Effect Of Smear Layer Removal Research Articles

Adhesion of a glass-ionomer root canal sealer to human dentine.

This in vitro study evaluated the effect of smear layer removal on adhesion to human dentine of Ketac-Endo, Grossman, and Sealer 26 root canal sealers. A total of 60 extracted human maxillary and mandibular molars with their crowns ground flat were used. The teeth were divided into two groups: Group 1, the dentine surface received no treatment; Group 2, EDTA-C was applied to the dentine surface for 5 min. Ten samples were tested for each sealer and each group. Adhesion was measured with a Universal Testing Machine. Sealer 26 showed greater adhesion both with and without smear layer (p < 0.01). Ketac-Endo and Grossman sealers were statistically equal, having the lowest values of adhesion. Application of EDTA-C did not alter the adhesion of Ketac-Endo and Grossman sealers. However, the use of EDTA-C increased the adhesion of Sealer 26. The epoxy resin-based root canal sealer (Sealer 26) adhered better to dentine prepared with and without EDTA-C than glass-ionomer-based sealers and the zinc oxide eugenol-based (Ketac-Endo and Grossman) sealers.

Scanning electron microscopy of root canal walls after removing the smear layer

The purpose of this study was to investigate ultrastructurally the effect of smear layer removal by applying different root canal irrigances: 3% HO2, 4% NaOCl and 15% Na-EDTA (in combination with 3% HO2, 4% NaOCl) and establish the appearance of root canal dentine surface after treatment with 15% Na-EDTA for different time periods(1 min and 5 min) using additional irrigant 3% HOor 4% NaOCl. 22 22 Teeth with single and double canals extracted for orthodontic reasons, were used in this study. After instrumentation, coronal and apical parts were removed. Middle parts were cut longitudinally into two equal segments. The specimens were grouped and treated: with HO2, NaOCl, and with combination of Na-EDTA+ HO2 and Na-EDTA+NaOCl where the irrigation with 2 Na-EDTA lasted 1 or 5 minutes. Control segments were enlarged and irrigated with distillate water to obtain the smear layer. The results obtained showed that irrigation with HOand NaOCl did 22 not remove the smear layer, one-minute application of 15% Na-EDTA followed by 4% NaOCl showed that the smear layer was completely removed. Using of 3% HOafter Na-EDTA over the same period of time obtained 22 less "clear" surfaces. Five-minute application of Na-EDTA caused excessive peritubular and intertubular dentinal erosion. It is concluded that for effective removal of smear layer with Na- EDTA, this procedure should not last longer than 1 minute and should be followed by NaOCl.

Effect of smear layer removal on bleaching of human teeth in vitro

The purpose of this study was to evaluate objectively in vitro the effectiveness of bleaching artificially discolored teeth with or without the smear layer present using sodium perborate mixed with sterile water or 35% hydrogen peroxide (H2O2). Seventy fully developed maxillary anterior teeth were artificially stained with human hemoglobin and separated into one control and four experimental groups. After the smear layer was removed on half the experimental teeth and left intact on the other half, all of the teeth were bleached intracoronally with sodium perborate and 35% H2O2 or sodium perborate plus water. The bleaching agents were applied twice over a 6-day period. The changes in tooth shade were objectively analyzed using a SP78 sphere spectrophotometer at 1, 30, and 60 days postbleaching. The presence or absence of the smear layer did not significantly influence the outcome of bleaching (p > 0.05). The teeth bleached with sodium perborate and 35% H2O2 were significantly lighter than the teeth bleached with sodium perborate and sterile water (p < 0.0001) at each experimental period. Based on the findings of this study, it is not advantageous to remove the smear layer before intracoronal bleaching.

An Investigation into the Pressure Transmitted to the Pulp Chamber on Crown Cementation: A Laboratory Study

Pressure changes in the pulp chamber resulting from crown cementation have not been previously quantified. An experiment was designed to investigate the effect of smear layer removal on the peak pressure transmitted to the pulp chamber with crown cementation. Ten matched pairs of single-rooted premolar teeth were collected from adolescents and prepared for full-coverage crowns. The pulp tissue from each tooth was removed. One tooth from each pair had the smear layer removed with the application of 37% phosphoric acid for 30 s. The null hypothesis states that the removal of the dentinal smear layer will not change pressure in the pulp chamber resulting from the cementation. Before cementation, a hydrostatic head of pressure was used to perfuse the tooth, and the perfusion rate was recorded. Crowns were cemented with zinc phosphate cement with a seating force of 100 N. The mean peak pressures recorded were 85 Pa (SE 12 Pa) with the smear layer intact, and 194 Pa (SE 49 Pa) when the dentin was etched. The difference in the peak pressures transmitted to the pulp chamber with the two groups was significant (p < or = 0.05). A significant negative correlation was found between dentin thickness and the peak pressure transmitted to the pulp chamber (r = -0.5531, p < or = 0.01). We have shown that the pressure transmission to the pulp chamber during crown cementation can be measured. Since smear layer removal significantly influences the peak pressure, it is concluded that the pressure detected is at least partially dependent on the fluid flow through the dentin.

The effect of smear layer removal on marginal contraction gaps

The presence of the smear layer prevents direct contact between dentine and a dentine adhesive. The use of agents to remove the smear layer theoretically should improve the bonding of composite resins to dentine. This study examined the effect of smear layer removal on the effectiveness of a dentine bonding agent in reducing marginal contraction gaps. The agent used for smear layer removal in this study was ethylenediamine tetra-acetic acid (EDTA). Eighty cavities measuring 2 mm in diameter and 1.5 mm in depth were prepared in dentine and randomly assigned to two equal groups. The control group was restored with Prisma Universal Bond 2 Adhesive and Prisma Fil Resin. The experimental group was similarly restored after pretreatment of dentine with 0.5% EDTA for 60 s. All specimens were thermocycled and the marginal contraction gaps were assessed using a Nikon Measurescope. The mean contraction gap was expressed as a percentage of the cavity diameter. Results showed that the experimental group registered smaller contraction gaps (mean: 0.021%) than the control group (mean: 0.027%). No penetration of material into dentine was observed. Pretreatment with EDTA did not significantly improve the effectiveness of the dentine bonding agent used in terms of reduction of marginal contraction gaps.

Effect of smear layer removal on the diffusion of calcium hydroxide through radicular dentin

Forty single-rooted teeth were sectioned transversely through the cementoenamel junction and instrumented to a size #50 K-Flex file at the working length by saline irrigation. Each root was placed in a dilution vial containing 10 ml of normal saline, and the pH and Ca2+ levels were recorded after 24 h. The roots in group 1 then received a final irrigation with 20 ml of normal saline. Group 2 received a final irrigation with 10 ml of 17% ethylenediaminetetraacetic acid followed by 10 ml of 5.25% NaOCl to remove the smear layer. Group 3 was irrigated in the same manner as group 2, but calcium hydroxide (CH) was placed into the root canal. Group 4 was irrigated with 20 ml of NaOCl, and CH was placed into the root canal. The pH and Ca2+ levels were recorded at 1, 3, 5, and 7 days. After 7 days a 3- x 3- x 1-mm external defect was created in the coronal one third of the root surface. The pH and Ca2+ levels were subsequently recorded at 1, 3, and 7 days. Groups 3 and 4 demonstrated significantly higher H+ and Ca2+ levels than did groups 1 and 2 three days after CH placement and at all subsequent intervals. Group 3 demonstrated significantly higher H+ and Ca2+ readings at some but not all intervals. The results demonstrated that CH diffuses from the root canal to the exterior surface of the root and that the removal of the smear layer may facilitate this diffusion.

Glass ionomer bond strength and treatment of dentin with polyacrylic acid

This investigation compared the effect of smear layer removal using various treatments with polyacrylic acid on the shear bond strength of glass ionomer restorative materials to dentin. Three brands of glass ionomer were applied to prepared dentin surfaces of extracted human molars, after one of four treatments with polyacrylic acid. Samples using dentin surfaces with the smear layer left intact served as controls. Comparison of mean shear bond strength values for all possible combinations of restorative material and polyacrylic acid treatment indicated that samples produced using 26% polyacrylic acid had lower ( p < 0.05) values in some instances. No other significant differences were found when test values were compared with each other or with control values. The authors concluded that removal of the smear layer does not enhance the dentin-glass ionomer restorative bond strength, as has been suggested by other investigators. Scanning electron photomicrographs indicate that treatment with higher concentrations of polyacrylic acid produces higher degrees of dentinal tubular orifice patency.

Dentin smear layer: an asset or a liability for bonding?

Despite concerns and claims that the smear layer on dentin is undesirable for bonding, supportive evidence is lacking. The clinical efficacy of various agents for smear layer removal and the effect of smear layer removal on the bond strengths of a glass-ionomer cement and three representative dentin bonding agents were examined. For all but one dentin bonding agent (Gluma), a 15-second treatment with 17% EDTA caused a reduction in bond strength. For Gluma, no significant bond was obtained without EDTA treatment. While Gluma probably bonds via dentinal collagen, the other materials interact primarily with dentinal calcium. Removal of the smear layer for adhesives reliant on the presence of calcium is therefore undesirable. The clinical effects of some agents proposed for smear layer removal were examined by SEM of replicas.

The effect of smear layer removal on the in vitro cytotoxicity of four dental restorative materials

Smear layer removal has been advocated in vivo by some authors to increase the bonding of certain dental restorative materials and to remove any bacteria remaining after cavity preparation. The possibility of an increase in the chemical toxicity of restorative materials after smear layer removal is difficult to evaluate in vivo due to the effect of other variables such as an increase in bacterial penetration and possible toxicity of the conditioners employed. Therefore, the present study set out to determine whether smear layer removal would influence the in vitro cytotoxicity of four dental restorative materials. The model cavity system was employed using dentine slices 100 μm and 500 μm thick with or without a smear layer present. After an initial study to determine the effect of a range of conditioners on eugenol release through treated dentine phosphoric acid was used for smear layer removal. With 100-μm dentine slices the cytotoxicity of Kalzinol, AquaCem and Poly-F Plus was significantly increased after smear layer removal but not zinc phosphate cement. With 500-gmm slices only the cytotoxicity of Kalzinol increased after smear layer removal. Therefore, it appears that smear layer removal, particularly if the intervening dentine is thin, will increase the cytotoxicity of some dental restorative materials.