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CONTENTS • • • • • • • • • • • • Introduction History Definition Composition Smearing phenomenon Morphology of smear layer Smear layer in restorative dentistry Smear layer in endodontics Removal V/S retention Smear layer removal Smear layer hybridization Conclusion
calcific in nature. cementum after instrumentation with either rotary instruments or endodontic files. According to Cohen: It is defined as an amorphous relatively smooth layer of microcrystalline debris whose featureless surface cannot be seen with the naked eyes. As suggested by David Pashley. Its increasing importance has paralleled the interest in adhesive bonding to tooth structure. According to American Association of Endodontics (AAE) It is defined as a surface film of debris retained on dentin or other tooth surface like enamel. According to DCNA (1990): When a tooth structure is cut instead of being uniformly sheared the mineralized matrix shatters. Its effect as a so called “cavity liner” is just beginning to be appreciated. the Smear layer as a cavity liner may unquestionable have both beneficial and detrimental effect. . termed as SMEAR LAYER. Most of which is scattered even the enamel and dentins surfaces to form a layer. enamel or cementum or as a contaminant that precludes interaction with the underlying pure tooth tissue. the smear layer has become a force to be reckoned with during the last decade. The full significance of the smear layer has been slow to be perceived. Thus there is a need to alter the traditional procedures of restorative T/T to take advantages of its beneficial effect and to avoid its negative effects. produced by reduction or instrumentation of dentin. Definition: According to Schwartz: It is defined as any debris.2 INTRODUCTION Unknown and unrecognized for years.
The organic component consists of heated coagulated proteins. microorganisms etc.3 HISTORY It is difficult to say by whom. Switzer and Stewart in 1963 were the first to use SEM and coin the term “SMEAR LAYER”. Jones. COMPOSITION Consists of both organic and inorganic components. Lozdan and Boyde showed that smear layers were common on enamel and dentin following instrumentation. collagen. (i) Surfaces instrumented with diamond burs were rougher then with carbides.5-15 µm was coated. using a light microscope. (ii) Dry cutting produced rougher surfaces in comparison to wet cutting. Goldman in 1982 suggested that if a smear layer was allowed to remain within a pulp canal system. In 1972. the concept of the smear layer was first introduced. SMEARING PHENOMENON Ehlrich in 1976 stated that smearing occurs when “hydroxyapatite within the tissue is swept along and reset in the matrix”. In 1970 Erich et al attempted to quantify and identify among the tooth surface instrumented with burs. it might provide a reservoir of potential irritants. necrotic/viable dentin and/or pulp tissue. odontoblastic processes. Lemmie and Draycot in 1952 were the first to describe a “Grinding Debris” on teeth structure instrumented by burs and abrasives. the smear layer. . Inorganic component consists of non-specific inorganic components and hydroxyapatite crystals.5 µm in organic layer on which mineralized debris of upto 0. saliva. (iii) Smear layer was generally less than 0. Boyde.
• Proportional to rake angle • less thick SL and shallower WET VERSUS DRY CUTTING • Reduced thickness • Thicker smear layer . which makes interaction with bonding materials difficult if not impossible. DIAMOND POINTS V/S STEEL & TUNGSTEN CARBIDE BURS: • • • • Relative deep and uniform grooves Rougher surface Grooves run parallel To direction of motion of cut Debris pushed deeper away from Into plugs (ahead of Abrading surface) • Lesser evidence of grooves • Less rough • Runs perpendicular • Less deep (ejected cutting surface • • N/A Thicker smear layer and Smear plugs. 2. Rather the smearing phenomenon is suggestive of a physico chemical phenomenon rather than a thermal transformation. Cutting instrument Force applied Dry/ wet cutting Chemical or irrigation if any. While the smear plug may enter the dentinal tubule from a few years to upon 40µm. However the thickness of smear layer is influenced by 1.4 This smearing tends to lower the surface energy of the substrate. Temperature upto 600°c is reached when dentin is cut without a coolant. 3. 4. Thus the postulation that melting and solidification of HA is the reason behind smear layer formation stands unacceptable. A typical smear superficial layer may range in thickness from 1 year to 5µm. This temperature is lesser than the melting point of hydroxyapatite (1120 °C).
Thereby reducing a) b) c) d) Fluid hydrodynamic flow in the tubules. As evident in SEM studies the smear layer is neither continuous in distribution nor in its structure. IMPACT OF SMEAR LAYER IN RESTORATIVE DENTISTRY: Clinically untreated smear layer has been showed to reduce postoperative sensitivity by upto 86%. However the smear layer itself may become a cause of future insult and damage to the pulp. Smear layer and smear plugs physically form a superficial protective layer. THE FORCE FACTOR Greater the force application the thicker and deeper the smear layer and smear plugs so formed. The penetration of irritation chemicals inside dentin. Serves as an iatrogenically insulating layer. CHEMICAL TREATMENT Varies from material being used as a chemical irrigant. Patchy distribution of SL provides possible . Preventing further entry of bacteria into tubules and resultant colonization and pulpal irritation.5 • • • More organized Layers Not uniform but rather patchy • Slightly loose superficial • Uniform thickness and distribution: Structurally and constitutionally same for both. ‘Nanoleakage’ a term which refers to percolation and movement of microorganisms between the smear layer and restorative agent is always a possibility. which covers the cut dentin surface and seals the dentinal tubule orifices. It acts as a barrier to both the entry of harmful noxious agents into dentin and also as a barrier against proper bonding between the tooth structure and the restorative material.
it may cause early failures in bonds between restorations and tooth structure. Lastly the presence of any viable bacteria within the smear layer may themselves led to endodontic failure. Moreover the presence of bacteria within dentinal fins and tubules greatly increase the impact of the smear layer on successful endodontic outcome. from normal would lead to microleakage and result in failure. Microleakage along the tooth wall smear layer interface and Nanoleakage within the smear layer and finally between the smear layer. Thus in summary bond failures can occur at 1) Smear layer-tooth surface 2) Within smear layer itself 3) Between smear layer and restorative material 4) Nanoleakage without bond failure. The weak nature of bonding of smear layer to underlying dentin and enamel also serves as an area of potential bound failure. The presence of smear layer moreover interferes with the penetration of sealer/ gutta percha into lateral and accessory canals and a close adaptation with the dentin walls. Any such alterations. IMPACT OF SMEAR LAYER IN ENDODONTICS In endodontics the perceived benefit of postoperative sensitivity is absent. .6 entry points for penetration of bacteria and their toxins to cause pulpal harassment. The presence of nanochannels inside the smear layer also functions in the same manner. THE PREDICAMENT? The benefits and drawbacks of smear layer became clear amongst the researchers and clinicians in mid 70’s. all serve as areas for reinfection. Because of its interference in the bonding mechanism and bond strengths so obtained. endodontic failure would result.sealer interface. If these bacteria and there by products should reach the periapical area some how.
7 Those people who were in favour of retaining the layer set their argument on its effect on postoperative sensitivity and its inability to affect the outcome of endodontic success and failure. . Citric Acid etc for removing the smear layer. He also formulated several commercially available products like Tubulicid Blue and Tubulicid Green for the removal of smear layer. poor bond strengths. H2O2. Critic acid. SMEAR LAYER REMOVAL Smear layer can be removed completely or partially by using a wide variety of elements and after liquid agents. Maleic acid Sodium hypochlorite Urea peroxide Lactic acid Utrasonics etc. Phosphoric acid. slowly and steadily the people who favored the retention of smear layer fell in minority and found themselves out numbered. As more and more research and study date pecolated in. While those who vociferously favoured the removal of this layer argued about the ill-effects of nanoleakage. Inorganic Acids: - Phosphoric acid (H3PO4) . Historically Water Hydrogen peroxide. Benzylkonium chloride. Benzylkonium chloride. Brannstrom and colleagues published several articles describing the use of water... and a reservoir of microorganisms. EDTA.. EDTA.have been used.
1µm 2. Owever deposition of precipitated mineral crystals make it disadvantageous.14µm 1. But nevertheless were tried.2 ± 0.1 ± 0.8 Which the discovery of total-etch concept by Buonocore in 1955 complete removal of smear layer was noted using 85% H3PO4 for 2 minutes. Lactic Acid and H3PO4.5% to 5.25% is not effective in complete removal of smear layer.2 µm 8. -50% lactic acid produced cleaner walls however it was not effective in dissolving the smear plugs.7 ± 0. SODIUM HYPOCHLOKITE NaOCl alone in concerntrations varying between 0.1 ± 0.2 µm 4. However the smear layer removal was different for different etching time and also the depth of dentin demineralization. However. -20% tannic acid and 20% polyacrylic acid were less effective than EDTA and other irrigating solutions in removing smear layer. HYDROGEN PEROXIDE (2% H2O2) Due to its effervescence it removes loose debris very quickly but it is not efective in removing smear layer and is only partially effective when used in conjunction with NaOCl.6 µm - 25% Citric Acid removed smear layer better than the other acids such as PAA. . 5sec 15sec 30sec 60sec 120sec Organic acids: 1. Over a period of time 37% H3PO4 applied for 15 seconds was accepted a clinically efficacious for removal of smear layer and acid conditioning of tooth surface for receiving a resin bonding agent.9 ± 0. When applied for 20 sec it produced acceptable results. its combined usage with EDTA solutions completely removed the smear layer and plugs from the canal system.
thereby creating a space for the bonding agent to fill up the plugs to form resin tags and make a hybrid layer with the exposed collagen networks.25% NaOCl to achieve complete removal of the smear layer and disinjection of the canals.25% NaOCl.9 CHELATING AGENTS EDTA solution (17% EDTA) EDTAC (EDTA +Cetrimide) REDTA (Original Goldmanns formula) Rc-prep (EDTA + urea peroxide + carbowax) either when used alone or in conjuction with 3% or 5. H2O2. It produces better action in comparison to 5. The action being facilitated by acoustic streaming and cavitation. Shaper sonic etc in conjuction with an irrigant helps obtain smear free canals faster and more reliaby.25% NaOCl with or without ultrasonics are the best known method for removal of the smear in endodonis. Ingle recommends soaking a tooth’s root a final flush of 5. Salvizol another chelating also proove to be equally effective in removing smear layer when used in combination with 5. But is inferior to EDTA + .25% NaOCl. prior to observation. ULTRASONICS: Ulrasonic agitation using brands like Rispi Sonic. Cavi Endo. GLYOXIDE: (10% urea peroxide + glycerol) An irrigating solution was first first proposed by Stevart in 1961. As time elapses and restorative dentistery and particularly adhesive dentistery grows by leaps and bounds.6 times) due to deposition of carbowax residue. Piezon. The controversy of smear layer has risen from the “Ashes like a Phoenix”. However use of RC-prep is associated with greater microleakage (upto 3. and hence should not be used for removing the smear layer. Triosonic. Buonocores total etch concept removed the smear layer completely. Enac.
or A three step procedure (ESPE) (Vivadent) (3M) (3M) (Kurraray) (Kurraray) (Dentsply) (Ivoclar) “Clearfil” wich itself incorporated the acidic primer thereby elemenating the need for an etching and rinsing step in the total etch The total eteh concept consists of The self-etching primers are available in either as . (NRC and Prime and Bond NT) (Dentsply) In the one-step self-etching concept the etchant. Two step procedure b.2nd step a. primer and the unfilled resin all are combined into one container (PROMPT. However in 1994 Kurraray in Japan introduced a Self Etching Prinmer named concept. Single step procedure In the two step self-etching concept the etchant and primer are combined and an unfilled resin is applied separately.10 This micro machanical interlocking of resin with collagen is termed as hybridisation and the layer so formed “HYBRID LAYER”. combines the primer and the adhesive resin Acid etchant Primer + Adhesive . Later on several companies intensified research into this new and exciting concept of dentin bonding and came up with a wide variety of self etching primers namely Prompt L Pop Syntax 3 Scotechbond Singlebond Clearfil liner BondSE Clearfil SE Xenoll Adhese An Etchant An dentin primer An unfilled resin A two step total etch concept.L POP) ESPE. The hybrid layer was first discribed by Nakabayashi in 1992.1st step .
4-0. Thus the SEP’s incorporate the smear layer into the hybrid layer. However the bond strengths to enamel are still inferior (~ 8-10 MPa) when compared to the total etch concept. Action of H3PO4 seems to diminish as demineralization process progresses and ceases after about 10 seconds. CONCLUSION As far as endodontics is concerned smear layer removal is mandatory and is best achieved with a combination of 17% EDTA and 5. though the smear bond strengths to enamel are yet to be comparable with those of total etch concept.11 These self-etching primers contain varying percentage of methacrylated phosphoric esters.0. (~17-20 MPa).2 µm (NRC + Prime ‘n’ Bond NT) . These SEP depending on their depth of penetration into subsurface (below the smear layer) dentin may be classified as Mild Moderate Aggressive .5 µm (MegaBond) .2. Smear layer hybridization rather than removal is fast gaining acceptance in restorative dentistry especially with the introduction of SEP’s.0 µm (Prompt L pop) The incorporation of the Smear Layer into the bonding process and hybrid layer formation directly translates into reduced postoperative dentin sensitivity.1.5-5.2-2. . but the future looks promising. and at the same time maintain an acceptable dentin bond strength of 10-15 MPa comparable with that of the total etch concept.28% NaOCl wash.
12 On the conclusion it is still not finalized whether the smear layer should be removed/ retained or modified to best serve a given preference and thus the controversy continues… .
Sturdevant . Suppl 6. 2001 .Operative Dent.Schwartz .Ingle .Vikram Sikri .Pg 298 August .Pg 296 August .13 REFERENCES • • • • • Operative Dentistry Operative Dentistry Endodontics Operative Dentistry Management Alternatives for carious lesions • • Dental Materials 17(2001) Dental Materials 17(2001) .
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