E-ISSN 2548-0839
Volume : 10 Issue : 4 Year : 2025

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SEM Analysis and Pulp Tissue Dissolution Following Retrograde Preparation and Irrigation in Surgical Endodontics: A Novel Approach [Eur Endod J]
Eur Endod J. Ahead of Print: EEJ-02419 | DOI: 10.14744/eej.2025.02419

SEM Analysis and Pulp Tissue Dissolution Following Retrograde Preparation and Irrigation in Surgical Endodontics: A Novel Approach

Alfredo Iandolo1, Mariangela Cernera, Cosimo Ferraro, Marzio Galdi, Luigi Esposito, Gianrico Spagnuolo, Davide Mancino, Dina Abdellatif
1Besançon Regional University Hospital Center, Besançon, France.
2Sinergies Laboratory EA 4662, University of Franche-Comté, Besançon, France
3Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80126 Naples, Italy
4Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, 84081 Salerno, Italy.
54. Faculty of Dental Surgery, Federation of Medicine Translational of Strasbourg and Federation of Materials and Nanoscience of Alsace, University of Strasbourg, France.

Objective: This study aimed to assess the efficacy of a novel retrograde irrigation protocol involving ultrasonic activation, compared with conventional techniques, using two complementary experimental models.
Methods: Experiment 1: Sixty extracted human mandibular premolars were endodontically prepared, obturated, and randomly assigned to three groups (n=20): Group 1 (saline irrigation), Group 2 (ultrasonically activated 17% EDTA gel and 5.25% NaOCl gel), and Group 3 (no irrigation). Following 1 mm apical resection and 3 mm retrograde cavity preparation, root-end cleanliness was assessed using scanning electron microscopy (SEM). Three calibrated, blinded examiners evaluated smear layer and debris scores. Experiment 2: A 3d-printed artificial canal system with lateral extensions containing bovine pulp tissue was used to simulate organic material. Groups received: Group 1 (saline), Group 2 (ultrasonically activated 5.25% NaOCl gel), Group 3 (no irrigation). Pulp dissolution was measured using a high-precision analytical microbalance.
Data were analysed using the Kruskal-Wallis test and Dunn-Bonferroni post hoc (Experiment 1), and one-way ANOVA with Tukey HSD (Experiment 2). A significance level of p<0.05 was adopted.
Results: In Experiment 1, Group 2 showed significantly lower debris and smear layer scores than Groups 1 and 3 (p<0.001). In Experiment 2, only Group 2 achieved complete pulp tissue dissolution (p<0.001).
Conclusions: Ultrasonically activated EDTA and NaOCl gel significantly enhance cleaning efficacy and organic tissue dissolution in retrograde endodontic surgery, allowing for a more conservative apical resection approach.

Keywords: Dentin Debris, EDTA, Endodontic Surgery, Sodium Hypochlorite, Ultrasonics.

Corresponding Author: Mariangela Cernera
Manuscript Language: English
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