SMEAR LAYER

CONTENTS
• Introduction
• Definition
• History
• Morphology of the smear layer
– Formation of smear layer
– Structure
– Thickness
– Composition
• Physiological considerations
– Influence on sensitivity of dentin
– Influence on permeability of dentin
• Functional implications in Restorative dentistry
• Smear layer & Bonding
• Smear layer in Endodontics
• Influence of smear layer on sealing
• Removal of smear layer
– Chemical
– Ultrasonics
– Lasers
• Conclusion
 INTRODUCTION
• Whenever the tooth surface is altered by rotary or manual
instrumentation, cutting debris is smeared over the enamel &
dentin surfaces, forming what is termed the smear layer.

• When tooth structure is cut, instead of being uniformly

sheared, the mineralized matrix shatters.

• Considerable quantities of cutting debris, made up of very

small particles of mineralized collagen matrix, are produced.
• The term 'smear layer' is used most often to describe the
grinding, debris left on dentin by cavity preparation.

• However, the term applies to any debris produced

iatrogenically by the cutting, not only of coronal dentin, but
also of enamel, cementum, and even the dentin of the root
canal
 DEFINITION
• According to Schwartz and Summit :
The smear layer has been defined as “ any
debris , calcific in nature , produced by reduction or
instrumentation of dentin , enamel or cementum , or as a
‘contaminant’ that precludes interaction with the
underlying pure tooth tissue”

• According to Cohen:
Smear layer is an amorphous ,relatively smooth layer
of microcrystalline debris whose surface cannot be seen
with naked eye.
Morphology of the Smear
Layer

A John Gwinett
• Whenever dentin is cut with a hand instrument or a rotary
instrument, the mineralized matrix shatters rather than
being uniformly sheared or cleaved, producing considerable
quantities of cutting debris.

• Much of the debris, made up of small particles of

mineralized collagen matrix, is spread over the surface of
the dentin to form what has been called a 'smear layer'
(Eick & others, 1970)

• It is analogous to wood being covered by wet sawdust

 Smear layer after use of steel and
tungsten burs

• Steel and tungsten carbide burs produce an undulating

pattern, the troughs of which run perpendicular with the
direction of movement of the hand piece.

• Fine grooves can be seen running perpendicular to the

undulations i.e., parallel with the direction of rotation of the
bur.
Such a phenomenon is referred to as galling and the
frictional humps represent a "rebound effect" of the
bur against the tooth surface..
• The galling phenomenon appears more marked with
tungsten carbide burs which run at high speed.

• The fine grooves can be related to small facets found on

the cutting flutes of the bur.

• These facets arise because of wear of the flutes and act as

abrading points scratching the tooth surface as the bur
rotates
Debris & smearing by a steel bur
Smear layer after use of Diamond points

• Diamond points unlike carbide burs remove the dentinal

structure by abrading action.

• As burs rotate, the flute undermines the tooth surface and

the amount removed depends upon the angle of the flute.

• On the other hand, abrasive particles, passing across the

tissue, plough troughs in which substrate is ejected ahead
of the abrading particle and elevated into ridges parallel
with the direction of travel of the particle
• Several factors govern the size of the grooves, including
particle size, pressure, and hardness of the abrasive
relative to the substrate.

• At low magnification the surface is traversed by relatively

parallel deep grooves, the size of the grooves depending
upon the coarseness of the abrasive.

• The grooves run parallel with the direction of motion of

the handpiece.

• At higher magnification fine grooves run within the deep

grooves.
SEM of dentin abraded. – occluded dentinal
tubules & prominent peritubular mounds
• A significant difference exists between diamond points
used with and without a coolant of water spray.

• In the absence of coolant, smeared debris can be found

commonly on the surface.

• The smeared debris does not form a continuous layer but

exists rather as localized islands with discontinuities
exposing the underlying dentin.
• If the diamond is allowed to log with cutting debris, the
smear layer appears to cover a wider area.

• Coolant of water spray does not prevent smearing but

appears to significantly reduce the amount and
distribution of it.
 Formation of smear layer
• Boyde et al (1963) observed the smear layer using SEM and
considered that the frictional heat during cavity preparation
was the most important factor in the formation of the smear
layer.

• The frictional heat may be 600°C, much below the melting

point of apatite (which is 1500°C to 1800°C)

• Therefore smearing was probably a physicochemical

phenomenon involving mechanical shearing and thermal
degradation of hydroxyapatite proteins
• Eirich and Westwood in 1976 observed that the plastic
flow of hydroxyapatite is believed to occur at lower
temperatures than its melting point and may also be a
contributing factor to smearing.
 Structure of the smear layer
• The smear layer is absent from specimens of demineralized
teeth examined by light microscope because the smear
layer is dissolved during demineralization.

• When examined in undemineralized specimens by

scanning electron microscope :

 At low magnification smear layer shows a typically

amorphous, relatively smooth, featureless surface and
the dentinal tubules are obscured.
 At higher magnification, the smear layer exhibits a granular
substructure.

• This appearance may be formed by translocating and

burnishing the superficial components of the dentine
• Eick et al (1970) showed that smear layer was made up of
tooth particles ranging from less than 0.5m to 15m

• Pashley et al (1988) found out that these particles were

also composed of globular subunits, 0.05-0.1m in
diameter which originated from mineralized fibers.
 Thickness of the Smear Layer
• The thickness of the smear layer was reported to be 1-5m
(Goldman et al in 1981 and Mader et al in 1984)

• This thickness may depend upon the type and sharpness of

the cutting instruments and whether the dentine is cut dry
or wet (Barnes 1974, Gilboe et al 1980)

• Thickness increases with increasing roughness of the bur.

• Use of coarse diamond burs produces a thicker smear layer
than carbide burs
DCNA Jan 1990

• The thickest smear layer was produced of about 10-15m in

an invitro study using a coarse diamond blade mounted on a
metallurgical saw
(Pashley, Michelich and Kehl 1981)
 Layers of the Smear layer
Cameron (1983) and Mader et al (1984) described the
smear layer material in two parts:

• First, superficial smear layer which is adhering loosely to

the underlying dentin and

• Second, the smear material packed into dentinal tubules

called smear plugs
• The extension of this packed material into dentinal tubules
was calculated as extending up to 40µm.

• It was also concluded that this tubular packing

phenomena of smear layer was due to the action of burs
and endodontic instruments
(Brannstrom and Johnson 1974, Mader et al 1984)
• However, Cengiz et al (1990) proposed that the
penetration of smear material into dentinal tubules could
be caused by capillary action as a result of adhesive
forces between the dentinal tubules and the smear
material.
 Composition of the Smear layer
• The composition of the smear layer reflects the
composition of hard tissues from which they are formed

(Eick et al, 1970; Thompson et al, 1989; Eliades et al, 1990)

 It contains both organic and inorganic substance.

 • Collagen
• Heated coagulated proteins
• Necrotic or viable pulp tissue
Organic • Odontoblastic processes
• Saliva
• Blood cells
• Microorganisms

• Minerals from the dentinal structures

Inorganic • Some non specific inorganic contaminants
Physiologic Considerations

David H Pashley
• The smear layer increases the resistance to movement of
fluid across dentin discs both in vivo and vitro.

• As the rates of filtration of fluid provide a convenient,

quantitative method of assessing the presence of a smear
layer, they were used to compare a variety of different
methods of producing a smear layer on dentin etched with
acid in vitro.

• The ease with which fluid could flow through etched dentin
(dentin free of a smear layer), termed 'hydraulic
conductance'
INFLUENCE ON SENSITIVITY OF DENTIN
• Dentin sensitivity is caused by open tubules in exposed dentin
(Brannstrom 1982, 1986, 1992).

• . Most of the resistance to the flow of fluid across dentin is

due to the presence of the smear layer. Etching dentin greatly
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 (Johnson &
Brannstrom, 1974).
 INFLUENCE ON PERMEABILITY OF
DENTIN

• The presence of a smear layer has a large influence on

permeability of dentin.

• Substances diffuse across dentin at a late that is

proportional to their concentration gradient 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 square millimeter, and by the diameter of
these tubules.

• Both of these values vary as a function of distance from

the pulp chamber

(Forssell-Ahlberg, Brannstrom & Edwall, 1975, Garberoglio

& Brannstrom, 1976)
Area of surface of dentin at various distances
from the pulp
• The actual area of diffusional surface is the product of
tubule density and the area of each tubule

• Thus, area of diffusional surface varies from about 1% at

the DEJ to about 22% near pulp.
• It is important to distinguish between transport of
materials by diffusion and by convection.

• Diffusion occurs from areas of higher concentration to

areas of lower concentration.

• Diffusion varies with the square of radius(πr2)

• During diffusion, the concentration of substances is
dissipated over distance.

• For instance, the Concentration of microbial products

entering the pulp chamber through very thick dentin (i.e.
long tubules) is only a fraction of the concentration of
these agents on the dentin surface.
• The transport of materials across dentin by convection is due
to the presence of a pressure gradient.

• In convection, there is no change in the concentration of

substances dissolved in the fluid because the fluid and all that
is dissolved in it is made to flow from one point to another.

• The driving force is the pressure, which is dissipated over

distance
• Transport across dentin by convection or fluid filtration
varies with the fourth power of radius.(πr4)

• Thus, movement of fluid across dentin by convection is

much more sensitive to the degree of occlusion of tubules,
that is, the presence or absence of a smear layer, than is
movement of substances by diffusion
• The presence of the smear layer has a profound effect on
the resistance to movement of fluid across dentin by
modifying the tubular radius.

• The smear layer accounted for 86% of the total resistance

to flow of fluid

• Removing the smear layer increases dentin permeation by

diffusion about 5-6 times and by convection (or filtration)
about 25-36 times.
 Functional implications in
Restorative Dentistry

• Smear layer is of concern as it masks the underlying dentin

matrix and may interfere with the bonding of adhesive
dental cements such as the polycarboxylates and glass
ionomers, which may react chemically with the dentin
matrix.

• Dahl (1978) demonstrated that simply pumicing the dentin

surface produced a threefold increase in the tensile strength
of the bond between dentin and polycarboxylate cement
over that seen with zinc phosphate cement which relies
strictly upon mechanical roughness for retention.
 Remove the smear layer by etching with acid

(Lee & others, 1971, 1973; Bowen, 1978; Brannstrom &

others, 1979b, 1980; Pashley & others, 1981)

• This seemingly extreme procedure does not injure the pulp

(Brannstrom, 1982), especially if dilute acids (Bowen, 1978)
are used for short periods of time.

• Etching dentin with 6% citric acid for 60 seconds removes all

of the smear layer (and smear plugs) as does 15 seconds of
etching with 37% phosphoric acid (Pashley & others, 1981).
• Advantages are that the
o smear layer is entirely removed,
o the tubules are open and available for increased retention,
and
o the surface collagen is exposed for possible covalent
linkages with new experimental primers for cavities

(Fusayama et al, 1979; Bowen & Cobb, 1983)

• Further with the smear layer gone, one doesn't have to
worry about it slowly dissolving under a leaking restoration
or being removed by acid produced by bacteria, leaving a
void between one cavity wall and the restoration which
might permit bacterial colonization.
• Disadvantage of removing the smear layer is that, in its
absence,

o there is no physical barrier to bacterial penetration of

dentinal tubules.

o Further, with nothing occluding the orifices of the tubules, the

permeability of dentin increases four to ninefold depending
upon the size of the molecule

(Pashley 1978; Boyer & Svare, 1981).

 Brannstrom’s concept (1982) –

• Removing most of the smear layer over the tubules

without removing the smear plugs in the tubules is ideal.

• Difficult to achieve clinically because of the complex

geometry of many cavities & difficulty of obtaining
adequate access.
 Another entirely different approach would be to use a
resin that would infiltrate through the entire thickness of
the smear layer and either bond to the underlying matrix
or penetrate into the tubules.
 Another approach is to try to fix the smear layer with
glutaradehyde
(Hoppenbrouwers, Driessens & Stadhouders, 1974)
or tanning agents such as tannic acid or ferric chloride
(Powis & others, 1982)

• The idea is to increase the cross linking of exposed

collagen fibers within the smear layer and between it and
the matrix of the underlying dentin to improve its
cohesion
 Laser & Smear layer

• Lasers work by thermomechanical ablation process that

involves microexplosions within the tooth structure

• Does not produce a smear layer

• ErYAG laser reveals a typically scaly, coarse & irregular

surface.
• Surface is rough but not demineralized

• Patent dentinal tubules

 Drawbacks :

• Substructural cracks in dentin

Kataumi et al 1998
• More fractures within the dentin
Van meerbeek et al 2003,Martinez et al 2000, Giachetti et al 2004

• Structural weakening is not only confined to the uppermost

layer.
• Also weakens dentin to a depth of 3-5µm – jeopardizes
adhesion of resin materials.
Smear layer & Bonding

Bowen
Nakabayashi
• Smear layer can be a detriment to effective bonding.

• Inherent weak attachment to the underlying dentin.

• Brittle in nature

• Early smear layer research – nonacidic adhesives – bonds

were prone to cohesive failure
 Two strategies are used to overcome the low attachment
strengths of the smear layer:

1. Removal of the smear layer prior to bonding (etch & rinse

approach)

2. Use of bonding agents that can penetrate the smear laer

and incorporate it into the hybrid layer (self etch approach)

 Both techniques have been successful

 Removal of smear layer (Etch & Rinse system)
o Greatly increases the dentin permeability
o Better micromechanical retention

 Early systems: (hydrophobic resins)

• Outward fluid flow in tubules resulting in water
contamination of bonding lower bond strength
• Dentinal fluid would dilute bonding primers

 Recent adhesive systems increased hydrophilicity

provides better bonding to wet dentin surface
Hybridization
Nakabayashi 1982
Hybridization – formation of hybrid layer
• Process of resin interlocking in the demineralized dentin surface,
thereby providing micromechanical retention .

• Term commonly used for bonding after acid etching but also to
the layers produced by a self-etch adhesive
Incorporating the smear layer
(Self-etch approach)
Smear Layer in Endodontics
• Endodontic smear layer is very similar to coronal smear
layer in composition

• May also contain remnants of odontoblastic process, pulp

tissue & bacteria
 Effect of instrumentation on
endodontic smear layer
• Thickness of the smear layer may depend on the type &
sharpness of cutting instrument.

• Amount of smear layer produced during rotary preparation,

as with Gates-Glidden or post drills is greater than that
produced by hand filing
Czontskowsky et al 1990
 “Smear layer production by 3 rotary reamers with different
cutting blade designs : A SEM Study”
Spangberg et al OOOOE 2003;96;601

Profile
Hero 642
Stainless steel engine reamer (Mani)

All instruments left a smear layer

However least was in Hero 642
 Surface texture of smear layer

• Hero 642 grp – characterstic snowy & dusty appearance –

many open dentinal tubules

• Profile grp – shiny & burnished appearance – few openings –

thick smear layer in a tree bark pattern

• Steel reamers – thinner & less compressed than Profile

 “Effects of irrigation on debris & smear layer on canal walls
prepared by 2 rotary techniques : A SEM study”
Peters et al JOE 2000

• Lightspeed & Profile

• Tap water & alternating 5.25% NaOcl + 17% EDTA

• Using only water – similar for both LS & PF

• With EDTA/NaOCl – better for LS – larger canal preparations –
more effective removal of smear layer
 “Comparative investigation of 2 rotary NiTi instruments:
Protaper vs RaCe : cleaning effectiveness”
Schafer et al IEJ 2004

• Completely clean canals were never observed.

• Debris removal – better with RaCe
• Smear layer removal – no significant difference

 Final apical preparation diameter in Protaper grp = 30 & in

RaCe grp = 35
 “Efficiency of rotary nickel titanium K3 instruments
compared with stainless steel hand K-Flexofile. Part 2.
Cleaning effectiveness and shaping ability in severely curved
root canals”
Schafer et al IEJ 2003

• For debris removal, K-Flexofiles achieved significantly better

results than K3 instruments.
• The results for remaining smear layer were similar.
• K3 instruments maintained the original canal curvature
significantly better than K-Flexofiles.
• K3 files possess radial lands and this design feature might
explain their poorer cleaning efficiency
“Cleaning efficiency of Anatomic endodontic technology
(AET), Profile system and manual instrumentation in oval
shaped root canals” - An in vitro study

Dr. E.Sujayeendranath Reddy, Dr. Madhu Pujar

 Results :

• At 1, 5 and 10-mm levels the root canals prepared with AET

had significantly less surface debris and smear layer on the
canal walls compared with canals prepared with ProFile or
manual instrumentation.

• For all three groups significantly lower mean smear layer

scores (P < 0.05) were recorded at 5 and 10-mm levels
compared with the 1 mm level
 Several reasons that may explain why AET-shaped root
canals have lower debris and smear layer scores

• Instruments are made of stainless steel

• Instruments are stiffer than nickel-titanium rotary

instruments and can be easily forced towards the root
canal walls and the polar recesses during the side-to-side
lifting motion.
• Special handpiece - The Endo-Eze handpiece uses a
reciprocal quarter turn motion (oscillating angle of 30°)

• Resulted in a larger preparation with an increased volume

of irrigants in direct contact with the root canal walls
• Reduced efficiency of the ProFile rotary instruments may
be the flat configuration of the outer edges, which may be
responsible for packing debris further into dentinal
tubules, thus making it more difficult to remove

Conclusion –
• Although better instrumentation scores were obtained in
canals prepared with AET, complete cleanliness was not
achieved by any of the techniques and instruments
investigated
 Bacterial presence

• Bacterial penetration into the dentinal tubules upto 150µm

in the apical 2/3rd
Sen et al 1995
Effect of smear layer on penetration of
root canal medicaments

Bystrom & Sundquist (1985)

• Presence of smear layer can inhibit or significantly delay the

penetration of antimicrobial agents (irrigants & intracanal
medicaments) into the dentinal tubules

Orstavik & Haapasalo (1990)

• Removing the smear layer for decreasing the time necessary

to achieve the disinfecting effect of medicaments.
Influence of smear layer on sealing and
obturation
• One of the objectives of a successful endodontic treatment is
the total obturation of the root canal system.

• Leakage through an obturated root canal is expected to take

place at the interfaces between sealer and dentin or sealer
and the filling material, or through voids with in the sealer.

• Hence the sealing quality of a root canal depends much on

the sealing ability of the sealer.
• Microleakage in the root canal is a complex subject because
many variables may influence leakage such as, root filling
techniques, the physical and chemical properties of the
sealer and most importantly the smear layer.
SMEAR LAYER
 Keeping the smear layer

limit bacterial or toxin penetration by

may block the dentinal tubules
altering the dentin permeability

Michelich et al 1980,
Pashley et al 1981, Safavi
et al 1990
Yang et al 2002, Holstein et al 1990,
Foster et al 1993, Lester et al 1977,
Holz et al 1987, White et al 1984
Effect of Smear layer on Sealing ability of
canal obturation : A Systematic Review &
Meta-analysis

A Shahravan et al
JOE Feb 2007
• To determine whether smear layer removal reduces leakage
of obturated teeth in vitro

• Studies between 1975 – 2005

• Categorized based on the method of leakage test

• 26 studies included
• 65 comparisons

• Type of leakage test

 Dye leakage test (44 comparisons)

 Fluid filtration test (7 comparisons)
 Electrochemical test (7 comparisons)
 Bacterial leakage test (6 comparisons)
 Volumetric dye leakage test (1 comparison)
 Dye leakage test studies

• Combined effect showed that removing smear layer

decreases dye leakage

• Taylor et al 1997,
“Coronal leakage : effects of smear layer, obturation
technique & sealer” JOE 1997:23:508
• Cold vs Warm compaction ; ZOE vs resin sealer

• Most significant difference with Cold lateral compaction &

resin sealer
• Saunders et al 1994 – warm technique with GIC based
sealer

• Evans et al 1986

• Kennedy et al 1986 – chemically softened GP with ZOE

sealer

• Park et al 2004 – warm technique with resin sealer

• 2 types of dyes used – Methylene blue & India ink

• Methylene blue – more penetration

-acidic
-small molecular size
 Fluid Filtration test studies

• 4 of 7 comparisons showed a significant difference in favour

of removing the smear layer

Cobankara et al 2004,
 “Evaluation of influence of smear layer on the apical &
coronal sealing ability of two sealers” JOE 2004
• AH 26 & RoekoSeal
• Removal of the smear layer had a positive effect in reducing
apical & coronal leakage for both.
 Economides et al 2004
“Comparative study of apical sealing ability of a new resin
based sealer” JOE 2004 :30:403

• Fibrefill (resin based) & Calcibiotic Root canal sealer (CaOH

based)
• Fiberfill showed less leakage than CRCS
• Microleakage was less when the smear layer was removed.

 Timpawat et al 2001
“ Effect of removal of smear layer on apical microleakage”
 Electrochemical test studies

• 6 out of 7 comparisons showed results in favour of removing

it

• Von Fraunhofer et al 2000 – cold compaction with resin based

sealer

• Bayirli et al 1994 – warm compaction with CaOH based sealer

 Bacterial leakage test studies

• 2 of 6 comparisons reported a significant difference in favour

of smear layer removal

• Clark-Holke et al 2003 – cold compaction with resin based

sealer

• Behrend et al 1996 – warm technique with ZOE based sealer

• Others – no significant difference

 Volumetric dye leakage

• Only 1 study – significant difference in favour of removing the

smear layer

• Vassiliadis et al
“Effect of smear layer on coronal microleakage”
OOOOE 1996
• Cold technique with ZOE sealer
 Following explanations have been drawn by several
authors to support the idea of removing the smear layer :

• It has an unpredictable diameter & volume, because a

great portion of it consists of water
(Holz et al 1987)

• Contains bacteria & necrotic tissue

(McComb & Smith 1975, Goldberg et al 1977)
• May act as a substrate for the bacteria letting them
penetrate deeper into dentinal tubules
(George S, Anil Kishen 2005)

• May limit the optimum penetration of disinfecting agents,

medicaments & root canal filling materials into tubules
(Wayman et al 1979, Yamada et al 1983)
 According to meta-regression analysis

• Obturation type,
• sealer type,
• type of dye used,
No effect on the results
• site of leakage test,
• duration of the test &
• year of publication

Concluded that removal of smear layer improves the

fluid tight seal whereas other factors did not produce
significant effects.
Removal of Smear Layer
 Smear
layer
Removal

Lasers

Ultrason Chemica
ics l
 Chemical removal
 Sodium hypochlorite

• Organic tissue dissolving activity

Rubin et al 1979, Goldman et al 1982

• Not effective in removing smear layer

Baker et al 1975, Goldman et al 1981, Berg et al 1986,
Baumgartner et al 1987

• NaOCl + H2O2 – Not effective

Bitter et al 1989
 Chelating agents

 EDTA – chelates the calcium ions in dentin & dissolves the

inorganic portion
Grossman et al 1988
• Decalcifies dentin to a depth of 20-30µm in 5 min

• When used alone EDTA removed the inorganic portion but left
an organic layer in the tubules.
 Sodium hypochlorite + EDTA

• Alternating the use of EDTA & NaOCl is an effective method

for smear layer removal
Goldman et al 1982, Yamada et al 1983 ,
Baumgartner et al 1987, Cengiz et al 1990

 Most effective final flush of 10ml of 17% EDTA followed by

10ml of 5.25% NaOCl
• EDTA acts on inorganic component demineralizing the
dentin

• NaOCl acts on organic component tissue dissolving &

antimicrobial properties
 EDTAC (with cetavlon)
– To reduce the surface tension
– Increased wetting effect
– Deeper penetration into irregularities
 “The effect of EDTAC and the variation of its working
time analyzed with scanning electron microscopy”
Goldberg & Spielberg. 1982

• Different working times evaluated were 5, 15 & 30

minutes.

• The results showed that the effect of EDTAC could be

seen after 5 minutes but the strongest effect was
detected at 15 minutes with no variations after 30
minutes
 “Time-dependent effects of EDTA on dentin structures
Calt , Ahmet Serper. JOE Jan 2002

• Final irrigation was done with 10ml of 17% EDTA for 1 & 10
min respectively in each group followed by 10ml of 5%
NaOCl in both the groups

• The results showed that 1 minute EDTA irrigation was

effective in removing the smear layer , whereas a 10 minute
application caused excessive peritubular and intertubular
dentinal erosion.
 “Efficacy of several concentrations of sodium hypochlorite
for root canal irrigation”
Craig Baumgartner , Paul Cuenin JOE Dec 1992

• Sodium hypochlorite solutions in concentrations of 5.25%,

2.5% & 1% were equally effective in removing the dentinal
debris & pulpal remnants.
 “Effect of Application time of EDTA and sodium
hypochlorite on intracanal smear layer removal – SEM
analysis”
Texeira CS, Felippe MC IEJ May 2005

• Final irrigation with 3 ml of 15% EDTA followed by 3 ml of

1% NaOCl for different time durations of 1 min, 3 min & 5
minutes respectively.

• Were equally effective in removing the smear layer

 Organic acids

 Citric acid

• More effective than NaOCl alone (Baumgartner 1984)

• Better than many acids such as polyacrylic acid, lactic acid &
phosphoric acid (Meryon et al 1987)
• Wayman et al 1979 – showed best results with sequential use
of 10% citric acid & 2.5% NaOCl, then again followed by 10%
citric acid .

• However, not as effective as 17%EDTA-NaOCl combination

(Yamada et al 1983)

 Disadvantage of citric acid – left precipitated crystals in the

root canal which may interfere with root canal obturation.
 Lactic acid (50%) – less effective than 50% citric acid –
attributed to viscosity of lactic acid.

 Tannic acid (25%) – effective in removing the smear layer

Bitter et al 1989

• But Sabbak et al 1998 – tannic acid increased the cross-

linking of exposed collagen within the smear layer and
within the matrix of the underlying dentin

increasing the organic cohesion to the tubules

 Salvizol (Bis-Dequalinium-Acetate)

• Removes the smear layer

Kaufman et al (1981)
• Has low surface tension

• Less toxic than NaOCl

• But less effective than EDTA

Berg et al (1986)
 EGTA (Ethylene glycol-bis-NNN tetraacetic acid)

• Calt , Serper 2000

• 17% EDTA / 17% EGTA followed by 5% NaOCl

• Both effective in removing the smear layer and EGTA caused

less dentinal erosion.
• Can be used as an alternate chelator.
 Tetracyclines (Doxycycline)

• Low pH in concentrated solution & can act as a calcium

chelator.

• Can cause surface demineralization

• Substantivity
 Barkhordar et al (1997) –
• Doxycycline HCl (100mg/ml) is effective in removing the
smear layer

Ersev et al (2001) –
• Tetracycline as effective as 50% citric acid but tetracycline
demineralized less peritubular dentin than citric acid.
 MTAD
(Mixture of tetracycline isomer, an acid & a detergent)
Torabinejad et al 2003

• Irrigation with 5.25% NaOCl & final rinse with

– 17% EDTA
– MTAD

• MTAD is an effective solution for the removal of smear layer &

does not significantly change the structure of dentinal tubules
 Smear Clear (SybronEndo)
17% EDTA + 2 additional proprietary surfactants

• Jantarat et al 2007 – compared 17% EDTA with Smear Clear

as the final irrigating solution

Conclusion
• SmearClear seems to be the best solution for removal of the
smear layer after root canal instrumentation.
 Ultrasonic removal
 Acoustic streaming

 Cameron et al ,1983
“The use of ultrasonics in the removal of smear layer : A SEM
study”

o Debris free canal with the use of 3% NaOCl solution +

ultrasonics for 5 mins
• Cameron et al , 1988
“Use of ultrasonics for smear layer removal: effect of
sodium hypochlorite concentration”

o Complete smear removal with 4% NaOCl + ultrasonics for 2

mins

 Prati et al 1994 – achieved smear removal with ultrasonics

 In contrast , it has also been found that ultrasonics were not
able to remove the smear layer.
(Cymerman et al 1983, Baker et al 1988, Goldberg 1988)

 Baumgartner et al , 1992
“Efficacy of several concentrations of NaOCl for root canal
irrigation”

o Ultrasonically energised NaOCl did not remove the smear

layer
 “Effects of EDTA with and without surfactants or
ultrasonics on removal of smear layer”
Jeen-Nee Lui et al JOE April 2007

• 17% EDTA /Smear Clear and with / without ultrasonics

• The results showed that addition of surfactants to EDTA did

not result in better smear layer removal.

• But the use of ultrasonics with 17% EDTA improved smear

layer removal
 Laser Removal
• Takeda et al (1998) – lasers can be used to vaporize tissues in
the root canal, remove the smear layer & eliminate the
residual tissue in the apical portion of the canal.

• Dederich et al (1993) used Nd:YAG laser

• Disruption of the smear layer but melting of the dentin

 Other lasers- CO2 laser, Argon laser

• Takeda et al (1998) – using the Er:YAG laser demonstrated
optimal removal of smear layer without melting, charring
& recrystallization associated with other lasers.

• Kimura et al (2002) - removal of smear layer with Er:YAG

laser

 Main difficulty with laser removal of smear layer – access

to small canal spaces with relatively large probes for
delivery of laser beam
 CONCLUSION
• In Restorative dentistry, numerous studies have proved the
pros & cons of smear layer as a natural cavity liner and
adhesion inhibitor.

• Hence depending on the kind of restoration, the operator

should choose whether to incorporate, modify or remove
the smear layer.
 In endodontics –
• On the basis of available evidence it can be concluded that
root canal instrumentation produces smear layer which
may contain bacteria and may prevent penetration of
intracanal medicaments into the dentinal tubules.

• It seems reasonable to suggest that removal of smear

layer can result in a more thorough disinfection of the
root canal system and ensure better adaptation between
the obturation materials & root canal walls.
 REFERENCES

• Sturdevant’s Art & Science of Operative Dentistry – 5th ed

• Textbook of Operative Dentistry – Summit
• Pathways of the Pulp- Cohen – 9th edition
• Endodontics – Ingle – 6th ed
• Hybridization of dental hard tissues- Nakabayashi
• DCNA 1990 Vol 34
• Operative dentistry 1984 Supplement 3
• OOOOE Dec 2002
• Int Endodontic Journal 1995 Vol 28
• JOE Feb 2007
• Operative Dent 2006 Vol 31
• Dent Mat 2008 Vol 24
• Dent Mat 2003 Vol 19
• OOOOE 2003; 96;601
• IEJ 2004; 37;239
• JOE Jan 2000; 26