Odontology
DOI 10.1007/s10266-016-0251-8
ORIGINAL ARTICLE
Effectiveness of XP-endo Finisher, EndoActivator, and File
agitation on debris and smear layer removal in curved root canals:
a comparative study
Amr M. Elnaghy1 • Ayman Mandorah2 • Shaymaa E. Elsaka3
Received: 15 January 2016 / Accepted: 27 April 2016
Ó The Society of The Nippon Dental University 2016
Abstract The purpose of this study was to assess the
efficacy of the XP-endo Finisher (FKG Dentaire SA, La
Chaux-de-Fonds, Switzerland) file on debris and smear
layer removal in curved root canals in comparison to dif-
ferent irrigation regimens. Seventy-five freshly extracted
human mandibular molar teeth with mesial root curved
more than 20° were used in this study. The mesial root
canals were mechanically prepared using the BT-Race
rotary system (FKG Dentaire) and divided into five groups
(n = 15) according to the following irrigation techniques:
positive control, non-agitated, File agitation, XP-endo
Finisher, and EndoActivator (Dentsply Tulsa Dental Spe-
cialities, Tulsa, OK, USA). Root canals were split longi-
tudinally and evaluated by scanning electron microscopy.
Five-grade scoring system was used to assess the presence
of debris and smear layer at the coronal, middle, and apical
regions. The XP-endo Finisher and EndoActivator groups
revealed significantly lower debris and smear layer scores
than the other groups at the coronal, middle, and apical
regions (P \ 0.05). There was no significant difference
between XP-endo Finisher and EndoActivator groups
(P [ 0.05). The apical region had higher debris and smear
layer scores compared with the coronal regions in all
groups (P \ 0.05), except for the positive control group;
there was no significant difference between the three
& Amr M. Elnaghy
aelnaghy@mans.edu.eg
1
Department of Endodontics, Faculty of Dentistry, Mansoura
University, Mansoura 35516, Egypt
2
Dental Department, King Faisal Hospital, Makkah, Saudi
Arabia
3
Department of Dental Biomaterials, Faculty of Dentistry,
Mansoura University, Mansoura, Egypt
regions of the root canal (P [ 0.05). Irrigation of curved
root canals using XP-endo Finisher and EndoActivator
methods appears to be more effective on debris and smear
layer removal than the other tested groups.
Keywords Curved root canals
Debris
EndoActivator

Smear layer
XP-endo Finisher
Introduction
The cleaning and shaping of root canals is a crucial step in
root canal treatment procedures [1]. Shaping of root canals
produces an irregular layer of debris, known as the smear
layer, which is formed on the dentinal walls [2, 3]. It has
been reported that the smear layer hindered the penetration
of intracanal disinfectants [4] and sealers into the dentinal
tubules, which may lead to compromising the seal of canal
filling [5, 6]. A systematic review and meta-analysis [7]
reported that the general agreement has proceeded toward
preferring the removal of the smear layer.
Several irrigating solutions have been used to decrease
residual debris, bacteria, necrotic tissues and the smear
layer which is formed by the mechanical instrumentation of
the root canal system [4, 8]. Sodium hypochlorite (NaOCl)
has become the most commonly used irrigating solutions in
endodontics [9]. Alternative irrigant solutions including a
deproteinizing agent, EDTA and a calcium chelating agent
have been suggested for the effective removal of the smear
layer [10, 11]. To enhance cleanliness, irrigants should be
in contact with root canal [8]. The conventional syringe
irrigation method delivers solutions no further than
0–1.1 mm beyond the needle tip [12]. This method is
inadequate for complete cleaning of the complex anatomy
of root canal system including isthmus, fins, lateral and
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accessory canals [13]. It has been introduced different
irrigation devices to enhance the flow and distribution of
irrigating solutions within the root canal system [13, 14],
particularly at the apical third level.
The EndoActivator System (Dentsply Tulsa Dental Spe-
cialities, Tulsa, OK, USA) is a sonically driven canal irri-
gation system that includes a portable handpiece and 3 types
of disposable flexible polymer tips of different sizes that do
not cut root dentin [15]. Recently, a new nickel–titanium
rotary finishing file has been developed called the XP-endo
Finisher file (FKG Dentaire SA, La Chaux-de-Fonds,
Switzerland). The XP-endo Finisher file is supposed to be
used after any root canal instrumentation to accomplish an
enhanced cleaning of the root canal while conserving dentin.
It has been reported that XP-endo Finisher curved bulb can
expand its extent 6 mm in diameter when the file tip is
squeezed or 100-times of a corresponding sized file [16, 17].
The XP-endo Finisher has a small core size (ISO 25 in
diameter and zero taper) with improved flexibility. The XP-
endo Finisher file is formed using a proprietary NiTi alloy
(Martensite-Austenite Electropolish-FleX). The XP-endo
Finisher file performs at different temperature and is claimed
to have a high flexibility [16, 17].
The aim of this study was to evaluate the effectiveness
of the XP-endo Finisher file on debris and smear layer
removal in curved root canals after biomechanical instru-
mentation in comparison to different irrigation regimens.
The null hypothesis was that there is no statistically sig-
nificant difference between the examined agitation
methods.
Materials and methods
Selection and specimen preparation
Seventy-five freshly extracted human mandibular molar
teeth with mesial root curved more than 20° according to
method of Schneider [18] were used in this study. Teeth
were stored in 0.5 % chloramine-T at 4 °C until use. Teeth
were checked by radiographs to insure complete apex
formation. The access cavity was prepared, and the mesial
root was separated from the distal root using a low speed
diamond saw (Isomet 1000, Buehler Ltd., Lake Bluff, IL,
USA). The specimens were decoronated using a low speed
diamond saw under water to achieve a standardized root
length of 15 mm. The working length was established at
109 magnification using a surgical microscope (Global
Surgical, St. Louis, MO, USA) by inserting size 10 K-file
to root canal terminus and subtracting 1 mm from this
measurement. The apex was sealed with sticky wax to
prevent the irrigant solutions from escaping through the
apex to simulate in vivo situations [19, 20].
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Odontology
The mesial root canals were mechanically prepared
using the BT-Race rotary system (FKG Dentaire) and the
Rooter-Endo-motor (FKG Dentaire) with 800 rpm and
1.5 N cm, under constant irrigation with 2.5 % NaOCl
using 30-gauge needle (NaviTip; Ultradent, South Jordan,
UT, USA). Biomechanical preparation of the root canals
was instrumented as follows:
1. Glide path was established using ScoutRace #15/0.02.
2. BT1 #10/0.06, BT2 #35/0.00, and BT3 #35/0.04 files
were used to the full WL.
Then, the root canals were irrigated with 10 mL distilled
water to prevent the extended effects of the NaOCl solution
[21].
Final irrigation procedures
After biomechanical preparation of the root canals, the
specimens were divided randomly into 5 groups of 15 teeth
each. The groups were as follows:
Group 1 (n = 15): positive control; no final rinse and no
additional agitation of the irrigant were performed.
Group 2 (n = 15): non-agitated; final rinse with 5 mL
17 % EDTA (CanalPro, Coltene/Whaledent, Langenau,
Germany) and no additional agitation of the irrigant was
performed.
Group 3 (n = 15): File agitation; 17 % EDTA was
agitated with the BT2 file placed at the WL, with slight in-
and-out movements for 60 s.
Group 4 (n = 15): XP-endo Finisher file; 17 % EDTA
was agitated with XP-endo Finisher file which set at
800 rpm and advanced to the WL. Slow and gentle
7–8 mm lengthwise movements were made for 60 s.
Group 5 (n = 15): EndoActivator (Dentsply Tulsa);
17 % EDTA was agitated with the EndoActivator red tip
(25/0.04) at 10,000 cycles/min for 60 s.
After EDTA agitation, the specimens in groups 2–5
were irrigated for 60 s with 1 mL 2.5 % NaOCl followed
by a final rinse with 5 mL sterile saline solution. The root
canals were then dried with size 35 paper points (FKG
Dentaire), and the specimens were stored in 1.5 mL
Eppendorf tubes [19].
Scanning electron microscopy analysis
A diamond disc at low speed was used to groove the roots
through the buccal and lingual surfaces. Then, the roots
were split longitudinally with a chisel and mallet into 2
halves. For each specimen, the half enclosing the most
visible part of the apex was selected and the other half was
discarded. Then, each specimen was grooved to 3 levels
from the root apices using a diamond bur to define the
coronal, middle, and apical thirds [15]. The specimen was
Odontology
dehydrated with ascending concentrations of ethyl alcohol
(30–100 %), and placed in a desiccator for 24 h. Each
specimen was coated with gold and evaluated under a
scanning electron microscope (SEM) (JEOL, JSM-
6510LV, JEOL Ltd., Tokyo, Japan). The photomicrographs
from the apical to coronal thirds of the root of each spec-
imen were taken at 4009 for debris and 10009 for smear
layer evaluation [19].
The photomicrographs were analyzed by 2 examiners
who were specialists in endodontics and were blind to
group status. The presence of debris was evaluated by
using the following scores: score 1; clean root canal wall
and only few small debris particles, score 2; few small
agglomerations of debris, score 3; many agglomerations of
debris covering less than 50 % of the root canal wall, score
4; more than 50 % of the root canal wall covered by debris,
and score 5; complete or nearly complete root canal wall
covered by debris [19].
The presence or absence of a smear layer was evaluated
using the following scores [20]: score 1; no smear layer and
dentinal tubules open, score 2; small amounts of scattered
smear layers and dentinal tubules open, score 3; thin smear
layer and dentinal tubules partially open (characteristic
image of crescent), score 4; partial covering with a thick
smear layer, and score 5; total covering with a thick smear
layer. This scoring system was applied to the coronal,
middle, and apical thirds of the canal. Before scoring, the 2
examiners evaluated the first 30 specimens together for
calibration purposes. The results were tabulated and sub-
mitted to statistical analysis [19].
Statistical analysis
The data were analyzed using the Statistical Package for
the Social Sciences, version 15 (SPSS, Chicago, IL, USA).
The agreements between the 2 examiners regarding the
debris and smear layer scores were evaluated with Cohen
kappa. Comparisons between groups were analyzed
Table 1 Debris and smear
Parameter Groups
layer median scores for the
tested groups Positive control Non-agitated
Debris scores
Coronal 5Aa 3Ba
Middle 5Aa 4Bb
Apical 5Aa 4Bb
Smear layer scores
Coronal 5Aa 3Ba
Aa
Middle 5 4
Apical 5Aa 4Bb
Median values represented with common or same superscript uppercase letters (row) or lowercase letters
(column) are not significantly different (P [ 0.05)
statistically using the Kruskal–Wallis nonparametric anal-
ysis of variance and Mann–Whitney U tests. Statistical
significance level was set at P \ 0.05.
Results
Excellent agreement was revealed between the two
examiners (K = 0.864). This suggests that there was reli-
ability and reproducibility between the examiners. Table 1
shows the mean and standard deviation results of SEM
analysis of the root canal walls regarding debris and smear
layer scores.
Debris and smear layer scores
The results of debris and smear layer scores of tested
groups are presented in Table 1. The XP-endo Finisher
(group 4) and EndoActivator (group 5) revealed signifi-
cantly lower debris and smear layer scores than the other
groups at the coronal, middle, and apical regions
(P \ 0.05). There was no significant difference between
XP-endo Finisher and EndoActivator groups (P [ 0.05).
Similarly, there was no significant difference between non-
agitated and File agitation groups in debris and smear layer
scores at the coronal, middle, and apical regions
(P [ 0.05). A comparison between root canal regions, the
apical region had higher debris and smear layer scores
compared with the coronal regions in all groups
(P \ 0.05), except for the positive control group; there was
no significant difference between the three regions of the
root canal (P [ 0.05). Figure 1 shows representative pho-
tomicrographs of smear layer of each group at the coronal,
middle, and apical regions.
A post hoc power analysis was performed using GPower
v3.1.3 software (University of Düsseldorf; Düsseldorf,
Germany), indicated that a total sample size of 75 speci-
mens would have been needed to obtain power of 0.94.
File agitation XP-endo Finisher EndoActivator
3Ba 2Ca 2Ca
3Ba 2Ca 2Ca
4Bb 3Cb 2Ca
3Ba 2Ca 2Ca
Bb Bb Cb
4 3 2Ca
4Bb 3Cb 3Cb
123

Fig. 1 Representative scanning electron microscope photomicrographs (10009) of smear layer of different tested groups at the coronal (C),
middle (M) and apical (A) thirds
Discussion
The goal of the endodontic treatment is the elimination of
microorganisms and the avoidance of reinfection. To
accomplish this, root canals are cleaned before root canal
obturation through mechanical instrumentation accompa-
nied with irrigants and intracanal medications [22]. In cases
of infected root canals, remaining debris and smear layer
harbor microorganisms and their by-products [23]. The
smear layer which is an amorphous and irregular layer is
formed on root canal walls after instrumentation. Potential
detrimental effects may happen if the smear layer is not
removed throughout root canal treatment [19]. Microor-
ganisms remaining in the smear layer after mechanical
preparation of an infected root canal can survive and
reinfect the canal [19]. It has been reported that the smear
layer hindered the intracanal disinfectants and sealers from
diffusion into dentinal tubules and has the possibility of
diminishing the seal of the root canal filling [24, 25].
Syringe irrigation is a typical method for root canal
irrigation; however, this method is not effective in the
apical third of the root canal [26]. It is difficult to entirely
eliminate the remaining debris and smear layer, especially
in the apical third of the curved root canal due to the
smaller size of the apical third compared with the other
regions hinders the circulation and action of the irrigating
solutions [27]. Consequently, the objective of this study
was to assess the effectiveness of the XP-endo Finisher file
in removing the debris and smear layer in curved root
canals after biomechanical instrumentation in comparison
to different irrigation regimens by using SEM. SEM is a
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Odontology
valuable tool to assess the cleanliness of canal walls as it
allows assessment of the whole segment of the canal on the
basis of a distinct numeric evaluation score for debris and
smear layer [1, 28, 29]. The results lead to the rejection of
the null hypothesis since differences on debris and smear
layer removal were found between the groups.
The most generally used irrigant in endodontics is
NaOCl as it has bactericidal effect and results in tissue
dissolution [30]. Among other irrigants used during root
canal preparation is EDTA. The efficiency of different
concentrations of EDTA for smear layer removal has been
investigated, and this generally considered as an effective
procedure in the removal of the smear layer in comparison
with other substances in the final irrigation [19, 24, 29].
Similarly, in the present study, the groups treated with
EDTA revealed substantial debris and smear layer removal,
irrespective of the technique used.
XP-endo Finisher and EndoActivator groups resulted in
more effective debris and smear layer removal than other
groups. It has been reported that the EndoActivator system
increases the efficiency of irrigation better than traditional
needle irrigation [31]. It has polymer-based tips that do not
damage the canal wall [32]. The finding in this study
regarding the results of XP-endo Finisher file in debris and
smear layer removal can be attributed to its metallurgy.
The development and manufacture of XP-endo Finisher
files are dependent on the shape-memory principles of the
NiTi alloy. The file is straight in its martensitic phase
which is formed when it is cooled. When the file is sub-
jected to the body temperature (the canal) it will convert its
shape because of its shape-memory to the austenitic phase.
Odontology
It has been claimed by the manufacturer that the austenitic-
phase shape in the rotation mode permits the file to contact
and clean areas that are otherwise difficult to reach with
regular instruments. After the file has been cooled down, it
can be returned manually to its original straight shape
(martensitic phase) again [17].
Except for the positive control group, the results
revealed that regardless of irrigation regimens used, the
coronal thirds were significantly cleaner when compared
with the apical one-third. This finding is in agreement with
previous studies [24, 28, 33, 34]. This finding could be
attributed to the larger diameter in these areas, exposing
dentin to a higher volume of irrigants and making smear
layer and debris removal easier [28, 34, 35].
It has been reported that the total removal of the smear
layer happened only in root canal prepared to an apical
diameter of minimum 0.30 mm [36]. In the present study,
the last file used for the preparation of root canals was BT3
#35/0.04; which seems to be suitable for hydrodynamic
flow [37].
Although the scoring method used in the present study
involved qualitative analysis; it is a simple and direct
scoring system, performed by calibrated examiners with
concordance between them [32]. In addition, the large
number of observations made, evidently increase the reli-
ability of the results obtained [32, 38].
Conclusion
Within the limitations of this study, it can be concluded
that irrigation of curved root canals using XP-endo Finisher
and EndoActivator methods seems to be more effective in
the removal of debris and smear layer compared with other
tested groups. None of the irrigation methods assessed in
this study totally removed the debris and smear layer. Root
canal cleanliness was noticeably improved in the coronal
than in the apical root canal region. Future studies are
required to confirm these introductory data and to assess
the biofilm removal and apical disinfection.
Acknowledgments The authors would like to thank FKG Dentaire
SA for providing the materials used in this study. The authors deny
any conflicts of interest related to this study.
Compliance with ethical standards
Conflict of interest The authors declare that they have no conflicts of
interest.
References
1. Metzger Z, Teperovich E, Cohen R, Zary R, Paqué F, Hülsmann
M. The self-adjusting file (SAF). Part 3: removal of debris and
smear layer-A scanning electron microscope study. J Endod.
2010;36:697–702.
2. McComb D, Smith DC. A preliminary scanning electron micro-
scopic study of root canals after endodontic procedures. J Endod.
1975;1:238–42.
3. Byström A, Sundqvist G. Bacteriologic evaluation of the efficacy
of mechanical root canal instrumentation in endodontic therapy.
Scand J Dent Res. 1981;89:321–8.
4. Orstavik D, Haapasalo M. Disinfection by endodontic irrigants
and dressings of experimentally infected dentinal tubules. Endod
Dent Traumatol. 1990;6:142–9.
5. Kennedy WA, Walker WA 3rd, Gough RW. Smear layer removal
effects on apical leakage. J Endod. 1986;12:21–7.
6. Saunders WP, Saunders EM. The effect of smear layer upon the
coronal leakage of gutta-percha fillings and a glass ionomer
sealer. Int Endod J. 1992;25:245–9.
7. Shahravan A, Haghdoost AA, Adl A, Rahimi H, Shadifar F.
Effect of smear layer on sealing ability of canal obturation: a
systematic review and meta-analysis. J Endod. 2007;33:96–105.
8. Zehnder M. Root canal irrigants. J Endod. 2006;32:389–98.
9. Carson KR, Goodell GG, McClanahan SB. Comparison of the
antimicrobial activity of six irrigants on primary endodontic
pathogens. J Endod. 2005;31:471–3.
10. Peters OA, Barbakow F. Effects of irrigation on debris and smear
layer on canal walls prepared by two rotary techniques: a scan-
ning electron microscopic study. J Endod. 2000;26:6–10.
11. Ciucchi B, Khettabi M, Holz J. The effectiveness of different
endodontic irrigation procedures on the removal of the smear
layer: a scanning electron microscopic study. Int Endod J.
1989;22:21–8.
12. Munoz HR, Camacho-Cuadra K. In vivo efficacy of three dif-
ferent endodontic irrigation systems for irrigant delivery to
working length of mesial canals of mandibular molars. J Endod.
2012;38:445–8.
13. Mancini M, Cerroni L, Iorio L, Armellin E, Conte G, Cianconi L.
Smear layer removal and canal cleanliness using different irri-
gation systems (EndoActivator, EndoVac, and passive ultrasonic
irrigation): field emission scanning electron microscopic evalua-
tion in an in vitro study. J Endod. 2013;39:1456–60.
14. Gu LS, Kim JR, Ling J, Choi KK, Pashley DH, Tay FR. Review
of contemporary irrigant agitation techniques and devices. J En-
dod. 2009;35:791–804.
15. Uroz-Torres D, González-Rodrı́guez MP, Ferrer-Luque CM.
Effectiveness of the EndoActivator system in removing the smear
layer after root canal instrumentation. J Endod. 2010;36:308–11.
16. Trope M, Debelian G. XP-3D FinisherTM file—the next step in
restorative endodontics. Endod Pract US. 2015;8:22–4.
17. FKG Dentaire SA The XP-endo Finisher file Brochure. http://
www.fkg.ch/sites/default/files/fkg_xp_endo_brochure_en_vb.pdf
18. Schneider SW. A comparison of canal preparations in straight
and curved root canals. Oral Surg Oral Med Oral Pathol.
1971;32:271–5.
19. da Costa Lima GA, Aguiar CM, Câmara AC, Alves LC, Dos
Santos FA, do Nascimento AE. Comparison of smear layer
removal using the Nd:YAG laser, ultrasound, ProTaper Universal
system, and CanalBrush methods: an in vitro study. J Endol.
2015;41:400–4.
20. Caron G, Nham K, Bronnec F, Machtou P. Effectiveness of
different final irrigant activation protocols on smear layer
removal in curved canals. J Endod. 2010;36:1361–6.
21. Hu X, Peng Y, Sum CP, Ling J. Effects of concentrations and
exposure times of sodium hypochlorite on dentin deproteination:
attenuated total reflection Fourier transform infrared spectroscopy
study. J Endod. 2010;36:2008–11.
22. Schirrmeister JF, Liebenow AL, Braun G, Wittmer A, Hellwig E,
Al-Ahmad A. Detection and eradication of microorganisms in
123

root-filled teeth associated with periradicular lesions: an in vivo
study. J Endod. 2007;33:536–40.
23. Rodig T, Dollmann S, Konietschke F, Drebenstedt S, Hulsmann
M. Effectiveness of different irrigant agitation techniques on
debris and smear layer removal in curved root canals: a scanning
electron microscopy study. J Endod. 2010;36:1983–7.
24. Garip Y, Sazak H, Gunday M, Hatipoglu S. Evaluation of smear
layer removal after use of a canal brush: an SEM study. Oral Surg
Oral Med Oral Pathol Oral Radiol Endod. 2010;110:e62–6.
25. Wang Z, Shen Y, Haapasalo M. Effect of smear layer against
disinfection protocols on Enterococcus faecalis-infected dentin.
J Endod. 2013;39:1395–400.
26. Peeters HH, Suardita K. Efficacy of smear layer removal at the
root tip by using ethylenediaminetetraacetic acid and erbium,
chromium: yttrium, scandium, gallium garnet laser. J Endod.
2011;37:1585–9.
27. Blank-Goncalves LM, Nabeshima CK, Martins GH, Machado
ME. Qualitative analysis of the removal of the smear layer in the
apical third of curved roots: conventional irrigation versus acti-
vation systems. J Endod. 2011;37:1268–71.
28. Kamel WH, Kataia EM. Comparison of the efficacy of smear
clear with and without a canal brush in smear layer and debris
removal from instrumented root canal using WaveOne versus
ProTaper: a scanning electron microscopic study. J Endod.
2014;40:446–50.
29. Rödig T, Döllmann S, Konietschke F, Drebenstedt S, Hülsmann
M. Effectiveness of different irrigant agitation techniques on
debris and smear layer removal in curved root canals: a scanning
electron microscopy study. J Endod. 2010;36:1983–7.
30. Sirtes G, Waltimo T, Schaetzle M, Zehnder M. The effects of
temperature on sodium hypochlorite short-term stability, pulp
dissolution capacity, and antimicrobial efficacy. J Endod.
2005;31:669–71.
123
Odontology
31. de Gregorio C, Estevez R, Cisneros R, Heilborn C, Cohenca N.
Effect of EDTA, sonic, and ultrasonic activation on the pene-
tration of sodium hypochlorite into simulated lateral canals: an
in vitro study. J Endod. 2009;35:891–5.
32. Blank-Gonçalves LM, Nabeshima CK, Martins GH, Machado
ME. Qualitative analysis of the removal of the smear layer in the
apical third of curved roots: conventional irrigation versus acti-
vation systems. J Endod. 2011;37:1268–71.
33. Khedmat S, Shokouhinejad N. Comparison of the efficacy of
three chelating agents in smear layer removal. J Endod.
2008;34:599–602.
34. Yang G, Wu H, Zheng Y, Zhang H, Li H, Zhou X. Scanning
electron microscopic evaluation of debris and smear layer
remaining following use of ProTaper and Hero Shaper instru-
ments in combination with NaOCl and EDTA irrigation. Oral
Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106:e63–71.
35. Schäfer E, Lohmann D. Efficiency of rotary nickel-titanium
FlexMaster instruments compared with stainless steel hand
K-Flexofile. Part 2: Cleaning effectiveness and instrumentation
results in severely curved root canals of extracted teeth. Int Endod
J. 2002;35:514–21.
36. Khademi A, Yazdizadeh M, Feizianfard M. Determination of the
minimum instrumentation size for penetration of irrigants to the
apical third of root canal systems. J Endod. 2006;32:417–20.
37. Khademi A, Yazdizadeh M, Feizianfard M. Determination of the
minimum instrumentation size for penetration of irrigants to the
apical third of root canal systems. J Endod. 2006;32:417–20.
38. Kuah HG, Lui JN, Tseng PS, Chen NN. The effect of EDTA with
and without ultrasonics on removal of the smear layer. J Endod.
2009;35:393–6.