CONTENTS

• INTRODUCTION
• HISTORY
• DEFINITIONS OF SMEAR LAYER
• SMEAR LAYER IN CONSERVATIVE DENTISTRY AND ITS
IMPLICATIONS
 PHYSIOLOGICAL CONSIDERATIONS
 PATHOLOGICAL AND TREATMENT
CONSIDERATIONS
 FUNCTIONAL IMPLICATIONS
• SMEAR LAYER IN ENDODONTICS AND ITS
IMPLICATIONS
• REMOVAL OF SMEAR LAYER
• BONDING AND THE SMEAR LAYER
• CONCLUSION
• REFERENCES
MORPHOLOGICAL CONSIDERATIONS
Literature Review:
The earliest studies on the effects of various instruments on dental tissues were
those reported by Lammie and Draycott (1952) and Street (195)! "fter the use of
different burs and abrasive stones# these authors# usin$ powdered $raphite# disclosed
rid$es and trou$hs on the cut surfaces! %iewed with a li$ht microscope# the pattern
and ma$nitude of the $rooves varied# with diamond abrasives producin$ the most
stri&in$ anomalies! This techni'ue for disclosin$ the topo$raphical dental has a
si$nificant limitation# namely# that the powdered $raphite wei$ht tends to obscure
more surface detail than it would hi$hli$ht!
(eyton and )ortell (195*) understood this problem and substituted a thin
metal coatin$ for the $raphite! +mployin$ a techni'ue of metal vapori,ation described
by Scott and -yc&off (19.*)# they deposited copper on cut surfaces of teeth and
e/amined them with reflected li$ht microscopy! Si$nificant differences were noted
between burs and stones# throu$h different speeds# with and without coolant#
produced no notable differences!
Diamonds produced relatively deep and uniform $rooves where as burs
showed less evidence of $rooves and tendency toward nonuniform# uneven cuttin$!
Scott and 01 2eil (19*1) reported a transmission electron microscope study
that a ma3or advance was made in the description of the morpholo$ical detail of cut
surfaces of teeth! They observed the microscopic anomalies lest from the action of the
tool and found no mar&ed differences in surface te/ture with different instruments!
4epeated replication of the surfaces with collodial continued to e/tract cuttin$
debris# identified as apatite by electron diffraction! -hile the prismatic structure of
enamel was recorded in replicas# cut surfaces of dentin were usually irre$ular and
without any evidence for the tubular nature of this tissue! This study was conducted
durin$ the advent of research into adhesive restorative materials! 5n this conte/t# and
importantly# )aster (19*1) and S&inner (19*1) emphasi,ed Scott and 01 2eil1s
conclusion cut surfaces of teeth is a &ey to formulatin$ adhesive restorative systems!
6oyde# Switsur and Stewart (19*) appear to have been amon$ the first to
describe in $reater detail# usin$ S+)# the nature of the surface deposits insitu# which
Scott and 01 2eil (19*1) removed with their replication procedures! 6oyde and his
cowor&ers also appear to have presence of what they called a 7swear layer8 on
surfaces of cut enamel! Such a layer was readily removed with sodium hypochlorite#
leadin$ then to conclude that an or$anic layer containin$ apatite particles was
deposited or smeared on the enamel throu$h frictional heat $enerated durin$ cuttin$!
They believed that hetero$enous nature of enamel was the source of the smeared
components!
6oyde and his 9owor&ers (19*) attributed smearin$ of enamel to meltin$ of
the tissue by frictional heat! 5ndeed# studies have shown that temperature will rise up
to *::
:
9 in dentin when it is cut without a coolant! This value is si$nificantly lower
than the meltin$ point of apatite (15:
:
; 1<::
:
9) and has led most to conclude that
smearin$ is a physicochemical phenomenon rather than a thermal transformation of
apatite involvin$ mechanical shearin$ and thermal de$radation of the protein!
Smear a!er "De#i$iti%$&':
(' Smear La!er :
The smear layer is a layer of debris# comprisin$ both or$anic and inor$anic
components# found on canal walls after endodontic instrumentation!
(+ndodontics in clinical practice 5
th
edition! ="4T>1S)!
2) Smear La!er:
-hen the tooth surface is altered by rotary and manual instrumentation durin$
cavity preparation# cuttin$ debris# formin$ what is termed the smear layer!
0r
The smear layer has been defined as 7any debris# calcific in nature# produced
by reduction or instrumentation of dentin# enamel or cementum8# or as a
7contaminant8 that precludes interaction with the underlyin$ pure tooth tissue!
(?undamentals of 0D) @ames 6! Summitt!
)' Smear La!er:
-hen cuttin$ or abradin$ procedures are applied to a dentin surface# an
amorphous layer of or$anic film and debris is created that has been termed the smear
layer!
((rinciples and practice of operative dentistry (9harbeneau)
rd
edition!)
.) Smear La!er :
The instrumentation involved in cuttin$ a cavity preparation produces a
tenacious layer of debris# particularly on the dentin! This thin layer#
appro/imately 5 to 1: µm# is referred to as the smear layer!
(Te/t boo& of operative Dentistry)
rd
edition! (6aum# (hillips# Lund)!
*' Smear a!er:
9ut dentinal surfaces are covered with a thin# deran$ed layer called the smear
layer!
()inimally invasive 4estorations with boundin$) )ichel De$ran$e!
+' Smear a!er:
The cuttin$ of both enamel and material# rich in calcium that is smeared over
the surface of the enamel and dentin is &nown as smear layer!
(4estorative dentistry an inte$rated approach) (eter @acobsen!
,' Smear La!er:
" layer consists primarily of tooth debris# other contaminants such as pla'ue#
pellicle# saliva and possibly blood# which partially occludes the tubule orifices# when
dentin is cut or polished durin$ dental treatment is &nown as smear layer!
((reservation and 4estoration of tooth structure) Araham @! )ount!
-' Smear a!er:
" layer after scalin$# abrasion# attrition# caries# and cavity preparation leaves
microcrystalline debris that e/tends sli$htly into the dentinal tubules# covers the
dentinal surface# and is usually several microns in thic&ness called as smear layer!
(+ndodontic therapy .
th
edition) ?ran&lin S! -ine!
.' Smear a!er:
The cuttin$ of dentin durin$ cavity preparation produces microcrystalline
$rindin$ debris that coats the dentin and clo$s the orifices of the dentinal tubules! This
layer of debris is termed the smear layer!
((athways of the pulp <
th
edition) 9ohen!
SMEAR LAYER: PHYSIOLOGICAL CONSIDERATIONS DESCRIPTION
AND PRODUCTION:
-henever dentin is cut with either a hand instrument or a rotary instrument# the
minerali,ed matri/ shatters rather than bein$ uniformly sheared or cleaved# producin$
considerable 'uantities of cuttin$ debris! )uch of debris# made up of very small
particles of minerali,ed colla$en matri/# is spread over the surface of the dentin to
form what has been called a Bsmear layer1 (+lic& and 0thers# 19C:)! 5t is analo$ous to
wood bein$ covered by wet sawdust! "lthou$h a similar phenomenon occurs in
enamel!
D The smear layer is absent from specimens of deminerali,ed teeth e/amined by
li$ht microscopy because the smear layer is dissolved durin$ deminerali,ation!
D -hen e/amined in undeminerali,ed specimens by S+) the smear layer loo&s
li&e an amorphous# relatively smooth# featureless surface! 5ts constituents are
below the resolution of the S+)!
D T+) may provide important new information about the si,e of due particles
constitutin$ the smear layer as well as their pac&in$ density and the
dimensions of the diffusion channels between the particles!
D The depth of smear layer varies widely dependin$ upon whether the dentin is
cut dry or wet# the amount and composition of the irri$atin$ solution used# the
si,e and shape of the cavity (or root canal)# and the type of instrument
employed (Ailboe and others# 19<:)!
D Aenerally spea&in$# cuttin$ without water spray $enerates a thic&er layer of
debris (smear layer) than cuttin$ with a copious spray of air and water!
D ?urther# coarse diamond burs tend to produce thic&er smear layers than
carbide fissure burs (6rannstron# =ant, and 2ordenvall# 19C9# Shortall# 19<1)!
D Smear layer increases the resistance to movement of fluid across dentin discs#
both in vivo and invitro!
D The ease with which fluid could flow throu$h etched dentin (dentin free of
smear layer) termed Bhydraulic conductance11!
D 6rushin$ etched dentin with an oran$ewood stic& decreased hydraulic
conductance ** E! The use of a rotary rubber cup containin$ prophyla/sis
paste was even more effective at reducin$ hydraulic conductance! These
pastes are much more abrasive than dentifrices and hence and far more
effective at creatin$ a smear layer!
STRUCTURE:

The smear layer has anamorphous# irre$ular and $ranular appearance when ;
viewed under S+)! )c9omb and Smith (19C5) su$$ested that smear layer associates
with root canal treatment consisted of not only dentin as in coronal smear layer but
also remnants of odontoblastic processes# pulp tissue and bacteria! =ence it may
contain or$anic or inor$anic material!
"ccordin$ to 9ameron (19<<) the smear layer on the walls of the root canal
could have a relatively hi$h or$anic content in the early sta$es of instrumentation
because of necrotic and For viable pulp tissue in root canals!
+ic& et al (19C:) showed that smear layer was made of tooth particles ran$in$
from less than :!5 µm to 15 µm! (ashley et al (19<<) found out that there particle
were also composed of $lobular subunits# appro/imately :!:5 to :!:1 µm in diameter
which ori$inated from minerali,ed fibers! The reported thic&ness of this layer is 1!5
µm (Aoldman et al 19<1 G )ader et al 19<.)! This thic&ness may depend on the type
of sharpness of cuttin$ instrument and whether the dentin is cut dry or wet!
9ameron (19<) and )anderal et al (19<.) described the smear material in two
parts! ?irst# superficial smear layer and second# the smear material pac&ed in to the
dentinal tubules! The e/tension of thus pac&ed material into dentinal tubules was
calculated as e/tendin$ up to .: µm! it was also calculated that this tubular pac&in$
phenomenon of this meal layer was due to action of burs and endodontic instruments!
=owever penetration of smear material into dentinal tubular could be capillary
action as a result of adhesive forces between the dentinal tubular and smear material!
This hypothesis of capillary action may e/plain the pac&in$ phenomenon
observed by "H tense et al (19<9) that showed that this penetration was increased
upto 11: µm by use of surface rea$ents as wor&in$ solution durin$ endodontic
instrumentation!
FORMATION:
The e/act mechanism of the formation of the smear layer is incompletely
understood!
6oyde et al observed the smear layer usin$ S+) and considered that frictional
heat durin$ cavity preparation was the most important!
%arious studies showed that temperature up to *::
:
were obtained when
cuttin$ was carried out uncooled! "patite melts at 15:
:
; 1<::
:
! 5t would appear
therefore that smear formation is a physicochemical rather than a simple thermal
phenomenon! (lastic flow of hydro/y apatite may occur below its meltin$ point!
+lrich and Hoblit, et al considered that smear layers were formed by brittle
and ductile transition and alternatin$ rupture and transfer of apatite and colla$en
matri/ on to the surface! Dentin (5 E colla$en matri/) was a much richer source of
protein than enamel# dentin matri/ may contribute to smear layer formed on enamel!
Awinnett considered that smear layer was formed on enamel and dentin
surface by cuttin$ when ener$y was e/pended! ?rictional heat# plastic and elastic
deformation resulted in the alteration and deterioration of dentin! 9ontaminants
lowered the surface ener$y and hence reactivity! ?rictional heat produced
temperatures well below the meltin$ point of appetite# therefore swearin$ was
probably a physiochemical phenomenon# involvin$ mechanical shearin$ and thermal
de$radation of protein!
The e/act composition and mechanisms of formation of smear layer#
particularly over dentin are therefore un&nown! 5t would appear li&ely that
composition and attachment mechanism of the smear may vary with in one wall of
any cavity! There will be differences between the smear layer created in sound tooth#
preparation and that created durin$ the instrumentation of carious dentin! 9arious
dentin differs in si,e of its tubules and de$ree of minerali,ation from sound dentin!
These chan$es depend on the host response and the rate of pro$ress of carious lesion
thro1 the dentin!
SI/E 0 THIC1NESS:
5n one of the earliest studies ;+ic& et al described the smear layer as an
or$anic film less than :!5 ; 15 microns in si,e! 5t was present on all cut surfaces but
not necessarily in continuous layers!
5n the current literature a thic&ness of 1 ; 5 microns is commonly noted!
(ashly et al have observed rather thic&er smear layers in their studies and $ive
a value of 1: ; 15 microns!
ATTACHMENT TO DENTIN:
The e/act mechanism of the attachment of the smear layer to the dentin
surface is poorly understood!
The de$ree of attachment of the smear layer to the underlyin$ dentin is
variable! The smear layer may chan$e the morpholo$ical and physicochemical
properties of the dentin surface and hence influence retention of restorative materials!
5n some area it is firmly attached while in others it may lift free# accordin$ to
Awinnett!
Several authors have attached adhesive materials to dentin covered with smear
layer and then in the course of measurin$ the bond stren$ths achieved observed that
mode of failure of the bond!
EFFECTS ON MOVEMENT OF FLUID IN AND OUT OF DENTINAL
TUBULES:
The smear layer will reduce dentin permeability and provide resistance to fluid
movement in dentin accordin$ to (ashely et al# the reduction of dentin!
(ermeability may be an important factor of the pulp to a $iven restoration! The
movement of fluid in the dentin tubules is considered to be an important phenomenon
related to dentin sensitivity!
(ashley distin$uished between fluid movement inwards from the dentin
surface and outwards from the dentin tubules! =e defined diffusion as the movement
of fluid from a hi$h to a low concentration and $ave the e/amples of microbial to/ins
on the cavity floor movin$ inwards towards the pulp! The rate of such movement
varies with the s'uare of radius! The defined pressure $radient in the tubules which
results in a tendency for fluid outflow from the tubule ends! This varies width .
th
power of radius an hence is much more sensitive to reduction of diameter of tubules
as a result of smear form!
The smear layer $iven <* E of the total resistance to fluid movement to
tubules towards the pulp! (ashley calculated that the diffusion surface is 1 E of the
dentin surface area at the D+@ and 22 Eof dentin surface area near the pulp when the
dentin is etched!
(ashley postulated that if the smear layer is removed# diffusion is increased by
5 ; * times! -ith the smear layer present the diffusion area is 1!C E in tubules 1 mm
from pulp! +tchin$ increase this to C!9 E! The smear in this case had occluded C<!5 E
of the tubule orifices with debris!
POTENTIAL ADVANTAGES 0 DISADVANTAGES OF THE SMEAR LAYER:
The main advanta$es of the presence of a smear layer on dentin are I
1) 4eduction of dentin permeability to to/ins and oral fluids!
2) 4eduction of diffusion of fluids prevents wetness of cut dentin surfaces
accordin$ to 6rannstorm et al and @ohnson et al!
) 6acterial penetration of dentinal tubules is prevented!
The main disadvanta$es areI
1) 5t may harbour bacteria# either from ori$inal carious lesion or saliva which
may multiply ta&in$ nourishment from smear layer or dentinal fluid!
2) Smear layer is permeable to bacterial to/ins!
) The smear may prevent the adhesion of composite resin system# bondin$
a$ent# A59 and poly carbo/ylate cements!
SMEAR LAYER: PATHOLOGICAL AND TREATMENT
CONSIDERATIONS:
(' BACTERIA IN THE SMEAR LAYER UNDER RESTORATIONS:

The patholo$ical conse'uences of the smear layer and whether it should be
present or absent under restorations are rather complicated 'uestions! To a $reat
e/tent they seem to be related to the presence of bacteria under the restoration!
0ne 'uestion wasI 5s it possible that bacteria entrapped in the smear layer
survive and multiply under these restorationsJ
6rannstrom and 2ybor$# 19C done a study# those facial cavities were
prepared in 2: contralateral pairs of human premolars! 0ne cavity# randomly selected
after preparation# was cleaned with water spray# while the other was cleaned with an
antiseptic deter$ent! 6oth cavities were then filled with composite and allowed to set!
5n both teeth# the outer part of the fillin$ was removed and replaced with ,inc o/ide
and eu$enol or cavity cement! 5n this way we prevented the $rowth of bacteria into
the contraction $ap between the resin and the cavity walls!
The teeth were e/tracted after three to si/ wee&s! They were coded and
histolo$ic evaluation was made by two observers!
The histolo$ic evaluation revealed that in 1C of the water ; cleaned cavities#
with the smear layer remainin$# numerous bacteria were presentG in the antiseptically
cleaned cavities# bacteria were absent! These results were hi$hly si$nificant and
showed that a few bacteria entrapped in the smear layer may survive and multiply!
There was also pulpal inflammation under these cavities!
The fact that bacteria may multiply on cavity walls even if there is no
appreciable communication to the oral cavity seems to indicate that certain
microor$anisms $et sufficient nourishment from the smear layer and dentinal fluid!
The presence of a smear layer may also affect the retention of a linin$ and of
lutin$ cements! Their retention is obtained mainly throu$h mechanical interloc&in$
into microundercuts in the dentin! 5t is possible that the presence of a superficial
smear layer will wea&en mechanical retention between the linin$ and the surface of
the cut dentin!
)a3or 19C. su$$ested that bacteria are not present in freshly prepare smear
layers# in vitro study!
0n the other hand# in normal clinical procedures# especially when operatin$ on
carious teeth# usually with low ; speed or hand instruments in the final preparation#
we must consider the $reat ris& of bacteria survivin$ in the smear layer! 6acteria may
even be left in the narrow $ap between the enamel and dentin at the lateral walls# as
well as in sin$le tubules in minerali,ed dentin underneath!
6ases of K0+ and eu$enol and 9a (0=)
2
may have $ood antiseptic effects but#
unfortunately# under permanent restorations these bases of 9a(0=)
2
# such as Dycal#
may disappear when lea&a$e occurs# leavin$ a fluid space for bacteria to enter!
SMEAR LAYER ON DENTIN E2POSED TO THE ORAL CAVITY :
"nother 'uestion concerns what may happen to the smear layer on surfaces
e/posed to the oral cavity and left unrestored e!$!# in root plannin$# after superficial
$rindin$# or under poorly fittin$ temporary crowns!
• -hen a smear layer is produced e/perimentally on human dentin# and
left e/posed# it disappears after a couple of days and is replaced by bacteria# and
after a wee& almost all tubules are opened and some even widened!
• There may be 1:#::: ; 2:#::: tubules per s'uare millimeter e/posed
on a superficial# hypersensitive e/posure!
• The conse'uence is the invasion of bacteria! 6acteria may plu$ the
apertures of the tubules! "fter two wee&s# however# we have occasionally seen a
minerali,ed pellicle bloc&in$ the apertures of the tubules! (6rannstron# 19<2)!
3' REMOVAL OF THE SMEAR LAYER UNDER RESTORATIONS:
-e cannot e/pect a minerali,ed pellicle to develop under a restoration where
saliva does not circulate! =owever outward flow of fluid in dentinal tubules and
around fillin$s may be reduced with time! The pulpal ends of the tubules may be
partly bloc&ed by irre$ular dentin!
"s reported by (ashley (19<.)# accumulation of solids in tubules and at their
outer apertures may contribute to a reduced flow of fluid! Lnder favourable
conditions a minerali,ed pellicle may develop at the outer aperture of the contraction
$ap! The same has been observed in the apertures of tubules of cut dentin left
unprotected!
• The smear layer may be detached and follow the outward flow of fluid in the
contraction $ap! 5n a vital tooth this flow is directed outward due to the
pressure $radient ; a hi$her pressure of fluid in the pulp! The si,e of the $ap
around the restoration may vary from 5 to 2: µm!
• 9ertain bacteria may directly dissolve enamel and the hi$hly minerali,ed
peritubular dentin and may remove at least parts of the smear layer!
• =istolo$ic sections sometimes reveal that the bacterial layer is closely oriented
to the surface of the cut dentinG the bacteria have# in other words# occupied due
smear layer!
• Sometimes the whole bacterial layer is detached from the cavity and no
bacteria are seen in the dental tubules because of the presence of smear plu$s
in the tubule apertures! Thus is one reason why we may not always find a
correlation between pulpal inflammation and the presence of bacteria on
cavity walls!
)' THE PROTECTIVE EFFECT OF SMEAR PLUGS IN TUBULE
APERTURES AND THE CONSE4UENCE OF REMOVING THE PLUGS :
The de$ree of inflammation in the pulp seems to depend on the amount and
type of to/in# from both live and dead bacteria# reachin$ the pulp# rather than the
presence of bacteria with in the tubules! ?rom opened tubules# bacteria many easily
reach the pulp and multiply! Therefore# removal of smear plu$s should be avoided!
(ashley (19<.) has also demonstrated that smear plu$s reduce permeability of dentin!
"nother important conse'uence of etchin$ and the removal of smear plu$s and
peritubular dentin at the surface is that the area of wet tubules may increase from
about 1: to 25 E of the total! Subse'uently it is difficult to $et the dentin dry because
fluid# continues to be supplied from below thro1 the tubules!
5n sensitive dentin# the tubules are open all the way! 5t is better to &eep them
occluded with disinfected smear and with peritubular dentin preserve at the surface!
The permeability is reduced and the cut dentin can be more easily desiccated with a
blast of air!
5' PULPAL IRRITATION DUE TO REMOVAL OF THE SMEAR LAYER
:
"pplication of 5: E citric acid or CE phosphoric acid for even five seconds
is sufficient to remove smear plu$s and peritubular dentin at the surface!
"cid etchants# deter$ents# a thin mi/ of phosphate cement# silicate# A59# and
resins donot produce any appreciable dama$e and inflammation to the pulp# not even
when applied to e/posed pulps (6rannstron# 19<2# 19<.)!
6ut various acids and +DT" are capable of removin$ the smear layer but#
unfortunately# they also removed the smear plu$s and peritubular dentin! Several
investi$ations were performed to find a suitable cleanser that would retain the smear
plu$s and remove only the superficial smear layer!
" deter$ent should remove the superficial smear layer# so that an antiseptic
component in the cleanser can reach and &ill any bacteria present in smear plu$s!
0ne acceptable solution contain a surfactant combined with :!2 E +DT" and
ben,y$l&onium chloride to which 1 E sodium fluoride was added! ?luoride in this
concentration is antibacterial and $ets a fluoride impre$nation of cavity walls and
remainin$ smear plu$s!
*' SMEAR LAYER IN ROOT CANALS AFTER REANSING :
The morpholo$y of the canal wall is interestin$! 5n adult teeth# the wall may be
partly covered with a tubular# irre$ular dentin and thus the tubules are bloc&ed in the
same way as under erosion and abrasion! 5nfection may not be seen in the tubules in
such an area!
5n youn$ teeth# have lar$e areas with primary dentin facin$ the root canal!
?rom a necrotic and infected canal# bacteria enter the dentin and can be found rather
deep in the tubules! 5nfected tubules with fluid communication to the e/terior may
cause patholo$ical complications such as e/ternal resorption of roots and periapical
pathosis!
5n the treatment of infected roots there is a $ood reason to remove smear plu$s
from the apertures of the tubules by usin$# for instance# +DT"! 5n this way the
bacteria with in the tubules at some distance can be more easily destroyed by an
intracanal dressin$! 0n the other hand# if the asepsis or the sealin$ is poor# we may
run ris& of reinfectin$ dentinal tubules opened and widened by treatment with +DT"!
The situation is similar to that for cavities!
The absence of superficial smear may facilitate $ood contact between the
sealin$ material and the wall of cut dentin!
Ti$ht seal is must to prevent the contamination of root canal from oral cavity!
FUNCTIONAL IMPLICATIONS
DENTAL MATERIALS:
Dental materials scientists have been concerned about the smear layer insofar
as it mas&s the underlyin$ dentin matri/ and may interfere with the bondin$ of
adhesive dental cements such as the polycarbo/ylates and $lass ionomers bein$
developed# which may react chemically with the dentin matri/!
Dahl (19C<) demonstrated that simply pumicin$ the dentin surface produced a
threefold increase in tensile stren$th of bond between dentin and polycarbo/ylate
cement# which relies strictly upon mechanical rou$hness for retention! (resumably
allowin$ cement to react chemically with the smear layer# rather than with the matri/
of sound intertubular dentin# produces a wea&er bond due to the fact that the smear
layer can be torn away form the underlyin$ matri/!
-hen the cements are applied to dentin covered with a smear layer and then
tested for tensile stren$th# the failure can be either adhesive (between cement and
smear layer) or cohesive (between constituents of the smear layer)!
5f one wants to increase the tensile stren$th of a cement ; dentin interface
there are several approaches to due problem!
1) 4emove the smear layer by etchin$ with acid! This seemin$ly e/treme
procedure does not in3ure the pulp# especially if dilute acids are used for short
periods of time! +tchin$ dentin with * E citric acid for *: seconds removes all of
the smear layer (and smear plu$s) as does 15 seconds of etchin$ with C E
phosphoric acid! The advanta$es are that smear layer is entirely removed# the
tubules are open and available for increased retention# and the surface colla$en is
e/posed for possible covalent lin&a$es with new e/perimental primers for
cavities!
?urther# with the smear layer $one# one doesn1t have to worry about it
slowly dissolvin$ under a lea&in$ restoration or bein$ removed by acid produced
by bacteria# leavin$ avoid between the cavity wall and the restoration# which
mi$ht permit bacterial coloni,ation!
The disadvanta$e of removin$ the smear layer is that# in its absence# there
is no physical barrier to bacterial penetration of dentinal tubules! ?urther# with
nothin$ occludin$ the orifices of the tubules# the permeability of dentin increases
four to nine fold dependin$ upon the si,e of the molecule!
2) "nother entirely different approach would be to use resin that would infiltrate
throu$h the entire thic&ness of the smear layer and either bond to the underlyin$
matri/ or penetrate into tubules!
Smear layers on deep dentin may have more or$anic material in them than
those on superficial dentin! This may be due to the $reater number of
odontoblastic processes or to the $reater amount of proteo$lycans linin$ the
tubules!
) "nother approach is to try to fi/ the smear layer with $lutaraldehyde or
tannin$ a$ents such as tannic acid or ferric chloride!
The idea is to increase the cross lin&in$ of e/posed colla$en fibers with in
the smear layer and between it and the matri/ of the underlyin$ dentin to improve
its cohesion!
.) " fourth and most convenient approach to the problem is to remove the smear
layer by etchin$ with acid and replace it with an artificial smear layer composed
of a crystalline precipitate (9auston and @ohnson# 19<2)!
6owen has used this approach by treatin$ dentin with 5 E ferric o/alate#
which replaces the ori$inal smear layer with a new comple/ permittin$ e/tremely
hi$h bond stren$ths to be produced between resin and dentin!
ENDODONTICS:
The presence or absence of the smear layer is of interest not only to restorative
dentistsG but to endodontists as well whenever dentin is filed# a smear is produced on
its surface (fi$ # p$ ;1C)! 5f a smear layer containin$ bacteria or bacterial products
were allowed to remain with in the pulp chamber or root canals# it mi$ht provide a
reservoir of potential irritants! The removal of smear layer from the dentin linin$ the
pulp chamber and root canals has been sub3ect of numerous investi$ations!
Aoldman and others (19<2) recommend alternate use of 2a09l and +DT" to
remove smeared dentin! The sodium hypochlorite removes or$anic material# includin$
the colla$enous matri/ of dentin and +DT" removes the minerali,ed dentin# thereby
e/posin$ more colla$en! Such preparative treatment of root canals presumably
permits a better adaptation of obturatin$ materials and sealers to the dentin!
Aoldman1s $roup has recently demonstrated that removin$ the smear layer
from the root canal permits increased tensile stren$th of plastic posts! The increased
retention was associated with penetration of the resin into the open dentinal tubules!
(fi$! 5)!
PERIODONTICS:

• (eriodontics produce a smear layer on root dentin durin$ deep scalin$
or root plannin$! (4e$ister (19C) found# empirically# that etchin$ radicular
dentin with saturated citric acid facilitated reattachment followin$ periodontal
flap sur$ery!
• 4e$ister (19C)# 4e$ister and 6urdic& (19C5# 19C*)# 4irie# 9ri$$er and
Selvi$ (19<:)# and 2albandian and 9ote (19<2) have shown that this procedure
(etchin$ with citric acid) stimulates cemento$enesis and the subse'uent
intertwinin$ of colla$enous fibers of the periodontal li$ament with fibers of the
matri/ of dentin or cementum! They also demonstrated that cementum did not
form as readily on dentin covered with a smear layer!
• The those cases where repair did ta&e place in the presence of a smear
layer# the cementum or periodontal fibers# or both# pulled away from the
underlyin$ dentin durin$ histolo$ic processin$# indicatin$ a very wea& bond or
attachment!
• 9areful e/amination of published transmission electron micro$raphs
ta&en of minerali,ed sections of roots that were planed but not etched with acid
reveals the presence of a finely $ranular or$anic layer interposed between root
dentin and developin$ cementum! "uthors have called it ,one 1 or $ranular
3unctional cementum! 5t probably represents simply a fine# this# smear layer
created on the surface of radicular dentin durin$ root plannin$! 5ts presence
clearly modifies local reaction of tissue in that it apparently inhibits attachment
of firm new connective tissue white permittin$ mi$ration of the epithelium over
its surface!
• +tchin$ effectively removes the smear layer in addition to e/posin$
colla$en fibers in the matri/ of radicular dentin! +ven after removal of the
mineral phase of the smear layer by saturated citric acid# there still remains an
or$anic smear layer# which may interfere with subse'uent interdi$itation of
colla$en fibers of periodontal li$ament and dentin matri/!
• The or$anic smear layer is easily rubbed off with a cotton pellet and
this indicates how important it may be to standardi,e techni'ues of etchin$#
namely# specifyin$ concentration of acid# time of e/posure# time of rinsin$#
dabbin$# or rubbin$# and so forth!
RESTORATIVE DENTISTRY:
-henever castin$s are cemented into place# patients are as&ed to bite down on
a cotton roll or seatin$ aid that places all of the masticatory force on that one tooth!
• The ma/imum bitin$ force that is comfortable for a patient is about 9D
12 &$ in the incisor re$ion and 2:: &$ in due molar re$ion!
• 5f for the sa&e of simplicity# we assume that only 1: E of that
ma/imum force is concentrated on 1 cm
2
of a molar crown# then the force per
unit area# that is# pressure# $enerated on and inside the casin$ would be 2: &$ F
cm
2
! Since the cement is an incompressible li'uid# it will transfer this pressure to
fluid on and in dentin! There is even dan$er that the cement may enter the
dentinal tubules before it sets# displacin$ an e'ual volume of dentinal fluid into
the pulp! This may be responsible for the pain that some unanestheti,ed patients
feel durin$ cementation of crowns and can be e/plained by hydrodynamic
theory of dentin sensitivity! Thus# it may be movement of fluid per se# rather
than the acidity of the cement# that produces pain and pulpal irritation!
The pressure $enerated durin$ the seatin$ of castin$s can be even hi$her if
the surface area of cavity is smaller!
The case with which fluid can forced across dentin is formali,ed by a tern
called the hydraulic conductance (Lb)! This term describes the volume of fluid
transported across a &nown area of surface per unit time under an $radient of
unit pressure!

• The 'uestion of microlea&a$e restorative material is beyond the scope!
5t is worth mentionin$ however that there are atleast 2 or routes by which
substances can lea& into the pulp!
• ?irst# even if there were no $ap between dentin and a restorative
material# bacterial products could theoretically diffuse around the material via
small channels and interstices with in the smear layer! Lnfortunately# one cannot
perfectly adapt amal$am or any other restorative material to the walls of a
prepared cavity! Thus# there avoids and spaces between amal$am and dentin that
allow considerable microlea&a$e!
• )ost clinicians use a cavity varnish or liner to seal dentin! These
or$anic films are placed on moist dentin# which# microscopically# has pools of
li'uid on it# which produce an uneven layer of film of variable thic&ness and
permeability! +ach layer provides potential routes for micro lea&a$e!
• 5f one could produce a truly adhesive fellin$ material that had no
shrin&a$e upon polymeri,ation and a coefficient of thermal e/pansion close to
that of tooth structure# then one would want to remove the smear layer and omit
the use of any cavity liner or varnish that did not react chemically with both the
dentin and the resin!
INFLUENCE ON SENSITIVITY OF DENTIN:
• +tchin$ the dentin of roots# whether done therapeutically or by the
action of microor$anisms of pla'ue# can rewove the thin la$er of coverin$
cementum or smear layer# or both# there by e/posin$ patent dentinal tubules to
the oral cavity! This can lead to sensitivity of dentin to the point where it
interferes with the patient1s oral hy$iene! "s movement fluid is central to the
hypothesis# several careful studies have been made of the most important
variables influencin$ movement of fluid throu$h dentin! Theses studies indicate
that most of the resistance to the $love of fluid across deities is due to the
presence of the smear layer!
• +tchin$ dentin $reatly increases the ease with which fluid can move
across dentin! This is accompanied clinically by increased sensitivity of dentin
to osmotic# thermal and tactile stimuli!
• 5f dentin is sensitive# then accordin$ to the hydrodynamic theory of
dentin sensitivityG the dentinal tubules must be patent and must allow movement
of fluid across dentin! 5f fluid can move# it seems reasonable to assume that
bacterial products from pla'ue coverin$ those surfaces of sensitive dentin may
also permeate dentin into the pulp! The presence of a smear layer will prevent
bacterial penetration of the tubules but will permit bacterial produce a mild# low
; $rade inflammatory response that lowers the pain threshold in the affected
teeth# ma&in$ them more sensitive than they would be in the absence of pla'ue!
INFLUENCE ON PERMEABILITY OF DENTIN
• The presence of a swear layer has a lar$e influence on permeability of dentin!
Substances diffuse across dentin at a rate that is proportional to their
concentration $radient and the surface area available for diffusion!
• The area available for diffusion in dentin is determined by the density of
dentinal tubules# that is# the number of tubules per s'uare millimeter# and by
due diameter of these tubules! 6oth of these values vary as a function of
distance from the pulp chamber!
• The actual area of diffusional surface is the product of tubule density
and the area of each tubule!
• 5f one loo&s at the surface of a smear layer in S+)# one would predict
that it -i$ht be impermeable! =owever# e/periments both in vitro and in vivo
have demonstrated that is topically labeled solutes of various molecular si,es
easily penetrate the smear layer
• 4emoval of the smear layer by etchin$ with acid increased the area of
diffusional surface of the tubules to C!9E!
T6e Smear La!er i$ E$7%7%$ti8&
4esearchers became aware of the endodontic smear layer about 19C5!
• Tidmarsh# in 19C<# treated instrumented teeth with the use of 5:E citric acid
and found the dentin to be $enerally clean of the smear layer and the
dentinal tubules wide open!
• 5n endodontics# the smear layer results directly from the instrumentation
used to prepare the canal wall and are found only where the walls are
prepared and not in uninstrumented areas! The amount of smear layer
produced by automatic preparation will be $reater in volume than that
produced by fin$er filin$!
• ?ilin$ a canal without irri$ation will produce a thic&er layer of dentin debris
than similar situations in which a copious spray or constant canal irri$ation
is used!
• The presence or absence of the smear layer in endodontics is 3ust as
important! -hen a canal is instrumented# the swear layer produced will
remain with in the canal and pulp chamber! The bacteria and bacterial
products found in the smear layer can provide a reservoir of potential
irritants!
C%m9%$e$t& %# t6e Smear La!er
The e/act proportionate composition of the endodontic smear layer has not been
determined# but S+) e/aminations have disclosed that its composition is both or$anic
and inor$anic
• The inor$anic material in the smear layer is made up of troth structure and
some non specific inor$anic contaminants!
• The or$anic components may consist of heated coa$ulated proteins# necrotic
or viable pulp tissue and odontoblastic processes plus saliva# blood cells and
micro ; or$anisms!
• 0nce a root canal has been instrumented# the hi$h ma$nification of the
electron microscope will disclose that the normal canal anatomy has been lost
by the instrumentation and that a thic& smear layer has been found! The dentin
surface of the canal appears $ranular amorphous and irre$ular!
• " profile view of the specimen may show in consistency # disclosin$ fine
particulate material# densely or loosely pac&ed to various depths in to the
dentinal tubules!
• Tubule pac&in$ is seen most often where less than half the ciramference of the
tubule has been fractured away!

• 5nstrumentation by other means than fin$er filin$s and irri$atin$ solutions may
produce a pac&in$ phenomenon with a different appearance!
PHYSICAL BARRIER FOR BACTERIA AND DISINFECTANT
The advanta$e and disadvanta$es of smear layer and whether it should be
removed or not from the instrumented root canals is still controversial! The role of
smear layer actin$ as a physical barrier to bacteria and bacterial by products has been
supported by many researchers!
• %o3inovic et al (19C) showed that dentinal plu$s stopped bacterial invasion
into dentinal tubules!
• )ichelich et al (19<:) and diamond and 9arrell (19<.) also stated that bacteria
could not penetrate into dentin in the presence of smear layer!
• 9onversely 6a&er et al (19C5) and >amada et al (19<) observed that bacteria
could remainin$ the smear layer and dentinal tubules despite instrumentation
of the root canal and thus they may survive and multiply and can $row into
dentinal tubules!
• 5t has also been shown that removal of smear layer facilitated passive
penetration of bacteria! The e/tent of this bacterial invasion is dependent on
the type of bacterial species and on time!
• -illiam and $old man (19<5) showed that swear layer delayed the penetration
of proteus vul$aris# but was not a complete barrier to this bacteria!
• Smear layer itself is permeable even to lar$e molecules such as albumin!
• "fter de$radation of the smear layer by proteolytic en,ymes released by
certain bacteria a $ap will develop between the fillin$ material and the canal
wall# permittin$ the lea&a$e of other bacterial species and their by products
alon$ the canal walls into dentinal tubules and the periradicular tissues!
• -hen the root canal becomes heavily infected# bacteria may be found deep in
the dentinal tubules $iven after chemo mechanical instrumentation of the root
canal# some bacteria still remain in the canal and dentinal tubules! ?or this
reason# chemomechanical cleansin$ is often supported by the use of
disinfectant!
• "ccordin$ to some authors (Aoldbery and "bramovich 19CC# -ayman et al
19C9# >amada et al 19<# and )adev 19<C)# The presence of the smear layer
may bloc& the antimicrobial effects of inter canal disinfectants in to the
tubules!
• 5n 19<:# =appa concluded that the smear did delay# but not abolish the action
of the disinfectants! =owever# followin$ the removal of smear layer# bacteria
in dentinal tubules can be easily destroyed and in this way# it may be
beneficial to use lower concentration and For amounts of anti bacterial a$ent
since all of these a$ents show some de$ree of to/icity to viable host cell!
A9i8a Lea:a;e
• (lastici,ed A( can enter the dental tubules when the smear layer is absent!
This can establish a mechanical loc& between the $utta perch and the canal
wall! 9oupled with the increased surface area at the interface between fillin$
and canal wall# this loc& should create an impermeable seal!
• Thus# the use of in3ected thermoplastic ,ed A( should be accompanied by the
use of a sealer re$ardless of whether or not the smear layer has been removed!
• 0n the other hand# Hennedy directly contraindicated most of +van1s
conclusions! Hennedy stated that an absence of the smear layer causes less
apical lea&a$e than A( ;filled canals with the smear layer intact!
=e also stated that the use of a chelatin$ a$ent on the smear layer would increase
apical lea&a$e!
?urthermore# he stated that CD day duration between instrumentation and
obturation allows for an increased amount of apical lea&a$e! =e concluded that
removal of smear layer would improve A( seals if the master cones are softened
with chloroform and used with a sealer and lateral condensation!
• The $reater the de$ree of canal preparation# the smatter the amount of
apical lea&a$e!
-ith situations in which apical lea&a$e e/isted in the presence of dentin plu$s#
it must be concluded that the plu$s were permeable! Their porosity allowed
them to fall short of the $oal of creatin$ a hermetic apical seal!
• 5n addition to bein$ porous# dentin plu$s allowin$ lea&a$e e/hibited lar$e
amounts of shrin&a$e! Scannin$ electron microscopic e/amination of
unsatisfactory apical plu$s always showed mar$inal and structural defects!
• ?urther considerations for advocatin$ smear layer removal in endodontics
are the importance of creatin$ a $ood apical plu$ and the effects the two
main types of sealers have on the canal walls!
SEALERS
• 6ecause of the bacterial content of the swear layer any apical e/trusion of the
smear layer durin$ instrumentation or obturation can defeat one of the $oals of
endodontic therapyI
To be considered an ideal sealer# a material should not of itself cause or
further irritation in this tissue! Some root canal fillin$ materials# especially 2
2
paste
and silver points# are not biocompatible!
• +ndodontic sealers act as a $lue to ensure a $ood adaptation of $utta percha to
the canal walls! 5f the smear layer is not removed# the A( may
occasionally be $lued to the dentin in the smear layer as well as to e/posed
parts of due canal wall! 2ot bein$ firmly attached to the dentin# the smear
layer may laminate off the canal wall and create a false seal# voids in the fill#
and an e/pelled environment for microlea&a$e!
• Smear layer induced inflammation of the periapical area can be caused by over
instrumentation or by the careless measurement and fittin$ of a master cone!
• The type of sealer used has different implications once the smear layer is
removed! " powderDli'uid combination# the most common of which is
Arossmen1s sealer# contains small particles in the powder that could enter the
orifices of due dentinal tubules and help create a secure interface between
sealer and canal wall!
• 9a(0=)
2
based sealers have the advanta$e of promotin$ the apposition of
cementum at the canal ape/ and sealin$ it off a$ainst micro lea&a$e!
"lthou$h 9a(0=)
2
has dentinD re$eneratin$ properties# the formation of secondary
dentin alon$ the canal wall is prevented by the absence of vital pulp tissue!
• Dentin fillin$ occur durin$ instrumentation# but the formation of an apical
plu$ from them is often an inadvertent or accidental occurrence!
• The use of some dentinD bondin$ a$ents to harden the smear layer to the canal
wall and to harden the apical plu$ is a sub3ect for research! 5t is doubtful that
the bondin$ a$ent would be ant microbial to the bacteria in the smear layer!
• 5f the smear layer is removed# the use of a 9a(0=)
2
sealer will not promote
enou$h effect on bone to seal lateral canals! The calcium ion is used in the
formation of asteroid or dentoid type material! 9irculation of blood (-hich is
absent in filled canals) is needed for the calcium ion to promote new tissueG
thus the 9a(0=)
2
sealers are effective for sealin$ only at the root ; ape/)
POST CEMENTATION
4ecent research has embraced the modalities of composite cements# A59# and
dentin bondin$ a$ents# tryin$ to sort these out# hopin$ to find a techni'ue to
improve the tensile strenp the of cemented posts!
4emoval of smear layer increase the cementation on bond and the
tensile stren$th of the cementin$ medium! A59 are effective in post
cementation after smear layer removal because the $lass ionomer has a better
union with tooth structure!
• These has been no si$nificant difference between cements when the final
canal rinse was 299 of 5!25E sod hypochlorite!
-hen an unfilled 6isDA)" resin was used after sod tryochlorite rinse# the
stren$th of the resin bond was better than that of poly carbo/yl ate cement!
-hen the swear layer was removed by blushin$ with +DT" and Sod!
=ypochlorite rinse# the 6isDA)" resin flowed into the e/posed dentinal
tubules and into the serrations on the post# vastly improvin$ retention!
• The use of a dentin bondin$ a$ent prior to cementin$ a post with a
composite cement or a A59 may or may not dictate removal of the smear
layer# dependin$ upon which bondin$ a$ent is used or whether a A5 is
used!
REMOVAL OF SMEAR LAYER
Smear layer removal is a controversy that fluctuates with the various modalities of
restorative dentistry! 5n operative dentistry# it may depend on the type of dentin
adhesive used or on the use of $lass inomers!
6ut# in endodontics# its removal is becomin$ une'uivocal! 5n operative
techni'uesG the concept of removin$ most of the smear layer over the tubules is an
ideal that is difficult to achieve clinically because of the comple/ $eometry of many
cavities and the difficulty of obtainin$ ade'uate success!
The most recent thin&in$ veers toward retainin$ the smear layer even if it
limits the stren$th of dentin bondin$ a$ents because it is a natural cavity liner that
reduces the permeability of the dentin for more than any cavity varnish!
6ondin$# or obturatin$ to the smear layer must be considered a wea& union
because the smear layer can be torn away from the underlyin$ matri/! 5n endodontics#
once the layer is removed# a better adaptation of the obturatin$ materials and sealers
becomes possible! Dentin permeation by diffusion is increased five to si/ times and
by convection 25 to * times! This attribute allows an improved penetration of
disinfectin$ a$ents# medicaments and obturatin$ materials!
The smear layer1s presence plays a si$nificant part in an increase or decrease
in apical lea&a$e! 5ts absence ma&es adaptation of the Ap to the canal will be
si$nificantly increased! -ithout the smear layer# the lea&a$e will still occur but at a
decreased rate!
Some products# used sin$ly or in combination# will remove it!
• The 'uality of the smear layer removal will vary with the type of solvent
used!
The solventsDor$anic or inor$anicDmay or may not be effective when
used by themselves but their action may be enhanced when actin$ in
combination with another irri$ant!
• 2either hand nor automated instrumentation will provide a clean canal!
5nstead of eliminatin$ one! The character of the debris formed by hand
filin$ is $ranular in contrast with the automated formed debris that
appears finer and ca&ed!
• 5rri$atin$ solutions have been used durin$ and after instrumentation to
increase cuttin$ efficacy of root canal instruments and to flush away
debris! The efficacy of the irri$atin$ solution is dependent not only on
the chemical nature of the solution but also on the 'uantity and temp# the
contact time# the depth of penetration of irri$ation needle# the type and
the $ua$e of needle # the surface tension of irri$atin$ solution and the a$e
of the solution (in$le 19<5)
SODIUM HYPOCHLORITE

The or$anic tissue dissolvin$ activity of 2a09l is well &nown and increases
with risin$ temp! =owever the capacity to remove smear layer from the instrumented
root canal walls has been found to be insufficient!
)any authors have concluded that use of 2a09l durin$ or after
instrumentation produces superficial clean canal walls with smear layer present!
The alternate use of =
2
:
2
and 2a09l solutions was often advocated in the
past!
)9 9ombe and Smith (19C5) and 6etter (19<9) showed that this combination
was not more effective in removin$ smear layer!
• "ddin$ surface active rea$ents to 2a09l to increase its action proved also
not to be effective (9amerson 19<*)
CHELATING AGAENTS
The most common chelatin$ solutions are based on +thylene ; Diamine tetra
acetic acid (+DDT") which reacts with calcium ions in dentin and forms soluble
calcium chelates (Arossman et al 19<<)!
• 2y$aurd ; 0stby (19*) found that +DT" decalcified dentin to a depth of
2:D: mm in 5min
• ?raser (19C.) stated that the chelatin$ effect was almost ne$li$ible in the
apical third of the root canals!
• Different preparation of +DT" have been used as a root canal irri$ant! 5n a
combination# urea pero/ide was added to float the dentinal debris from the
root canal! =owever it appeared that despite further instrumentation and
irri$ation# and irri$ation# a residue of this mi/ture (49D(rep) was left on the
canal walls!
• " 'uaternary ammonium bromide (cetrimide) has been added to +DT"
solution to reduce surface tension and increase penetrability of the solutions!
)9D9ombe and Smith (19C5) reported that when this combination (4+DT")
was used durin$ instrumentation# there was no smear layer e/cept in the
apical part of the canal! "fter in ;%5%0 use of 4+DT" it was shown that
root canal surfaces were uniformly occupied by patent dentinal tubules with
very little superficial debris! -hen used durin$ and after instrumentation#
remnants of odontoblastic processes could still be seen with in the tubules
even thou$h there was no smear layer present! (Aoldman et al 19<1)
5t was indicated that optimal wor&in$ time of +DT" into root canal
was 15min and no more chelatin$ action could be e/pected after this period!
• "nother root canal chelatin$ a$ent is salvisol which is based on properties
similar to materials of the 'uarternary ammonium $roup and possess the
combined action of chelation and or$anic debridement!
• 0ne study smear layer removal by +AT" ethylene $lycol ;2#2#21#21 ; tetra
acetic acid was done in 2::: by Semra 9alt and "hmet Serper!
They evaluated the effects of +AT" on removal of the smear layer on the
canal wall as an alternative to +DT" by usin$ S+)! Smear layer was
removed from the instrumented root canals by irri$ation with 1CE +AT" or
1CE +DT"# followed by 5E 2a09l! The effects were compared!
4oot canals which were irri$ated with +DT" followed by 2a09l# it
was observed that the smear layer was completely removed from the
instrumented root surfaces obtained from the middle and the apical third! 5nter
tubular and peritubular dentinal erosion was observed in the middle third of
the root canals! 5n some areas# this e/cessive erosion lead to con3u$ation of
two or more tubules that indicated the destructive effect of +DT" !
The combination of +AT" and 2a09l irri$ation was effective in
removin$ the Smear layer from the dentin walls! 5n these specimens# dentinal
tubules seemed to be completely open to the canal surface# and theyG were not
obscured by the smear layer in the middle third# this combination didn1t cause
erosion of the intertubular and peritubular dentin! 6ut didn1t completely
remove the superficial smear layer in the apical third# and some of the dentinal
tubular orifices were clo$$ed!
" chelator reacts with calcium ions in the hydro/yapatite crystals to
produce a metallic chelate! 4emoval of calcium ions from the dentin softens
the dentinal tissue# especially the hydro/yapatite ; rich peritubular dentin and
increases the diameter of e/posed dentinal tubules
• The erosion of the e/posed $lobular surface of the calcospherites and the
enlar$ement of orifices of the dentinal tubules probably resulted from the
alternatin$ action of 2a09L# which dissolved the or$anic component of
the dentin# and +DT"# that deminerali,ed the inor$anic component! "nd
in some areas dentinal tubules were con3u$ated in some areas! =owever#
this effect was not observed durin$ +AT" administration!
The main advanta$e of +AT" over +DT" is that is somewhat effective
in removin$ the smear layer without inducin$ erosive action!
+AT" was not as effective as +DT" in the important apical third! ?urther it is
not clear that the erosion and 3oinin$ of orifices from +DT" action is deleterious!
These results seem to indicate that +DT" action is simply stron$er than that of
+AT"!
ORGANIC ACIDS
9itric acid appeared to be an effective root canal irri$ant (9oel 19C5) and
even more effective than 2a09l alone in removin$ the smear layers (6aume$artner et
al 19<.)! This acid removed smear layer better than many acids such as polyacrylic
acid# lactic acid and phosphoric acid e/cept +DT"!
• -ayman et al (19C9) showed that canal walls treated with 1:E#25E and
5:E citric acid solutions were $enerally free of smeared appearance# but they had
the best results in removin$ smear layer with se'uential use of 1:E citric acid
solution and 2!5E! 2a09l solution# then a$ain followed by 1:E solutions of citric
acid!
• =owever it was also observed that 25E! 9itric acid# 2a09l $roup was not
as effective as 1CE +DT" ; 2a09l combination!
6esides 9itric "cid left precipitated crystals in the root canal which mi$ht be
disadvanta$eous in root canal obturation! -ith 5:E lactic acid# the canal walls were
$enerally clean# but the openin$ of dentinal tubules didn1t appear to be completely
patient!
6itter (19<9) introduced the use of 25E! Tannic acid solution as root canal
irri$ant cleanser! 5t was demonstrated that the canal walls irri$ated with this solution
appeared si$nificantly cleaner and smoother than the walls treated with a combination
of =
2
:
2
and 2a09l and that smear layer was removed!
REMOVAL OF SMEAR LAYER IN THE ROOT CANAL USING
O2IDATIVE POTENTIAL <ATER
5t is used as an irri$ant for the efficacy of removin$ the smear layer!
6actericidal and deminerali,in$ effects have recently been noted to occur in
the tooth structure when 0(- is used durin$ dental treatment! 5noue et al investi$ated
the ability of 0(- to etch the $round tooth surface for composite bondin$! The
showed it could condition both enamel and dentin for bondin$ with composite resin!
0(- has been developed in @apan and is defined as an electrolytically
obtained hi$hly acid water havin$ accumulated in the anodeDcontainin$ compartment
after sodium chlorideDadded =
2
: has consumed 0=Dions!
5t constitutes the counterpart of al&aline water formin$ in the cathodeD
containin$ compartment after the water therein has consumed =M ions!
5t &ills %iruses as well as bacteria p= is 2!C or less# and o/idationDreduction
potential as hi$h as 1:5:)% or more in contrast to that of tap water!
• 5t also has several activated o/y$enDcontainin$ antimicrobial constituents#
such as =09l and 0

! 0(- is safe enou$h for patients to hold in the oral
cavity!
ULTRASONICS
"fter the introduction of ultrasonic devices# the use of ultrasound was
investi$ated is endodontic! " continues flow of sodium hyprochlorite solution
activated by and ultra sound delivery system was used for the preparation and
irri$ation of the root canal! 5t was observed that this method produced smear free root
canal surfaces!
9amerson (19<<) showed that while conc! 0f 2E to .E 2a09l in
combination with ultrasonic ener$y# were able to remove smear layer# lower
concentrations of solution were unsatisfactory! =owever "hmad et al (19<C)
classified that their techni'ue of modified ultra sonic instrumentation usin$ 1E
2a09l removed the debris and smear layer more effectively than the techni'ue
recommended by )artin and 9unnin$hav (19<) !
9amerson (19<) also compared the effect of different ultrasonic irri$ation
periods on removin$ smear layer and found that a and 5 win irri$ation produced
swear free canal walls while a l min irri$ation was ineffective!
OTHER AGENTS
Two commercial formulas from Sweden# Tubuliced 6lue Label and Tubulicid
4ed Label will remove most of the smear layer without affectin$ the smear plu$s in
the dentinal tubules!
LASERS:
Lasers have been tried on tooth structure for several years!
The effects of lasers e/posure on dentin and its potential application in
endodontics have been e/plored by a number of investi$ators!
• 2dI >"A laser to irradiate root canal walls and showed melted# recrystalli,ed#
and $la,ed surfaces!
• )oshonov et al demonstrated that or$an Laser irradiation of the root canal
system was efficient in removin$ intracanal debris!
• Hoba reported a histopatholo$ical and clinical e/amination of pulsed 2dI
>"A laser application to oneDvisit treatment of infected root canals!
Study done by Tomomi =arashima et al in 199< chec&ed the efficacy A +rI
>"A laser irradiation in removin$ debris and smear layer on root canal walls!
+rI >"A laser irradiation produced melted and sealed tubules# accompanied
by evaporation of the or$anic matri/# and could result in the reduction of fluid
permeability# sterili,ation of the contaminated root ape/ and a increased resistance to
root resorption!
• -i$dor et al compared the thermal increase in teeth caused by e/posure to
90
2
# 2dI>"A and +rI >"A laser caused less thermal dama$e than either the
2dI>"A or 9o
2
laser!
• )orita and Hoba reported that pulsed 2dI >"A laser had the capability of
evaporatin$ debris and remnant pulp tissue pain wouldn1t occur! ?or this
purpose# the laser tip has to be improved!
@0+ %ol 2.G 2o<# "u$ 199<
Gir%mati8 8ea$i$;
Airomatic handpiece produces oscillation of root canal instruments throu$h a
9:
:
are! 5t has been reported to be an effective method for cleansin$ root canals
(?romme and Aelttfit# 19C2)! =owever# numerous other structure shave indicated that
hand instrumentation was superior to the $iromatic tech! ?urther more# hand
instrumentation caused lesser e/trusion of debris throu$h the apical foramen# a
possible factor in endo 7flare ups8 than the $iromatic tech! 5n the final analysis#
neither hand nor $iromatic instrumentation is capable of removin$ tissue in
irre$ularities# resorption lacunal and lateral canals!
BONDING AND THE SMEAR LAYER
5n $eneral# diamonds# throu$h the introduction of $rooved anomalies# produce
a $reater surface area than buss! This has implications in bondin$ where differences in
the bond stren$th of resin attached to enamel have already been reported to be hi$her
for diamonds compared to burs!
The increased surface area probably offered a lar$er number of reaction or
retentive sites! These sites in enamel are primarily micromechanical and the retention
mechanism for this tissue lies in the multitude of superficial micropores enhanced
followin$ acid conditionin$ of the tissue! "cids are amon$ several a$ents that can
remove the smear layer! +/G phosphoric acid in $el or solution in a concentration
ran$in$ from : to *5E is the most popular a$ent!
The application of this a$ent to dentin removes the smear layer and by
dissolution of the peritubular dentin# the luman of the dentinal tubule is si$nificantly
enlar$ed! -hen phosphoric acid removes the smear layer and enlar$es the dentinal
tubules# it also appears to de$rade the colla$en matri/!
Some of the de$radation products may be removed with water but the surface
of the acidDconditioned dentin appears relatively smooth with a $elatinous 'uality
even after a thorou$h lava$e!
Treatment with sodium hypochlorite brin$s about a si$nificant morpholo$ical
chan$e! 5t dissolves the or$anic material to produce a rou$her te/ture to the surface#
which is dependent upon the time of application of this a$ent! -hen tubules are
e/posed in lon$itudinal section# lateral of sodium hypochlorite!
5n addition the composition of dentin and its surface followin$ instrumentation
also dictates choice of treatment! -e are presently pursuin$ different chemical
treatment!
The observation that smear layers could occlude the tubular structure of dentin
and bone was first made by %an =euwenhoc& in 1*CC(01Sulliuan and ?lannelly
199:)# althou$h he did not call them smear layers! )ore recently dentinal smear layer
was described by 6oyde et al!
The composition of smear layer was demonstrated by +ic& et al (19C:) to
consist of calcium and phosphate plu$# or$anic material (containin$ sulfur# nitro$en
and carbon)!
The composition of the smear layer reflects the composition of dentin from
which it is formed! Thus the smear layer is superficial normal dentin may have a
composition close to that of intertubular dentin# where as the composition of the
smear layer in deep dentin would reflect its lesser de$ree of minerali,ation! Similarly
smear layers created on caries affected tissue may contain colla$en that has been
denatured by the action of proteoDlytic en,ymes from cario$enic bacteria! 9aries
affected dentin has also been found to contain whiteloc&ite than normal dentin as has
sclerotic cervical dentin! Thus smear layer created on caries affected dentin and
sclerotic tissue may contain intratubular whitloc&ite!
• 5t self ; etchin$ primers are used without the sensin$ step it is possible that the
deminerali,ed colla$en from the smear layer will remain on the deminerali,ed
surface where it may become incorporated into the hybrid layer!
• Dentin adhesives such as scotch bond dual cure (m dental product)# Dentin
"dhesiv (vivadent)# 6ondlite (&err)# (risma Lniversal bond (Dentsply)# didn1t
treat the smear layer with an acid to remove it prior to resin application!
These adhesives were thus applied directly to the smear layer! They were not
very successful and bond stren$ths of DC )pa were commonly reported!
• The interaction of bondin$ a$ents with smear layers thus deserves continued
consideration! Little is &nown re$ardin$ any correlation between the depth of resin
penetration into the smear layer and the resultin$ bond stren$th!
-hen manufacturers be$an addin$ =+)" to their bondin$ a$ents# shear bond
stren$ths increased from about 5)pa to 1:D12 )pa! 0ne presumption was that
the filled channels around the particles of $rindin$ debris that ma&e up the smear
layer!
• The presence of smear plu$ into the dentinal tubule may provide anchora$e of
smear layer to the underlyin$ dentin matri/ in a manner analo$ous to that of
epithelial pro3ections in to connective tissue stren$thenin$ the dermal epidermal
interface!
• 5f the smear layer is thin enou$h i!e!# 1))# or the ability of the bondin$ a$ent to
penetrate it sli$htly! This may lead to lar$e bond stren$th from 1:D12 )pa to 2:D
2. )pa!
• Awinnett (199. measured the bond stren$th of the all bond 2# 0ptibond (&err)
and Scotch bond multipurpose dentin bonin$ system to acid etched dentin before
and after treatment with 5E 2a09l to remove the e/posed colla$en fibrils!
"lthou$h the thic&ness of hybrid layer varied dependin$ upon the bondin$
system# no variance in bond stren$th was recorded!
• Some investi$ators have advocated usin$ an abrasive system to remove
the loose smear layer (Awinnett 199.) with the hope that such treatment mi$ht
improve bond stren$ths!
• 2i&aido et al (1995) reported no chan$e in resin enamel bond stren$th
followin$ the abrasion of either substrate with sodium bicarbonate powder!
• 2a&abayashi et al (1995) su$$ested usin$ a polishin$ paste containin$
hydro/yapatite particles so that the smear layer mi$ht be removed without
deminerali,in$ the substrate! 6oth air abrasive system and such polishin$
techni'ues would not been practical under many clinical conditions!
Thus appropriately treated smear layers and acid condition dentin surface will
li&ely remain the most clinically relevant surfaces for bondin$!
The smear layer occupies a strate$ic position in restorative dentistry! 5t e/ists
at the interface of most restorative materials and the dentin matri/!
0ur &nowled$e of the smear layer# its structure and function# is rapidly
$rowin$ and will influence all areas of clinical dentistry in the wear future! )uch
wor& need to be done# but promise of $reater understandin$ of the smear layer should
provide increased benefits thro1 improved dental therapy!
Smear La!er = M%7i#!i$; A76e&ive&
Dentin adhesives that modify the smear layer are based on the concept that the
smear layer provides a natural barrier to the pulp# protectin$ it a$ainst bacterial
invasion and limitin$ the outflow of pulpal fluid that mi$ht impair bondin$ efficiency!
+fficient wettin$ and in situ polymeri,ation of monomers infiltrated into the smear
layer are e/pected to reinforce the bondin$ of the smear layer to the underlyin$
dentinal surface# formin$ a micromechanical and perhaps chemical bond to the
underlyin$ dentin! )ost typical in this $roup are the primers that are applied before
the application of polyacidDmodified resin composites# or compomers!
The interaction of these adhesives with dentin is very superficial# with only a
limited penetration of resin into the dentinal surface! This shallow interaction of the
adhesive system with dentin# without any colla$en fibril e/posure# confirms the wea&
acidity of these smear layerD modifyin$ primers! The dentinal tubules commonly
remain plu$$ed by smear debris!
Smear La!er = M%7i#!i$; A76e&ive&
)ost of today1s adhesive systems operated for a complete removal of the
smear layer# usin$ a total ; etch concept!
• Their mechanism is principally based on the combined effect of hybridi,ation and
formation of resin ta$s!
• These systems are in their ori$inal confi$uration# applied in three consecutive
steps and subse'uently cate$ori,ed as three ; step smear
LayerD removin$ systems has been reduce to two steps by combinin$ the
primer with the adhesive resin in one solution!
T6ree = &te9 a76e&ive&
A7va$ta;e&
i) Separate application of conditioner# primer and adhesive resin!
ii) Low techni'ue sensitive!
iii) (roven effectiveness of adhesion to enamel and dentin in vitro and
in vivo!
iv) )ost effective and consistent results!
v) (ossibility for particle ; filled adhesive (7shoc& absorber8)
Di&a7va$ta;e&
1) 4is& of overetchin$ dentin (hi$hly concentrated phosphoric acid etchants)!
2) Time ; consumin$ three ; step application procedure!
) (ost conditionin$ rinsin$ re'uired!
.) Sensitive to over wet or over dry dentin surface conditions!
Tw% = &te9 ">%$e = ?%tte@' a76e&ive
A7va$ta;e&
i) 6asic features of three ; step systems!
ii) "pplication procedure simple with one less step!
iii) (ossibility for sin$le ; dose pac&a$in$!
iv) 9onsistent and stable composition!
v) =y$ienic application (unidose# to prevent cross contamination)
vi) (ossibility for particleD filled adhesive (7shoc& absorber8)
Di&a7va$ta;e&
i) "pplication not substantially faster (multiple layers)
ii) )ore techni'ue sensitive (multiple layers)
iii) 4is& of a too ; thin bondin$ layer (no $lossy film# no stress ; relievin$
7shoc& absorber8)
iv) +ffects of total etch techni'ue!
• 4is& of overetchin$ dentin
• (ost conditionin$ sensin$ re'uired!
• Dentin ; wetness sensitive!
v) 5nsufficient lon$ ; term clinical results!
SMEAR LAYER = DISSOLVING ADHESIVES
• " simplified application procedure is also a feature of the smear layer ; dissolvin$
adhesives or 7selfDetchin$ primers!
• These primers partially deminerali,e the smear layer and the underlyin$ dentin
surface without removin$ the dissolved smear layer remnants or unplu$$in$ the
tubule orifices!
• 9oncept of self ; etchin$ primers has already been introduced with an earlier
$eneration of scotch bond 2 ; li&e systems# such as "4T 6ond# ecusit (rimer ;
)ono (D)A)and syntac! =owever# these systems are advocated for dentin
bondin$ only and# therefore# re'uire selective enamel etchin$ in a separate step!
The current two ; step smear layer ; dissolvin$ adhesives provide self ;
etchin$ primers for simultaneous conditionin$ and primin$ of both enamel and dentin!
• The actual rational behind these systems are to superficially deminerali,e dentin
and to simultaneously penetrate it to the depth of deminerali,ation with monomers
that can be polymeri,ed in situ!
REFERENCES
1) ?undamentals of operative dentistry ; a contemporary approach# @")+S 6 SL))5TT# 2nd
edition!
2) Selt,er and 6ender1s Dental (ulp# H+22+T= ) ="4A4+"%+S
) (ulp dentin biolo$y in restorative dentistry# 5%"4 " )@04
.) +nododontics in clinical practice# ="4T>1S # 5th edition!
5) )inimall invasive restorations with bondin$# )59=+L D+A4"2A
*) 5ntroduction# 0per Dent# Suppl! # 19<. y
C) Te/tboo& of 0perative Dentistry# L50>D 6"L)# rd edition!
<) (athways of the pulp# <th edition# ST+(=+2 90=+2!
9) +ndodontic therapy#.th edition# ?4"2HL52 S!-+52+!
1:) "rt and science of operative dentistry#.th edition# STL4D+%"2TS1
11) )odern practice (D92") @an 2::. vol .< no 1Gp$ 1.C
12) +fficacy of +rI>"A laser irradiation in removin$ debris and smear layer on root
canal walls! @0+# %0L 2. 2o < "u$ 199<# 5.< ; 551!