Smear layer - its role

In Conservative dentistry
& Endodontics
 OUTLINE
•Introduction
•Definitions
•Literature review
•Morphology of smear layer
•Physiological considerations
- description & production
- structure & formation
-composition
-size/thickness
-attachment to dentin
-effect on movement of fluid in & out of
•Advantages of smear layer
•Disadvantages of smear layer
•Pathological & treatment
considerations
•Functional implications
- Dental materials
- Restorative dentistry
- Endodontics
•Removal of smear layer
•References
•Conclusion
 Definitions –

1)Acc to Operative Dentistry Journal (1984), the term

smear layer applies to “any debris produced
iatrogenically by the cutting, not only of dentin, but also
of enamel, cementum and even the dentin of the root
canal”.

2)The AAE defined smear layer as “a surface film of

debris retained on dentin or other tooth surfaces like
enamel, cementum after instrumentation with either
rotary instruments or endodontic files.
3)The cutting of dentin during cavity preparation
produces microcrystalline grinding debris that
coats the dentin & clogs the orifices of the dentinal
tubules. This layer of debris is termed smear layer.
- Cohen

4)Smear layer is a layer of debris,comprising both

organic & inorganic components, found on canal
walls after endodontic instrumentation.
- Harty
5)Tooth preparation with rotary instruments generates
cutting debris, some of which is compacted unavoidably
into a layer on the cut surface . This is called as smear
layer.
- Sturdevant

6) When cutting or abrading procedures are applied to a

dentin surface, an amorphous layer of organic film
& debris is created that has been termed as smear layer
- Charbenaeu
7)Acc to DCNA (1990) when tooth structure is cut, instead
of being uniformly sheared, the mineralized matrix shatter.
Existing of the strategic interface of restorative materials
and the dentin matrix most of the debris is scattered over
the enamel and dentin surfaces to form what is known as
smear layer.
 LITERATURE REVIEW

•Earliest studies by Lammie & Draycott(1952) & Street(1953)

viewed with light microscope & Epi-illumination

•Peyton & Mortell (1956) used thin metal coating…

Reflected light microscopy

•Diamonds …

•Scott & O’Neil (1961) reported

TEM study…
•Cutting debris identified as apatite by
electron diffraction.

•Boyde, Switsur & Stewart (1963) were among the first to

describe using SEM the nature of surface deposits

•Boyde…first to describe & demonstrate “smear layer”

•Believed enamel was the source.

•Eick & others (1970) used an electron microprobe with
SEM…

•Boyde et al (1963) attributed smearing of enamel to

Melting of tissue by frictional heat.

•Plastic flow of hydroxyapatite occurs at lower temp…

•Smearing is a physiochemical phenomenon.

MORPHOLOGY OF SMEAR LAYER

•Steel & TC burs produce an undulating pattern

•Galling phenomenon

•Discontinuities in smear layer as pits & gouges…

•Some portions firmly attached…

•Smeared debris doesn’t form continuous layer…

Galling phenomenon Grooves traversing dentin
Cut by diamond
Debris & evidence of
smearing
Description & production-

•Analogous to wood covered by wet sawdust.

•Amorphous, relatively smooth , featureless

•Depth of smear layer depends on-

Gilboe & others,1980
•Cutting without water spray thicker smear layer

•Diamond burs…

•Smear layer increases the resistance to movn of fluid…

•Hydraulic conductance
orangewood stick decrease HC
rubber cup
Structure-

•Amorphous, irregular & granular app under SEM

•Acc to Cameron(1988) smear layer on root canal has high

organic content in the early stages…

•Eick et al(1970)- 0.5-15um

•Pashley et al (1988)- 0.05-0.01um globular subunits

•Thickness – 1.5um (Goldman et al 1981, Mader et al1984)

• Cameron (1983) & Mander et al (1984) described smear
layer in 2 parts-

• Hypothesis of capillary action

Formation-

•Exact mechanism unknown.

•Boyde et al…frictional heat

•Temp during cutting- upto 600 C

•Apatite melts at 150-1800 C

•Smear formation is a physicochemical rather than simple

thermal phenomenon.

•Elrich & Koblitz et al…brittle & ductile transition

•Dentin matrix may contribute to smear layer on enamel.
 Composition-

ORGANIC INORGANIC

Smear layer created on sound &

carious teeth is diff…
Size / Thickness-
Eickel et al…. < 0.5-15 micron

current literature 1-5 micron

Pashley et al…10-15 micron

Attachment to dentin-

• exact mechanism not known.

• some areas it is firmly attached, some areas its

free. (Gwinett)
Effect of movement of fluid in & out of
Dentinal tubules-

•Smear layer reduces dentin permeability- Pashley

•Pashley distinguished b/w inward & outward

flow from dentinal tubules

•Diffusion…eg. Microbial toxins

•Pressure gradient…
varies with 4th power of radius.

•Smear layer 86% resistance to fluid movement.

•Pashley calculated diffusion surface…
1% at DEJ & 22% near pulp

• if the smear layer is removed diffusion

increases 5-6 times
Advantages of smear layer
Disadvantages of smear layer
mear layer: pathological & treatme
onsiderations
1)Bacteria in the smear layer under restorations-

Is it possible that bacteria entrapped in smear layer

Survive & multiply???

Brannstrom & Nyborg 1973 did a study…

One cavity- cleaned with water
Other cavity-cleaned with antiseptic detergent

few bacteria entrapped in the smear layer may survive

& multiply.
•Mjor 1974 suggested bacteria are not present in freshly
prepared smear layer

•Bacteria may be left in the narrow gap b/w enamel &

dentin

•For adequate retention of luting cements smear layer

Must not be present
2)Smear layer on dentin exposed to the oral cavity

•Disappears & replaced by bacteria…

•10,000-20,000 tubules/mm2 on hypersensitive exposure

•After 2 weeks,mineralized pellicle

(Brannstron 1982)
3) Removal of smear layer under restorations-

•Smear layer may be detached & follow the outward flow..

•Size of the gap 5 -20um.

•That’s y dentin is hypersensitive when an ill fitting

crown is removed …

•Sometimes no correlation b/w bacteria in cavity walls

& pulpal infl as….
4)The protective effect of smear plugs in tubule apertures
& the consequences of removing the plugs-

•Smear plugs didn’t prevent bacterial toxins from

Diffusing into the pulp( Bergenholtz 1977)

•Degree of infl in the pulp depends on-

•Pashley (1984)… smear plugs reduce permeability of

dentin
•Etching the area of wet tubules from 10% to 25%

•Drying is not a problem in eroded or abraded dentin…

•In sensitive dentin its better to keep the tubules occluded

with disinfected smear layer….
5)Pulpal irritation due to removal of smear layer-

•Acid etchants, detergents, thin mix of phosphate cement,

silicate,GIC & resins don’t produce any appreciable
damage & infl to pulp…(Brannstron 1982,1984)
•Various acids & EDTA remove smear layer & smear plugs

•Tubulicid , Red Label

Composition- 0.2% EDTA
Benzalkonium chloride
1% NaF
It didn’t irritate the pulp
6)Smear layer in root canals after reaming-

•Adult teeth walls partly covered with atubular dentin

•Young teeth…

•Infected tubules with fluid communication to the exterior

may cause external resorption.

•In infected roots remove smear plugs…

 Dental materials

Functional

Implications
Restorative
dentistry Endodontics
 He
DENTAL MATERIALS

•When cements are applied to dentin covered with smear

layer failure can be

Cohesive Adhesive
Approaches to increase Ap
the tensile strength of a
cement-Dentin interface:

1)Remove the smear layer by acid etching-

Advantages: increased retention
collagen exposed for covalent linkages

Disadvantages:
2)To use resin that will infiltrate through smear layer:

•Acid etching….removes smear layer & peritubular dentin

•Smear layers on deep dentin more organic content

•Adhesive strength of all cements 50% greater in superficia

than in deep dentin.
3)Fix the smear layer with glutaraldehde or tanning
Agents-

Increase the cross linking of exposed collagen fibers

Within the smear layer….
4)Remove the smear layer by acid etching & replace it
With artificial smear layer composed of crystalline ppt
-Causton & Johnson 1982

Bowen …5% ferric oxalate

 RESTORATIVE DENTISTRY
i
Bonding & smear layer-

•Bond strength higher for diamonds than burs…

•Composition of smear layer reflects the composition of

dentin from which it forms…

•Smear layer on carious dentin & sclerotic tissue may

contain intratubular whitlockite.
 t
Smear layer

Solid phase Liquid phase

Reasons for retaining the smear layer-

• dentin permeability
• effect of pulpal pressure
 h
Removal of smear layer may facilitate bonding by
Following mechanisms-

•Exposed collagen interact with primers

•Amino gps act as catalyst to polymerization reactions
•Exposed collagen promotes micromechanical bonding
 Conditioning of dentin

Physical effects Chemical effects

 I generation DBA
• NPG GMA- Primer
• Chelating action with surface dentin
• Bond strength – 2.8 Mpa
• Ex: Cervident (SS White)
II Gen DBA- 1980’s
• Phosphate esters of BisGMA or HEMA
• Smear layer weakest link
• Ex: Clearfil F(Kuraray)
Scotch Bond 1983
Dentin Adhesit
Prisma Universal
• Bond strength – 2-7 Mpa
 Draw backs of I & II Gen DBA

• Lack of adequate bond strength

• Hydrophobic
• Biocompatibility
• Lack of knowledge of smear layer
• Modify or remove smear layer
• Conditioning & priming
• Bond strength= 9-15 Mpa
• I system- FNP ,Tenure
• Retention decreases with time
• Resin did not penetrate the smear layer
• Nakabayashi (1982)

Hybrid layer
• Ex: All bond -2(21.4 MPa)
• Scotch bond Multipurpose (21 MPa)
• Clearfil Liner bond 2 (kuraray)- 20-28 MPa
SEprimer- Phenyl P, HEMA
b RESIN- MDP, Bis GMA & HEMA
• Hybridization & Wet bonding technique
• One component resin (Priming + bonding)
• Ex:
Prime & Bond ,Prime & Bond 2.1
-PENTA, TEGDMA ,UDMA in acetone
- sensitive to acid conditioned dentin
- 20 MPa
 ADVANTAGES
• Bond strength sufficient
• Some agents incorporate Fluoride
• Time saving

Disadvantage
• Solution must be refreshed
 TYPE I TYPE II
• SE Primer & Adhesive • Primer & Self-etching
adhesive
• Primer applied to tooth • Mixed & applied.
followed by adhesive.

Ex: Clearfil SE • Ex: Xeno III

Nano Bond
Optibond
Prompt L Pop
• Modification of type II Sixth gen
• Single bottle containing acidic adhesive
• Solvent-water
• Ex: G-Bond , i-Bond, Clearfil S3
orization of adhesives acc to mode of action
t
hesives which modify the smear layer & incorpo
the bonding process-
mechanical bond
esives which completely remove the smear layer

s based on combined effect of hybridization &

ag formation.
Total etch technique
 ives which dissolve the smear layer rather than
EP+ adhesive)

superficially demineralize dentin & simultaneously

with monomers.
 CATEGORIZATION OF ADHESIVES
ACCORDING TO MODE OF ACTION
Systems smear layer Smear layer Smear layer
modifying Removing dissolving

1 step •Hytac OSB

•Pertac universal
bond
•Prime & bond2.1
•Solist
•Tokuso light bond
2 step •Optec universal •Fuji bond LC •Clerafil liner bond 2
bonding •Gluma 2000 •Denthesive 11
•Pro bond •Optibond solo •Opti bond(no etch)
•Tokuso light bond •Prime & bond2 •Imperva bond
(2 step) (total etch) •Scotchbond 2
•tripton •Scotch bond 1 •Syntac
•XR bond
Systems smear layer Smear layer Smear layer
modifying Removing dissolving

3 step •All bond 2

•Amalgam bond plus
•Clearfil liner bond
•Gluma
•Imperva bond
•Mirage bond
•Optibond
•Scotchbond
multipurpose
•Tenure
•Scotchbond
multipurpose plus
INFLUENCE ON SENSITIVITY OF DENTIN-

•Most of the resistance to the fluid flow…

•Etching increases sensitivity…

•Smear layer prevents bacterial penetration but permits

bacterial products to diffuse.
INFLUENCE ON PERMEABILITY OF DENTIN-

•Diffusion proportional to conc. Gradient &

surface area.

•Area for diffusion is determined by density of

Dentinal tubules & their diameter.

•Diffusional surface…

•Removal of smear layer increases diffusion surface

to 7.9%
 ENDODONTICS
•Amount of smear layer produced by automatic
preparation is greater…

•Without irrigation…thicker layer

•Diamond burs produce thicker smear layer…

 CONCERNS???
Concerns

Long term
Bacteria stability
Dentinal tubules-

•In the root straight course…

•1-3u diameter

•Density-4900 to 90,000
density increases in apico-coronal direction
Physical barrier for bacteria & disinfectants-

•Vojinovic et al(1973) showed dentinal plugs stopped

bacterial invasion.

•Conversely Baker et al (1975) & Yamada et al (1983)…

•Williams & Goldman (1985)…smear layer delayed

penetration of P.vulgaris

•A.viscous , C.diptheria & S.sanguis digested the smear

layer…

•Not a strict barrier

•May block the antimicrobial effects of intracanal
disinfectants…

•Orstavik & Happasalo (1990)…smear layer did delay

but didn’t abolish the action of disinfectants
Apical leakage-
•Thermoplasticized GP…

•Kennedy stated…absence of smear layer causes less

apical leakage

Chelating agents…

•Greater the canal preparation smaller apical leakage.

•SEM…unsatisfactory apical plugs showed marginal &

structural defects
Sealers-

•if smear layer is not removed…

•Smear layer may laminate off the canal & create false seal

•Smear layer induced infl…

•Grossman’s sealer

•Ca(OH)2 based sealers

•No evidence supporting that the smear layer extruded

thro the apex…
•Use of DBA to harden the smear layer…

•Tight fitting post…

•If smear layer is removed Ca(OH)2 will not seal lateral

canals…
Post cementation-
•Removal of smear layer increases cementation bond…

•GIC

•Shorter posts

•SEM…with unfilled resins, serrated posts…parallel

posts more retentive

•Use of DBA may or maynot indicate smear layer removal

Effect of smear layer on sealing ability of
Canal obturation: a systematic review &
Meta-analysis-
-JOE,Vol.33,2,Feb 2007

•Purpose-

•Results-
53.8%-no significant diff
41.5%-in favor of removing smear layer
4.7%-in favor of keeping it

p<0.001
Smear layer removal improves apical & coronal seal
& doesn’t depend on….

Explanations by several authors to support smear layer

Removal-
• unpredictable diameter
•Bacteria
•Limits the optimum penetration of IC medicaments
• Resin based obturating materials….smear layer must be
removed.

• Removal of smear layer during root

end resection…
tetracycline
citric acid
REMOVA
L OF
SMEAR
LAYER???
Reasons for retaining the smear layer;
• lowers the dentin permeability

• prevents decrease in bond strength

• lowers effect of pulpal pressure

•Most recent thinking to retain the smear layer
as it acts as natural cavity liner.

•In endodontics once the layer is removed better

adaptation of obturating materials.

•Without smear layer leakage decreases…

 depth of pen-
Efficacy of the irrigating solution depends on:
etration

Contact Type &gauge

1. Chemical naturetime Of needle
2. Quantity & temp
3. Contact time
ST of soln
4. Depth of penetration of irrigation needle
temp
5. Type & gauge of needle
6. Surface tension Age of
7. quantity
Age of solution soln

-Ingle,1985

Efficacy of irrigating solutions in removing

the smear layer depends on
1. Sodium hypochlorite-

• Produces superficial clean canal walls…

• Adding surface active agents ineffective

2.Chelating agents-

•Most common EDTA

•Nygaard Ostby (1963) found EDTA decalcified

to a depth of 20-30u in 5 mins.

•Fraser (1974)…chelating effect negligible in

apical third.

•Urea peroxide added…

•Cetrimide…REDTA…
•No smear layer except apical 1/3rd
•Optimal WT of EDTAC- 15 mins.

•Salvizol…aminoquinaldinum diacetate Canal treated with salvizol

chelation+ organic debridement
Better cleansing properties than EDTAC.

•Berg et al(1986) found REDTA surpassed Salvizol

& other soln.
Coronal portion of canal treated with EDTAC. The
tubules are open, and the canal is
clean and free of smear.
•EGTA…Semra Calt & Ahmet Serper

•Root canals irrigated with 17% EDTA followed by

NaOCl…

•Combination of EGTA & NaOCl…

effective
no erosion
didn’t remove smear layer from apical third.

•Main advantage of EGTA over EDTA…

•EDTA action is stronger than EGTA.

Intratubular & peritubular dentinal erosion in middle third
Chelator preparations-

Liquid chelators-
1.Calcinase
2.REDTA
3.EDTAC & DTPAC
4.EDTA-T
5.EGTA
6.CDTA
7.Largal ultra
8.Salvizol
9.Decal
10.Tubulicid plus
11.Hypaque
12.Endodilator N-O
13.Smear Clear
Paste type chelators-

1. Calcinase slide
2. RC Prep
3. Glyde file
4. File care EDTA
5. File EZE
3.Organic acids-

•Citric acid…Loel 1975

•Waymen et al…10%, 25%, 50% citric acid

•25% citric acid-NaOCl combination was not as

effective as 17% EDTA-NaOCl

•Citric acid left ppt crystals…

Figure 10-41 A, Canal wall untreated by acid. Note granular material and obstructed tubuli.
B,Midroot canal wall treated with citric acid.
The surface is generally free of debris. C, Midroot canal wall cleaned with phosphoric acid, showing
an exceptionally clean regular surface.
D, Apical area of root canal etched by phosphoric acid, revealing lateral canals.
•50% lactic acid…

•Bitter(1989) introduced 25% tannic acid…

•40% polyacrylic acid

4.NaOCl & EDTA-

Working soln…

Irrigating soln…

Acc to Goldman et al(1982) most effective working

Soln. was 5.25% NaOCl & most effective final
Flush 10ml of 17% EDTA followed by…
5.Oxidative potential water-

•Bactericidal & demineralizing

•Inoue et al…composite bonding

•pH-2.7 or less

•Antimicrobial constituents- HOCl & O3

6.Ultrasonics-

•Cameron (1988)…2% & 4% NaOCl+ ultrasonic

energy…

•Apical region less debris & smear layer…

•3 & 5 min effective

•Direct physical contact of the file…

SEM micrograph of an apical area prepared by
Lightspeed and the irrigant then activated using a size 15
stainless steel K-file. Small amounts of debris and complete
removal of smear layer is visible (original magnification
400×
7.Other agents-

•Tubulicid blue label

•Tubulicid red label

•MTAD
8.Lasers –

•Takeda et al…

•Effectiveness of lasers depends on many factors-

-power
-duration
-absorption of light in the tissue
-geometry
-tip to target distance
•Er:YAG lasers…

•Destruction of peritubular dentin

•Nd:YAG- melted, recrystallized & glazed surfaces.

•Morita & Koba…Nd:YAG can evaporate debris

& pulp remnants
-JOE,Vol.24,8,Aug 1998

•Wigdor et al compared thermal increase in teeth

Er:YAG least damage
9.Giromatic cleaning-

•Produce oscillation thro 90 arc

•Effective (Fromme & Gelttfit 1972)

109
Pathways of pulp-Cohen
Endodontic practice- Ingle
Art & Science of Operative Dentistry- Sturdevant
Textbook of operative dentistry- Vimal Sikri

110
Operative dentistry,supplement 3,1984
IEJ,36,810-30,2003
OOOOE 2002:94:658-66
JOE,Vol.33,2,Feb 2007,96-103
IEJ 1995,28,141-48
DCNA,Vol.34,1,Jan 1990,13-25
JOE,Vol.29,3,March 2003

111
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