Smear Layer Removing Ability of Root Canal Irrigation Solutions: A Review.

AIM: The purpose of this review is to address the smear layer removing the ability of root different canal irrigants including ethylenediaminetetraacetic acid (EDTA), a mixture of tetracycline, acid and detergent (MTAD), tetraclean, citric acid, Q-Mix, maleic acid, and smear clear. BACKGROUND: Smear layer is a layer which is produced during instrumentation. It contains both organic and inorganic materials. It may also contain bacteria and their byproduct considering the root canal situation. This layer may prevent the penetration of the healing material introduced to the canal to the interior of the dentinal tubules. In addition, it can affect the adaptation of sealing materials to the root canal walls. REVIEW RESULTS: The smear layer removal ability of MTAD is superior and faster than EDTA. Tetraclean is similarly composed of an acid, an antibiotic, and a detergent. The presence of doxycycline is believed to help the smear layer removal ability of these irrigants. Antibiotics such as tetracycline had similar smear layer removal ability as even citric acid. EDTA is an amino acid with a chelating ability that sequestrates metal ions. Some believed EDTA smear layer removing ability is better than MTAD, tetraclean, SmearClear, and 20% citric acid which is controversial in case of comparison between MTAD and EDTA. Phosphoric acid is efficient enough to be comparable to EDTA in removing the smear layer. Maleic acid is an organic compound with acid etching smear layer removal. Its ability seems to be similar or even better than EDTA. Citric acid as another organic acid is believed to be used as smear removing agent. HEBP is another chelating agent that can be used in combination with NaOCl; however, HEBP is a weak decalcifying agent compared to EDTA and hence cannot be applied as a mere final rinse. QMiX is a combination of CHX, EDTA, and detergent and should be used at final rinse. It is believed that QMiX is as efficient as EDTA. Smear clear is a 17% EDTA solution including an anionic and cationic (cetrimide) surfactant. The ability of QMiX is similar to EDTA. CONCLUSION: There are different canal irrigation solutions with various smear layer removal ability that some should be used as a mere final rinse and some should not. CLINICAL SIGNIFICANCE: The usage of canal irrigation solutions depends on the clinical situation and preference of the dentists. This study provides a good guide for clinician of the field.

A Review on Triple Antibiotic Paste as a Suitable Material Used in Regenerative Endodontics.

As the root canal system shows different and complicated anatomies, mechanical instrumentation alone has not the ability to provide a bacteria-free environment in root canals. On the other aspect, necrotic tissue remaining can decrease the effects of root canal irrigants and medicaments and also interfere with the adaptation of root canal fillings to dentin. As a result, certain disinfection and irrigation procedures are required to remove the remaining tissues from the root canal area thoroughly and also be able to eliminate the microorganisms. Triple antibiotic paste (TAP) containing metronidazole, ciprofloxacin and minocycline has been proposed as a root canal medicament due to its antimicrobial effects in endodontic regenerative procedures. The purposes of this review were to determine the properties of TAP drugs and to evaluate the efficiency of TAP on the root canal disinfection, in primary and permanent teeth, along with its affection in regeneration/revascularization procedures. The biocompatibility and disadvantages of this medicament were also discussed.

Root Canal Irrigants and Dentin Bonding: An Update.

The purpose of the review was to assess the effect of root canal irrigants on dentin bonding. A PubMed-based search was conducted on the articles published from 1980 to 2016. A brief overview and reviewing the effect on dentin bonding of common root canal irrigation solutions such as sodium hypochlorite (NaOCl), chlorhexidine (CHX), ethylenediaminetetraacetic acid (EDTA), mixture of a tetracycline, acid and a detergent (MTAD) and ozone was conducted. Findings showed that, depending on the type of dentin bonding, using NaOCl may decrease, increase or not affect the bond strength. In addition, due to its broad-spectrum matrix metalloproteinase-inhibitory effect, CHX as well as MTAD can significantly improve the resin-dentin bond stability. However, the effect of ozone therapy on bond strength was controversial.