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Decalcifying Effect of Three Chelating Agents

Background and Objectives: The objective of my study is to determine the efficacy of 17% EDTA plus 1.25 %
sodium lauryl ether sulfate (EDTA-T), 10% Citric acid and 17% EDTA with respect to calcium ion extraction from
the root canal dentin.
Method: The study sample comprises of 90 freshly extracted permanent human maxillary incisors. Access cavity
is prepared in all the teeth. A step back method of biomechanical preparation is done. The last instrument to be
used in the apical third is K-file no. 40 and in the middle and coronal third K-file no. 80 is used. At the change of
each instrument, 2 ml of sodium hypochlorite irrigating solution is used for irrigation. The final irrigation is done
by dividing the samples into nine groups. Final irrigation is done for 3 minutes, 10 minutes and 15 minutes with
20 ml of the irrigation solutions, EDTA-T, 10% Citric acid and 17% EDTA. The solution is collected in a container
after the required time periods for each group and calcium concentration in the solution used for final irrigation
is determined by using atomic absorption spectroscope. The values are recorded and the data is statistically
analyzed using one-way ANOVA for multiple group comparisons followed by Newman-Keul’s range test for
pairwise comparisons, with level of significance as 5%.
Results: 10% citric acid showed maximum amount of calcium extracted. 17% EDTA also showed calcium extraction
similar to citric acid but comparatively less. EDTA-T showed least amount of calcium extraction, though it had the
best penetrability of 17% EDTA because of the presence of surfactant 1.25% sodium lauryl ether sulfate.
Interpretation and Conclusion: Overall, the maximum decalcification of the root canal with respect to calcium
ion extraction was seen with 10% citric acid.
Key words: biomechanical preparation, final irrigation, decalcification, calcium extraction, chelation.

to report the presence of smear layer on root canal

The success of endodontic treatment is mainly

walls. The smear layer is an amorphous structure

dependant on thorough cleaning and shaping of root

composed of an organic portion, that is coagulated

canal system. A clean root canal system along with

proteins, necrotic and normal pulpal tissue, saliva,

a three dimensional seal is the clinician’s road to

microorganisms, etc. and an inorganic portion that

success. In endodontics smear layer results directly

is minerals from the dentinal structure. Thus,

from instrumentation used to prepare the canal wall.

adequate removal is not possible only by sodium

Because the tooth structure is cut, instead of being

hypochlorite but a chelating agent is required for

uniformly sheared, the mineralized matrix shatters

removal of inorganic dentin. Ostby, found that

and forms smear layer, which is scattered over the

EDTA reduced the time necessary for debridement,

dentinal surface. McComb and Smith were the first

aided in enlarging narrow or obstructed canals. The

* Post-graduate Student, ** Professor, *** Professor & Head. # Dept Of Conservative Dentistry & Endodontics, College Of Dental Sciences, Davangere-577004


Although The solution was collected in a container after 1. Citric acid is less cytotoxically irritable to used for irrigation.ENDODONTOLOGY DECALCIFYING EFFECT OF THREE CHELATING AGENTS solution is neither bactericidal nor bacteriostatic. acid is related to its low pH. for multiple group comparisons followed by METHODOLOGY Newman-Keul’s range test for pairwise comparisons. All experimental teeth are cleaned and dried but it inhibits the growth of eventually destroyed in a desiccator for 1 hour. The last citric acid as an endodontic irrigant. For final irrigation. One-way ANOVA is used extraction from the root canal dentin. association of Tergentol (sodium lauryl ether sulfate) Group 6 : 20 ml of 10% EDTA for 10 minutes. Tergentol could Group 8 : 20 ml of 17% EDTA for 15 minutes. was used with a no. reported the effects of removal of smear layer no. the teeth were rinsed in tap water to RESULTS remove the attached soft tissue and stored in In all the solutions the calcium extraction is deionized water (pH7). In endodontics. freshly extracted maxillary incisors collected. denaturation of proteins. that the smaller the concentration of citric acid Group 1 : 20 ml of EDTA-T for 3 minutes. stimulate a reduction in its surface tension and Group 9 : 20 ml of 10% citric acid for 15 minutes. Group 4 : 20 ml of EDTA-T for 10 minutes. 10% Citric presented as mean.25% sodium lauryl ether sulfate with 17% EDTA the required time periods for each groups and the did not allow calcium removal with same intensity calcium concentration in the solution used for final as EDTA. showing at the middle third of the tooth. the smaller the antimicrobial effect of citric Group 2 : 20 ml of 17% EDTA for 3 minutes. addition of a surface-active agent. A high-speed handpiece generally effective at pH of 7. Descriptive data are is to determine the efficacy of EDTA-T. study. The purpose of my study absorption spectroscope. After extraction. citric acid is widely accepted as an irrigant. which promotes the Group 3 : 20 ml of 10% citric acid for 3 minutes. with Furacin later with EDTA. Access opening was done bacteria by the process of starvation. Goldman et instrument to be used in the apical third is K-file al. but further research is still being carried irrigation was determined by using atomic out in respect to EDTA-T. At each instrument change. the groups tissue than EDTA. standard acid and 17% EDTA with respect to calcium ion error and range values. obtained with citric acid were similar to those by 80. It is believed that Group 7 : 20 ml of EDTA-T for 15 minutes. Smith and Wayman concluded were divided as follows. Yamaguchi et al. EDTA is for all the selected teeth. proposed instrumentation in all ninety teeth.4 round bur on the lingual side. A P-value of 0. Citric acid has also been shown to be effective on anaerobic microorganisms. till the time of experimental 44 . Pavia and Antoniazzi first recommended the Group 5 : 20 ml of 17% EDTA for 10 minutes.05 or less was considered statistically The experimental method consisted of ninety significant.2. Biomechanical its biocompatibility compared to EDTA and effective preparation was done using step back technique of smear layer removal. standard deviation. wettability and improve its penetration into the uninstrumented areas of root canal system. 2ml of NaOCl is EDTA. 40 and in the middle/coronal third is K-file no. solution.

90 17% EDT A EDTA 82. Citric because it precipitates in the canal to form crystals.2 – 36.6 1.2 1. MEAN.6-198.7 90. EDTA-T has been used for better penetration antimicrobial effect.5 2.45 3. amount of calcium extraction in comparison to 17% yet it is not preferred to be used in dental clinics EDTA and EDTA-T at all three time intervals.4 68.ENDODONTOLOGY DECALCIFYING EFFECT OF THREE CHELATING AGENTS CALCIUM EXTRACTION OF THREE SOLUTIONS AT THREE DIFFERENT TIME INTERVALS seen to be highest in the first 10 minutes.82 130.01.8 are effective in effective three dimensional seal.32 110.8 10% Citric Acid 70.8. EDTA-T extracted the least effect was seen between 3 and 10 minutes.6 168.5 6.4 31. It has a disagreeable removal of smear layer.4 DISCUSSION SE Range Mean SD 80. 10 AND 15 MINUTES (ppm) 3 Minutes Materials 10 Minutes Range Mean SD EDT A–T EDTA 28.7 1.8 4.01 SE itself by my study to be the most effective in terms 10% citric acid has shown to have the highest of calcium ion extraction out of the three solutions. citric acid has maximum efficacy in terms of calcium extraction.8 – 96.5 3.128.88 5. showing that the maximum effect is at early time periods. All recording done has a P-value less than 0.15 188.2 117.6 1.9 5.33 162.6-84.6-174. helps level and association of 1.9 4. Overall.2. when compared with 10% citric acid and with 17% EDTA.2-78. The amount of calcium from root dentin compared to probable reasons for this could be as it forms 10% citric acid and 17% EDTA at the three times it complex with calcium of tooth which is greater than has shown an increase in permeability at the apical that of EDTA.1 77.146. It is also economical compared to of calcium ions with same intensity as EDTA used EDTA and at concentrations used in dentistry it has alone.3 SE 15 Minutes Range Mean SD 58.2 1.05 4.9 1.2-98. EDTA-T solution has the least efficacy in terms of calcium ion extraction at the three different time intervals. Though citric acid has proved of 17% EDTA into the dentinal tubules by use of 45 .8 89. At 3 minutes there is a significant statistical difference between EDTA-T and 10% citric acid and between EDTA-T and 17% EDTA. RANGE. STANDARD DEVIATION OF Ca++ REMOVAL AFTER 3. At fifteen minutes the calcium ion extract readings are less.5 193.9 0.25% sodium lauryl ether in cementum formation and periodontal tissue sulfate with 17% EDTA did not allow the chelation regeneration. acid compared to EDTA is as good a chelating agent. It is biocompatible to the tissues.2 1. which may harbor microorganisms and hamper the The 10% solutions with a pH of 1.2 137. showing the time dependant effects. The maximum decalcifying odor and sour taste.7 2.

it is self-limiting and shows no corrosive effect on instruments. Koulaouzidou EZ. but according to my efficacy. intertubular dentin. EDTA of pulp remnants. inhibits macrophage function. Overall. 17% EDTA though 17% EDTA was statistically similar with respect to an efficient chelating agent. GonzalezRodriguez MP. if we think in terms of calcium extraction. Ostby proposed the use of EDTA because. inflammatory reaction of is generally used as it has a decalcification action. But thinking in terms of an efficient smear layer removal and patient comfort. 2. Oral Surgery Oral Medicine Oral pathology. 10% Citric acid and 17% EDTA on root canal dentin. than EDTA. 2004. Beltes P. Oral Surgery Oral Medicine Oral pathology. 25(1): 21-23.ENDODONTOLOGY DECALCIFYING EFFECT OF THREE CHELATING AGENTS the surfactant Tergentol (1. At 3 minutes 4) In dental clinics because of its crystal there was a slightly more decalcification of 17% precipitation in the root canal that harbors EDTA than 10% citric acid. Haznedaroglu F. out of the three 5. 28(1): 17-19. abut at 10 and 15 microorganisms and prevents an effective three minutes citric acid showed more decalcification dimensional seal. Journal of Endodontics. its leakage to periapical tissues efficient in final irrigation. sodium lauryl ether sulfate present which decreases 46 . EDTA and Citric acid on smear layer removal. Teixeira AM. both can be recommended as good study. 10% citric acid is an ideal 4. 2003. 96(3): 340-344. Decalcification of root canal dentin by citric acid. helps make possible the bypassing of broken instruments in 3. 95(2): 23423 solutions EDTA is the most ideal. periapical tissues. 98(4): 499-503. Cytotoxic effects of different concentrations of neutral and alkaline EDTA solutions used as root canal irrigants. International Endodontic Journal. Calt S. sour taste and disagreeable odor. solution. placed second in line of use after 10% citric acid. causing erosion of peritubular and 1. supported by various authors it should be decalcifying agents. Thus. EDTA and sodium citrate. Time dependant effects of EDTA on dentin structures. Margelos J. This could be as EDTA causes necrosis citric acid is not preferred as a final irrigant. Oral Surgery Oral Medicine Oral pathology. Serper A. because of the surfactant. Scelza MFZ. Machado-Silveiro LH. Pereira M. Effect of three different time periods of irrigation with EDTA-T. from my study. Scelza P. 2003. increases wettability of the uninstrumented areas 3) Calcium extraction with 10% citric acid and and helps remove smear layer. Efficacy of various concentrations of citric acid at different ph values for smear layer removal. It showed similar effects to citric acid. Gonzalez-Lopez S. 2) EDTA-T shows most efficient penetration into the root canal dentin. Decalcifying effect of EDTA-T. Kortsaris AH. canals. toxicity has been shown at 17% though comparatively less than citric acid but concentrations. Scelza P. Pierro V. reduces time necessary for debridement. it has certain dentin dissolving effects. 2004. 1) Least amount of calcium ion extraction at the three time intervals is seen with EDTA-T. 1999. Journal of Endodontics.2002. Scelza MFZ. 37: 365-369.25% sodium lauryl ether surface energy thus increasing the wettability of sulfate) which reduces the surface tension and EDTA and its better penetrability. CONCLUSION The following conclusions have been drawn 6. it has also shown time BIBLIOGRAPHY dependant effect. aids in enlarging narrow or obstructed canals.