The Effect of Smear Layer Removal on Endodontic Outcomes
Uniformed Services University Of The Health Sciences Bethesda United States
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In endodontics, a smear layer is created during mechanical shaping of the root canal system. Smear is a surface film of debris consisting of dentin particles, tissue remnants and bacteria. The combined use of ethylene diamine tetraacetic acid EDTA and sodium hypocholorite NaOCl irrigants has been shown to effectively remove smear layer during canal instrumentation. However, removal is not universally practiced by all clinicians. To date, the only evidence supporting smear layer removal is based upon in vitro studies or empiricism. Objective A prospective, randomized, double-blinded, clinical trial investigated the effect of smear layer removal from the root canal system on healing outcomes. A secondary analysis assessed the influence of covariant factors on healing. Materials and Method Subjects were selected from the Endodontic Clinic population at Naval Postgraduate Dental School NPDS, Bethesda, MD. Patients who agreed to participate in the study were consented and randomized into one of two experimental groups. All subjects received a standardize devaluation and treatment regimen with the exception of the irrigants used. In one group, the root canals were irrigated using a 17 EDTA solution to remove the smear layer. In the remaining group, 0.9 sodium chloride was used which did not remove smear layer. A standardized follow-up radiographic and clinical evaluation to establish periapical healing was conducted one year after root canal treatment.