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Smear Layer Management

EDTA is a decalcifying chelating agent used as a 15% to 17%
buffered solution during instrumentation of root canals. The
decalcifying efficacy of EDTA-containing pastes is variable.160,441
EDTA acts as a chelator with calcium ions and removes the
dentinal debris produced on the root canal walls during preparation.
It thus opens dentinal tubules, promoting better penetration
of disinfectants.154,191,422,485 Whenever the wall of a root
canal is instrumented, whether by hand or rotating instruments,
the parts of a dentin wall touched by an instrument are
covered by a surface layer called the smear layer.261,296
The smear layer, which consists of dentin shavings, cell debris,
and pulp remnants,369 can be described as itself having two
separate layers: a loose, superficial deposit and an attached
stratum that extends into the dentinal tubules, forming occluding
plugs.87
For some time, clinicians and researchers paid little attention
to the smear layer, partly because it was a thin superficial
layer (1 to 5 m) that might be present or not, depending on
the type of instrument and the sharpness of its cutting blades.369
Also, because acids and chelating agents dissolve the smear
layer, it was removed and escaped attention in routinely processed
specimens (Fig. 9-76).109 Smear layers are not seen in
unprepared canal areas, which may have calcospherites, buttonlike
structures that are abundant on intracanal surfaces.
Some authors have reported that an overlying smear layer
delays but does not eliminate the effect of medicaments.287
Others contend that a smear layer may adversely affect disinfection
and may also increase microleakage after canal obturation.
369 Although organic substrate in a smear layer may serve
Chelating agents were introduced to endodontic treatment
by Nygaard-Ostby in 1957 for treatment of calcified narrow
root canals.216 EDTA is the chelating solution customarily used
in endodontic treatment. It is available in both liquid and paste
forms with common concentrations between 15% and 17%.143
A detergent is frequently added to the liquid to decrease surface
tension, to increase the cleaning ability, and to enhance the
bactericidal action of the solution.323 The effectiveness of
EDTA is related to time of application, the pH, and the
concentration.208,Demineralization results in increased dentin permeability119
because of the removal of the smear layer and plugs and
enlargement of the tubules. It appears that the tubular enlargement
is due to selective removal of the peritubular dentin.141
The action of chelators and acids appears to be more effective
in the coronal and middle thirds of the root and is reduced
apically.143,188 This reduced activity may be a reflection of canal
size.172 This is a clinical concern because of the more irregular
structure of dentin in the apical third. Another investigation
demonstrated marked variations in the apical portion of the
root,204 including accessory root canals, areas of resorption and
repaired resorptions, pulp stones, irregular or absent primary
tubules, irregular secondary dentin, and cementum-like tissue
lining the apical root canal wall. The variable structure of the
apical region of human teeth presents challenges to the use of
endodontic obturation techniques requiring adhesives, because
this may influence the dentin bonding ability in the apical
region.204

EDTA appears to be biocompatible when used clinically216;

however, irreversible decalcification of periapical bone and
neuroimmunologic disturbances have been noted.269 Extrusion
of both NaOCl and EDTA in clinical treatment should be
avoided.130,228,306
The recommended time for removal of the smear layer is 1
to 5 minutes.53,143,264 The small particles of the smear layer are
primarily inorganic with a high surface-to-mass ratio that facilitates
removal by acids and chelators. Investigators have found
that a 1-minute exposure to 10 ml of EDTA was adequate to
remove the smear layer and that a 10-minute exposure caused
excessive removal of both peritubular and intratubular dentin.53
The use of EDTA in combination with NaOCl is recommended300,307
and may enhance the cleaning188,349 and antimicrobial
effects of these solutions when compared with using
them alone.49
peritubular
dentin is harder than intertubular dentin and therefore is more
quickly dissolved in acid than intertubular dentin. By preferentially
removing peritubular dentin, acid-etching agents used
during dental restorative procedures and ethylenediaminetetraacetic
acid (EDTA) used in endodontic treatment enlarge the
openings of the dentinal tubules, making the dentin more
permeable.