{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T11:43:10Z","timestamp":1792582990882,"version":"4.5.0"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Oral Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The fracture of a nickel-titanium instrument in the apical third of a root canal presents a significant clinical challenge, as it creates a compacted barrier of dentinal debris and smear layer that is shielded by a vapor lock, severely limiting irrigant efficacy. This study aimed to compare the efficacy of Ultrasonic Activation (UAI), Diode Laser-Activated Irrigation (LAI), and Manual Dynamic Agitation (MDA) in overcoming this barrier by evaluating both irrigant penetration and direct debris removal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Ninety human mandibular first molars with standardized, non-bypassable apically fractured instruments were divided into two parts. Part 1 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200945) assessed irrigant penetration using Confocal Laser Scanning Microscopy (CLSM) after activation of Rhodamine B dye. Part 2 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200945) evaluated debris and smear layer removal using Scanning Electron Microscopy (SEM) and the H\u00fclsmann scoring system. In both parts, teeth were randomly assigned to one of three final irrigation activation protocols (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200915 each): MDA (as a control group), UAI, or LAI (970\u00a0nm diode laser at 2.0\u00a0W).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      CLSM analysis revealed that UAI achieved a significantly greater penetration area in the apical section compared to LAI (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04). Crucially, UAI was the only technique that showed no significant difference in penetration area between the obstructed apical section and the unobstructed control section (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.10). SEM evaluation demonstrated that both UAI and LAI were significantly more effective at removing debris and smear layer than MDA (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05), with no statistically significant difference between UAI and LAI (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009\u2265\u20090.76).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Within the limitations of this in-vitro model, ultrasonic activation produced greater apical penetration area than diode laser activation, while ultrasonic and diode laser activation produced significantly better debris and smear-layer removal than manual dynamic agitation. No statistical difference was observed between ultrasonic and diode laser activation for SEM-based cleaning scores. Further studies incorporating thermal safety assessment and biofilm models are required before clinical recommendations can be made.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12903-026-09982-0","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T10:53:43Z","timestamp":1792580023000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative efficacy of ultrasonic, diode laser, and manual irrigant activation around an apically separated instrument: an in vitro study"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6981-5402","authenticated-orcid":false,"given":"Kareem Ayman","family":"Asfor","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2089-6305","authenticated-orcid":false,"given":"Nihal Adel","family":"Leheta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sybel Mokhtar","family":"Moussa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"issue":"7","key":"9982_CR1","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1016\/j.joen.2023.05.007","volume":"49","author":"RCL Godoy","year":"2023","unstructured":"Godoy RCL, Bueno C, De Martin AS, Pelegrine RA, Fontana CE, Duarte MAH, et al. 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All methods were performed in accordance with the relevant guidelines and regulations. Informed consent was obtained for the use of extracted teeth.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"2078"}}