Abstract
Background:
All-in-one irrigants introduced recently claim to impart added benefits for endodontic disinfection; however, their effects on root dentin need to be evaluated.
Aims:
The aim of the study was to evaluate the dentinal wettability and surface roughness of Triton and Twin Kleen irrigating solutions on root dentin.
Materials and Methods:
Eighty dentin blocks (6 mm × 6 mm) were prepared using middle root portion obtained by horizontal sectioning of forty single-rooted extracted human mandibular premolar teeth which were further mounted in acrylic blocks (4 cm × 4 cm) and were randomly allotted into four groups (n = 20) and subjected to 10 ml of experimental irrigating solutions for 5 min as follows, group 1: normal saline (Control), group 2: 5.25% sodium hypochlorite (NaOCl) +17% ethylenediaminetetraacetic acid (EDTA), group 3: Triton, and group 4: Twin Kleen. Half of the specimens in each group (n = 10) were tested for wettability by using goniometer, and another half (n = 10) were subjected to surface roughness using atomic force microscopy.
Statistical Analysis:
One-way analysis of variance and post hoc Tukey test (P ≤ 0.05).
Results:
Group 3 exhibited the highest wettability followed by group 4, group 2 and least in group 1 (control group). Surface roughness was found to be highest in group 2 followed by group 3, group 4 and least in group 1.
Conclusion:
Triton and Twin Kleen have shown better wettability and less surface roughness compared to 17% EDTA and 5.25% NaOCl.
Keywords: Atomic force microscopy, contact angle, surface roughness, Triton, Twin Kleen, wettability
INTRODUCTION
Successful endodontic treatment relies on a combination of key factors that work together to ensure the tooth is properly cleaned, disinfected, and sealed. Effective irrigation is essential for flushing out debris, bacteria, and remaining tissue within the morphology of the root canal system.[1,2] Sodium hypochlorite (NaOCl) is a widely used irrigant; other solutions such as ethylenediaminetetraacetic acid (EDTA) and chlorhexidine are used for specific purposes, such as to dissolve inorganic tissue of the root canal and removing the smear layer or enhancing antimicrobial action.[3] However, these conventional irrigants alone cannot impart the functions of an ideal irrigant such as effective smear layer removal, pulp dissolving ability, and antibacterial activity,; therefore, a combination of several irrigant regimens was used for canal disinfection.[4] However, this resulted in untoward effects such as interactions between irrigants, effects on physical properties of root dentin, inactivation of antimicrobial action of one of the combined irrigants etc.; moreover, it required several irrigants for optimal disinfection, hence it was found time-consuming.[5] To overcome these drawbacks, recently all in one solutions were introduced.
Triton, a newer all-in-one irrigating agent (Savannaha, Brasseler, USA), was recently introduced, consisting of two parts in a unique single unit. Part A has 13 chelators such as 1,2,4-Butanetricarboxylic acid, 2-phosphono, citric acid, sodium dodecylbenzenesulfonate, alcohols, ethoxylated liquids, and polyethylene glycol 4-ether. Surfactants are sodium lauryl sulfate and 2-Ethylhexyl sodium sulfate. Sodium cumenesulphonate is a stabilizer, and sodium hydroxide is a pH modifier. Part B constitutes of 8% NaOCl and sodium hydroxide.[6]
Twin Kleen (Maarc Dental Innovations Endo, India) is composed of 18% etidronate also known as 1-hydroxy ethylidene-1, 1-bisphosphonate (HEDP), and 3%–5% NaOCl. It has effective smear layer removal, antimicrobial action, organic and inorganic debris removal, less cytotoxic, and less time-consuming. It is available as a capsule, which is mixed with 3% NaOCl and should be used within 120 min.[7]
The wettability and surface roughness of root dentin are crucial in understanding the effectiveness of irrigation as well as the bonding of restorative materials to dentin. Wettability is measured using a contact angle goniometer, and it refers to how well a liquid spreads over a surface, which in dental terms relates to the ability of the root canal irrigants to penetrate and interact with the dentin surface. The wettability of dentin influences the ability of sealing materials to adhere to the dentin walls.[8] Surface roughness refers to the microscopic texture of the dentin surface after an irrigant has been applied. Since some irrigants cause the removal of the mineral content from the dentin, leading to a rougher surface, which may enhance the mechanical interlocking of sealers. However, excessive roughness can negatively impact the bonding of restorative materials and lead to increased leakage or sensitivity.[9] Surface roughness is measured by atomic force microscopy because it provides 3-dimensional surface topography with high-resolution images, more accurate.[10] Therefore, these two variables have clinical significance since there are no studies comparing all-in-one irrigating solutions regarding their effect on root dentin wettability and surface roughness were reported earlier. Hence this study was undertaken to fill the gap in existing literature. This study aims to compare the root dentinal wettability and surface roughness of Triton and Twin Kleen irrigating solutions using a contact angle goniometer and atomic force microscopy. The null hypothesis states that there is no significant difference between the irrigations used in the study.
MATERIALS AND METHODS
Institutional ethical clearance was obtained for this study (2024–2025/IEC/13) and performed accordingly. Sample size was estimated by using open software R core version 4.0.2 (Microsoft Corporation, Washington, USA) using balanced One-way analysis of variance (ANOVA) with a significant level of 0.05, power of test 80%, and effective size is 0.55. Therefore, based on a previous study,[2] 80 samples were used in this study.
Forty human mandibular premolar teeth extracted for the orthodontic treatment purpose were obtained. The teeth which do not have any fractures and caries mainly on root surface and with single root were selected and radiographed to rule out single canal and no presence of restoration or root canal therapy, then these teeth were cleaned in ultrasonic bath (Alpha Chem, Ankleshwar, India) and stored in 0.1% thymol (Sisco Research Laboratories Pvt. Ltd. Mumbai, India) solution till further use.
All specimens were decoronated followed by apical third root resection to obtain a root segment of 6 mm height using high speed diamond disc (Nexus medodent, Korea) under water cooling, then these samples were further sectioned in buccolingual direction to get two parallel dentin blocks of dimensions (6 mm × 6 mm) therefore, totally 80 specimens were obtained. Then inner dentinal portions were smoothened by using abrasives (Sumare, SP, Brazil) and mounted in an acrylic block (DPI, Mumbai, India) (1 cm × 1 cm) with the dentinal surface facing outward and were then divided into four groups (n = 20) randomly as follows:
Group 1: Normal saline (control group) (Aculife Healthcare Pvt. Ltd., Ahmedabad, Gujarat)
Group 2: 5.25% NaOCl + 17% EDTA (Organo Biotech Laboratories, Delhi, India)
Group 3: Triton (Savannaha, Brasseler, USA)
Group 4: Twin Kleen (Maarc Dental Innovations Endo, India).
The specimens in each group were subjected to 10 ml of different irrigation solutions for 5 min using a 30-gauge needle with a disposable syringe and rinsed with 10 ml of distilled water and blot dried. In group 2, the specimens were irrigated with 5 ml of 5.25% NaOCl, then rinsed with 5 ml of normal saline, and then subjected to 5 ml of 17% EDTA solution for 1 min. Whereas, in groups 3 and 4, the irrigants were used as per the instructions of manufactures. In an automated container, both parts A and B of Triton were mixed in 1:1 ratio and were used further. The contents of two capsules of Twin Kleen (each capsule contains 0.45 g) were added to a beaker containing 10 ml of 3% NaOCl and stirred with a sterile spatula for about 60 s, and the solution was aspirated in a 10 ml syringe.[7] Half of the specimens in each group (n = 10) were tested for wettability, and another half (n = 10) were subjected to surface roughness testing.
Evaluation of wettability
Wettability was measured using a contact angle goniometer (Ossila, Sheffield, UK) by the sessile drop technique on dentin surface. Two drops (0.0002 ml/drop) of irrigant were disposed on each dentin surface using a microsyringe, and images were taken, and contact angles were recorded [Figure 1].[2]
Figure 1.
Contact angle measurements showing Wettability: (a) Normal saline, (b) 17% ethylenediaminetetraacetic acid + 5.25% sodium hypochlorite (c) Triton, and (d) Twin Kleen
Evaluation of surface roughness
Surface roughness (Ra) was measured using digital atomic force microscope (Oxford Instruments Asylum Research, Santa Barbara, California, USA) by AFM probes (tap 190AI-G) operated in contact mode with dentin surface with 300 ms scanning speed and 10 micrometer of scanning size, and the measurement values are viewed using Nano Surf Easy Scan Microsoft version 3.7.3.6, (Nanosurf AG, Switzerland), and data were recorded [Figure 2].
Figure 2.
Atomic force microscopic images showing surface roughness: (a) Normal saline, (b) 17% ethylenediaminetetraacetic acid + 5.25% sodium hypochlorite (c) Triton, (d) Twin Kleen
Statistical analysis
Statistical Package for the Social Sciences (SPSS) software version 23 (IBM Statistics, Chicago, IL, USA) was used. Analysis by Shapiro–Wilk test showed that the data were normally distributed; therefore, one-way ANOVA and post hoc Tukey tests were used at the level of significance set at P ≤ 0.05.
RESULTS
For wettability, the least values were found in group 3 and slightly higher in groups 4 and 2 and highest in group 1 (control group). While surface roughness was found to be highest in group 2, followed by groups 3 and 4 and least in group 1 (control group), [Table 1]. Significant difference between all the groups, except between groups 3 and 4 for both wettability and surface roughness was shown by post hoc Tukey test [Table 2].
Table 1.
Comparison of wettability and surface roughness for all groups by one way ANOVA
| Groups | Wettability (degrees) | Surface roughness(nm) | ||
|---|---|---|---|---|
|
|
|
|||
| Mean | SD | Mean | SD | |
| Normal saline | 54.3 | 0.88 | 4.06 | 0.86 |
| 5.25%NaOCl +17%EDTA | 48.68 | 1.54 | 41.68 | 1.43 |
| Triton | 39.06 | 0.83 | 33.20 | 1.07 |
| Twin kleen | 39.72 | 0.96 | 31.86 | 1.2 |
| P | <0.05 | |||
SD: Standard deviation, EDTA: Ethylenediaminetetraacetic acid
Table 2.
Post hoc Tukey multiple comparison of surface roughness and wettability between groups
| Groups | Surface roughness (nm) | Wettability (°) | ||
|---|---|---|---|---|
|
|
|
|||
| Difference | P | Difference | P | |
| Group 1 and group 2 | 37.62 | 0.000 (significant) | 6.87 | 0.000 (significant) |
| Group 1 and group 3 | 27.81 | 0.000 (significant) | 16.11 | 0.000 (significant) |
| Group 1 and group 4 | 29.12 | 0.000 (significant) | 15.45 | 0.000 (significant) |
| Group 2 and group 3 | 9.80 | 0.000 (significant) | 9.23 | 0.000 (significant) |
| Group 2 and group 4 | 8.50 | 0.000 (significant) | 8.57 | 0.000 (significant) |
| Group 3 and group 4 | 1.30 | 0.076 (NS) | 0.65 | 0.540 (NS) |
NS: Not significant
DISCUSSION
Wettability refers to the ability of a liquid to spread over a surface, which is influenced by surface tension and the interaction between the liquid and the solid surface.[8] Surface roughness is another important factor as it affects the retention of debris, the adherence of microorganisms.[10] This study evaluating the wettability and surface roughness of Triton and Twin Kleen irrigation solutions on root dentin demonstrated that both solutions exhibited significantly greater wettability and lower surface roughness compared to 5.25% NaOCl and 17% EDTA; hence, the null hypothesis was rejected.
Triton and Twin Kleen are all-in-one irrigation solutions, with surfactants that generally reduce the surface tension of the liquid, allowing for rapid spread on the root dentin therefore enhances the dentinal wettability, suggesting that Triton and Twin Kleen penetrates the root canal walls more effectively, potentially aiding in more efficient cleaning and disinfection.[6] In contrast, 5.25% NaOCl and 17% EDTA, although effective in dissolving organic and inorganic tissues, did not show the same level of wettability. This could be due to their chemical nature and inability to alter surface tension as significantly as the all-in-one irrigation solutions.[11] These findings align with a study by Castagnola et al.[12] and Bandoo et al.,[13] found that Triton and HEDP with 6% NaOCl showed effective smear layer removal and debris removal compared to 6% NaOCl with 17% EDTA; however, Giardino et al.[14] reported that HEDP increased the surface tension of NaOCl; hence, it limits the penetration into dentin. Hence, this could be the reason for less wettability in Twin Kleen compared to Triton.
This study findings demonstrated that Triton and Twin Kleen showed less surface roughness compared to 17% EDTA + 5.25% NaOCl. The carboxyl groups of EDTA get ionized by releasing hydrogen atoms that compete with calcium ions and form a stable compound in the dentin.[15] In addition, EDTA further dissolves intertubular and peritubular dentin, softening the calcified components of dentin. Consequently, it results in a rougher surface.[16] In contrast to the more potent chelating agent 17% EDTA, Triton and Twin Kleen contain milder chelating agents such as citric acid in Triton and HEDP in Twin Kleen, which have less pronounced effects on the root dentin surface. Similar findings were reported by Kaul et al.,[17] showing less surface roughness for 9% HEBP and citric acid compared to 17% EDTA.
Although no discernible difference was found between Triton and Twin Kleen in the present study, the latter displayed significantly less surface roughness than the former. These findings could be due to their composition and pH. Both these irrigants contain mild chelating agents which exhibit minimal drastic effects on dentin as mentioned earlier. Twin Kleen has an acidic pH of 4.9 at room temperature; which is a significant fact because it indicates that HEDP and NaOCl interact chemically to produce HOCl, or free available chlorine (FAC). For the first hour, the solution is active. After that, the HEDP rapidly dissociates into phosphonic and acetic acids upon effervescence, which are neutralized by NaOCl, lowering the chelating activity and FAC.[18] This might be another reason for its minimal effect on root dentin surface roughness. In contrast, Triton’s chelating agent, citric acid, has an acidic pH of 1.28; however, Triton’s additional ingredients and pH modifiers raise its overall pH to 8.3 at room temperature, making it stable and alkaline.[19] The notable activity of citric acid is probably caused by its increased ability to demineralize dentinal tubules and peritubular dentin in addition to eliminating the smear layer.[20] Conversely, Twin Kleen containing HEBP, a soft chelator, makes a significant amount of intertubular dentin area available for hybridization, and it partially diminishes the surface calcium of root dentin, resulting in less surface alterations.[21]
This study findings are similar to Tartari et al.,[22] who reported that 2.5% NaOCl with 9% HEBP reduced the surface roughness than in combination with 10% citric acid and 17% EDTA. This suggests that HEDP is a mild irrigant that has a minimal effect on the dentin surface than both citric acid and EDTA. Since there are no studies comparing the surface roughness of Triton and twin Kleen based on these study findings, it can be hypothesized that the new one-component irrigants enhance wettability and less surface alterations compared to the conventional NaOCl and EDTA regimen.
Some limitations of this study are it is an in vitro study design which does not replicate the natural biological environment to the root canal, smaller sample size, and other factors such as pH, concentration, and amount of solutions used and their application time might affect the result outcome hence, further studies need to be undertaken in future.
CONCLUSION
Newer all-in-one solutions Triton and Twin Kleen have shown better wettability and less surface roughness of root dentin.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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