 Introduction

 Definition
 History
 Composition
 Parts
 Morphology
 Effect of smear layer
 Smear layer in restorative
dentistry
 Smear layer in
endodontics
 Conclusion

2
 INTRODUCTION

Unknown and unrecognized for years, 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. Most dentists know now it exists but are often puzzled
as to whether or not they should cope with it. Since the smear layer
has been recognized, dentist have come to realize that they must
renew their acquaintance with the science of dental materials so they
can understand the relationships of the products they work with to
the smear layer.

4
 According to Schwartz:
It is defined as any debris, calcific in nature, produced
by reduction or instrumentation of dentin, enamel or
cementum or as a contaminant that precludes
interaction withAccording to Cohen:
the underlying pure tooth tissue.
Cutting of the dentin during cavity preparation
produces microcrystalline grinding debris that coats
the dentin and clogs the orifice of dentinal tubules.
According to American Association of Endodontics
This layer of debris is termed as smear layer.
(AAE)
It is defined as a surface film of debris retained on
dentin or other tooth surface like enamel, cementum
after instrumentation with either rotary instruments
or endodontic
According to DCNAfiles.
(1990):
When a tooth structure is cut instead of being
uniformly sheared the mineralized matrix shatters. Most
of which is scattered even the enamel and dentins
surfaces to form a layer; termed as SMEAR LAYER.
5
HISTORY
SEM first reported by Eick et al. (1970) showed that the smear layer
was made of particles ranging in size from less than 0.5–15 µm.
SEM studies of cavity preparations by Brannstrom & Johnson
(1974) demonstrated a thin layer of grinding debris. They estimated
it to be 2–5 µm thick, extending a few micrometres into the
dentinal tubules.
First researchers to describe the smear layer on the surface of
instrumented root canals were McComb & Smith (1975). They
suggested that the smear layer consisted not only of dentine as in
the coronal smear layer, but also the remnants of odontoblastic
processes, pulp tissue and bacteria.
Lester & Boyde (1977) described the smear layer as ‘organic matter
trapped within translocated inorganic dentine’. As it was not
removed by sodium hypochlorite irrigation, they concluded that it
was primarily composed of inorganic dentine.

6
HISTORY
Cameron (1983) and Mader et al. (1984) discussed
the smear material in two parts: first, superficial
smear layer and second, the material packed into the
dentinal tubules. Packing of smear debris was
present in the tubules to a depth of 40 µm.

Brannstrom & Johnson (1974) and Mader et al.

(1984) concluded that the tubular packing
phenomenon was due to the action of burs and
instruments. Components of the smear layer can be
forced into the dentinal tubules to varying distances
(Moodnik et al. 1976, Brannstrom et al. 1980, Cengiz
et al. 1990) to form smear plugs.

7
HISTORY

When viewed under the SEM, the smear layer often

has an amorphous irregular and granular appearance
(Brannstrom et al. 1980, Yamada et al. 1983, Pashley
et al. 1988) (Fig. 3). The appearance is thought to be
formed by translocating and burnishing the superficial
components of the dentine walls during treatment
(Baumgartner & Mader 1987).

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 COMPOSITION
RESTORATIVE DENTISTRY
 Denatured collagen
 Hydroxyapatite and other cutting debris
Superficial layer of dentin is more important
because the bond strength of all adhesive
systems is always 50% more in this layer. This
can be attributed to the fact that the smear
layer found in deep dentin contains more
organic material than those found on the
superficial dentin
ENDODONTICS
Organic :
 Heated coagulated proteins
 Necrotic or viable pulp tissue
 Odontoblastic processes
 Saliva
 Blood cells and micro-organisms.
Inorganic:
 minerals from dentinal structures
 hydroxyapatite crystals
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PARTS

Bilaminar structure present on all restoratively or endodontically treated

dentinal surfaces unless it has been treated with acid or chelating agent.

Average depth of 1-5μm. The depth entering the dentinal tubules may vary
from a few microns upto 40μm.
The two parts of the smear layer are: 1) The superficial layer
2) The deep layer

10
PARTS
Outer layer (superficial layer) is thin, amorphous, easy to remove and about 1-5 μm thin.
Lies on the actual tooth surface, covering or overlying the tubules and intertubular dentin. Various factors will
determine the depth of this layer.

IN RESTORATIVE DENTISTRY
 Dry cutting of dentin - thicker layer as compared to when dentin was cut with a water coolant.
 Use of coarse diamond burs - a thicker layer than carbide burs, which produces a thicker smear layer than
finishing burs.
 Smear layer produced with high speed is more difficult to remove than that produced with low speed.

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PARTS
IN ENDODONTICS
 Filing a canal without irrigating will produce a thicker smear layer than those in which constant canal irrigation is
done.
 Closer the instrument to the dentinal walls (narrow canals) the more is the centrifugal force and the smear layer
will be thicker and more resistant .
 Thickness of smear layer found with the use of different endodontic instrument in increasing order was found to
be as hand files, profiles and protapers.
 Use of sodium hypochlorite with EDTA was found to be more effective in reducing or removing the smear layer
because of the synergistic action of the two.

Deep layer (inner layer/ smear plugs):

• Consists of materials which have been forced into the dentinal tubules, forming a smear plug which occludes the
tubules and strongly adheres to the canal walls.
• These can extend upto 40μm into the tubules.
Many theories have been proposed to describe the formation of the smear layer.
 Brannstrom and Johnson concluded that this packing of the smear plugs was due to the rotatory action of burs
and endodontic instruments. This rotation causes the centrifugal scattering of the smear material which enters the
tubules if they are oriented properly.
 Cengiz proposed that the adhesive forces between the dentinal tubules and the smear material formed smear
plugs by capillary action.
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M In restorative dentistry
O o When tooth structure is cut, the matrix shatters and produces considerable amount of debris.
o When this is viewed under low magnification, tungsten carbide burs produce troughs which run perpendicular to the direction of
R the handpiece.
o Fine grooves are seen which run parallel to the rotating bur. This phenomenon is called as galling and the frictional humps
represent a rebound effect of the bur against the tissue.
P
H
IN ENDODONTICS
O  Once the root canal has been instrumented, the high magnification of electron microscope discloses the normal canal anatomy that
has been lost and that a thick smear layer has been formed.
L  Dentin surface of the canal appears granular, amorphous and irregular.
 Packing material shows a segmented appearance as if it had been packed in increments. Tubule packing is seen when less than half
O the circumference of the tubule has been fractured away. This packing phenomenon is not seen if more than half the circumference
of the tubuleofhas
SEM picture thebeen fractured.
galling pattern on a dentin surface Grooves traversing the dentin surface abraded with diamond
G
Y 13
EFFECTS OF SMEAR LAYER
Dental materials:
• Attachment of the smear layer to the underlying dentin is about 5 μm.
• Initial sealing process under amalgam restorations maybe compromised
because of instability of the smear layer and its penchant for leaching under
amalgam. This will produce a widening of the amalgam tooth micro-crevice
and ultimately weaken the sealing mechanism. In order to reduce the
microleakage, a layer of liner should be applied before condensing
amalgam.
• Glass ionomer cements and composite resins bond to the tooth structure
by chemical means. However this chemical bonding may be affected in the
presence of the smear layer.

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EFFECTS OF SMEAR LAYER
Dentin permeability:
• Dentinal tubules act as a pathway for irritants towards the pulp.
• Diameter of the tubules at the pulpal end is greater than that at the
dentinoenamel junction which increases the dentin permeability in the deeper
layers. The smear plugs lower dentin permeability by forming a physiologic
barrier to hydrodynamic fluid shifts and to bacterial toxins.
• Thus, removal of smear layer will increase permeation diffusion by 5-6 times and
by convection by 25-36 times.
[In diffusion, there is movement of substance from higher to lower concentration and the
concentration of the substance is dissipated over a distance.
In convection, movement of substance is due to a pressure gradient but no dissipation of
concentration occurs.]
• These problems must be considered whenever dentin is etched to facilitate
retention of a restorative material. If such restorations undergo microleakage or
fracture, the etched dentin will be more permeable than the dentin with an intact
smear layer.

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EFFECTS OF SMEAR LAYER
Dentin sensitivity:
• Rapid movement of the dentinal fluid within the tubules will stimulate the A delta nerve fibers to produce a brief,
sharp, well localized pain called dentinal hypersensitivity.
• Smear layer offers a major resistance to fluid movement across dentin which is an important mechanism of dentin
sensitivity. It has been seen that 15 seconds of acid etching will increase the fluid movement by 20 times. This will
result in an increased dentinal sensitivity if the dentin is not sealed with a restorative material.
• Restorative materials or techniques which do not require the removal of smear layer tend to create less post -
operative sensitivity. This is because the smear layer and plug complex account for 86% of the resistance to fluid
movement across dentin.

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EFFECTS OF SMEAR LAYER
Endodontics:
 During instrumentation, the smear layer produced harbours bacteria and its
products which can provide a reservoir of potential irritants.
 It may crack open and pull away from the underlying dentinal tubules. This
can hamper the gutta percha obturated over the smear layer. Therefore
removing it will aid in better adaptation of sealers and obturating materials in
the dentin by increasing the permeability of dentin.

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EFFECTS OF SMEAR LAYER
Role played in microleakage :
 Microleakage is defined as the movement or flow of oral fluids and bacteria into
the microscopic gap between a prepared tooth surface and a restorative material.
This can cause recurrent caries and sensitivity.
 Most restorative materials cause some amount of leakage due to solubility of
cements, differences in coefficient of thermal expansion and inability of materials to
adapt 100% to the walls of the tooth.

 Williams and Goldman showed that the smear layer delayed the penetration of
Proteus and Vulgaris. A. Viscosus and Cornybacterium are capable of digesting the
smear layer however, they cannot remove the smear plugs. If the smear layer is
removed by acid etching, then bacterial invasion into the dentinal tubules will take
place a lot more easily. Removal of smear layer decreases micro leakage but
increases permeability.

 Smear layer on root canal walls acts as a physical barrier and may reduce adhesion
and penetration of the sealer into the tubules. If the smear layer is not removed, the
durability of the apical seal should be evaluated over a long period.

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EFFECTS OF SMEAR LAYER
Post cementation:
Removal of the smear layer increases the bond and tensile strength of the
cementing medium.

Glass ionomer cements are effective in post cementations after smear layer
removal because, of better chemical union with the tooth structure.

When an unfilled BISGMA resin was used after sodium hypochlorite and EDTA
rinse, the strength of the resin bond was better as the smear layer was removed
by flushing with EDTA and sodium hypochlorite , the BISGMA resin flowed into
the exposed dentinal tubules and into the serrations on the post thereby
improving the retention.

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SMEAR LAYER IN RESTORATIVE DENTISTRY
Smear layer removal is a controversy that fluctuates with the various modalities of restorative
dentistry.
In operative dentistry, it may depend on the type of dentin adhesive used or the use of glass ionomer.
Smear layer and smear plugs physically form a superficial protective layer, which covers the cut dentin
surface and seals the dentinal tubule orifices. Thereby reducing
 Fluid hydrodynamic flow in the tubules.
 Penetration of irritation chemicals inside dentin.
 Preventing further entry of bacteria into tubules and resultant colonization and pulpal irritation.
 Serves as an iatrogenically insulating layer.
However the smear layer itself may become a cause of future insult and damage the pulp.

Inside the preparation, if the smear

layer remains, it protects the pulp by
plugging the tubules, preventing On the other hand, if it is removed, it allows
ingress of bacteria and their toxins as absolute adaptation of the restoration to the
well as chemical toxins. true dentin surface, especially in the case of
resins and amalgams.

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SMEAR LAYER IN RESTORATIVE DENTISTRY
The weak nature of bonding of smear layer to underlying dentin and enamel also serves as an area of
potential bound failure. Thus in summary bond failures can occur at
 Smear layer-tooth surface
 Within smear layer itself
 Between smear layer and restorative material

Answer seems to lie:

Agents that clean the dentin surface yet leave tubules still plugged or better yet,
completely clean the dentin and the tubuli orifices and then replug the tubules
with a precipitate or a bonding agent.
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SMEAR LAYER IN RESTORATIVE DENTISTRY
AGENTS FOR SMEAR LAYER REMOVAL:
Buonocore, in 1955, was first to reveal the adhesion of acrylic resin to acid etched enamel. He used 85%
phosphoric acid for etching, later Silverstone revealed that optimum concentration of phosphoric acid
should range between 30-40% to get a satisfactory adhesion in the enamel.

 37% phosphoric acid is used for 15 to 30 seconds. If the concentration is greater than 50 percent,
then monocalcium phosphate monohydrate may get precipitated while at concentrations lower than 30
percent, dicalcium phosphate monohydrate is precipitated which interferes with adhesion.
 Citric acid: Acid etching dentin for 60 sec with 6% citric acid removed nearly all of the smear layer as
well as the surface peritubular dentin of the tubules.
 Polyacrylic acid: It is used in combination with glass ionomer cement. An application of not more
than 5 sec followed by a copious water rinse results in cleaner surface.
 Maleic acid: Maleic acid has been in use as acid conditioner in some adhesive systems.

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SMEAR LAYER IN RESTORATIVE DENTISTRY
Classification of Modern Adhesives
Basically, three adhesion strategies have been employed to modern dentin bonding agents on the basis of their
interaction with the smear layer. These are:
1. Smear layer modifying agents
2. Smear layer removing agents
3. Smear layer dissolving agents.
Smear Layer Dissolving Adhesives
These agents partly demineralize the smear layer and
Smear Layer Removing the Dentin Adhesives
superficial dentin surface without removing the
Smear Layer Modifying Agents
 Bonding agents completely remove the smear layer
 Bonding agents modify the employing
smear layertotal
& incorporate smear plugs. They make use of acidic primers also
etch concept. They work
termed onetch
as self the primers or self etch adhesives which
it in the bonding process. principle of hybrid layer and resin tags.simultaneous conditioning and priming of both
Steps: In these, enamel is Steps:
selectively provides
In etched
these, with 37% and dentin are etched
enamel enamel and dentin. After this, adhesive is applied
phosphoric acid (taking care not to etch dentin). After
simultaneously using an acid (preferably 37% phosphoric
washing and drying the tooth, primer and adhesive are without washing the tooth surface.
acid). After washing and drying Thethe tooth
basis surface,
for use primer
of these systems is to condition the
applied separately or in combination. This results in
and bonding agent are applieddentin eitherand
separately or in
micromechanical interaction of dentin and bonding to simultaneously penetrate to the depth of
combination. For example: demineralized dentin with monomers which can be
system without exposure of •collagen fibrils. For example,
Scotch bond multipurpose
Prime and Bond. polymerized. For example:
• Gluma. • Self etch primer – Adper prompt
• Self etch adhesive – Prompt – L – pop
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SMEAR LAYER IN RESTORATIVE DENTISTRY

23
SMEAR LAYER IN RESTORATIVE DENTISTRY

24
SMEAR LAYER IN RESTORATIVE DENTISTRY

25
SMEAR LAYER IN RESTORATIVE DENTISTRY

26
SMEAR LAYER IN ENDODONTICS
Should the smear layer be removed?
Yes as
 Unpredictable thickness and volume, because a great portion of it consists of water.
 Bacteria, their by-products and necrotic tissues may survive and can proliferate into
the dentinal tubules which may serve as a reservoir of microbial irritants.
 Limit the optimum penetration of disinfecting.
 It can act as a barrier between filling materials and the canal wall and therefore
compromise the formation of a satisfactory seal.
 It is a loosely adherent structure and a potential avenue for leakage and bacterial
contaminant passage between the root canal filling and the dentinal walls

27
SMEAR LAYER IN ENDODONTICS
METHODS TO REMOVE smear layer:
Most common chelating solutions are based on EDTA which reacts with the calcium ions in dentine and
forms soluble calcium chelates. EDTA decalcifies dentine to a depth of 20–30 µm in 5 min.

Different preparations of EDTA have been used as a root canal irrigants.

 Root canal preparations i.e. a mixture of EDTA and urea peroxide left a residue of this mixture after
instrumentation. This may have disadvantages in the hermetic sealing of root canals.
 The combination of EDTA + cetrimide (a quarternary ammonium bromide) left no smear layer except in the
apical part of the canal.
 Bis-dequalinium-acetate (BDA), a dequalinium compound and an oxine derivative has been shown to remove
the smear layer throughout the canal, even in the apical third. BDA is well tolerated by periodontal tissues and
has a low surface tension allowing good penetration. It is considered less toxic that NaOCl.
Salvizol is a commercial brand of 0.5% BDA and possesses the combined actions of
chelation and organic debridement. When comparing Salvizol with 5.25% NaOCl, both were found comparable in
their ability to remove organic debris, but only Salvizol opened dentinal tubules (Kaufman & Greenberg 1986).

28
SMEAR LAYER IN ENDODONTICS
 Tetracyclines have unique properties in addition to their antimicrobial aspect. They have low pH in concentrated
solution, and because of this can act as a calcium chelator and cause enamel and root surface demineralization
(Bjorvatn 1982).
Haznedaroglu & Ersev (2001) showed that 1% tetracycline
hydrochloride or 50% citric acid can be used to remove the smear layer from surfaces of root canals. Although
they reported no difference between the two groups, it appeared that the tetracycline demineralized less
peritubular dentine than the citric acid.

 Torabinejad et al. (2003) developed MTAD (mixture of a tetracycline isomer, an acid, and a detergent) an
effective solution for the removal of the smear layer. This irrigant demineralizes dentine faster than 17% EDTA
(De-Deus et al. 2007).

SODIUM HYPOCHLORITE & EDTA

Goldman et al. (1982) examined the effect of various combinations of EDTA and NaOCl, and the most effective final
rinse was 10 mL of 17% EDTA followed by 10 mL of 5.25% NaOCl, a finding confirmed by Yamada et al. (1983).

29
SMEAR LAYER IN ENDODONTICS

QMiX is a novel endodontic irrigant for smear layer removal with added antimicrobial
agents. It contains EDTA, CHX and a detergent. Despite the CHX content, mixing
QMiX with sodium hypochlorite does not produce any precipitate and the solution
does not turn brown/orange.

30
SMEAR LAYER IN ENDODONTICS
A new formulation of 18% etidronic acid with 5% NaOcl has
been commercially available as “Chloroquick”.

31
SMEAR LAYER IN ENDODONTICS

32
SMEAR LAYER IN ENDODONTICS
FILE SYSTEM AND IRRIGATION SYSTEMS:

33
SMEAR LAYER IN ENDODONTICS
Laser removal:
 Lasers can be used to vaporize tissues in the main canal, remove the smear layer and eliminate residual tissue
in the apical portion of root canals (Takeda et al. 1998a,b, 1999).

 Effectiveness of lasers depends on many factors, including the power level, the duration of exposure, the
absorption of light in the tissues, the geometry of the root canal and the tip-to-target distance (Moshonov et
al. 1995).

 Takeda et al. (1999) using the erbiumyttrium- aluminium-garnet (Er:YAG) laser, demonstrated optimal removal
of the smear layer without melting, charring or recrystallization associated with other laser types.

 Kimura et al. (2002) also demonstrated the removal of the smear layer with an Er:YAG laser. Although they
showed removal of the smear layer, photomicrographs showed destruction of peritubular dentine.

34
 There are two schools of thought regarding the smear layer. One is that it is
protective in nature and so should be retained. The other is that it is
contaminated and could be harmful in the long run. After weighing the pros and
cons of this entity, the presently accepted concept is to remove the superficial
smear layer while retaining or modifying the smear plugs.
 In endodontics, the accepted concept is that the smear layer should be
removed so that there is a fluid tight seal between the canal walls and the
obturating material.
 Despite the great number of commercially available smear layer removing
agents and the several methods to use them, clinicians seem confused. More
studies are required in order to clarify the role of the smear layer, the need to
remove it and the best method to remove it in order to reduce microleakage
and ensure successful outcomes of dental treatment.

35
 Operative dentistry - Vimal Sikri
 Textbook of operative dentistry - Nisha garg, Amit garg
 Bhagwat S, heredia A, mandke L. The smear layer revisited.
 Van landuyt k, de munck j, coutinho e, peumans m, lambrechts p, van
meerbeek b. Bonding to dentin: smear layer and the process of
hybridization. Indental hard tissues and bonding 2005 (pp. 89-122). Springer,
berlin, heidelberg.
 Violich dr, chandler np. The smear layer in endodontics–a review.
International endodontic journal. 2010 jan;43(1):2-15.
 Shahravan a, haghdoost aa, adl a, rahimi h, shadifar f. Effect of smear layer
on sealing ability of canal obturation: a systematic review and meta-analysis.
Journal of endodontics. 2007 feb 1;33(2):96-105.

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