealer (Bolhari B. et al.,
2014), and diffusion of intracanal medicaments
(Bhagwat S. et al., 2016). Therefore, various
root canal irrigating solutions and techniques
have been developed and assessed for getting
rid of smear layer to maximize the root canal
wall cleaning and disinfection (Bolhari B et al.,
2014; Bhagwat S. et al., 2016).
Since the smear layer comprises two different
Figure (4): The mean of smear layer scores in root canal forms of matter; organic and inorganic, utilizing
segments; coronal, middle, and apical thirds. of both organic and inorganic solvents such as:
NaOCl and EDTA is carried out for total
eliminating of smear layer (Bhagwat S. et al.,
2016). However, operating the alternate use of
EDTA and NaOCl can prolong the duration of
endodontic visit increasing the endodontist’s
fatigue. Furthermore, NaOCl can generate
adverse biological reactions for example:
heamolysis, cytotoxicity, and skin necrosis and
ulceration (Perotti S. et al., 2018). Thus,
several researchers have been lately concerned
with other root canal irrigating solutions
(Shravya, S. et al., 2020). Base on many in-vitro
Figure (5): SEM pictures of using conventionally (group I) studies, using of solutions of herbal extracts
and Er,Cr:YSGG–laser-activated saline (group II) such as Salvadora persica or pilu (S. persica) can
techniques showed that there was no statistical differences be acted as promising intracanal irrgants due to 394
between the two groups; group I (a) and group II (b) when
their encouraging influences on biologic
using at coronal third. The picture exhibited that there
were statistical differences between the two groups; group structures: Antibacterial, antioxidant, anti-
I (c) and group II (d) when using NaOCl at middle third. cariogenic & chelation actions (Shravya, S. et
Also, there were statistical differences between the two al., 2020). Also, they are more available, more
groups; group I (e) and group II(f) when using salvadora P cost effective, more limited for bacterial
at apical third.
resistance and lower cytotoxcity than chemical
ones (Shravya, S. et al., 2020). At present,
All available data are submitted with the results
literature showed that employment of
section of the main script.
Salvadora persica or pilu (S. persica) solutions in
endodontics have positive outcomes in the
Discussion
matter of smear layer removal, pulpal tissue
Root canal mechanical instrumentation utilizing
dissolution, and antimicrobial activity (Shravya, S.
hand or engine-driven endodontic files always
et al., 2020).
creates an unavoidable thin layer covering the
Chemical disinfection procedure of root canal
prepared root dentin and occluding the cut
system traditionally performed by means of
dentinal tubules known as smear layer
conventional syringe/needle method. On the
(Bhagwat S. et al., 2016). Microscopic dentin
other hand, this method unable to achieve
chips, dental pulpal soft tissue residue,
utmost root canal sterilization because of its
biological cellular relics can be found in smear
limitation to efficiently displace the strongly
layer (Bhagwat S. et al., 2016). Remove of
attached dentin-cutting precipitations, bacteria,
smear layer after applying the endodontic files
and pulpal soft tissue remnant from dentin walls
is mandatory for accomplishing successful
of root canals particularly apical one third of
endodontic treatment (Bhagwat S. et al.,
root canal(Amato M. et al., 2011; Rasheed S.
2016). In fact, ineffective cleaning of root canal
and Jawad H., 2022). Hence, improving the
walls dramatically reduces dentin permeability
fluid flow of intracanal irrigant by means of
manual or engine-driven is obligatory Selecting of human single-canal, single-root
(Krongbaramee T. et al., 2020). anterior dentitions had no or minimal root
As photon energy of laser irradiation had curvature (less than 20°) was done for achieving
proved its competence to effectively agitate the high standardization of the study specimens.
root canal irrigating solutions, many infrared Additionally, the preparation of the conventionally
laser wavelengths were examined to be a proper accessed root canal continued up to size# x4
tool for optimizing root canal cleaning and Protaper Next file to guarantee the research work
disinfecting procedure (Olivi G. and Olivi M. standardization. Furthermore, other variable
2016). During laser-activated irrigation, laser factors; the volume of root-canal irrigating
beam should be operated in proper parameters solution and total irrigation time were
and accurately applied on specific intracanal standardized for each root canal examined in
irrigant depending on evidence-based protocols. this study; 5 ml and 60 sec, respectively
Incorrect laser beam settings and technique can (Alakshar A. et al., 2020).
induce higher thermal laser-tissue interaction Selecting teeth with straight or minimal curved
causing reversible injuries to periradicular (less than 20°) root canal allow introducing of
biological structures (Olivi G. and Olivi M. the needle tip as well as laser delivery tip into
2016). root canal to full application length without
Currently, the wavelengths of mid-infrared facing complexities or difficulties (Alakshar A.
Erbium family (2780 nm, Er,Cr:YSSG and 2940 et al., 2020).
nm, Er:YAG lasers) are the most suitable laser Teeth were cleaned & shaped with rotary files
irradiation wavelengths can be utilized for till size# x4 to achieve suitable root canal
activating the water-based intracanal irrigant preparation allowing a good enough flushing
due to their specific affinity to water (Olivi G. and diffusion of the examined root canal
and De Moor R., 2016). irrigating solutions with no risk for occurrence
Er,Cr:YSSG-laser-activated irrigation generates apical overpreparation and other intracanal
shockwave-like impact on inrtracanalirrigant iatrogenic errors (Haupt F. et al., 2020).
using conventional flat or more recent radial Each NiTi file was used for three canals only to
firing tip (RFT) by means of laser/irrigant avoid bluntness of cutting edges of the file and 395
photomecnanical interaction (Jezeršek M. et occurrence of microcrack defects on its surface
al., 2020). Contrary to flat tips, radial firing tips (Elemam R. et al., 2016).
can permit some lateral laser emission which Subablative photon energy levels of Er, Cr:YSGG
can laterally irradiate the few areas of root laser beam were selected in accordance to (Al-
surfaces and more surrounding intracanal Mafrachi R., 2019) for this study. Subablative
irrigating fluid solution (Olivi G. and Olivi M. Er,Cr:YSGG laser should be applied during laser-
2016). activated irrigation technique to avoid possibly
Actually, few studies had been carried out to reversible periiradicular damage which may
evaluate the solution of S. persica extract happen as a result of unwanted higher thermal
regarding its ability to eliminate the smear laser/irrigant interaction (Keskin G. and
layer. Also, there are no studies have Çiloğlu M. et al., 2021).
investigated the conventional laser-assisted The photon energy was delivered in contact
irrigation method using Er,Cr:YSGG-laser with a mode with the intacanal irrigant through 415-
radial-firing tip on smear layer removing- μm-diameter, 21-mm-length radial firing tip
capacity of the S. persica extract irrigating (RFT3-21) to laterally irradiate the intracanal
solution. Consequently, this study aimed to irrigants and root dentin because the laser beam
microscopically assess the agitation of S. persica is refracted out from this tip at a highly
extract and sodium hypochlorite final irrigating divergent angle (Verdaasdonk R., 2021).
solutions with Er, Cr:YSGG-laser using radial- SEM evaluating technique was recruited to
firing tip on smear layer removal and dentinal powerfully assess the smear layer precipitated
tubules opening by scanning electron on dentin root and the presence of dentinal
microscope (SEM). The null hypothesis was that tubules’ opening at coronal, middle, & apical
there are no differences in smear layer removal one-thirds of root canal even though its
with different intracanal irrigating solutions preparation considers a destructive approach to
used. specimens (Alakshar A. et al., 2020).
The sectioning of teeth was achieved by low- small cavitation bubbles) occur. (Nagahashi T.
speed precision cutting saw for minimizing the et al., 2022). Cavitation effect of laser increases
specimen’s deformity during its preparation for the shearing stresses on root dentin and
SEM. enhances the cleaning effect of the laser-
A qualified practioner microscopically activated root canal irrigant. (Nagahashi T. et
photographed the root canal segments at a al., 2022).
magnification of x2000 which is a suitable In contrast to salvadora P and NaOCl intracanal
power to assess and capture smear layer scores irrigants results, Er,Cr:YSGG laser-activated
of root dentin (Sukhbir K. et al., 2019; saline irrigant solution (group II, subgroup A)
Kharouf N. et al. 2020; Sharma S. et al., 2020; recorded higher mean values of smear layer
Alakshar A. et al., 2020; Mohamed N. et al., score compared to those conventionally
2022). Two well-trained qualified evaluators activated by syringe/needle technique (group I,
independently assessed the SEM images based subgroup A) at coronal and apical root thirds.
on Hűlsmann-score system for strengthening This may be related to insufficient laser energy
the findings’ reliability and evading the human absorbed by saline irrigant at coronal and apical
bias (Alakshar A. et al., 2020). two-thirds. At middle one-third laser-activated
Based on the obtained results from this study, saline irrigant solutions showed better smear
thesignificant differences between conventional layer eliminating capacity than conventionally
syringe/needle (group I) and Er,Cr,YSGG-laser- activated ones.
activated (group II, subgroup B) irrigation Regarding the results of the examined
techniques are denoted that the efficiency of intracanal irrigants at root apical region,
Er,Cr:YSGG-laser-activated technique was Er,Cr:YSGG laser-activated irrigants (group II,
better than the conventional syringe/needle subgroup A and B) showed more potent
technique for eliminating the smear layer from cleaning effect on dentinal walls of root canal
the entire root dentin. The finding of proving that radial firing tip was properly
Er,Cr:YSGG-laser-activated technique researched the apical one-third and being in
accomplishes superior smear layer cleaning contact with the more intracanal irrigant
results compared to conventional syringe/needle permitting additional laser energy absorption, 396
technique were reported in several previous further laser cavitation and better smear layer
studies such as(George R. et al., 2008; DiVito elimination. These results are coincided with
E. et al., 2012; Sabari M., 2012; Murugesan M. (George R. et al., 2008;DiVito E. et al., 2012;
et al., 2013; Madhusudhana K. et al., 2016; Murugesan M. Sabari, et al., 2013)
Wang X. et al. 2017; Montero-Miralles P. et On the other hand, SEM evaluation of this study
al., 2018; Ozbay Y. and Erdemir A., 2018; Al- revealed that using of Er,Cr:YSGG subablative
baker H. et al., 2021) parameters were positively influenced the
These findings may be ascribed to that the smear layer cleaning efficacy of the root canal
physical effect of using pulsed Er,Cr:YSSG on irrigant associated with no thermal collateral
intracanal irrigant. (van der Sluis L. et al., damage (George R. et al., 2008; DiVito E. et al.,
2016) When the incident photon energy of 2012; Sabari M., 2012; Murugesan M. et al.,
Er,Cr:YSGG laser is absorbed by root canal 2013; Madhusudhana K. et al., 2016; Wang X.
irrigant solution during laser-activated et al. 2017; Montero-Miralles P. et al., 2018)
irrigation technique, the water molecule are or unwanted removal of the dentin root
increasingly heated-up and exploded creating (Montero-Miralles P. et al., 2018).
large vapor bubble at the end of the inserted Concerning the effect of root segment on smear
optical fiber of the delivery laser system. (van layer eliminating capacity of the intracanal
der Sluis L. et al., 2016) Then, the generated irrigants, the mean value of smear layer score
vapor bubble in irrigant solution is collapsed generally increased towards the root apex when
inducing pulling the irrigant fluid towards the using the same activation method; conventional
bubble center allowing better irrigant flow syringe/needle (group I) or Er,Cr:YSGG-laser-
inside the root canal and more agitation (van activated irrigation techniques (group II) for the
der Sluis L. et al., 2016; Nagahashi T. et al., same intracanal irrigant; saline (subgroup A),
2022). Moreover, once collapsing of vapor NaOCl (subgroup B) & salvadora P (subgroup C).
bubble is completed, shock waves (numerous There were statistical differences between the
smear layer scores recorded at different root apical one-third was the highest between all
segments for each intracanal irrigants except for evaluated subgroups (group I, subgroup A and
laser-activated NaOCl irrigant (group II, B) with no statistical difference was occurred
subgroup B). This is indicated that the smear between them. This signifies that smear layer
layer removal efficacy by activated intractacanal removing-capacity of conventionally activated
irrigant gradually reduced in apical direction. salvadora P at the apical root dentin can be less
This may be attributed to insufficient root canal powerful than the other examined irrigants;
irrigant that had been in contact with root NaOCl& saline. In contrast, Er,Cr:YSGG-laser-
dentin increases as the distance between root activated salvadora P root canal irrigant
canal region and the root canal orifice is far recorded lower smear layer score mean than
particularly in apical one-third. Moreover, the other laser-activated irrigants at apical root
complexity of apical one-third of root canal region. This implies that smear layer removing-
anatomy (Montero-Miralles P. et al., 2018; capacity of active salvadora P at the apical root
Rasheed S. and Jawad H., 2022) and its greater dentin was the best compared to other
extent of tubular sclerosis (Ayranci L. et al., examined irrigants and recommends that
2016) can negatively affect the smear layer salvadora P solution is the intracanal irrigant of
removal potency of root canal irrigants. These choice in case Er,Cr:YSGG-laser-activated
results are in accordance with those of previous irrigation technique will be applied.
studies (Nakamura V. et al., 2013; Zand V. et
al., 2014; Ozbay Y. and Erdemir A., 2018; Conclusions
Hora B. et al., 2021) Under the conditions of this study, employing
However, the study findings showed that the Er,Cr:YSGG pulsed laser (25 mJ, 50 Hz, air and
mean value of smear layer score recorded at water spray off) at short pulse duration (60
middle one-third of root canal was lower than μsfor activating the intracanal irrigants to
that measured at coronal one-third after using remove root canal smear layer was more
salvadora P as an intracanal irrigant activated valuable than using conventional
by conventional method (group I, subgroup C). syringe/needle activation technique. Salvadora
Furthermore, the mean value of smear layer P intracanal irrigant was the most effectual in 397
score of the same intracanal irrigant; salvadora removing smear layer from the entire root canal
P activated by Er,Cr:YSGG laser (group II, wall particularly when it was activated by
subgroup C) at coronal and middle two thirds Er,Cr:YSGG laser. Hence, this may be considered
was identical.This may be due to salvadora P a helpful protocol for elimination smear layer
irrigant made a higher or same contact with root during a root canal therapy.
dentin of middle one-third in comparison to that
of coronal one-third. Conflict of interest:
Regarding the results of the examined The author declares no potential conflicts of
intracanal irrigants measured at different root interest
segments; coronal, middle and apical root
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Neuro Quant Ology | October 2022 | Volume 20 | Issue 13 | Page 388-400 | Doi: 10.14704/NQ.2022.20.13.

Effect Of Agitation Of Salvadora Persica Extract

Introduction al., 2021). Therefore, the rationales of root

Figure (1): showed the ESEM (a), Er,Cr:YSGG laser device

Table (4): Mann whiteny U statistics of smear layer scores

Table (6): Mann whiteny U statistics of smear layer scores

Figure (3): The mean of smear layer scores in different

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