A Comparative Evaluation of Smear Layer Removal by Using Four Different Irrigation Solutions like Root Canal Irrigants: An In Vitro SEM Study
Saurabh Mankeliya, Rajnish K Singhal, Anushri Gupta, Neha Jaiswal, Vivek K Pathak, Ashish Kushwah
Root canal irrigants, Scanning electron microscope, Smear layer
Citation Information :
Mankeliya S, Singhal RK, Gupta A, Jaiswal N, Pathak VK, Kushwah A. A Comparative Evaluation of Smear Layer Removal by Using Four Different Irrigation Solutions like Root Canal Irrigants: An In Vitro SEM Study. J Contemp Dent Pract 2021; 22 (5):527-531.
Background: The present study aimed to evaluate and compare the efficacy of 17% ethylenediaminetetraacetic acid (EDTA), 18% etidronic acid, 10% citric acid, and 7% maleic acid in the removal of smear layer at the apical third of the root canals.
Materials and methods: Sixty single-rooted teeth were equally divided into four study groups (n = 15), according to the type of irrigant used (17% EDTA, 18% etidronic acid, 10% citric acid, and 7% maleic acid) to remove the smear layer effectively from apical third of root canal. In each group, respective irrigant was used with 5.25% of sodium hypochlorite during instrumentation. Each study sample was then sectioned longitudinally and removal of smear layer was observed using a scanning electron microscope (SEM) at 2000×.
Results: A 7% maleic acid revealed better smear layer removal than all other three groups at apical third. A 10% citric acid was found to be more efficient than EDTA and etidronic acid. The intergroup comparison was performed using Mann–Whitney U test, and there was no significant difference between all the study groups, except maleic acid.
Conclusion: The present study compared the effect of various irrigants as an adjunct with 5.25% of sodium hypochlorite for root canal irrigation during and after instrumentation. The use of irrigants aids in the removal of the smear layer from the root canals, thereby increasing the success rate of endodontic therapy.
Clinical significance: This study supports the hypothesis that a thorough use of root canal irrigants can efficiently remove the smear layer which is the key for successful root canal treatment. The present study helps in choosing an appropriate irrigant that can ensure complete root canal debridement from all thirds, especially from the apical third of the root canal.
Kuruvilla A, Makonahalli B, Sahadev J, et al. A comparative evaluation of smear layer removal by using EDTA, etidronic acid, and maleic acid as root canal irrigants: an in vitro scanning electron microscopic study. J Conserv Dent 2015:18(3):247–251. DOI: 10.4103/0972-0707.157266.
Khademi A, Feizianfard M. The effect of EDTA and citric acid on smear layer removal of mesial canals of first mandibular molars, a scanning electron microscopic study. J Res Med Sci 2004;2:80–88.
Mahajan V, Kamra A, Dahiwale S. The effect of 17% EDTA and MTAD on smear layer removal and on erosion of root canal dentin when used as final rinse: an in vitro SEM study. J Int Clin Dent Res Organ 2010;2(3):113–118. DOI: 10.4103/2231-0754.95282.
Lottanti S, Gautschi H, Sener B, et al. Effects of ethylenediaminetetraacetic, etidronic, and peracetic acid irrigation on human root dentine and the smear layer. Int Endod J 2009;42(4):335–343. DOI: 10.1111/j.1365-2591.2008.01514.x.
Violich DR, Chandler NP. The smear layer in endodontics—a review. Int Endod J 2010;43(1):2–15. DOI: 10.1111/j.1365-2591.2009.01627.x.
Joy K, Karim R, Kumar V, et al. Comparative analysis of endodontic smear layer removal efficacy of 17% EDTA, 7% maleic acid, and 2% chlorhexidine using SEM: an in vitro study. J Int Soc Prev Community Dent 2016;6(Suppl 2):S160–S165. DOI: 10.4103/2231-0762.189755.
Torabinejad M, Khademi AA, Babagoli J, et al. A new solution for the removal of the smear layer. J Endod 2003;29(3):170–175. DOI: 10.1097/00004770-200303000-00002.
Nabi S, Farooq R. Comparison of diode laser with maleic acid and ethylenediaminetetraacetic acid on smear layer removal from root canals: a scanning electron microscope study. Endodontology 2020;32(2):91–95. DOI: 10.4103/endo.endo_125_18.
Ballal NV, Kandian S, Mala K, et al. Comparison of the efficacy of maleic acid and ethylenediaminetetraacetic acid in smear layer removal from instrumented human root canal: a scanning electron microscopic study. J Endod 2009;35(11):1573–1576. DOI: 10.1016/j.joen.2009.07.021.
Prabhu SG, Rahim N, Bhat KS, et al. Comparison of removal of endodontic smear layer using NaOCl, EDTA, and different concentrations of maleic acid—a SEM study. Endodontology 2003;15:20–25.
Paque F, Luder HU, Sener B, et al. Tubular sclerosis rather than the smear layer impedes dye penetration into the dentin of endodontically instrumented root canals. Int Endod J 2006;39(1):18–25. DOI: 10.1111/j.1365-2591.2005.01042.x.
Takeda FH, Harashima T, Kimura Y, et al. A comparative study of the removal of smear layer by three endodontic irrigants and two types of laser. Int Endod J 1999;32(1):32–39. DOI: 10.1046/j.1365-2591.1999.00182.x.
De-Deus G, Zehnder M, Reis C, et al. Longitudinal co-site optical microscopy study on the chelating ability of etidronate and EDTA using a comparative single-tooth model. J Endod 2008;34(1):71–75. DOI: 10.1016/j.joen.2007.09.020.
Taneja S, Kumari M, Anand S. Effect of QMix, peracetic acid, and ethylenediaminetetraacetic acid on calcium loss and microhardness of root dentine. J Conserv Dent 2014;17(2):155–158. DOI: 10.4103/0972-0707.128058.
Yamada RS, Armas A, Goldman M, et al. A scanning electron microscopic comparison of a high volume final flush with several irrigating solutions: part 3. J Endod 1983;9(4):137–142. DOI: 10.1016/S0099-2399(83)80032-6.
Economides N, Liolios E, Kolokuris I, et al. Long-term evaluation of the influence of smear layer removal on the sealing ability of different sealers. J Endod 1999;25(2):123–125. DOI: 10.1016/S0099-2399(99)80010-7.
Andrabi SM, Kumar A, Kumar Tewari R, et al. An in vitro SEM study on the effectiveness of smear layer removal of four different irrigations. Iran Endod J 2012;7(4):171–176.
Hulsmann M, Heckendorff M, Lennon A. Chelating agents in root canal treatment: mode of action and indications for their use. Int Endod J 2003;36(12):810–830. DOI: 10.1111/j.1365-2591.2003.00754.x.
Schneider SW. A comparison of canal preparations in straight and curved root canals. Oral Surg Oral Med Oral Pathol 1971;32(2):271–275. DOI: 10.1016/0030-4220(71)90230-1.
Gu XH, Mao CY, Kern M. Effect of different irrigation on smear layer removal after post space preparation. J Endod 2009;35(4):583–586. DOI: 10.1016/j.joen.2009.01.006.
Mello I, Kammerer BA, Yoshimoto D, et al. Influence of final rinse technique on ability of ethylenediaminetetraacetic acid of removing smear layer. J Endod 2010;36(3):512–514. DOI: 10.1016/j.joen.2009.11.004.