Adhesion of Root Canal Selaers To Dentin
Adhesion of Root Canal Selaers To Dentin
Adhesion of Root Canal Selaers To Dentin
8
tubule orifices are enlarged because of
Microleakage (Mean±SD) in mm
7
dissolution of peritubular dentin resulting in
6 better adhesion. In this study 30% citric acid was
5 used. Khademi et al. demonstrated that 20%
Citric Acid produces more erosion of dentin
4
compared to 7% Citric Acid and 17% EDTA.14
3
Machado-Silveiro et al. indicated that the
2 decalcifying effect of 10% Citric Acid on dentin is
1 more than 17% EDTA.15
0
A B C D
No statistically significant difference was
observed between Smear Clear (Group A1) and
17% EDTA (Group B1) and Smear Clear (Group A1)
I. Inter Group Comparison: Minimum and 30% Citric Acid (Group C1). Smear Clear is a
microleakage was observed when 30% Citric Acid new irrigant with a surfactant resulting in smear
was used as an irrigant. It is reported to cause layer removal comparable to Citric Acid.
more erosion of the dentinal wall creating more
adhesion surface area for a resin-based sealer It may be suggested that removal of smear layer
when compared to EDTA. 12Smear Clear group may potentiate the beneficial effects of calcium
showed less leakage than 17% EDTA which might hydroxide. It facilitated Ca (OH) 2 diffusion
be due to additional surfactant present in the through the dentinal tubules and potentiates the
irrigant. Smear Clear and 17% EDTA have mostly therapeutic effect of Calcium Hydroxide Sealers
shown no significant difference in leakage values in the treatment of avulsed or luxated teeth to
when used as an irrigant. 7Maximum leakage was reduce the occurrence of inflammation, surface
seen with normal saline (Control Group) as resorption or replacement resorption.16 Hence it
irrigant which does not remove smear layer and may be stated that Acroseal must be used with a
debris. The smear layer is an amorphous, non- smear layer removing agent for better
homogeneous, weakly adherent structure and therapeutic benefits.
has a low density because of its higher water
content, which makes it unstable and hence B. Comparison of Microleakage observed in
susceptible to dye infiltration.13 different smear layer removing agents when AH
Plus was used as sealer: AH Plus sealer has strong
II Intra Group Comparison adhesion ability to dentine and good sealing
Comparison of microleakage observed in ability. It is described as having a faster setting
different smear layer removing agents when time. The advantage of resin-based sealers over
Acroseal was used as sealer : Discussing the ZOE-based sealers is that they can not only lock
performance of Acroseal in presence of different into open dentinal tubules but also adhere to the
irrigating agents it was observed that Acroseal exposed dentinal surfaces.17
showed maximum leakage when Normal Saline
was used as an irrigant whereas minimum AH Plus sealer showed maximum leakage in
leakage was seen when 30% Citric Acid was used presence of normal saline. This could be because
as an irrigant. of the relatively weak bond of the smear layer to
the underlying dentine, approximately 5 mpa,
30%Citric Acid) ~ Smear Clear < 17% EDTA < which may be insufficient to withstand the
Normal Saline: There was a statistically significant shrinkage associated with the curing of resins,
difference between mean microleakages in and the smear layer may be pulled away from the
samples irrigated with Smear Clear and Normal dentine and provide an avenue for microleakage.
NJIRM 2019; Vol.10(4) July-August eISSN: 0975-9840 pISSN: 2230 - 9969 42
Adhesion of Root Canal Sealers to Dentin after Dentin Pre-treatment
17% EDTA ~ 30% Citric Acid < Smear Clear sudden setting and debonding of the sealer from
<Normal Saline : Minimum leakage was seen in dentinal walls or cohesive fracture caused by
presence of 17% EDTA may be due to alteration shrinkage setting stresses might explain the
of the dentin surface energy as a result with higher leakage.21 Further no significant difference
pretreatment with EDTA. EDTA significantly in leakage values of Endomethasone-N was
decreased the wetting ability of dentinal wall.18 observed when either 30% Citric Acid or 17%
Therefore, a suitable dentin substrate could be EDTA were used. Hence it may be stated that
provided for the adhesion of materials with when Endomethasone is used as a sealer the
hydrophobic nature as the resinous AH plus. irrigant of choice may be either citric acid or 17%
Furthermore, the effective removal of smear EDTA.
layer by EDTA allowed for the extension of the
resin into the open dentinal tubules, creating Smear Clear (Group A3) had significantly higher
efficient micro retention. Irrigation with 17% mean value as compared to 17% EDTA (Group B3)
EDTA also resulted in higher bond strength values and 30 % Citric Acid (Group C3.) No significant
for AH plus. The dentin adhesion of endodontic difference was observed between 17 % EDTA
sealers can be improved by dentin pretreatment (Group B3) and 30 % Citric Acid (Group C3).
with EDTAC. 19 Highest increases in adhesiveness
were found for other resin based sealers like Comparison of Microleakage observed in
Sealer 26, and Sealapex, Apexit. different smear layer removing agents when
Roekoseal was used as sealer: Roekoseal Sealer
Considering the qualities of AH Plus, which was showed minimum microleakage in presence of
seen to be the best sealer in presence of 17% Smear Clear as an irrigant. It contains
EDTA it may be stated that if the surface area of polydimethylsiloxane which gives the sealer good
dentin exposed to this sealer is increased, the flowability and high penetrability into dentinal
adhering and penetrating capacity of AH Plus is tubules. It also has excellent dimensional
improved and better seal is expected. Citric Acid stability, initial expansion and low solubility
as irrigant showed similar performance as 17% contributing to the better sealing ability and
EDTA. In this regard, irrigation solutions which minimal leakage scores.22
cause more erosion of dentinal wall and create a
porous etched surface would be a reasonable It has been suggested that the quality of the
choice. apical seal may be improved by increasing the
surface contact between the root canal and the
Comparing the mean microleakage of group A sealer. It has been shown that removal of smear
(Smear clear) and Group B (17 % EDTA) it was layer may allow sealer to penetrate into the
observed that AH plus showed more dentinal tubules, thereby giving a greater area of
microleakage in presence of Smear Clear. This surface contact which may delay the penetration
might be due to presence of surfactant Tween 80 of leakage materials.23
which might have permitted increased dentin
surface energy and wettability, hence increasing Thus the order of microleakage in different
intertubular dentin permeability as well as groups was: Smear Clear ~ Group 17%EDTA ~
exposure of collagen matrix and intertubular fluid 30% Citric Acid <Group Normal Saline :
which could have negatively affected the Technique of instrumentation, type of sealer
adhesion of the hydrophobic AH plus sealer.20 used, sealer thickness, type of filling technique,
type and concentration of chelating agents used,
Comparison of Microleakage observed in and the technique used to produce and remove
different smear layer removing agents when the smear layer and different laboratory
Endomethasone-N was used as sealer : In this procedures to check the leakage may vary the
study Endomethasone-N showed maximum dye results.
penetration in presence of normal saline whereas
minimum leakage was seen in presence of 30% The results of this study suggested that the
Citric Acid followed by 17% EDTA and Smear dentinal penetration of different sealers is
Clear. The chelate formed during setting reaction related to their physical and chemical properties
is known to slowly hydrolyse in presence of water such as dimensional changes, absorption and
to release eugenol and may be responsible for dissolution which may affect sealing ability of the
the gradual loss of its sealing ability. Also the sealers.
NJIRM 2019; Vol.10(4) July-August eISSN: 0975-9840 pISSN: 2230 - 9969 43
Adhesion of Root Canal Sealers to Dentin after Dentin Pre-treatment
Although some studies suggest that removal of improvement of sealing ability following smear
the smear layer reduces microleakage, the layer removal.
treatment with EDTA may leave a chelated layer
of dentin at the dentin-root filling interface. Reference :
Residual EDTA inside the dentinal tubules which 1. Brainstetter J., Von Fraunhofer A. The Physical
was measured up to 38% of the originally applied Properties and Sealing Action of Endodontic
volume may contribute additionally to ongoing Sealer Cements : A Review of the Literature ;
demineralization resulting in further increase in Journal of Endodontics, 1982, 8 ; 7 : 312-316.
microleakage.24 Residual EDTA also may interact 2. Violich D.R., Chandler N.P. The Smear Layer in
with the sealer, which has been demonstrated for Endodontics – A Review; International
zinc oxide eugenol sealer. However, Madison et Endodontic Journal; 201043: 2-15.
al. (1984) could not detect any influence of the 3. Sen B.H.¸ Kin B., Baran N. The Effect of Tubular
irrigation solution on the apical seal.25 Penetration of Root Canal Sealers on Dye
Microleakage. International Endodontic
Removal of smear layer has been suggested to Journal;1996 29, 23–8.
improve the adaptation of root canal fillings. 4. Economides N., Liolios E., Kolokouris I., Beltes
However, some sealers may behave differently in P. Long Term Evaluation of the Influence of
the absence of smear layer. Further studies are Smear Layer Removal on the Sealing Ability of
necessary to establish a correlation between Different Sealers. Journal of Endodontics;1999,
endodontic smear layer and the clinical 25, 123–5.
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Comparison of Four Common Root Canal
Conclusion: 30% Citric Acid as a root canal Irrigants and Two New Irrigants Containing
irrigant was most effective in smear layer Antibiotic; Journal of Endodontics, 2006,
removal followed by Smear Clear Group, followed 32(11), 1091-1093.
by 17% EDTA. All the sealers tested show 6. Yamaguchi M., Yoshida K., Suzuki R.,
minimum microleakage values in presence of 30 Nakamura H. Root Canal Irrigation with Citric
% Citric Acid. Acroseal in presence of normal Acid Solution. J Endod;1996, 22:27-9.
saline show maximum leakage and minimum 7. Da Silva L.E., Sanguino A.C., Rocha C.T.
leakage in presence of 30% Citric Acid. AH Plus Scanning Electron Microscopic Preliminary
show maximum leakage in presence of normal Study Of The Efficacy Of Smear Clear And
saline whereas minimum leakage in presence of EDTA For Smear Layer Removal After Root
17 % EDTA. Endomethasone-N show maximum Canal Instrumentation In Permanent Teeth;
leakage in presence of normal saline whereas Journal of Endodontics;2008 34(12), 1514-
minimum leakage in presence of 30% Citric Acid. 1544.
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normal saline whereas minimum leakage was Nakamura H. Root Canal Irrigation with Citric
observed in 30% Citric Acid Group. Acid Solution.1996, J Endod 22:27-9.
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15. Machado-Silveiro, LF. González-López, S. and Conflict of interest: None
González-Rodríguez, MP. Decalcification of Funding: None
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NJIRM 2019; Vol.10(4) July-August eISSN: 0975-9840 pISSN: 2230 - 9969 45