CHELATING AGENTS

IN ENDODONTICS
KANWALPREET DHALIWAL

CONTENTS

INTRODUCTION
HISTORY
USES
PREPARATIONS AVAILABLE

WORKING TIME

BIOCOMPATABILITY

ANTIBACTERIAL ACTIVITY
EFFECT ON OBTURATION

MECHANISM OF ACTION

EFFECT OF ROOT STRUCTURE

BLEACHING EFFECT

ROLE OF IRRIGANTS

CONCLUSION

ROLE OF SMEAR LAYER

RECOMMENDATIONS

INTRODUCTION
CHELATE----- CHELE----- CRAB CLAW
Stable complexes metal ions with organic
substances --- ring shaped bonds.

Stability of bond:
Chelator: more than one free pair of electrons
Central metal ion: less electrons

(Grossman et al 1988)

Action of Chelator
Ability to bind and inactivate metal ions.
Used for excretion of dangerous ions in
metal poisoning or copper metabolism
disturbances.( Zeeck et al 1992)

HISTORY
1951 first reports of demineralizing effects of

EDTA on dental hard tissues Hahn & Reygadas.

Phenolorphonic acids, reverse aqua regia, caustic

elements used.
1957 NYGAARD OSTBY endodontics 15%

EDTA(pH 7.3)
1963- EDTAC (0.84g cetavlon- detergent)-Goldberg.
1969- RC- PREP- Stewart et al paste type chelator.

USES
Adjuncts endodontic therapy
Removal of smear layer
Increased importance-

NiTi instruments.

rotary

Chelator preparations:
Liquid type
Paste type

Liquid type:
Calcinase:

Lege artis, Dettenhausen, Germany.

17% sodium EDTA
Sodium hydroxide stabilizer
Purified water.

REDTA:
o
o
o
o
o

Roth international, USA

17% EDTA
0.84g cetyl tri methyl ammonium
bromide cetrimide
9.25 ml- 5 M NaOH
100ml distilled water

EDTAC & DTPAC:

EDTA 15%, diethyl triamine penta acetic

acid

pH 8
0.75g cetyl tri methyl ammonium bromide

100ml

EDTA- T
Formula & Acao farmacia, Brazil
17% EDTA
Sodium lauryl ether sulphate

( Tergentol)

EGTA
Sigma, USA
Ethylene glycol bis- N,N,N,Ntetra acetic

acid (beta amino ethyl ether)

Binds to calcium ions more specifically than
EDTA.

CDTA:
1% solution cyclohexane 1,2diaminetetraacetic acid

Experimental solution

Largal Ultra
Septodont, France

15%EDTA as disodium salt

0.75% Cetrimide
Sodium hydroxide
pH 7.4

Salvizol

Ravens Germany

5% aminoquinaldinum diacetate

Propylene glycol

pH 6.6

Decal

Veikko Auer, Finland

5.3% oxyl-acetate
4.6%ammonium oxyl acetate
0.06% cetyltrimethyl ammonium bromide
pH 3.4
Acid component and chelator

Tubulicid plus
Dental therapeutics, Sweden

1.5g amphoteric-2(38%)
0.5g benzalkonichloride
3g disodium EDTA dihydrate
Phosphate buffer solution
100g distilled water
50% citric acid

Hyapaque

5%NaOCl

17% EDTA

Hyapaque:- high contrast injectable dye

diatrizoate meglumine
sodium iodine
water soluble
pH 6.7 7.7

Ruddles solution

Paste type
Calcinase slide

Lege artis, Germany

15% sodium EDTA

58 64% water
No peroxides, preservatives- self preserving
pH 8-9

RC Prep:

Premier dental, USA

10% urea peroxide

15% EDTA
Glycol
Aqueous ointment base

Glyde file
Detrey Dentsply, Germany

15% EDTA
10% urea peroxide

Filecare EDTA:
VDW antaeous, Germany

15% EDTA , 10% urea peroxide

File EZE
Ultra dent, USA

19% EDTA

Chelator preparations:
Liquid type
Calcinase
REDTA
EDTAC&DTPAC
EGTA
CDTA
Largal ultra
Salvizol
Decal
Tublicid plus

Paste type
Calcinase slide
RC Prep
Glyde file
File care EDTA
File EZE.

Advantages of pastes:
Can be easily mixed with water, easy to rinse out of

canal.
Thixotrophic- firm at room temp.
Easily adheres to instrument and root canal walls.

Mechanism of action
PRINCIPLE:

Concept of constant solubility product of dentin

by EDTA and its sodium salt.( Nygaard & Ostby)
Tooth dentin + EDTA
precipitate saturated
salt solution( constant conc.)
ions
solids

Phosphate + calcium (soluble in water, part of

dentin)

Calcium, phosphate + 2 Na EDTA

ions

Further dissolution of calcium ions continues .

calcium

Action is self limiting:

When all the ions are bound , demin stops.
EDTAH-3 + Ca 2+
EDTAH 3- + H

EDTACa 2- +H
EDTAH22-

Deprotonation of EDTA occurs as the pH falls

and reaction decreases.

Demin continues till all the ions get bound.
Nygaard & Ostby

Acc. To Paterson:
Action is not self limiting:
Continues till all the chelators
form complexes with calcium at
pH 4-5.

Effect of root structure

demineralization in coronal and
middle third.
demineralization in apical portion.

Apical portion:
increased

sclerosis(schroeder 1992)

less NCP/ non collagenous matrix proteins

EDTA removes ca bound with NCP and NCP

as such

Effect is amount of solution dependant

Apical portion- narrow canal- less sol less

demin.

Role of irrigants:

NaOCl accelerates erosion of dentinal

tubules( Niu 2002)

Synergistic effect

As smear layer is removed, increased

dentin permeation occurs leading to crystal

formation in the d.t. which decreases the
permeability. NaOCl removes these crystals.
(mjor2002)
Increased permeability- decreased

microleakage- better obturation.

EDTA+ NaOCl+ ultrasonic

(Goldberg, Yamada, Abbott, Baumgartner)

Cleaning action

Antimicrobial action

EDTA: removes smear layer(Mc Comb& Smith)

Causes dentinal tubule erosion(Torabinejad)

Dissolution of peritubular dentin(Goldberg )

Na0Cl no effect on EDTA

EDTA- decreases the effect of NaOCl( Cl
decreases by 0.50 to 0.06%)(Graweher 2003)
Therefore use the two solutions separately

Ultrasonic:(Abbott 1991)
Decreases the effect of EDTA:
Decrease the working time
Hinder the reaction.
Therefore use ultrasonics with NaOCl

Smear layer
Ground substance, pulpal remnants,

odontoblast processes, irrigants,

bacteria(infected teeth)

1.Removal of SL(Brannstrom, Bystrom,

Sundvist:

Increased bacterial multiplication

Decreased permeation of intracanal

medicaments

Decreased adaptation of GP.

2. Do not remove smear layer(diamond and

carrel)

Prevents bacterial invasion of dentinal tubules

Not a site of bacterial colonization

Working time of EDTA

15min (Goldberg & Spielberg)

14 hrs (MCCOMB ands Smith)

No diff 15min/14hrs(Nicholsan)

1-5 min (Yamada)

1 min exposure removes smear layer

10 min exposure increases peritubular and intertubular

erosion, undesirable( Calt Serper)

Therefore, no definite time recommended for optimal working.

Biocompatibility of chelating
agents
Nygaard& Ostby: 15% EDTA no periapical damage.

Paterson 1963 no effect of EDTA but EDTAC causes

increased periapical damage.

Lindeman 1985 EDTA not capable of collagen

destruction.

Cao et al 1992 if dentin intact, no affect on pulp

( used for dentin conditioning)

Koilaouzi et al 1999 severe irritation and cytotoxic.

Segura et al 1996 :

Irreversible decalcification of periapical bone.

Inhibits binding of vasoactive intestinal peptides)VIP) to
macrophages thus altering their action:
Increased inflammatory initiation
Decreased phagocytic activity
Increases plasma extravasation
Increased mediator action
Decreased action potential of nerves

EXTRUSION OF EDTA INTO PERIAPICAL TISSUES SHOULD BE AVOIDED.

ANTIBACTERIAL ACTIVITY OF
EDTA

Causes chelation of cations from the outer

membrane of bacterial cells
Activity present only till it has not formed bonds
with other metal ions
Zone of bacterial inhibition produced.
Increased efficacy with NaOCl( Bystrom &
Sundqvist)
Smear layer removal a must.

Antibacterial activity of various

products:
REDTA:
Salvizol- fungicidal, broad spectrum
antimicrobial(Narwrath 1960)
Decreases toxicity
Inhibits anaerobic growth.

RC Prep:
Increased efficacy against gram negative bacteria
Urea peroxide: oxidizing antibacterial agent., retains

activity in presence of blood.

Decreased growth of porphyromonas gingivalis,

strepto. Sobrinus, prevotella nigrescens.

 94.4% decrease in bacterial growth without intracanal

medicament.
(Steinberg 1999)
Antibacterial concentration:
0.25%EDTA
0.5% urea peroxide
50% glycol

Effect of EDTA on quality of

obturation

Increased accessory canal obturated(Villegas

2002)
Best results: Obtura II, system B
Sealers:
Best adhesive seal: sealer 26 (Dentsply)
Ca(OH)2 sealers: only slight increase in
adhesion.

Negative effect( Morris et al

2001)
Decreased bond strength of resin cements to
root treated with EDTA and NaOCl:
EDTA leaves a chelated dentin layer at the
dentin sealer interface
Residual EDTA ongoing demineralizationincreased apical leakage
EDTA and ZOE sealers: no significant diff in
leakage.

Bleaching effects:
Release of oxygen from urea

peroxide causes
effervescence but no bleaching
effect noted ( Mattis & Attin et al
2003)

Conclusions
Use of chelators recommended

during C&S.
Reduce the extent of smear layer

produced.
Effectiveness depends on the time

Effect decreases from coronal

towards apex.
Antibacterial effect is low, do not

replace liquid EDTA as irrigants in

place of NaOCl.
No evidence of bleaching noted.

Recommendations:
Before adding EDTA, dissolve the vital/ necrotic

tissue with NaOCl.

Chelator acts as a lubricant, reduces the incidence

of file fracture, no definite clinical evidence.

A final rinse of EDTA helps remove smear layer,

increases adhesion of sealers.

Use for 1 to 5 min.

Liquid EDTA can be introduced with

pipette or cotton to identify entrance to

calcified canals.
Apical extrusion is to be avoided.
Dont use to open a ledge or block in the

canal( perforations)
Do not use glass syringe to deliver EDTA.